Motor Systems at ETHZ - ETH Zurich | Flashcards & Summaries

Lernmaterialien für Motor Systems an der ETHZ - ETH Zurich

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TESTE DEIN WISSEN

What are spinal cord circuits and what do they do?

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major source of synaptic input to lower motor neurons


long distance local circuit neurons (medial)

  • axons extend over several spinal cord segments
    • coordinate rhythmic movement of upper and lower limbs
  • axons terminate bilaterally 
    • actual muscles group coordinates posture

short distance local circuit neurons (lateral)

  • short axons that extend <5 segments
  • terminate on ipsilateral side the cord as the cellbody
  • circuits are involved in fine control of distal extremities
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TESTE DEIN WISSEN

what are motor units and how do they work?

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TESTE DEIN WISSEN

= alpha-motor neuron and innervated fibers


different types of motor units: 

  • small sized, slow motor units
    • resistant to fatigue
    • posture and standing
  • intermediate sized, fast fatigue-resistant
    • walking and running
  • larged sized, fast fatiguable
    • brief and large forces e.g. jumping

activation (Henneman) principle: S-FR-FF

-> simple solution to problem of grading force

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TESTE DEIN WISSEN

How does the standard clinical assessment of SCI work?

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TESTE DEIN WISSEN

it can be done right after injury

ISNSCI = international standard for neurological classification of spinal cord injury

  • corticospinal tract (motor)
    • examination of movement of different muscles and force that can be generated 
    • scoring:
      • 0= total paralysis
      • 1= palpable or visible contraction
      • 2= active movement, gravity eliminated
      • 3= active movement against gravity
      • 4= active movement, against some resistance
      • 5= active movement against full resistance
      • 5+= normal correct pain/disuse
      • NT= not testable
  • Dorsal column (sensory)
    • sensibility (touch, pressure) porpioception enters spinal cord -> trails up on ipsilateral side 
    • principle: touch of different dermatomes with cotton bud
    • assessment: patients report sensation (0=absent, 1=altered, 2=normal)
    • limitation: sunjective assessment
  • spinothalamic tract (sensory)
    • pain and temperature 
    • enter spinal cord -> crosses -> travels up on contralateral side 
    • principle: touch of different dermatome with both sides of safety pin
    • assessment: reports sensation (0=can't distinguish dull from sharp, 1= altered, 2= intact)
    • limitation: sunjective assessment


completeness of injury: 

-> ASIA impairment Scale (AIS)

  • A: complete -no motor/ sensory function is preserved below level of lesion
  • B: sensory incomplete - no motor function preserved below lesion level
  • C: motor incomplete - less than half of key muscle can work against gravity
  • D: motor incomplete: more than half of key muscles below lesion level work against gravity
  • E: normal - sensory and motor function normal
Lösung ausblenden
TESTE DEIN WISSEN

How do advanced assessments (electrophysiological)  of SCI work?

Lösung anzeigen
TESTE DEIN WISSEN

neurophysiological assessment: 

  • VSR: vestibulospinal reflex
  • ASR: acoustic startle reflex
  • NCV: nerve conduction velocity
  • MEP: motor evoked potentials 
    • -> functional integrity of pyramidal tract
    • measures cortical excitability
    • coil over motor cortex -> magnetic stimulus -> toward target muscle -> EMG electrode 
    • acute: latency increase and decrease of amplitude

testing the afferent system

-> three major sensory tracts (dorsal column,spinothalamic and spinocerebellar tract)

  • SSEP: somatosensory evoked potentials 
    • measures functional ascending tract integrity 
    • electrical stimulus -> to brain -> can be measured as an answer
    • latency prolonged and amplitude decreased 
    • -> for dorsal column
  • CHEP: contact heat evoked potentials 
    • measures functional ascending tract integrity of spinothalamic tract
    • stimulates periphery with heat -> response measured in cortex
Lösung ausblenden
TESTE DEIN WISSEN

How is gait assessed?

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TESTE DEIN WISSEN
  • Function (walking aids, activities o daily life
  • quality (observing patient, 3D-gait)
  • Performance (how fast or how far)

requirement:

  • reliable (similar results under consistent conditions)
  • valid (degree to which tool measures -> SCIM)
  • responsive (sensitivity in detecting changes in function over time 


Established measures: 

  • clinical measures (ordinal score)
    • walking index of spinal cord injury (WISCI)
      • assesses the amount of assistance (physical, braces, devices) required to walk 10 meter
      • strength: low cost, moderate training required, little time required, valuable additional scale besides functional tests
      • limitations: ceiling effect, ordinal scale, not suitable for patients with good walking function 
    • spinal cord independence measures (SCIM)
    • lower extremity motor score (LEMS)
    • spinal cord injury functional ambulation inventory (SCI-FAI)
  • timed measures (continuous score)
    • 10-meter walking test (10MWT) -> nothing about performance
      • measured time needed to walk 10 meters. patients walk at preferred/ comfortable walking speed or at fastet speed possible and are allowed to use assistive devices
      • strength: minimal equipment needed, no advanced training needed, little time needed, used in clinical setting or at home, assesses walking function (walking speed)
      • limitation: does not account for the amount of assistance required, test can be performed at different speeds (comfortable vs. maximal), ceiling effect, patient must be able to walk
    • 6 min walking test (6MWT)
    • Timed up and go (TUG)
  • 3D gait analysis (continuous system)
    • It is the golden standard for the assessment of gait 
    • Strength: identify mechanism underlaying gait dysfunction, provides detailed kinematics, kinetics and spatial-temporal data
    • Limitations: requires expensive equipment, skilled examiners, limited to few specialised laboratories, often Lowe clinical impact
Lösung ausblenden
TESTE DEIN WISSEN

What approaches are there to treat spinal cord injury?

Lösung anzeigen
TESTE DEIN WISSEN

key targets to restore function

  • neuroprotection (protection of spinal cord from secondary damage)
    • minocycline
    • riluzole
    • surgery
  • goal-directed rehabilitation (gold-standard -> physiotherapy)
    • repetitions (more repetitions)
      • automated administration
      • assistance
    • practice time (increase practice time)
      • less need for supervision
    • higher motivation
    • optimal. difficulty level (individual adjustable difficulty)
      • added rsistance
      • decreased support/ assistacne
    • feedback (various feedback-forms)
      • inherent and augmented haptic feedback
      • assistance as needed
    • motivation (increased motivation)
      • success through assistance
    • variability (movement precision)
      • introduce errors
      • allow deviations
  • Reactivation
    • neurostimulation -> epidural stimulation of limbo sacral spinal cord -> popular, promising for patients
      • principle: spinal cord can get to a higher excitatory level
      • used for: incomplete lesions
      • can also improve in chronic patients
  • rewiring:
    • anti-Nogo-A
      • phase 2 study -> allows nerves to grow again after lesion
    • chondroitinase ABC
    • stem cells


Lösung ausblenden
TESTE DEIN WISSEN

what is autonomic dysreflexia?

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TESTE DEIN WISSEN

= acute, possibly life threatening increase in blood pressure due to noxious or non-noxious stimulus below level of lesion


penile vibrostimulation -> for semen "extraction": 

at ejaculation: hypertonia (280/150mmHg, bradycardia: 38bpm) -> calms slowly down after approx. 25 minutes

heart tries to compensate by lowering heart rate


mechanism: 

strong stimulus -> afferent -> massive sympathetic response -> widespread vasoconstriction -> hypertension -> baroreceptors in blood vessels detect hypertensive crisis -> signal brain IX and X (descending inhibitory signals blocked by SCI) -> heart rate slowed 


24h blood pressure monitoring -> to recognise activities prone to develop dysreflexia

Lösung ausblenden
TESTE DEIN WISSEN

What are causes, consequences and symptoms of SCI?

Lösung anzeigen
TESTE DEIN WISSEN

causes:

  • accidents
  • falls
  • violent felony
  • non-traumatic causes

consequences:

  • depend on affected structure and level of SCI
  • motor function: arm/hand function, waling ability, strong stability
  • sensory function
  • pain
  • bladder, bowel and sexual function

symptoms:

  • paresis to paralysis
  • Hyper-/hypoactive reflexes
  • decrease bladder/bowel function 
  • restricted sexual function
  • loss of sensory function (e.g. pain)
  • spasticity, clonus
  • psychological problems
  • depression (30%)
  • cardiovascular: blood pressure dysfunction
Lösung ausblenden
TESTE DEIN WISSEN

How often does SCI occur?

Lösung anzeigen
TESTE DEIN WISSEN

50% traumatic - 50% non-traumatic

50% sensorimotor complet - 50% incomplete

44% paraplegia - 56% tetraplegia

relative rare disease

1.8-8.3/100'000 sper year

4'500 in CH (prevalence)

average age 38 but increasing

male : female = 3.8 : 1

Lösung ausblenden
TESTE DEIN WISSEN

What is normal walking pattern and what does it depend on?

Lösung anzeigen
TESTE DEIN WISSEN

depends on: 

  • age
  • sex
  • height
  • physique
  • fitness
  • surface
  • mood
  • etc

definition of normal: 

bipedal human gait is...

  • smooth
  • precise
  • stable
  • symmetric
  • rhythmic
  • coordinated
  • economical 
  • adaptable


it is achieved by interaction between:

  • nervous system
  • muscles
  • tendons
  • ligaments
  • bones
Lösung ausblenden
TESTE DEIN WISSEN

What is Neuroplasticity?

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TESTE DEIN WISSEN
  • Any functional or cellular change in the nervous system
  • can occur in response to specific stimulus during both development and throughout life
  • injury of the nervous system itself can trigger plastica adaptations
Lösung ausblenden
TESTE DEIN WISSEN

What is the role of local circuit neurons and lower motor neurons?

Lösung anzeigen
TESTE DEIN WISSEN

local circuit neurons: major source of synaptic input to lower motor neurons


lower motor neurones: innervate skeletal muscles 

Lösung ausblenden
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Q:

What are spinal cord circuits and what do they do?

A:

major source of synaptic input to lower motor neurons


long distance local circuit neurons (medial)

  • axons extend over several spinal cord segments
    • coordinate rhythmic movement of upper and lower limbs
  • axons terminate bilaterally 
    • actual muscles group coordinates posture

short distance local circuit neurons (lateral)

  • short axons that extend <5 segments
  • terminate on ipsilateral side the cord as the cellbody
  • circuits are involved in fine control of distal extremities
Q:

what are motor units and how do they work?

A:

= alpha-motor neuron and innervated fibers


different types of motor units: 

  • small sized, slow motor units
    • resistant to fatigue
    • posture and standing
  • intermediate sized, fast fatigue-resistant
    • walking and running
  • larged sized, fast fatiguable
    • brief and large forces e.g. jumping

activation (Henneman) principle: S-FR-FF

-> simple solution to problem of grading force

Q:

How does the standard clinical assessment of SCI work?

A:

it can be done right after injury

ISNSCI = international standard for neurological classification of spinal cord injury

  • corticospinal tract (motor)
    • examination of movement of different muscles and force that can be generated 
    • scoring:
      • 0= total paralysis
      • 1= palpable or visible contraction
      • 2= active movement, gravity eliminated
      • 3= active movement against gravity
      • 4= active movement, against some resistance
      • 5= active movement against full resistance
      • 5+= normal correct pain/disuse
      • NT= not testable
  • Dorsal column (sensory)
    • sensibility (touch, pressure) porpioception enters spinal cord -> trails up on ipsilateral side 
    • principle: touch of different dermatomes with cotton bud
    • assessment: patients report sensation (0=absent, 1=altered, 2=normal)
    • limitation: sunjective assessment
  • spinothalamic tract (sensory)
    • pain and temperature 
    • enter spinal cord -> crosses -> travels up on contralateral side 
    • principle: touch of different dermatome with both sides of safety pin
    • assessment: reports sensation (0=can't distinguish dull from sharp, 1= altered, 2= intact)
    • limitation: sunjective assessment


completeness of injury: 

-> ASIA impairment Scale (AIS)

  • A: complete -no motor/ sensory function is preserved below level of lesion
  • B: sensory incomplete - no motor function preserved below lesion level
  • C: motor incomplete - less than half of key muscle can work against gravity
  • D: motor incomplete: more than half of key muscles below lesion level work against gravity
  • E: normal - sensory and motor function normal
Q:

How do advanced assessments (electrophysiological)  of SCI work?

A:

neurophysiological assessment: 

  • VSR: vestibulospinal reflex
  • ASR: acoustic startle reflex
  • NCV: nerve conduction velocity
  • MEP: motor evoked potentials 
    • -> functional integrity of pyramidal tract
    • measures cortical excitability
    • coil over motor cortex -> magnetic stimulus -> toward target muscle -> EMG electrode 
    • acute: latency increase and decrease of amplitude

testing the afferent system

-> three major sensory tracts (dorsal column,spinothalamic and spinocerebellar tract)

  • SSEP: somatosensory evoked potentials 
    • measures functional ascending tract integrity 
    • electrical stimulus -> to brain -> can be measured as an answer
    • latency prolonged and amplitude decreased 
    • -> for dorsal column
  • CHEP: contact heat evoked potentials 
    • measures functional ascending tract integrity of spinothalamic tract
    • stimulates periphery with heat -> response measured in cortex
Q:

How is gait assessed?

A:
  • Function (walking aids, activities o daily life
  • quality (observing patient, 3D-gait)
  • Performance (how fast or how far)

requirement:

  • reliable (similar results under consistent conditions)
  • valid (degree to which tool measures -> SCIM)
  • responsive (sensitivity in detecting changes in function over time 


Established measures: 

  • clinical measures (ordinal score)
    • walking index of spinal cord injury (WISCI)
      • assesses the amount of assistance (physical, braces, devices) required to walk 10 meter
      • strength: low cost, moderate training required, little time required, valuable additional scale besides functional tests
      • limitations: ceiling effect, ordinal scale, not suitable for patients with good walking function 
    • spinal cord independence measures (SCIM)
    • lower extremity motor score (LEMS)
    • spinal cord injury functional ambulation inventory (SCI-FAI)
  • timed measures (continuous score)
    • 10-meter walking test (10MWT) -> nothing about performance
      • measured time needed to walk 10 meters. patients walk at preferred/ comfortable walking speed or at fastet speed possible and are allowed to use assistive devices
      • strength: minimal equipment needed, no advanced training needed, little time needed, used in clinical setting or at home, assesses walking function (walking speed)
      • limitation: does not account for the amount of assistance required, test can be performed at different speeds (comfortable vs. maximal), ceiling effect, patient must be able to walk
    • 6 min walking test (6MWT)
    • Timed up and go (TUG)
  • 3D gait analysis (continuous system)
    • It is the golden standard for the assessment of gait 
    • Strength: identify mechanism underlaying gait dysfunction, provides detailed kinematics, kinetics and spatial-temporal data
    • Limitations: requires expensive equipment, skilled examiners, limited to few specialised laboratories, often Lowe clinical impact
Mehr Karteikarten anzeigen
Q:

What approaches are there to treat spinal cord injury?

A:

key targets to restore function

  • neuroprotection (protection of spinal cord from secondary damage)
    • minocycline
    • riluzole
    • surgery
  • goal-directed rehabilitation (gold-standard -> physiotherapy)
    • repetitions (more repetitions)
      • automated administration
      • assistance
    • practice time (increase practice time)
      • less need for supervision
    • higher motivation
    • optimal. difficulty level (individual adjustable difficulty)
      • added rsistance
      • decreased support/ assistacne
    • feedback (various feedback-forms)
      • inherent and augmented haptic feedback
      • assistance as needed
    • motivation (increased motivation)
      • success through assistance
    • variability (movement precision)
      • introduce errors
      • allow deviations
  • Reactivation
    • neurostimulation -> epidural stimulation of limbo sacral spinal cord -> popular, promising for patients
      • principle: spinal cord can get to a higher excitatory level
      • used for: incomplete lesions
      • can also improve in chronic patients
  • rewiring:
    • anti-Nogo-A
      • phase 2 study -> allows nerves to grow again after lesion
    • chondroitinase ABC
    • stem cells


Q:

what is autonomic dysreflexia?

A:

= acute, possibly life threatening increase in blood pressure due to noxious or non-noxious stimulus below level of lesion


penile vibrostimulation -> for semen "extraction": 

at ejaculation: hypertonia (280/150mmHg, bradycardia: 38bpm) -> calms slowly down after approx. 25 minutes

heart tries to compensate by lowering heart rate


mechanism: 

strong stimulus -> afferent -> massive sympathetic response -> widespread vasoconstriction -> hypertension -> baroreceptors in blood vessels detect hypertensive crisis -> signal brain IX and X (descending inhibitory signals blocked by SCI) -> heart rate slowed 


24h blood pressure monitoring -> to recognise activities prone to develop dysreflexia

Q:

What are causes, consequences and symptoms of SCI?

A:

causes:

  • accidents
  • falls
  • violent felony
  • non-traumatic causes

consequences:

  • depend on affected structure and level of SCI
  • motor function: arm/hand function, waling ability, strong stability
  • sensory function
  • pain
  • bladder, bowel and sexual function

symptoms:

  • paresis to paralysis
  • Hyper-/hypoactive reflexes
  • decrease bladder/bowel function 
  • restricted sexual function
  • loss of sensory function (e.g. pain)
  • spasticity, clonus
  • psychological problems
  • depression (30%)
  • cardiovascular: blood pressure dysfunction
Q:

How often does SCI occur?

A:

50% traumatic - 50% non-traumatic

50% sensorimotor complet - 50% incomplete

44% paraplegia - 56% tetraplegia

relative rare disease

1.8-8.3/100'000 sper year

4'500 in CH (prevalence)

average age 38 but increasing

male : female = 3.8 : 1

Q:

What is normal walking pattern and what does it depend on?

A:

depends on: 

  • age
  • sex
  • height
  • physique
  • fitness
  • surface
  • mood
  • etc

definition of normal: 

bipedal human gait is...

  • smooth
  • precise
  • stable
  • symmetric
  • rhythmic
  • coordinated
  • economical 
  • adaptable


it is achieved by interaction between:

  • nervous system
  • muscles
  • tendons
  • ligaments
  • bones
Q:

What is Neuroplasticity?

A:
  • Any functional or cellular change in the nervous system
  • can occur in response to specific stimulus during both development and throughout life
  • injury of the nervous system itself can trigger plastica adaptations
Q:

What is the role of local circuit neurons and lower motor neurons?

A:

local circuit neurons: major source of synaptic input to lower motor neurons


lower motor neurones: innervate skeletal muscles 

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