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Multiple systems

Depression & Neurological Impairments

Spinal cord injuries

(Williams, R., & Murray, A. 2015)

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Inability to generate normal force, reduction in peak force

Akinesia

Without voluntary movement

Stroke

Reduction in descending drives of motor neurons to hands = lack of hand control due to muscle weakness

MS

Demyelination of axons = slower conduction of signals away from the body

Spinal Cord Injuries

Descending pathway for motor neurons damaged

Excitatory input and firing rate of neurons reduced

Lack of initiation of muscles or weakness

Neuroplasticity

Part-task training

Meaningful Task Specific Training

(Kamper, D. G. et. al., 2006; Thomas, C. K. et. al., 2013; Narayan Arya, K. et. al., 2012)

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Spinal cord lesions

Sensory feedback impaired

Cerebellum inhibiting muscle tone

Types:

Hypotonia

Decrease in muscle tone

Cerebellum lesions

Cerebral Palsy

Flaccidity

Loss of muscle tone

Lower MN lesions

Spinal cord injuries

Rigidity

Stiffness of muscles

Basal Ganglia lesions

Spasticity

Hypertonia of muscles

Velocity

Motor Learning and Neuroplasticity

Balance

Strength

Range of motion

Walking

Functional Training

Ganguly, J. et. al., 2021; Patel, D. R. et. al., 2020; Ferreira-Sanchez, M. D. R. et. al., 2020; Yitayeh, A., & Teshome, A. 2016)

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Cerebellum Damage

Intergration of feedback and motor commands compromised

Descending drives

Central pattern generation

Timing, force, direction

Ataxia (lack of voluntary coordinated movements)

Asynergy (defect in coordination)

Dysmetria (over/undershooting intended position)

(Manto, M. et. al., 2012)

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Visual and sensory information processing impaired > lack of meaningful whole structures

(Khan, I. 2022)

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Progressive decline of memory and cognitive processing

(Dhakal, A. & Bobrin, B. D., 2023)

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Learning and Academic Performance

Fine and gross motor coordination

Muscle tone

Behaviour and Language

Hyperactivity/Hypoactivity

Disproportionate excitatory and inhibitory mechanisms

Gait

Sensory gait

Postural Balance

Adaptive/Reactive Response

Anticipatory/Reactive Response

(Galiana-Simal et. Al., 2020)

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Skin

Thermoreceptors (temperature

Mechanoreceptors (vibration, touch and pressure)

Nociceptors (pain)

Musculoskeletal

Muscle Spindle (muscle length, postural muscles, proprioception)

Golgi Tendon Organ (force of contraction, proprioception)

Joint Receptors (proprioception, coordination of muscle action)

Vestibular

Vestibular hair cells (sound vibration, position and movement of head)

Visual

Optic nerve (responds to light and transmits to brain)

(Marzvanyan, A., & Alhawaj, A. F. 2023)

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Motor Weakness

Lack of hand control

Mobility and Gait

Balance

Falls Risk

Lack of initiation of movements

Independence

(Kamper, D. G. et. al., 2006)

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Coordination

Gait abnormalities

Ataxic gait

Adaptive and proactive responses

Balance

Postural

Slowed timing of movements and responses

Fall risk

Reaching, grabbing and maniuplating objects

(Manto, M. et. al., 2012)

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Cerebellum and Basal Ganglia

Upper motor neuron lesions

Dopamine changes in Basal Ganglia - excitatory and inhibitory responses dysfunctional

MS, Parkinson's, Cerebral Palsy, Huntington's and Stroke

Ataxia

Lack of voluntary movement

Dystonia

Stiffness or sustained contractions

Dyskinesia

Tremors

Kinetic

Intentional

Postural

Choreiform - jerky, repetitive

Athetoid - large, writhing movements

Ganguly, J., et. al., 2021; Monbaliu, E., et. al., 2012, Radhakrishnan, D. M., & Goyal, V. 2018; Roos, R. A. 2010)

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Gait abnormalities

Hemiplegic gait

Spastic diplegic gait

Falls risk

Postural changes

Manipulation of objects

Decreased tone > weakness to grasp and manipulate objects

Increased tone > spasticity with increased velocity, lack of motor control with manipulation and fine motor tasks

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Gait abnormalities

Parkinsonian gait

Choreiform gait

Postural impairments

Risk of falls

Lack of control of fine and gross motor tasks

ADL's

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Spinal cord

Carries somatic and visceral information

Afferent: information going up from periphery to brain

Efferent: information going down from brain to periphery

White matter: carries and transmits information

Grey Matter: processes information

Nerves: bunch of neurons, axons transmit signals, plexus = bunch of axons

Brain Stem

Integrates and relays information from CNS to PNS through corticospinal tracts and cranial nerves

Sends neural signals down to spinal cord

Gait, posture and control of movements

Thalamus

Relays information to sensory and motor cortex

Cerebellum

Coordinating voluntary movements

Storing movement patterns

Postural control

Basal Ganglia

Excitatory and inhibitory feedback

Regulated by dopamine

Posterior Parietal Cortex

Visual and perceptual feedback

Forms visual map

Motor Cortex

Provides movement information

Speed and accuracy of movement

Responsible for movement on the opposite side of body

(Asan, A. S. et. al., 2022; Carmel, J. B. et. al., 2016; Schmahmann, J. D. et. al., 2009; Lanciego, J. L. et. al. 2012; Malhotra, P. et. al., 2009)

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Upper

Brain > Spinal Cord

Stroke

Tumor

Brain stem

Spinal cord (white matter)

Lower

Spinal cord > Muscles

Plexus

Spinal cord (grey matter)

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Neuropraxia: mild, compression

Demyelination

Reversible conduction block

Compression myelin sheath

E.g. Radial nerve compression/wrist drop

Axonotmesis: moderate, may recover, takes longer

Demyelination + axon loss

Endoneurium still in tact; neuron can regrow

Body can grow axon back

Terminal will die off

Distal end; wallerian degeneration

E.g. Crash injuries and displaced bone

Neurotmesis

Demyelination + axon loss + damage of:

1. Endoneurium (fair growth)

2. Perineurium (poor  growth)

3. Epineurium (no growth)

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White matter: transmits information and signals from cortex to periphery

Upper motor lesion

Axons damaged

Myelin loss

(Rost, N. S et. al., 2022)

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Frontal lobe

Movement

Speech/language processing

Behaviour

Occipital Lobe

Visual processing

Parietal lobe

Spatial and body awareness

Thalamus

Regulates consciousness and arousal

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Attention

in visual field

Neglect

1/2 clock face

Denial

body isn't their own

Apraxia

difficulty of language skills

Aphasia

Expressive: know what they want to say but can form the necessary movements or say them

Receptive: difficulty knowing meaning of words they once knew

Arousal

Consciousness

Problem solving

Memory loss

(Mitchell, A. J., et. al. 2010; Rost, N. S., et. al. 2022; Vuilleumier, P. 2013; Schiff, N. D. 2008)

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Independence

Mobility

Social

QOL

(Mitchell, A. J., et. al. 2010

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Scanning

Mirrors

Mental Practice

(Frank, C. et. al., 2016)

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Stroke

Parkinson's

MS

Head/Brain Injuries

Dementia

(Rost, N. S., et. al. 2022)

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Carries neural information to and from the brain and periphery

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Grey maatter: processing information

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Neurons receive input from receptors

Processes sensory information

Regulate motor & behavioural responses

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Habituation

Implicit

Repeated Exposure

Decreased neural sensory response

(Merchie, A., & Gomot, M. 2023)