Fall Risk Assessment and Chronic Fatigue

Neuromuscular Rehabilitation

• Neuroplasticity is the ability of the nervous system to adapt to intrinsic and extrinsic stimuli by reorganizing its structure, function, and connections.

• Neuroplasticity can occur at molecular, cellular, system and behavioural levels.

• This process can occur during development, in response to the environment, during disease and after therapy.

• The brain is composed of approximately 85 billion neurons and 85 billion glial cells.

• Neurons form networks responsible for specific functions, making approximately 10,000 synapses each.

• Key brain regions and their roles are described in the context of localizationism, including motor, sensory, language, cognitive, and emotions.

• The cerebellum has a significant role in motor coordination.

• Historical developments in understanding brain plasticity are outlined with relevant dates and scientists.

• This includes early evidence of brain change (1793), dynamic/adaptive interpretations (1890), and the demonstration of anatomical brain plasticity (1964).

• Mechanisms of neuroplasticity involve molecular changes in channels, cellular changes in synapse formation, and physiological/anatomical changes in neural networks, leading to improved motor/functional performance.

• Specific applications of neuroplasticity include cerebellar agenesis, neurotrophins and stroke, hemispherectomy and blindness.

• Studies demonstrate brain reorganization following sensory loss or impairment, with the remaining regions processing sensory information from the other side.

• In blindness the visual cortex has adopted the function of processing tactile information when reading braille.

• Chronic pain after limb amputation (phantom limb) is a possible maladaptive example of neuroplasticity due to reorganization in the somatosensory cortex.

• Clinical decision making in neurorehabilitation involves identifying the appropriate examination methods and interventions for a consumer.

• The process includes information gathering and analysis, and a dynamic, interconnected process of clinical reasoning.

• A rehabilitation role includes exercise intervention planning, motivation, and positive life impacts for the consumer.

• A biopsychosocial framework is important and a diagram illustrating the process is provided.

• Exercise Programs should provide comprehensive documentation of components, completion, and effectiveness.

• They enable efficient supervision by various clinical staffs.

• Layouts typically include identifying information, primary conditions, goals, exercises, intensity, duration, progression, and regression. Neuro rehabilitation can deviate from standard FITT format.

• Telehealth/virtual exercise training is crucial for outreach, and often a mandatory component of different funding/insurance services.

• Social aspects of disability cover types of disability, diversity, and prevalence.

• Various classifications are outlined differentiating through physical characteristics, cognitive functions, perception, or neurological function.

• Statistical data for prevalence and sociodemographic implications are provided for Australia.

• Different models of disability are described (medical, social, moral), including views toward disability and individuals with disability as defined by impairment and limitations or factors both intrinsic and extrinsic.

• Assessments to assess fall risks and balance includes neurological changes with aging (sensorimotor changes—muscle loss, peripheral sensation decline, executive function, and attention), cognitive changes, vision, sensation/proprioception, vestibular sensation.

• Gait and balance assessments evaluate sensory input, central processing, and motor response, essential for maintaining body position and stability, and essential for preventing falls in older adults.

• Several assessments of neurological aspects like vision, proprioception, and vestibular sensation, gait, balance, reaction time, and cognitive are listed.

• Specific exercise programs, including standing balance tests (tandem stance, one-leg stand), sit-to-stand tasks, walking tests (6m walk test, timed up and go/TUG), and the Berg Balance Scale, are detailed.

• Complementary assessments to consider include cognitive function, fear of falling, and environmental conditions.

• Technology, in the form of virtual reality or tele-rehabilitation, is used for enhancing motor skills and improving balance.

• Robot-assisted training uses technology to support body weight during tasks, helping functional movement.

• Virtual reality (VR) interventions are beneficial for improving arm function, postural control, balance, and gross motor functions in people with cerebral palsy, stroke, Parkinson's disease, and spinal cord injuries.

• Hydrotherapy benefits from buoyancy to reduce load on joints, drag for resistance, and temperature variations that can reduce pain and improve the effectiveness of exercise.

• The application of water in therapy should consider different temperatures, activities types, and conditions, and can aid in pain relief, reduction on joint strain, improved mental health, relaxation, and post-exertional recovery.

• Hydrotherapy can apply to conditions including cardiac rehab, MS, spinal cord injuries, and arthritis.

• Aquatic exercises are also suitable for people with impaired posture and/or decreased balance.

• Traumatic brain injuries (TBI) involve primary and secondary injuries, which can cause edema, intracranial pressure, and chemical changes.

• Severity of injury is assessed by the Glasgow Coma Scale and duration of post-traumatic amnesia.

• Multiple sclerosis (MS) is defined by chronic neurodegenerative disease affecting the central nervous system (CNS), leading to demyelination (the loss of myelin sheath).

• Various types of MS range from relapsing-remitting (RRMS) to primary progressive (PPMS) and secondary progressive forms (SPMS), based on clinical presentation and progression.

• Many factors are associated with the condition, including genetics, environmental conditions, and/or autoimmune diseases.

• Treatments for MS include disease-modifying therapies (DMTs), which often have substantial side-effects, and autologous hematopoietic stem cell transplants, which are high risk but may show promising outcomes.

• Chronic Fatigue Syndrome (CFS) is characterized by prolonged, disabling fatigue affecting ADLs that is not alleviated by rest, not a result of difficult activity and was not tolerated prior to onset, leading to significant functional impairment.

• The condition is often associated with multiple accompanying symptoms in varying systems and may be diagnosed by clinical history, examination, and investigation, given that there is no definitive way to diagnose conditions of this type.

• A lack of consensus among healthcare professionals is evident in the lack of a clear, universally recognized diagnostic approach.

• Risk factors are listed, including infections, psychological distress, and environmental influences or genetic predispositions.

• Exercise, combined with psychological interventions, plays a significant role in the management of CFS.

• Parkinson's Disease (PD) is a neurodegenerative disease affecting neurons in the substantia nigra part compacta, characterized by resting tremors, rigidity, postural instability, and bradykinesia (slow movement).

• It's a progressive disorder with motor and non-motor symptoms.

• Exercise plays a role in the management of PD, targeting motor impairments and maintaining/improving motor skills.

• Various exercise types are discussed and their potential benefits and limitations for improving motor symptoms and quality of life are documented.

• Assessment of PD includes the Hoehn and Yahr stages, and common assessments such as Postural Gait and Stability (PIGD), balance scales, gait assessments, falls efficacy scale (FES-I), and the MDS-UPDRS.

• Freezing of gait (FOG) is a crucial concern with PD, leading to balance problems.

• Visual cueing, both for FOG and broader gait control, can assist the patient to maintain some functionality

• Practical applications in cueing are discussed, covering visual, auditory, and somatosensory stimuli.

• Dementia is described as a progressive neurodegeneration disorder affecting cognition, and ultimately impacting functionality.

• Risk factors, diagnosis, and prevention are provided.

• Subtypes, including Alzheimer's disease, vascular dementia, frontotemporal dementia, and dementia with Lewy bodies, are distinguished, with respect to differences in specific symptoms and progression.

• Exercise plays an important role in maintaining/improving cognitive functions.

• Multiple sclerosis (MS) often results in symptom complexity due to its chronic, progressive nature and varying types, with high incidence amongst individuals living further from the equatorial latitudes within their populations.

• Diagnostic stages, characteristics and progression, along with disease-modifying therapies (DMTs), that target the underlying conditions and managing secondary symptoms, are discussed.

• Stroke is a vascular event where blood flow to the brain is interrupted.

• Different types of stroke are identified (ischemic and hemorrhagic), based on their cause.

• Risk factors, symptoms, and assessment, including the Glasgow Coma Scale (GCS), are presented, with implications and considerations for exercise prescription and management.

• Consequences may be varied including motor, sensory, cognitive and functional limitations, impacting various aspects of daily living.

Test your knowledge on fall risk factors and the assessment tools used for evaluating those at risk, particularly in new environments. Additionally, explore the relationship between Parkinson's disease and falls, as well as the characteristics of Chronic Fatigue Syndrome. This quiz covers essential concepts in health and safety related to these conditions.