Sensory integration is the ability to process sensory information from our environment to respond appropriately. It involves the tactile, auditory, visual, gustatory, olfactory, vestibular and proprioceptive senses. As teachers, we need to be aware of students' sensory needs and implement strategies like fidget toys, noise-cancelling headphones, weighted lap pads, and movement breaks to help students properly process sensory input. Meeting students' sensory needs allows them to better focus and learn.
OT for Kids - Introduction to the assessment, treatment and development of ha...Nathan Varma
This document provides an overview of a presentation on handwriting development and occupational therapy for children's handwriting difficulties. The presentation will cover typical handwriting development milestones from ages 0-10, common pencil grips, static and dynamic handwriting movements, visual perception skills related to handwriting, handwriting assessment tools, treatment programs and activities, and the services offered by OT for Kids including individual assessments and therapy, group programs, and staff training. The presentation will take place on August 16th from 9am-5pm and will be led by Nathan Varma, an occupational therapist and manager of OT for Kids.
Sensory processing disorder affects how the brain processes sensory information from the environment. It can cause individuals to be over-responsive or under-responsive to sensory input like touch, sound, and movement. A sensory room is designed to help individuals with SPD by providing controlled sensory activities and equipment tailored to their needs, with the goal of improving their ability to regulate and respond to sensory stimulation.
This document provides definitions and descriptions of motor speech disorders. It begins by defining motor speech disorders as resulting from neurological impairment that affects the retrieval, activation, or execution of speech movements. The two main types are described as dysarthria and apraxia. Dysarthria is defined as a group of speech disorders caused by disturbances in muscle control for speech. Various types of dysarthria are outlined based on the site of lesion and perceptual characteristics. Apraxia is defined as a disorder of the planning and programming of speech movements. Causes and characteristics of apraxia are also described.
A speech disorder is a condition in which a person has problems creating or forming the speech sounds needed to communicate with others. This can make the child's speech difficult to understand.
Common speech disorders are:
1. Articulation disorders
2. Phonological disorders
3. Disfluency
4. Voice disorders or resonance disorders
El documento describe los trastornos cognitivo-comunicativos (TCC), incluyendo sus causas principales como traumatismo craneal, lesiones en el hemisferio derecho, demencias y tumores. Explica que los TCC afectan procesos cognitivos como la atención, memoria, lenguaje y funciones ejecutivas. La rehabilitación de los TCC implica estimulación cognitiva, reactivación, reeducación y compensación de funciones a través de entrenamiento cognitivo y enfoques de comunicación funcional y pragmática.
1. Apraxia of speech is a motor speech disorder that causes difficulties in saying words correctly and consistently due to problems with planning and programming the movements needed for speech.
2. It is caused by neurological damage, often from stroke or head injury, and affects the motor planning areas of the brain rather than the muscles of speech.
3. Treatment focuses on relearning the motor aspects of speech through tasks to improve sound production, prosody, rate, and consistency of errors.
Sensory processing disorder (SPD) occurs when the brain has difficulty receiving and responding to sensory information from the environment. Children with SPD may struggle with tasks due to hypersensitivity or hyposensitivity to touch, movement, sights, sounds, and smells. This can impact social skills, motor skills, attention, and behavior. While estimates vary, around 1 in 20 children experience SPD symptoms significant enough to interfere with daily life. Educators need to understand SPD to better recognize signs in students and help implement strategies to support their learning. Occupational therapy can also help children process sensory information more effectively.
Sensory integration is the ability to process sensory information from our environment to respond appropriately. It involves the tactile, auditory, visual, gustatory, olfactory, vestibular and proprioceptive senses. As teachers, we need to be aware of students' sensory needs and implement strategies like fidget toys, noise-cancelling headphones, weighted lap pads, and movement breaks to help students properly process sensory input. Meeting students' sensory needs allows them to better focus and learn.
OT for Kids - Introduction to the assessment, treatment and development of ha...Nathan Varma
This document provides an overview of a presentation on handwriting development and occupational therapy for children's handwriting difficulties. The presentation will cover typical handwriting development milestones from ages 0-10, common pencil grips, static and dynamic handwriting movements, visual perception skills related to handwriting, handwriting assessment tools, treatment programs and activities, and the services offered by OT for Kids including individual assessments and therapy, group programs, and staff training. The presentation will take place on August 16th from 9am-5pm and will be led by Nathan Varma, an occupational therapist and manager of OT for Kids.
Sensory processing disorder affects how the brain processes sensory information from the environment. It can cause individuals to be over-responsive or under-responsive to sensory input like touch, sound, and movement. A sensory room is designed to help individuals with SPD by providing controlled sensory activities and equipment tailored to their needs, with the goal of improving their ability to regulate and respond to sensory stimulation.
This document provides definitions and descriptions of motor speech disorders. It begins by defining motor speech disorders as resulting from neurological impairment that affects the retrieval, activation, or execution of speech movements. The two main types are described as dysarthria and apraxia. Dysarthria is defined as a group of speech disorders caused by disturbances in muscle control for speech. Various types of dysarthria are outlined based on the site of lesion and perceptual characteristics. Apraxia is defined as a disorder of the planning and programming of speech movements. Causes and characteristics of apraxia are also described.
A speech disorder is a condition in which a person has problems creating or forming the speech sounds needed to communicate with others. This can make the child's speech difficult to understand.
Common speech disorders are:
1. Articulation disorders
2. Phonological disorders
3. Disfluency
4. Voice disorders or resonance disorders
El documento describe los trastornos cognitivo-comunicativos (TCC), incluyendo sus causas principales como traumatismo craneal, lesiones en el hemisferio derecho, demencias y tumores. Explica que los TCC afectan procesos cognitivos como la atención, memoria, lenguaje y funciones ejecutivas. La rehabilitación de los TCC implica estimulación cognitiva, reactivación, reeducación y compensación de funciones a través de entrenamiento cognitivo y enfoques de comunicación funcional y pragmática.
1. Apraxia of speech is a motor speech disorder that causes difficulties in saying words correctly and consistently due to problems with planning and programming the movements needed for speech.
2. It is caused by neurological damage, often from stroke or head injury, and affects the motor planning areas of the brain rather than the muscles of speech.
3. Treatment focuses on relearning the motor aspects of speech through tasks to improve sound production, prosody, rate, and consistency of errors.
Sensory processing disorder (SPD) occurs when the brain has difficulty receiving and responding to sensory information from the environment. Children with SPD may struggle with tasks due to hypersensitivity or hyposensitivity to touch, movement, sights, sounds, and smells. This can impact social skills, motor skills, attention, and behavior. While estimates vary, around 1 in 20 children experience SPD symptoms significant enough to interfere with daily life. Educators need to understand SPD to better recognize signs in students and help implement strategies to support their learning. Occupational therapy can also help children process sensory information more effectively.
This document discusses motor speech disorders, including cerebral palsy, dysarthria, and apraxia of speech. Cerebral palsy is a group of neurological disorders resulting from brain injury early in life that causes difficulties with motor movements. Dysarthria refers to speech impairments from disturbed muscular control caused by damage to the mature nervous system. Apraxia of speech affects the ability to organize and execute speech sounds and is caused by damage to Broca's area. The document provides details on characteristics, types, causes, and examples of each disorder.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This document discusses sensory processing disorder and how it can lead to challenging behaviors in children. It defines sensory processing disorder as difficulty processing and responding to sensory information from the senses. Children with autism or developmental disabilities often have sensory issues. The causes are not fully known but may involve irregular brain function. The document describes how children can be either sensory seekers who crave stimulation or sensory avoiders who are overstimulated easily. It provides interventions for each type and tips for managing tantrums which may result from sensory overload.
The document summarizes how the brain receives sensory information from receptors in the body. It discusses the different types of receptors and the pathways that sensory information takes to reach the brain. Sensory information is detected by receptors, converted to electrical signals, and transmitted through sensory neurons to the spinal cord and thalamus before reaching sensory areas in the brain. The two main pathways are the dorsal column-medial lemniscus pathway for touch and proprioception, and the spinothalamic pathway for pain, temperature, and crude touch sensations.
The document discusses the vestibular system, which consists of structures in the inner ear that detect sensations of balance and equilibrium. It contains the macula in the utricle and saccule, which detect linear acceleration and head position. It also contains the semicircular canals, which detect rotational movement. Hair cells in the macula and cristae of the semicircular canals transmit signals through vestibular nerves and pathways in the brainstem and cerebellum to integrate sensory information and allow proper balance and body orientation. The vestibular system is important for maintaining posture and equilibrium.
This document discusses paediatric voice disorders. It begins by describing vocal fold anatomy and the physiology of phonation. Common paediatric voice disorders are then outlined, including vocal nodules, laryngeal web, vocal polyps, cysts and papillomas. Both organic and functional disorders are discussed. The multidisciplinary evaluation of voice disorders is described, involving perceptual, acoustic, aerodynamic and endoscopic assessments. Management includes vocal hygiene training, voice therapy, medical treatment and phonosurgery as needed. The goals of behavioural voice therapy in children of different ages are explained.
This document discusses communication disorders, their prevalence, and how they are evaluated and accommodated for in students. It notes that approximately 16% of Americans have a communication disorder, which can impact academic performance. Communication disorders are evaluated through observations, screenings, prereferrals, and formal assessments. Evaluations consider cultural and linguistic factors for ELL students. Accommodations may include changes to presentation, response, setting, and the use of assistive technology.
Este documento presenta los resultados de un examen audiométrico realizado a un paciente. En él se incluyen los resultados de pruebas tonales puras, acumetría, logometría y de lenguaje a diferentes distancias para evaluar la audición del paciente. Además, contiene datos personales del paciente y del examinador, así como observaciones relevantes.
El documento describe las funciones de diferentes áreas de la corteza cerebral. Explica que la corteza es una lámina plegada de aproximadamente 2,6 mm de espesor y 2,6 m2 de superficie. Describe las funciones del neocortex dorsal posterior en el reconocimiento sensorial de objetos y las funciones específicas de las áreas visual, auditiva y somatosensorial en la percepción y comprensión. También describe las funciones del neocortex dorsal anterior en el control motor y cognitivo a través de las áreas motoras, prefrontales y de len
Csd 210 articulation disorders - fall 2010Jake Probst
This document discusses articulation development, differences, and disorders. It defines articulation disorders as difficulties producing speech sounds that can cause substitutions, omissions, additions, or distortions of sounds. Phonological disorders involve problems applying the sound rules of a language. Articulation disorders are common and have various causes like structural impairments, functional impairments, or unknown etiologies. Assessment of articulation involves testing sounds at the word and sentence level as well as in connected speech. Treatment aims to improve accuracy of target sounds across linguistic contexts.
Stammering is a speech problem that causes low self-esteem in children. Some tips to help children overcome stammering include slowing down their speech, maintaining eye contact, not interrupting them or finishing their sentences, and encouraging them to speak as often as possible in a supportive environment. Aphasia is a disorder caused by brain damage that affects speaking, listening, reading, and writing. While some may recover on their own, speech therapy is often helpful and aims to improve communication through restoring language abilities and learning new methods. Family support plays an important role by simplifying language and including the person in conversations.
The document discusses hearing loss and deafness. It describes the parts of the ear involved in hearing and classifies deafness into three types: conductive, sensorineural, and mixed. Numerous causes of each type are provided ranging from ear wax to old age. Treatments depend on the type and include hearing aids, surgery, cochlear implants, and speech therapy. Communication strategies and accommodations for people with hearing loss are also outlined.
Hearing impairment is defined as any hearing loss that affects educational performance but is not deafness. There are four categories of hearing loss based on location: conductive, sensorineural, mixed, and central. Common signs are difficulty hearing or understanding speech. In school, students may struggle with subjects involving listening, note-taking, discussions, and videos. Teachers and parents can help by designating note-takers, using assistive technology, ensuring proper seating, and not underestimating intelligence due to impairment.
This document discusses voice therapy for the management of benign voice disorders. It summarizes a study of 30 patients who underwent voice therapy with or without surgical procedures for conditions like vocal nodules, polyps, muscle tension dysphonia, sulcus vocalis, and others. Pre-therapy and post-therapy comparisons found improvements in voice quality ratings, patient quality of life measures, and laryngeal images. Voice therapy techniques discussed include vocal hygiene, exercises, massage, and various approaches. The study found voice therapy to be an effective non-surgical treatment for many benign voice disorders and helps prevent recurrence when used with surgery.
This document summarizes various tests used to evaluate hearing. It discusses tests of hearing thresholds like pure tone audiometry to determine the type and degree of hearing loss. Other tests discussed include tympanometry to assess middle ear function, otoacoustic emissions to evaluate cochlear outer hair cell function, and electrocochleography and BERA to objectively measure electrical responses in the cochlea and auditory nerve. The document provides details on the principles, procedures, and interpretations of these common audiological tests used to evaluate hearing.
This presentation provides an overview of sensory processing difficulties and regulation by occupational therapist Cynthia Miller-Lautman. It discusses how sensory processing issues can affect learning, behavior, and daily living. The presentation offers suggestions for parents and schools, such as providing movement breaks, outdoor time, and fidget tools. It also outlines what an occupational therapy evaluation involves and common sensory-based techniques used in therapy.
Overcoming Behavioral Roadblocks in Speech-Language InterventionBilinguistics
Challenging behaviors can impede progress in speech therapy. We will discuss the evaluation of behaviors that impact communication development and provide research-based intervention strategies to guide speech-language pathologists in developing effective treatment plans. We will include case studies of clinical interventions that improve communication in children with behavioral needs.
This document discusses motor speech disorders, including cerebral palsy, dysarthria, and apraxia of speech. Cerebral palsy is a group of neurological disorders resulting from brain injury early in life that causes difficulties with motor movements. Dysarthria refers to speech impairments from disturbed muscular control caused by damage to the mature nervous system. Apraxia of speech affects the ability to organize and execute speech sounds and is caused by damage to Broca's area. The document provides details on characteristics, types, causes, and examples of each disorder.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This document discusses sensory processing disorder and how it can lead to challenging behaviors in children. It defines sensory processing disorder as difficulty processing and responding to sensory information from the senses. Children with autism or developmental disabilities often have sensory issues. The causes are not fully known but may involve irregular brain function. The document describes how children can be either sensory seekers who crave stimulation or sensory avoiders who are overstimulated easily. It provides interventions for each type and tips for managing tantrums which may result from sensory overload.
The document summarizes how the brain receives sensory information from receptors in the body. It discusses the different types of receptors and the pathways that sensory information takes to reach the brain. Sensory information is detected by receptors, converted to electrical signals, and transmitted through sensory neurons to the spinal cord and thalamus before reaching sensory areas in the brain. The two main pathways are the dorsal column-medial lemniscus pathway for touch and proprioception, and the spinothalamic pathway for pain, temperature, and crude touch sensations.
The document discusses the vestibular system, which consists of structures in the inner ear that detect sensations of balance and equilibrium. It contains the macula in the utricle and saccule, which detect linear acceleration and head position. It also contains the semicircular canals, which detect rotational movement. Hair cells in the macula and cristae of the semicircular canals transmit signals through vestibular nerves and pathways in the brainstem and cerebellum to integrate sensory information and allow proper balance and body orientation. The vestibular system is important for maintaining posture and equilibrium.
This document discusses paediatric voice disorders. It begins by describing vocal fold anatomy and the physiology of phonation. Common paediatric voice disorders are then outlined, including vocal nodules, laryngeal web, vocal polyps, cysts and papillomas. Both organic and functional disorders are discussed. The multidisciplinary evaluation of voice disorders is described, involving perceptual, acoustic, aerodynamic and endoscopic assessments. Management includes vocal hygiene training, voice therapy, medical treatment and phonosurgery as needed. The goals of behavioural voice therapy in children of different ages are explained.
This document discusses communication disorders, their prevalence, and how they are evaluated and accommodated for in students. It notes that approximately 16% of Americans have a communication disorder, which can impact academic performance. Communication disorders are evaluated through observations, screenings, prereferrals, and formal assessments. Evaluations consider cultural and linguistic factors for ELL students. Accommodations may include changes to presentation, response, setting, and the use of assistive technology.
Este documento presenta los resultados de un examen audiométrico realizado a un paciente. En él se incluyen los resultados de pruebas tonales puras, acumetría, logometría y de lenguaje a diferentes distancias para evaluar la audición del paciente. Además, contiene datos personales del paciente y del examinador, así como observaciones relevantes.
El documento describe las funciones de diferentes áreas de la corteza cerebral. Explica que la corteza es una lámina plegada de aproximadamente 2,6 mm de espesor y 2,6 m2 de superficie. Describe las funciones del neocortex dorsal posterior en el reconocimiento sensorial de objetos y las funciones específicas de las áreas visual, auditiva y somatosensorial en la percepción y comprensión. También describe las funciones del neocortex dorsal anterior en el control motor y cognitivo a través de las áreas motoras, prefrontales y de len
Csd 210 articulation disorders - fall 2010Jake Probst
This document discusses articulation development, differences, and disorders. It defines articulation disorders as difficulties producing speech sounds that can cause substitutions, omissions, additions, or distortions of sounds. Phonological disorders involve problems applying the sound rules of a language. Articulation disorders are common and have various causes like structural impairments, functional impairments, or unknown etiologies. Assessment of articulation involves testing sounds at the word and sentence level as well as in connected speech. Treatment aims to improve accuracy of target sounds across linguistic contexts.
Stammering is a speech problem that causes low self-esteem in children. Some tips to help children overcome stammering include slowing down their speech, maintaining eye contact, not interrupting them or finishing their sentences, and encouraging them to speak as often as possible in a supportive environment. Aphasia is a disorder caused by brain damage that affects speaking, listening, reading, and writing. While some may recover on their own, speech therapy is often helpful and aims to improve communication through restoring language abilities and learning new methods. Family support plays an important role by simplifying language and including the person in conversations.
The document discusses hearing loss and deafness. It describes the parts of the ear involved in hearing and classifies deafness into three types: conductive, sensorineural, and mixed. Numerous causes of each type are provided ranging from ear wax to old age. Treatments depend on the type and include hearing aids, surgery, cochlear implants, and speech therapy. Communication strategies and accommodations for people with hearing loss are also outlined.
Hearing impairment is defined as any hearing loss that affects educational performance but is not deafness. There are four categories of hearing loss based on location: conductive, sensorineural, mixed, and central. Common signs are difficulty hearing or understanding speech. In school, students may struggle with subjects involving listening, note-taking, discussions, and videos. Teachers and parents can help by designating note-takers, using assistive technology, ensuring proper seating, and not underestimating intelligence due to impairment.
This document discusses voice therapy for the management of benign voice disorders. It summarizes a study of 30 patients who underwent voice therapy with or without surgical procedures for conditions like vocal nodules, polyps, muscle tension dysphonia, sulcus vocalis, and others. Pre-therapy and post-therapy comparisons found improvements in voice quality ratings, patient quality of life measures, and laryngeal images. Voice therapy techniques discussed include vocal hygiene, exercises, massage, and various approaches. The study found voice therapy to be an effective non-surgical treatment for many benign voice disorders and helps prevent recurrence when used with surgery.
This document summarizes various tests used to evaluate hearing. It discusses tests of hearing thresholds like pure tone audiometry to determine the type and degree of hearing loss. Other tests discussed include tympanometry to assess middle ear function, otoacoustic emissions to evaluate cochlear outer hair cell function, and electrocochleography and BERA to objectively measure electrical responses in the cochlea and auditory nerve. The document provides details on the principles, procedures, and interpretations of these common audiological tests used to evaluate hearing.
This presentation provides an overview of sensory processing difficulties and regulation by occupational therapist Cynthia Miller-Lautman. It discusses how sensory processing issues can affect learning, behavior, and daily living. The presentation offers suggestions for parents and schools, such as providing movement breaks, outdoor time, and fidget tools. It also outlines what an occupational therapy evaluation involves and common sensory-based techniques used in therapy.
Overcoming Behavioral Roadblocks in Speech-Language InterventionBilinguistics
Challenging behaviors can impede progress in speech therapy. We will discuss the evaluation of behaviors that impact communication development and provide research-based intervention strategies to guide speech-language pathologists in developing effective treatment plans. We will include case studies of clinical interventions that improve communication in children with behavioral needs.
Personal Trainer Fitness First corso base pedana vibranteFrancesco Perticari
Corso base per il corretto utilizzo della pedana vibrante Fitvibe, riservato ai personal trainer aderenti della Fitness First.
Francesco Perticari
(ISEF e Master Trainer Fitvibe)
Scienza e movimento n° 8
ANNO EDIZIONE: 2016
GENERE: Rivista, 56 pagine
Foam roller
di Giuseppe Berardi
Analisi cinematica del passo e valutazione post riabilitativa nelle lesioni del tendine d'Achille
di Cristian Berardi
Alterazioni dell'appoggio plantare e correlazioni posturali: indagine della scuola primaria
di Fabio Marino
BCAA e sport
di Giulio Merlini
La resistenza nella preparazione atletica del danzatore
di Romeo Cuturi, Omar De Bartolomeo, Sara Benedetti, Eva Fasolo
Dal web. L’espressione e la sollecitazione della resistenza nel corso dell'età evolutiva
di Pierluigi De Pascalis
L’avvocato risponde. Modelli societari per l'apertura di una palestra
di Fabio Volontà
1. La modulazione del tono muscolare
G. Ianieri,
NEURORIABILITAZIONE
WORK IN PROGRESS
2. TONO MUSCOLARE
Stato di contrazione basale di tutti i muscoli scheletrici del
corpo in particolare i muscoli anti-gravitari, valutabili sia alla
palpazione (tensione meccanica non riducibile
volontariamente), sia come sensazione di resistenza alla
mobilizzazione passiva di un segmento corporeo
FUNZIONE DEL TONO MUSCOLARE
Assicurare risposta più rapida dei muscoli
Mantenere la posizione del corpo nello spazio (postura)
3. Sensitività recettoriale
Eccitabilità interneuroni spinali
Guadagno sinaptico
Adeguata modulazione inibitoria segmentale
Efficace inibizione presinaptica
Sinapsi segmentali spinali
Tono
Cause periferiche
• resistenza elastica muscolare
• caratteristiche delle fibre muscolari
• proprietà reologiche del muscolo (stiffness)
4. capacità peculiare della fibra muscolare di riassumere la forma di riposo dopo che su di essa abbia
terminato di agire una forza deformante. Infatti la natura in parte elastica delle fibre muscolari si
manifesta nel corso delle contrazioni eccentrico-concentriche.
suddivisione del muscolo in due entità funzionali distinte:
• l'insieme della materia contrattile costituita dai sarcomeri
• struttura "portante" non contrattile, rappresentata dal connettivo muscolare distinta in
• componenti elastiche in serie composta principalmente dal tessuto tendineo (SEC)
• elementi elastici in parallelo come epimisio e fasci in genere (PEC)
Elasticità
Modello meccanico
5. Muscle Fibre TypingTYPE Speed Oxidative Glycolytic Colour
I Slow Yes No Pink-Red
IIa Fast Yes Yes Red
IIb Fast No Yes White
Risultati della colorazione per determinare le proprietà biochimiche delle cellule
6. Nell’arto spastico si ha un’aumento della stiffness passiva di tutte le
componenti muscolari contrattili e non
Il correlato meccanico è la diminuzione di potenza legata
alla progressiva perdita di fibre coinvolte nei movimenti
fasici cioè fibre di tipo II, veloci e anaerobiche (giustifica
il sintomo debolezza), mentre permane la funzione delle
fibre di tipo I, lente e aerobiche (giustifica l’ipertono e la
perdita di destrezza e finezza del movimento)
Le fibre atrofiche divengono tali sia per modificazione del
flusso ematico sia a causa di un bilancio proteico negativo
(aumentata proteolisi ridotta sintesi proteica)
Questo squilibrio influenza la composizione in isoforme
della miosina delle fibre colpite con produzione di isoforme
lente con diminuzione di potenza
7. SPASTICITA'
Aumento velocità-dipendente della resistenza
che un muscolo oppone al suo allungamento
passivo.
Tale disordine motorio nei riflessi tonici di
stiramento (tono muscolare) è sintomo di
danno del I motoneurone del SNC ed è
sensibile al trattamento riabilitativo
Può anche essere definita:
Esaltazione delle contrazioni muscolari toniche a partenza riflessa, antigravitaria, stereotipata,
realizzata in un contesto tale da ostacolare l’estrinsecarsi di configurazioni posturali adatte ed
articolate (PINELLI 1992)
8. Sebbene i cambiamenti muscolari e neurali sono solitamente correlati, i
cambiamenti muscolari nella spasticità non possono essere spiegati dalle
classiche interpretazioni sugli effetti dei cambiamenti neurali da soli
(1) alterazione delle dimensioni in spessore e lunghezza delle fibre
muscolari e della distribuzione del tipo di fibre
(2) proliferazione della matrice extracellulare
(3) aumento della rigidità della cellula muscolare spastica e, in misura
minore, del tessuto muscolare spastico (swich da una isoforma più elastica a una
più rigida di titina)
(4) minori proprietà meccaniche del materiale extracellulare nel muscolo
spastico rispetto al muscolo normale
(5) alterazioni del circolo capillare muscolare
Modificazioni significative nel
muscolo spastico
9. il maggior numero di capillari è presente attorno alle fibre di tipo I che posseggono numerosi
mitocondri, che consumano molto ossigeno nella propria funzione.
Le fibre di tipo II al contrario sono circondate da un minor numero di capillari in quanto
funzionano discontinuamente, in condizioni di prevalente anaerobiosi ma con ampie pause
per il riaccumulo del glicogeno
stretta correlazione tra tipologia delle miofibre e numero dei
capillari
Dopo denervazione i capillari intramuscolari degenerano
molto più velocemente delle miofibre
Si instaura di conseguenza una fibrosi peri vasale che
allontana i capillari stessi dalla superficie delle miofibre,
con conseguente sviluppo di focolai di ipossia regionale
che inibiscono la capacità di recupero del muscolo
denervato
10. Scale cliniche
SCALA DI ASHWORTH (Scala ordinale del tono da 1+ a 4)
ADDUCTOR TONE RATING SCALE (sforzo richiesto per abdurre le
coscie fino a 45° col paziente in posizione supina)
HYGIENE SCORE (facilità con cui è possibile ottenere la cateterizzazione
uretrale e la pulizia dell’area perineale)
FIM (valutazione grado di autonomia)
MISURA ESCURSIONE ARTICOLARE (goniometria articolare)
11. Sebbene l’Ashworth Scale sia ampiamente usata come un metodo di misurazione per la
valutazione degli effetti di interventi terapeutici e sulla ipertonia spastica, la sua affidabilità
resta discutibile
Studi inter-campione ed intra-campione
dimostrano l’affidabilità dell’Ashworth
nella valutazione della flessione del gomito
e del ginocchio, ma una scarsa associazione
per la caviglia, in virtù delle loro
caratteristiche articolari che si prestano ad
un range di movimento di 180 gradi e come
tali possono essere valutate in riferimento ad
un piano.
E’ inoltre difficile, conformemente al tipo
di misurazione nominale, fare una buona
comparazione tra gli stessi valori rilevati da
diversi operatori.
12. STOP USING THE ASHWORTH SCALE FOR THE ASSESSMENT OF
SPASTICITY
METHOD: A cross-sectional study on spasticity in the elbow flexors (part 1)
and knee extensors (part 2); in both parts AS was assessed while muscle
activity and resistance were recorded simultaneously; three raters
CONCLUSION: The validity and reliability of the AS is insufficient to be used as
a measure of spasticity. We should stop using AS as a single outcome measure and
focus on promising methods
RESULTS: For elbow flexor muscles, AS was not significantly
associated with electromyographic parameters, except for rater 2
(rho = 0.66, p<0.01). A significant moderate association was found
with resistance (0.54≤ rho ≤0.61, p<0.05). For knee extensors, AS
scores were moderately associated with muscle activity (0.56≤ rho
≤0.66, p<0.05) and also with resistance (0.55≤ rho ≤0.87, p<0.05)
J F M Fleuren, G E Voerman, C V Erren-Wolters, G J Snoek, J S Rietman, H J Hermens, A V Nene
J Neurol Neurosurg Psychiatry 2010;81:46-52
AIM: Many studies have been performed on the methodological qualities of
the MAS, but overall these studies seem inconclusive. The aim of this study
was to investigate the construct validity and inter-rate reliability of the MAS
for the assessment of spasticity in the upper and lower limb
13. Misura miometrica
Non è invasivo, è indolore
Il minimo impatto evita reazioni neurali e deformazioni non-elastiche
Procedura semplice con lettura istantanea di tre valori (TONO, ELASTICITA’, STIFFNESS)
14. L'ottenimento di buoni risultati è
strettamente legato alla percentuale di
tessuto fibroso presente nel muscolo
Ecografia
Auspicabile la valutazione ecografica delle condizioni anatomopatologiche dei muscoli
ipertonici prima della infiltrazione (opportunità di infiltrare) e successivamente
(eventuali modificazioni strutturali legate al trattamento riabilitativo)
METAPLASIA FIBROADIPOSA
FIBROSI MUSCOLARE
Aumento dell’iperecogenicità con disposizione
irregolare delle fibre collagene per il loro diverso
orientamento
Area iperecogena nel contesto di un muscolo
normale. Es:fibrosi postraumatica
MUSCOLO NORMALE
15. Baropodometria elettronica
misura la distribuzione delle pressioni
plantari nella stazione eretta sia in fase
statica che durante la deambulazione.
16. Produce una paralisi bloccando l'emissione
presinaptica di Acetilcolina con una
denervazione chimica reversibile della fibra
muscolare
Poiché la denervazione chimica è reversibile,
essendo il muscolo progressivamente reinnervato
dal nerve sproutings, la tossina botulinica ha
effetti temporanei
17. Attualmente l’obiettivo è di creare certezze
sull’utilizzo di alti dosaggi di tossina
botulinica
La necessità di analizzare l’uso di
alti dosaggi di tossina botulinica
in presenza di un alto tono
muscolare è scaturita dal riscontro
oggettivo che l’utilizzo di dosaggi
standard produce o il precoce
ripresentarsi della sintomatologia
spastica o risultati terapeutici non
in linea con le aspettative o in
pochi casi limite ad insuccessi
terapeutici
18. • La corretta posologia ed il numero di siti di iniezione
dovrebbero essere adattate alle necessità individuali in
base a :
– Valutazione clinico-strumentale
– Gravità della spasticità
– Dimensione dei muscoli coinvolti
– Numero dei muscoli coinvolti
– Localizzazione dei muscoli coinvolti
– Risposta ad un precedente trattamento
– Eventuale debolezza locale del muscolo
20. Patologia di base: ischemia cerebrale, 55 dx e 48 sn
N° pazienti: 103 (58 maschi, 45 femmine)
Età media: 56.4 ± 6.7 aa
Tempo medio intercorso tra l'insorgenza e trattamento: 21.5 ± 12.5 mesi
Tossina iniettata: Botox 10 U/0.1-0.2ml Dose Media arto Superiore: 300-600 U
Dose Media arto Inferiore: 400-700 U
23. Non vi è alcuna evidenza clinica della comparsa di anticorpi neutralizzanti
La somministrazione intramuscolare
di BTXA ad alte dosi è in grado di
indurre una soddisfacente riduzione
dell’ipertono muscolare per più di 2
anni nei pazienti scarsamente
rispondenti a dosaggi medio-bassi
Il trattamento sembra essere sicuro come la terapia a basso dosaggio
24. FACILITAZIONE DIFFUSIONE DELLA TOSSINA
Bendaggio Adesivo di Posizionamento Segmentario (BAPS)
massimo stiramento della muscolatura infiltrata
mantenuto per 5-14 giorni
distretti distali AS (Reiter, 1998)
25. APPROCCIO RIABILITATIVO PASSIVO
• Isocinetica, agendo sulle strutture articolari e muscolari, riduce la
componente di rigidità e aderenze tessuti molli.
• Stretching: stiramento muscoli inoculati, sfruttando le proprietà
visco-elasto-plastiche, si riducono o si evitano retrazioni muscolari
• Mobilizzazioni articolari: ricercare ROM fisiologico. Mobilizzare
tutte le articolazioni
• Prevenzione e trattamento retrazioni
muscolari
• Ausilii e/o tutori; palmari, dorsali
26. APPROCCIO RIABILITATIVO ATTIVO
Stimolazione elettrica neuro-muscolare muscoli antagonisti:
• F segmentaria
• effetto sul trofismo muscolare
• mobilizzazione articolare
• stimolazione fibre sensitive
• miglioramento del microcircolo locale, trofismo parti molli e del metabolismo locale
ABILITÀ GLOBALE
• Terapia occupazionale
• Training del passo
• ADL: esercizio quotidiano
27. 1. STATO GENERALE
2. CONDIZIONI PSICHICHE
3. CONDIZIONI MOTORIE
4. SENSIBILITA’
5. FATTORI SOCIALI E AMBIENTALI
6. CARATTERISTICHE DEL SUPPORTO ESTERNO
APPROCCIO GLOBALE
28. Il nostro studio evidenzia come la misurazione miometrica del tono
muscolare sia più sensibile e più accurata rispetto a quella ottenuta
dalle diverse scale di valutazione clinica
Inoltre, attraverso la quantificazione numerica delle variazioni,
anche minime, del tono, della elasticità e della stiffness muscolare, è
possibile avere una visione fisiopatologica più ampia del tessuto
muscolare.
Questo permette di programmare un intervento terapeutico-
riabilitativo più mirato, specifico per ciascun paziente
29.
30. E’ importante ricordare che:
la terapia con tossina botulinica deve essere
effettuata solamente da medici esperti nella
somministrazione e nel monitoraggio dei
vantaggi e degli eventuali effetti collaterali
la selezione dei pazienti, gli obiettivi da
raggiungere, ed un approccio multimodale sono
le chiavi del successo
31. Unità Operativa di medicina Fisica e Riabilitazione
Spastic Movement Disorders Day Hospital
