The Clinical Science of Neurological Rehabilitation(1), fizjoterapia
[ Pobierz całość w formacie PDF ]
The Clinical Science of
Neurologic Rehabilitation,
Second Edition
BRUCE H. DOBKIN, M.D.
OXFORD UNIVERSITY PRESS
Contents
Part I. Neuroscientific Foundations for Rehabilitation
1. ORGANIZATIONAL PLASTICITY IN SENSORIMOTOR AND
COGNITIVE NETWORKS 3
SENSORIMOTOR NETWORKS 4
Overview of Motor Control • Cortical Motor Networks • Somatosensory Cortical
Networks • Pyramidal Tract Projections • Subcortical Systems • Brain Stem
Pathways • Spinal Sensorimotor Activity
STUDIES OF REPRESENTATIONAL PLASTICITY 39
Motor Maps • Sensory Maps
BASIC MECHANISMS OF SYNAPTIC PLASTICITY 44
Hebbian Plasticity • Cortical Ensemble Activity • Long-Term Potentiation and
Depression • Molecular Mechanisms • Growth of Dendritic Spines • Neurotrophins •
Neuromodulators
COGNITIVE NETWORKS 52
Overview of the Organization of Cognition • Explicit and Implicit Memory Network •
Working Memory and Executive Function Network • Emotional Regulatory Network •
Spatial Awareness Network • Language Network
SUMMARY 64
2. BIOLOGIC ADAPTATIONS AND NEURAL REPAIR 76
TERMS FOR IMPROVEMENT AFTER INJURY 79
Compensation • Restitution and Substitution • Impairment and Disability
INTRINSIC BIOLOGIC ADAPTATIONS 81
Spontaneous Gains • Activity in Spared Pathways • Sensorimotor Representational
Plasticity • Spasticity and the Upper Motor Neuron Syndrome • Synaptogenesis •
Denervation Hypersensitivity • Axon Regeneration and Sprouting • Axon
Conduction • Growth Factors • Neurogenesis
POTENTIAL MANIPULATIONS FOR NEURAL REPAIR 99
Activity-Dependent Changes at Synapses • Stimulate Axonal Regeneration • Deploy
Neurotrophins • Cell Replacement • Pharmacologic Potentiation
MUSCLE PLASTICITY 113
Exercise • Atrophy • Regeneration • Combined Approaches
EXPERIMENTAL INTERVENTIONS FOR REPAIR OF SPINAL
CORD INJURY 118
Prevent Cell Death • Increase Axonal Regeneration • Remyelination • Other
Transplantation Strategies • Retraining the Spinal Motor Pools
ix
x
Contents
RELEVANCE OF ANIMAL MODELS OF REPAIR TO
CLINICAL TRIALS 129
Eight Potential Pitfalls of Animal Models
SUMMARY 134
3. FUNCTIONAL NEUROIMAGING OF RECOVERY 147
NEUROIMAGING TECHNIQUES 148
Positron Emission Tomography • Single Photon Emission Computerized Tomography •
Functional Magnetic Resonance Imaging • Transcranial Magnetic Stimulation •
Magnetoencephalography • High Resolution Electroencephalography • Intrinsic
Optical Imaging Signals • Near-Infrared Spectroscopy • Magnetic Resonance
Spectroscopy • Transcranial Doppler • Combined Methods
LIMITATIONS OF FUNCTIONAL NEUROIMAGING STUDIES 160
General Limitations • Subtraction Studies • Timing of Studies
METABOLIC IMAGING AT REST AFTER INJURY 163
Stroke • Aphasia • Traumatic Brain Injury • Persistent Vegetative State
ACTIVATION STUDIES: FUNCTIONAL REORGANIZATION
AFTER INJURY 167
Sensorimotor Reorganization After Central Nervous System Lesion • Peripheral
Nerve Transection
TRAINING-INDUCED REORGANIZATION 176
Sensorimotor Training • Aphasia • Cognition • Cross-Modal Plasticity
NEUROPHARMACOLOGIC MODULATION 184
Monaminergic Agents • Other Agents
SUMMARY 185
4. NEUROSTIMULATORS AND NEUROPROSTHESES 193
PERIPHERAL NERVOUS SYSTEM DEVICES 194
Functional Neuromuscular Stimulation • Nerve Cuffs
CENTRAL NERVOUS SYSTEM DEVICES 198
Neuroaugmentation • Spinal Cord Stimulators • Brain–Machine Interfaces •
Sensory Prostheses
ROBOTIC AIDS 203
Upper Extremity • Lower Extremity
TELETHERAPY 206
SUMMARY 206
Part II. Common Practices Across Disorders
5. THE REHABILITATION TEAM 213
THE TEAM APPROACH 213
The Rehabilitation Milieu
Contents
xi
PHYSICIANS 215
Responsibilities • Interventions
NURSES 218
Responsibilities • Interventions
PHYSICAL THERAPISTS 219
Responsibilities • Interventions for Skilled Action
OCCUPATIONAL THERAPISTS 231
Responsibilities • Interventions for Personal Independence
SPEECH AND LANGUAGE THERAPISTS 235
Responsibilities • Interventions for Dysarthria and Aphasia
NEUROPSYCHOLOGISTS 242
SOCIAL WORKERS 243
RECREATIONAL THERAPISTS 243
OTHER TEAM MEMBERS 244
SUMMARY 244
6. APPROACHES FOR WALKING 250
NORMAL GAIT 250
NEUROLOGIC GAIT DEVIATIONS 252
Hemiparetic Gait • Paraparetic Gait • Gait with Peripheral Neuropathy • Gait
with Poliomyelitis
QUANTITATIVE GAIT ANALYSIS 258
Temporal Measures • Kinematics • Electromyography • Kinetics • Energy
Expenditure
APPROACHES TO RETRAINING AMBULATION 262
Conventional Training • Task-Oriented Training • Assistive Devices
SUMMARY 268
7. ASSESSMENT AND OUTCOME MEASURES FOR
CLINICAL TRIALS 271
PRINCIPLES OF MEASUREMENT 272
Types of Measurements • Reliability and Validity • Choosing Measurement Tools
MEASURES OF IMPAIRMENT 275
Consciousness • Cognition • Speech and Language • Sensorimotor Impairment Scales
BEHAVIORAL MEASURES 288
Behavioral Modification • Neurobehavioral Scales
MEASURES OF DISABILITY 289
Activities of Daily Living • Instrumental Activities of Daily Living • Mixed
Functional Scales
xii
Contents
MEASURES OF HEALTH-RELATED QUALITY OF LIFE 298
Instruments • Adjustment Scales • Style Of Questions
MEASURES OF HANDICAP 302
MEASURES OF COST-EFFECTIVENESS 303
STUDY DESIGNS FOR REHABILITATION RESEARCH 303
Ethical Considerations • Types of Clinical Trials • Confounding Issues in Research
Designs • Statistical Analyses
SUMMARY 314
8. ACUTE AND CHRONIC MEDICAL MANAGEMENT 323
DEEP VEIN THROMBOSIS 323
Prevention
ORTHOSTATIC HYPOTENSION 324
THE NEUROGENIC BLADDER 325
Pathophysiology • Management
BOWEL DYSFUNCTION 329
Pathophysiology • Management
NUTRITION AND DYSPHAGIA 330
Pathophysiology • Assessment • Treatment
PRESSURE SORES 334
Pathophysiology • Management
PAIN 336
Acute Pain
• Chronic Central Pain • Weakness-Associated Shoulder Pain • Neck,
Back, and Myofascial Pain
DISORDERS OF BONE METABOLISM 348
Heterotopic Ossification • Osteoporosis
SPASTICITY 348
Management
CONTRACTURES 357
MOOD DISORDERS 358
Posttraumatic Stress Disorder • Depression
SLEEP DISORDERS 363
SUMMARY 364
Part III. Rehabilitation of Specific Neurologic Disorders
9. STROKE 375
EPIDEMIOLOGY 375
Fiscal Impact • Stroke Syndromes
[ Pobierz całość w formacie PDF ]