Neuro stroke rehabilitation

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A-Z OF STROKE REHAB THROUGH PHYSIOTHERAPY PRESENTED BY ASISH K DAS, CONSULTANT -WELLNESS RX INSTITUTE, WEST BENGAL.

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  • 1. ASISH K DAS WELLNESS RX PHYSIOTHERAPY CENTRE NEURO REHABILITATION UNIT www.akdwellnessrx.com [email_address] [email_address] [email_address] ASISH K DAS'S PLAN

2. Neuro Rehabilitation

  • Definition:
  • A process whereby patients who suffer
  • from impairment following neurologic
  • diseases regain their former abilities or, if full recovery is not possible, achieve
  • their optimum physical, mental, social and vocational capacity.

WELLNESS RXREHABILITATIONSERVICE 3. Neuro Rehabilitation Definition: Wikipedia a complex medical process which aims to aid recovery from a nervous system injury,and to minimize and/or compensate for any functional alterations resulting from it. Popovic & Sinkjaer(2003) -comprises methods & technology for maximizing the efficiency of preserved neuromuscular structures in human with motor disability 4. Common words used in Rehabilitation

  • Impairment -refer to the loss of structures
  • or function
  • Disability -refer to limitations or
  • restrictions resulting from the
  • impairments
  • Handicap -refer to the inability to perform
  • social/vocational functions resulting from
  • impairment

5. Neuroplasticity/Brain Plasticity

  • Definition:
  • The capability of the brain (or the CNS) toreorganize by forming new neural connections throughout life.
  • It allows the neurons in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in the environment .

REHAB is a process of healing from within !! 6. Cerebral Stroke

  • Demographics:
  • Leading cause of disability!
  • 15M stroke cases/year
  • worldwide
  • 5M die
  • 5M permanently disabled
  • Overall mortality is declining
  • Long-term survival post-stroke is improving

7. Five Basic Principles Governing Neuroplasticity

  • PRINCIPLE No. 1:
  • BODY PARTS COMPETE FOR
  • BRAIN REPRESENTATION!
  • Use dependent plasticity > experience dependent
  • plasticity
  • There is a need for the brain to use experience to
  • initiate a new synaptic connection between neurons
  • the more a part is used the bigger its area of
  • representation in the brain that correlates with
  • improved function
  • Opposite effect is learned non use

8. Five Basic Principles Governing Neuroplasticity

  • PRINCIPLE No. 2:
  • THE IPSILATERAL &
  • CONTRALATERAL HEMISPHERE
  • CAN CONTRIBUTE TO MOTOR CONTROL!
  • If 1 hemisphere is damaged, the intact
  • hemisphere may take over some of its
  • functions.
  • To recover, the neurons needed to be stimulatedthrough activity
  • Shown by functional MRI Scan studies on
  • stroke patients

9. Five Basic Principles Governing Neuroplasticity

  • PRINCIPLE No. 3 :
  • SENSORY STIMULATION
  • ENHANCES PLASTICITY!
  • Sensory stimulation enhances the sensory
  • representation of the body part
  • It makes that area in the brain hyper-excitable to
  • plasticity

10. Five Basic Principles Governing Neuroplasticity

  • PRINCIPLE No. 4 :
  • REDUCTION OF INHIBITION ENHANCES PLASTICITY!
  • Remove factors that make the patient less
  • motivated and sleepy!
  • Treat post-stroke depression but do not use
  • drugs that induce drowsiness!

11. Five Basic Principles Governing Neuroplasticity

  • PRINCIPLE No. 5:
  • PHARMACOLOGIC AGENTS CAN ENHANCE PLASTICITY!
  • in ischemic stroke, to reduce infarct site and
  • promote repair and improve final functional
  • outcome
  • to improve neurological recovery after stroke

12. Management

  • PRINCIPLE No. 1:
  • BODY PARTS COMPETE FOR BRAIN REPRESENTATION!
  • Ex:CIMT-constraint induced movement therapy

13. Constraint-Induced Movement Therapy (CIMT)

  • Principle of FORCED USE to avoid the Learned Nonuse of the paretic side for Stroke patients
  • Mainly for training of upper extremity

14. CIMT and Cortical Changes

  • Cortical changes associated CIMT plus mental practice. Images reflecting the activations in 4 subtractions in patient 2. The top row of images depicts the sites of activation by subtracting the rest condition from the actual movement of theaffected (right) handcondition (A) pretreatment (move affected > rest) and (B) posttreatment (move affected > rest). The second row depicts the sites from the subtraction of the rest from imagine moving the right hand condition both (C) pretreatment (imagine move affected > rest) and (D) posttreatment (imagine move affected > rest). Note (D) increased ipsilateral cortical activation. Shown are all activations that passed a criterion of P