202360 EHR525 Week 4a Principles of Exercise and Neurorehabilitation (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 Principles of Exercise and Neurorehabilitation Presenter: Jack Cannon School of Allied Health, Exercise and Sports Sciences 2 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 2 WHAT WE WILL COVER: ■ ■ ■ ■ ■ Goal of neurorehabilitation and role of the AEP. Functional recovery vs compensation. Mechanisms of functional recovery. Neuroplasticity and contribution to functional recovery. Implications for exercise prescription. School of Allied Health, Exercise and Sports Sciences 3 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 3 Introduction ■ Improved functional movement outcomes following neurological damage or disease may occur due to recovery or compensation. ■ Recent interest in the role of neuroplasticity in supporting functional recovery has dramatically increased and now a target of therapeutic and exercise interventions. ■ What is the goal of neurorehabilitation and role of the AEP? ■ What’s the difference between functional recovery vs compensation? ■ What mechanisms of neuroplasticity contribute to functional recovery? School of Allied Health, Exercise and Sports Sciences 4 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 4 GOAL OF NEUROREHABILITATION ■ Primary goal: To assist the client return to the highest level of function and independence possible while improving their overall quality of life. □ Includes physical, emotional, and social domains. ■ Achieved through a multidisciplinary neurorehab team: □ AEPs, OTs, PTs, GPs, Neurologists, Urologists, Orthotists etc. ■ Rehab provided through continuum of care: □ Inpatient vs. outpatient vs. community-based programs/outreach. School of Allied Health, Exercise and Sports Sciences 5 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 5 Role of AEP in Neurorehabilitation ■ AEPs in neurorehab work as part of a multidisciplinary team to: □ □ □ □ □ □ □ Prevent secondary disease (e.g. CVD, T2D, osteoporosis, etc) Prevent secondary effects (e.g. weakness, neglect, pressure injuries etc). Increase aerobic conditioning. Increase muscular fitness (strength, endurance, power). Improve physical health Increase/maintain joint ROM. and functional ability Increase balance, mobility, and functional performance. Increase functional conditioning to support ADLs and lifestyle needs. ■ Exercise should be prescribed in a way that supports neurorehab principles to promote nervous system health. School of Allied Health, Exercise and Sports Sciences Facilitate neuroprotection and neuroplasticity 6 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 6 RECOVERY OF FUNCTION AND COMPENSATION ■ Recovery: Achieving the functional goal in the same way it was performed premorbidly, that is, using the same processes used prior to the injury. ■ Compensation: Appearance of new motor patterns resulting from: □ Adaptation of remaining motor elements. □ Substitution where functions are taken over or replaced by different effectors or body segments. Functional outcomes may involve one or both processes. Both rely on motor skill learning. School of Allied Health, Exercise and Sports Sciences 7 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 7 Example: Functional Recovery ■ A person presents with left lower limb hemiplegia (weakness) following a stroke. ■ AEP Treatment: Exercises to strengthen the limb and improve progressive function (e.g. balance, weight transfers, STS, gait). ■ Outcome: included improved balance, coordination, and movement of the affected lower limb. □ Progressed from wheelchair to a quad cane, to a single point cane, and then by the end of treatment within 3 mths was able to ambulate independently. School of Allied Health, Exercise and Sports Sciences 8 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 8 Example: Compensation ■ A person presents with left lower limb hemiplegia (weakness) following a stroke. ■ AEP Treatment: Exercises to strengthen the limb and improve progressive function (e.g. balance, weight transfers, STS, gait). ■ Outcome: included improved balance, coordination, and movement of the affected lower limb. □ Progressed from wheelchair to a quad cane, and by the end of treatment after 6mths was able to ambulate using a single point cane. School of Allied Health, Exercise and Sports Sciences 9 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 9 Types of Functional Recovery ■ Spontaneous recovery: Natural recovery in the absence of intervention. ■ Training-induced recovery (neuroplasticity): Achieved through specific intervention designed to affect neural mechanisms (motor learning). School of Allied Health, Exercise and Sports Sciences 10 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 10 MECHANISMS OF FUNCTIONAL RECOVERY Cortical Reorganisation Training- or ActivityInduced Recovery (Neuroplasticity) Collateral Sprouting Unmasking Resolution of Diaschisis Spontaneous Recovery (Injury Reversal) Resolution of Edema Resolution of Penumbra Incident hours days weeks School of Allied Health, Exercise and Sports Sciences months years 11 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 11 Spontaneous Recovery: Resolution of Penumbra School of Allied Health, Exercise and Sports Sciences 12 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 12 Spontaneous Recovery: Resolution of Oedema School of Allied Health, Exercise and Sports Sciences 13 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 13 Spontaneous Recovery: Resolution of Diaschisis ■ Diaschisis: Loss of function in a structurally intact brain area due to loss of input from an anatomically connected area that is injured. □ E.g.. Crossed cerebellar diaschisis. ■ Cerebral shock: A short-term loss of function near and far from lesion site. ■ Full recovery is often expected. School of Allied Health, Exercise and Sports Sciences 14 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 14 NEUROPLASTICITY ■ Neuroplasticity: Ability of the nervous system to respond to intrinsic stimuli by reorganising its structure, function and/or connections as a result of experience. ■ Can be described at many levels: □ □ □ □ □ □ Brain level. Network level. Intercellular level. Intracellular level. Biochemical level. Genetic level. School of Allied Health, Exercise and Sports Sciences 15 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 15 Two Types of Neuroplasticity ■ 1. Adaptive neuroplasticity: Refers to those brain changes that contribute to enhanced function: □ Cognitive learning. □ Memory formation. □ Motor skill acquisition. ■ Allows to brain to compensate for lost function to due damage or disease: □ Often described as “re-learning”. Adaptive neuroplasticity associated with exercise provides a potential stimulus for functional recovery School of Allied Health, Exercise and Sports Sciences 16 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 16 Two Types of Neuroplasticity ■ 2. Maladaptive neuroplasticity: Refers to those brain changes that hinder functional recovery or the development of an unwanted symptoms: □ New onset epilepsy. □ Chronic pain or phantom limb pain. ■ Learned non-use: Refers to the disuse of impaired limb due to adverse reactions and failure resulting in suppression of behaviour. □ Results in decreased use adaptations affecting the neural and musculoskeletal systems. School of Allied Health, Exercise and Sports Sciences 17 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 17 MECHANISMS CONTRIBUTING TO ADAPTATIVE NEUROPLASTICITY ■ There are three (3) primary mechanisms contributing to adaptative neuroplasticity: □ Unmasking. □ Collateral sprouting. □ Cortical reorganisation. Mechanisms contributing to adaptive neuroplasticity are similar between healthy people and persons recovering from CNS injury or disease School of Allied Health, Exercise and Sports Sciences 18 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 18 Unmasking School of Allied Health, Exercise and Sports Sciences 19 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 19 Collateral Sprouting ■ Collateral sprouting: Neighbouring dendrites innervation denervated target. School of Allied Health, Exercise and Sports Sciences 20 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 20 Cortical Reorganisation ■ Following stroke: □ Intact adjacent areas of the cortex expand into quiet areas (due to unmasking of silent synapses). ■ Following injury cortical mapping is responsive to training. ■ Changes are progressive and reversible. ■ Once the task is learned, mapping changes persist long-term. School of Allied Health, Exercise and Sports Sciences 21 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 21 Cortical Reorganisation ■ Brain tumour surgery: □ □ □ □ B: Pre-surgery C: Post-surgery Orange: left hand clenching Blue: right hand clenching ■ Permanent change in synaptic connections and cortical mapping: □ “Brain re-wiring”. □ Important for functional recovery. School of Allied Health, Exercise and Sports Sciences 22 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 22 IMPLICATIONS FOR EXERCISE PRESCRIPTION ■ Motor skill training (e.g. goal-directed, functional movement) promotes: □ Cortical reorganisation and cortical synaptogenesis (changes in the cortex from neural activity). □ Influenced by 10 core principles of neuroplasticity. ■ Aerobic training promotes (70-80% Predicted HRmax): □ Cortical angiogenesis (new blood vessel development and increased blood flow in the brain). □ Supports a neuroplastic and neuroprotective environment (e.g. delivery of BDNF, reduced aged-related axonal dieback). ■ Strength training promotes: □ Motor unit recruit and firing frequency (spinal synaptogenesis). School of Allied Health, Exercise and Sports Sciences 23 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 23 10 Core Principles of Neuroplasticity School of Allied Health, Exercise and Sports Sciences 24 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 24 SUMMARY ■ Goal of neurorehabilitation is to support the client attain the highest level of function and independence possible while improving their quality of life. ■ Recovery refers to achieving a functional goal in the same way it was performed prior to damage or injury; while compensation involves the use of a new motor pattern to achieve the same outcome. ■ Functional recovery may occur due to spontaneous recovery or activity- or training-induced neuroplasticity. ■ Spontaneous recovery occurs as a result of normal healing processes; while neuroplasticity occurs as a result of brain changes related to experience. ■ Neuroplasticity may be adaptive or maladaptive. ■ Mechanisms contributing to neuroplasticity involve unmasking, collateral sprouting, and cortical reorganisation. School of Allied Health, Exercise and Sports Sciences 25 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 25