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

• 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)

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)

• Ataxia (lack of voluntary coordinated movements)

• Asynergy (defect in coordination)

• Dysmetria (over/undershooting intended position)

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

(Khan, I. 2022)

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

(Galiana-Simal et. Al., 2020)

• 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)

• Lack of hand control

• Mobility and Gait

• Balance

• Falls Risk

• Lack of initiation of movements

• Independence

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

• 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)

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)

• 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)

Brain > Spinal Cord

• Stroke

• Tumor

• Brain stem

• Spinal cord (white matter)

Lower

Spinal cord > Muscles

• Plexus

• Spinal cord (grey matter)

• 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)

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

• Movement

• Speech/language processing

• Behaviour

Occipital Lobe

• Visual processing

Parietal lobe

• Spatial and body awareness

Thalamus

• Regulates consciousness and arousal

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

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

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

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

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