202360 EHR525 Week 05b Common Neurological Impairments (1 Slide).pdf

WARNING This material has been reproduced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of th...

WARNING This material has been reproduced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice School of Allied Health, Exercise and Sports Sciences 1 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 1 EHR525 EXERCISE FOR NEUROLOGICAL & MENTAL HEALTH CONDITIONS Common Neurological Impairments Associated with CNS Lesions Presenter: Jack Cannon School of Allied Health, Exercise and Sports Sciences 2 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 2 What We Will Cover ■ Define key terms used to classify motor impairments associated with CNS lesions. ■ Describe motor impairments associated with lesions within the motor cortex. ■ Describe motor impairments associated with subcortical lesions. ■ Describe the relationship between primary motor impairments and secondary musculoskeletal effects. ■ Describe the functional effects of lesions within sensory systems. ■ Describe the effects of lesions within higher cortical association. School of Allied Health, Exercise and Sports Sciences 3 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 3 INTRODUCTION ■ Understanding physiology and pathophysiology of motor control is essential for working with neurological clients with movement problems. ■ Pathology within multiple systems can result in impairments that constrain functional movement. □ Effects on movement are dependent on the systems involved. ■ Constraints: Physiological barriers or other restrictions or limitations that shape or influence the motor pattern or outcome of movement. School of Allied Health, Exercise and Sports Sciences 4 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 4 KEY TERMS USED TO CLASSIFY IMPAIRMENTS ASSOCIATED WITH CNS LESIONS ■ Signs: Objective findings of pathology determined by physical examination. □ Examples: Ataxia, weakness, dystonia, etc. ■ Symptoms: Subjective report associated with pathology perceived by client; not necessarily observable from an examination. □ Examples: Pain, fatigue, etc. School of Allied Health, Exercise and Sports Sciences 5 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 5 KEY TERMS USED TO CLASSIFY IMPAIRMENTS ASSOCIATED WITH CNS LESIONS ■ Primary effects: Result directly from CNS pathology and affects the motor, sensory/perceptual, and/or cognitive/behavioural systems. □ Examples: Ataxia, hemiplegia, spasticity, emotional changes, etc. ■ Secondary effects: Secondary impairments refer to musculoskeletal changes that result from the primary CNS lesion. □ Examples: Muscle contractures, joint deformities, etc. School of Allied Health, Exercise and Sports Sciences 6 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 6 KEY TERMS USED TO CLASSIFY IMPAIRMENTS ASSOCIATED WITH CNS LESIONS ■ Abnormal motor behaviours associated with primary impairments can be described in terms of intensity. ■ Positive signs and symptoms: Refer to overactive behaviours. □ Examples: Hyperactive stretch reflex, resting tremor, etc. ■ Negative signs and symptoms: Refer to underactive behaviours. □ Examples: Paresis, bradykinesia. School of Allied Health, Exercise and Sports Sciences 7 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 7 IMPAIRMENTS DUE TO LESIONS IN ACTION SYSTEMS ■ Related to lesions within one or more CNS areas responsible for motor planning or execution: □ Motor cortex. □ Cerebellum. □ Basal ganglia. ■ Effects on lesions on movement differ between areas involved. School of Allied Health, Exercise and Sports Sciences 8 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 8 EFFECTS OF MOTOR CORTEX LESIONS ■ Motor cortex lesions can result in four (4) major effects on movement control: □ □ □ □ Motor weakness. Abnormal muscle tone. Loss of selective muscle activation and/or abnormal muscle synergies. Coactivation of functionally related muscle groups. School of Allied Health, Exercise and Sports Sciences 9 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 9 Motor Weakness ■ Inability or difficulty to recruit and/or modulate skeletal motor units to a level sufficient to produce force. ■ Terminology describing the extent of weakness: □ Paresis: Refers to weakness (difficulty activating motor units). □ Plegia: Refers to total paralysis (inability to activate motor units). ■ Terminology describing the location of weakness: □ Hemi: Affects one side of body (left or right). □ Para: Affects both lower extremities. □ Tetra: Affects all four limbs. School of Allied Health, Exercise and Sports Sciences 10 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 10 Abnormal Muscle Tone ■ Hypertonicity: Often expressed as spasticity. ■ Spasticity: Motor disorder; velocitydependent increase in tonic stretch reflexes. School of Allied Health, Exercise and Sports Sciences 11 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 11 Abnormal Muscle Tone ■ Upper limb spasticity: Internal rotation and adduction of the shoulder coupled with flexion at the elbow, the wrist and the fingers. □ Flexion synergy. ■ Lower limb spasticity: Adduction and extension of the knee with equinovarus foot. School of Allied Health, Exercise and Sports Sciences 12 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 12 Loss of Selective Muscle Activation and/or Patterns of Movement ■ Individuation (fractionation of movement): Ability to selectively activate a muscle allowing isolated joint motion. ■ Motor synergies: Abnormal coupling between muscles within functional groups. School of Allied Health, Exercise and Sports Sciences 13 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 13 Coactivation ■ Simultaneous activation of additional muscles during functional movements. ■ Present in both neurologically intact individuals during early stages of motor learning and individuals with neurological pathology. ■ Reduces the efficiency of movement and increases energy expenditure. School of Allied Health, Exercise and Sports Sciences 14 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 14 Apraxia ■ Loss of knowledge of how to perform skilled movement. □ Unable to perform a movement or sequence of movements, despite intact sensation, normal muscle strength and coordination, and an understanding of the task. • Example: Brushing one’s teeth with a dry toothbrush then putting toothpaste on the brush School of Allied Health, Exercise and Sports Sciences 15 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 15 Functional Movement Changes Due To Motor Cortex Lesions School of Allied Health, Exercise and Sports Sciences 16 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 16 Dysarthria ■ Speech disorder resulting from spasticity or paresis of the muscles used for speaking. ■ Spastic dysarthia: □ Caused by damage to the upper motor neurons. □ Characterised by harsh, awkward speech. ■ Flaccid dysarthia: □ Caused by damage to the lower motor neurons. □ Characterised by paresis of speech muscles. School of Allied Health, Exercise and Sports Sciences 17 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 17 EFFECTS OF CEREBELLAR LESIONS ■ Cerebellar lesions can result in three (3) major effects on movement control: □ Ataxia: Discoordination of voluntary movement are a hallmark feature of cerebellum pathology: • Delays in onset timing. • Dysmetria. • Dysdiadochokinesia. □ Hypotonia: Associated with pendular reflexes. □ Action or intention tremor: Rhythmic, involuntary oscillatory movement of a body part. School of Allied Health, Exercise and Sports Sciences 18 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 18 EFFECTS OF BASAL GANGLIA LESIONS ■ Basal ganglia lesions can result in two (2) broad effects on movement control: □ Hypokinesis: Characterised by diminished movement and includes bradykinesia, akinesia, and rigidity (lead pipe or cogwheel). • Example: Parkinson’s disease. □ Hyperkinesis: Characterised by excessive movement and includes resting tremor, kinetic tremor, and dystonia. • Example: Huntington’s Chorea. School of Allied Health, Exercise and Sports Sciences 19 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 19 SECONDARY MUSCULOSKELETAL EFFECTS ■ Primary motor impairments can result in a range of secondary musculoskeletal effects: □ □ □ □ □ Muscle atrophy and changes in fibre structure. Deconditioning. Contractures. Degenerative joint disease. Loss of bone mass/osteoporosis. School of Allied Health, Exercise and Sports Sciences 20 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 20 SECONDARY MUSCULOSKELETAL EFFECTS ■ Contracture: A permanent shortening of a muscle or joint. ■ Usually occurs in response to prolonged hypertonic spasticity. ■ A common secondary effect of motor cortex lesions. School of Allied Health, Exercise and Sports Sciences 21 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 21 IMPAIRMENTS DUE TO LESIONS IN SENSORY SYSTEMS ■ Related to lesions within one or more CNS areas responsible for receiving or processing sensory information: □ Somatosensory areas. □ Visual areas. □ Vestibular areas. School of Allied Health, Exercise and Sports Sciences 22 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 22 EFFECTS OF LESIONS IN PRIMARY SOMATOSENSORY AREA ■ Results in a loss of discriminative sensation (complete loss, numbness, tingling). ■ Strong association between impaired somatosensation and recovery of motor function following CNS injury or damage. ■ Stroke-related impairments associated with significant loss of function. School of Allied Health, Exercise and Sports Sciences 23 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 23 EFFECTS OF LESIONS IN VISUAL AREAS ■ Disorders of visual system vary according to location of lesion. ■ Implications for balance, trips, and general safety. School of Allied Health, Exercise and Sports Sciences 24 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 24 EFFECTS OF LESIONS IN VESTIBULAR AREAS ■ Problems related to: □ Gaze stabilisation. □ Posture and balance. □ Vertigo or dizziness. ■ Implications for falls and risk management during exercise. School of Allied Health, Exercise and Sports Sciences 25 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 25 IMPAIRMENTS DUE TO LESIONS IN HIGHER ASSOCIATION CORTICAL AREAS ■ Results in changes to personality, emotion, behaviour, and/or cognition. ■ Changes influence capacity to engage in exercise and interactions and ability to communicate with people: □ □ □ □ Attention. Orientation. Memory. Problem solving. School of Allied Health, Exercise and Sports Sciences 26 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 26 SUMMARY ■ Knowledge of the effects of common neurological lesions is important for determining functional deficits and developing intervention strategies. ■ Pathology within the motor cortex typically result in paresis, spasticity and problems with muscle synergies during movement. ■ Lesions within subcortical regions usually result in a loss of muscle tone, tremor, and problems with coordinating movement. ■ Secondary musculoskeletal effects can be significant and substantially impair movement capabilities. ■ Lesions affecting sensory systems can significantly constraint functional movement and must be considered when working with neurological clients. ■ Impairments within higher cortical association areas can indirectly affect movement through personality, emotion, behaviour, and/or cognition changes. School of Allied Health, Exercise and Sports Sciences 27 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 27