Neural Development and Cerebral Palsy

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Questions and Answers

What is the main role of the notochord in neural development?

It is responsible for the formation of the cerebral cortex.

It forms the central nervous system.

It provides temporary structural support for the developing embryo. (correct)

It differentiates into the peripheral nervous system.

Which part of the developing brain gives rise to the thalamus and hypothalamus?

Diencephalon (correct)

Telencephalon

Metencephalon

Mesencephalon

What is the primary function of chemoattractors in axonal migration?

They guide axons away from their targets.

They attract axons towards their specific targets. (correct)

They determine the pathway of neuronal migration.

They facilitate the formation of synapses.

Which of the following is NOT a key step in neural development?

Cell division (B) Signup and view all the answers

What is the significance of the observation that ocular dominance columns are disrupted if visual deprivation occurs 1-9 weeks after birth?

It emphasizes the critical period for visual development. (B) Signup and view all the answers

Which of the following is a potential consequence of leukodystrophy?

Impaired cognitive function (C) Signup and view all the answers

Which type of CP is most commonly associated with hypertonia (increased muscle tone) in the lower limbs?

Diplegia (D) Signup and view all the answers

Which prenatal factor is NOT considered a risk factor for CP?

Exposure to antibiotics during pregnancy (B) Signup and view all the answers

The vulnerability of preterm infants to CP is primarily due to:

Immature blood vessels (A) Signup and view all the answers

What is the primary difference between an IEP and a 504 plan?

IEPs provide specialized instruction and accommodations, while 504 plans provide only accommodations. (C) Signup and view all the answers

What is the primary function of the anterior tibialis muscle in gait?

To control ankle dorsiflexion in the swing phase. (D) Signup and view all the answers

Which of the following impairments can lead to an increased risk of falls in individuals with CNS injuries?

All of the above (D) Signup and view all the answers

What is the primary consequence of sarcopenia, or loss of muscle tissue, after CNS injury?

Decreased muscle strength and power. (B) Signup and view all the answers

What is the primary function of feedforward control in motor planning?

To plan and anticipate movements without relying on sensory feedback. (D) Signup and view all the answers

Which of the following is a potential contributor to lack of fractionation in individuals with CNS injuries?

Recruitment of reticulospinal fibers (D) Signup and view all the answers

Which of the following is a key driver of the 'Weight Acceptance' phase during gait analysis in neuro patients, according to the text?

Eccentric plantar flexor control (C) Signup and view all the answers

What specific developmental domain is NOT directly addressed in the 'Review of Typical Development' section?

Emotional (A) Signup and view all the answers

Which of the following is NOT a consideration for selecting and administering standardized tests in pediatric assessments?

Education level of the patient (D) Signup and view all the answers

What is the primary focus of the 'Participation and Activity' approach to examination in neuro patients?

Assessing functional limitations (D) Signup and view all the answers

What is the primary contributing factor to decreased ability for volitional movements in individuals with increased tone?

Abnormal motor control (B) Signup and view all the answers

Which of the following standardized tests is used to specifically assess motor performance in children with cerebral palsy?

GMFM (B) Signup and view all the answers

What is the primary focus of the 'Accelerated Skill Acquisition Program (ASAP)' for adult neuro patients?

Rehabilitating specific motor skills and enhancing performance (B) Signup and view all the answers

What is the difference between 'Hypomobility' and 'Hypermobility' in the context of interventions to alter motion in neuro patients?

Hypomobility is treated with stretching, while hypermobility is treated with splinting. (C) Signup and view all the answers

What is the significance of 'Baseline paretic knee power' in the context of augmenting force in neuro patients?

It directly influences functional strength gains during rehabilitation. (C) Signup and view all the answers

Which of the following is NOT a specific driver of the 'Stance' phase during gait analysis in neuro patients?

Hip flexor control (C) Signup and view all the answers

What is the primary goal of 'Improving Motor Control' in neuro rehabilitation, according to the text?

Enhancing coordination, accuracy, and smoothness of movement (A) Signup and view all the answers

Which of the following best describes the concept of 'Priming' in the context of motor control practice?

Exposing patients to specific stimuli before practice to enhance learning. (A) Signup and view all the answers

What is the primary purpose of 'validated measures of global development' in pediatric assessments?

To compare a child's development to that of their peers (C) Signup and view all the answers

Which of the following is NOT a characteristic of 'Norm-Referenced' standardized assessments?

Performance is assessed against established criteria (D) Signup and view all the answers

Which of the following is a key driver of the 'Propulsion' phase during gait analysis in neuro patients?

Eccentric plantar flexor control (B) Signup and view all the answers

What is the primary contributor to 'Metabolic cost' in individuals with neuro-disabilities?

Increased energy expenditure during movement (B) Signup and view all the answers

What are the main types of skills as defined in the content?

Discrete, Serial, Continuous (B) Signup and view all the answers

Which of these is NOT a critical element of gait according to the content?

Smooth, efficient, and rhythmic movement (D) Signup and view all the answers

What is a common characteristic of gait after stroke?

Slower walking speed (A) Signup and view all the answers

What is the main purpose of error augmentation during skill learning?

To allow the patient to experience and correct errors (C) Signup and view all the answers

Which of the following is NOT a principle of neuroplasticity?

Intensity is irrelevant (D) Signup and view all the answers

Which type of HIIT emphasizes high levels of neuromuscular intensity?

Long interval HIIT (B) Signup and view all the answers

What is the main purpose of praxis?

To generate new motor plans in response to environmental demands (A) Signup and view all the answers

Which brain region is involved in integrating sensory information for praxis?

Parietal lobe (D) Signup and view all the answers

Which of the following gait deviations is NOT commonly observed after stroke?

Symmetrical arm movements (A) Signup and view all the answers

What is the most accurate description of 'specificity' in the context of neuroplasticity?

Training that focuses on a specific task leads to improvements in that task (B) Signup and view all the answers

What is the main difference between a discrete skill and a serial skill?

Serial skills involve a sequence of movements, while discrete skills are single, isolated actions (A) Signup and view all the answers

How does the sensory-perceptual system influence skill learning?

It plays a critical role in sensing the environment and task constraints (C) Signup and view all the answers

Which of the following interventions BEST exemplifies the 'use it and improve it' principle of neuroplasticity?

Encouraging patients to perform activities they enjoy regularly (B) Signup and view all the answers

What is the primary factor that determines the success of a HIIT program?

The individual's motivation and adherence (B) Signup and view all the answers

How can the environment be manipulated to challenge a patient's balance during gait training?

Having the patient walk on uneven surfaces (C) Signup and view all the answers

Study Notes

Neural Development and Pathophysiology of Cerebral Palsy (CP)

Neural development involves ectoderm forming the brain, neural crest making the peripheral nervous system (PNS), neural tube forming the central nervous system (CNS), and the notochord as a temporary structure.
Signaling proteins are involved in the process. Brain structure varies.
Forebrain (prosencephalon) contains the telencephalon (cerebral cortex, basal ganglia, basal forebrain nuclei, thalamus, hypothalamus, epithalamus), diencephalon (thalamus, hypothalamus, epithalamus.)
Midbrain (mesencephalon) is comprised of the cerebral peduncles, midbrain tectum, and midbrain tegmentum.
Hindbrain (rhombencephalon) has the metencephalon (pons, cerebellum) and myelencephalon (medulla).
Spinal cord completes the structure.

Mechanisms of Neural Development

Schizencephaly and agenesis of corpus callosum are birth defects involving abnormal slits and clefts in cerebral hemispheres and the absence of a connection between hemispheres, respectively.
Neural precursor fate is determined by patterning processes.
Motor and sensory neurons have dorsal/sensory and ventral/motor locations, respectively.
Morphogens and signaling molecules with concentration gradients drive the exposure to diverse chemicals during development, crucial for neural differentiation. Neuronal migration guides neurons from center to periphery. Axon migration guides axons to their targets.

Pathway Selection and Synaptogenesis

Neurons use target selection, address selection, chemoattractors/repellents, and axon growth to find their proper pathways.
Nature vs nurture—nature provides the blueprint for patterning during migration, while nurture influences synaptic connections and overall development.

Myelination

Myelination begins at 28 weeks gestational age, with most of the corticospinal tract (CST) myelinated by 36 weeks.
This process improves posterior/anterior, inferior/superior, and proximal/distal motor function.
Sensory functions then motor functions are primarily affected. Motor function generally develops before sensory and more proximal to distal.

Role of Environment and Therapy

Environmental enrichment (e.g., sensory stimulation) plays a critical role in development, and experience helps to refine neuronal circuits. An example is the ocular dominance columns where input from the eye connects to specific regions of the brain.
- Retinal input connects to the lateral geniculate nucleus (thalamus).
Visual deprivation during early development can alter the organization of visual cortex.
Enrichment during critical developmental periods impacts neural development, improving motor skills.

Pathophysiology of Cerebral Palsy (CP)

CP is a group of permanent disorders of movement and posture, impacting developmental trajectories.
Various classifications are based upon muscle tone (e.g., spastic, hypotonic, ataxic, dyskinetic,) and limb involvement (e.g., quadriplegia, hemiplegia, diplegia.)
Prenatal, perinatal, and postnatal risk factors for CP include infections, maternal conditions, birth complications, and environmental toxins, and many other possibilities.

Individuals with Disabilities Education Act (IDEA) and Section 504

IDEA and Section 504 ensure that individuals with disabilities receive free appropriate education and related services.
IEP (Individualized Education Program) provisions focus on special education services, while 504 plans may address accommodations for non-special education settings (e.g., test-taking accommodations.)
Accommodations may be considered for test-taking, such as extra time or assistive technologies.

Management of the Foot and Ankle

Arthrokinematics: specific movements of the joints.
DF=dorsiflexion, PF=plantarflexion.
Gait, step cycle, and stance/swing phases in relation to leg and foot movements are important for analysis.
Pathological conditions such as spasticity and hypotonia are important to consider for effective intervention and management.

Adult Assessment and Treatment

ASAP (Accelerated Skill Acquisition Program) is a program designed to build skill competencies.
Interventions may involve training to increase capacity to build skills (stretching, splinting), motivation (social-cognitive), and functional strengthening/training.

Praxis

Praxis is the concept and planning of new motor actions to address environmental demands while integrating sensory, perceptual, cognitive, and contextual information.
Examples: cooking, using utensils, and dressing.

Adaptive and Efficient Gait Patterns

Efficient and adaptive gait involves optimizing energy use and minimizing exertion during movement
Gait is altered by impairment from stroke and cerebral palsy (CP)

Examination Assessments

A range of assessments (e.g., PDMS-2, BOT-2, GMFM, CAPE) tailored to the age and functional level of the patient and tailored to the impairment and type of movement.

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Description

Explore the intricacies of neural development related to cerebral palsy (CP). This quiz covers the formation of the brain, peripheral nervous system, and various structures within the central nervous system. Additionally, it examines specific birth defects and their impact on neural architecture.