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Samenvatting HOC Module Neurologie II (004814)
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Samenvatting met inhoudstafel, tabellen, grafieken en notities van het vak Neurologie 2 HOC
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NEUROLOGIE IISamenvatting HOC
1ste Master
2022 - 2023
,Inhoudstafel
1. Framework .................................................................................................................................................... 8
1.1. Definitie neurorevalidatie.................................................................................................................... 8
1.2. Klinisch redeneren in neuro revalidatie.............................................................................................. 8
1.3. De principes van neurorevalidatie ...................................................................................................... 9
1.4. RAMP: doelstellingen neurorevalidatie .............................................................................................. 9
2. Neuroplasticiteit ......................................................................................................................................... 10
2.1. Definitie............................................................................................................................................... 10
2.2. Plasticiteit van het gezonde brein ..................................................................................................... 10
2.2.1. De connectiviteit van het ZS ..................................................................................................... 11
2.2.2. Kritische periodes ...................................................................................................................... 11
2.2.3. Fysieke activiteit ........................................................................................................................ 13
2.3. Plasticiteit van beschadigde hersenen ............................................................................................. 13
2.3.1. Therapeutische toepassingen ................................................................................................... 14
3. Leren in neurorevalidatie........................................................................................................................... 16
3.1. Verschillende modaliteiten van leren ............................................................................................... 17
3.1.1. Impliciet en expliciet leren........................................................................................................ 17
3.1.2. Gewenning en sensitisatie ........................................................................................................ 18
3.1.3. Associatief leren: klassiek en operante conditionering .......................................................... 18
3.1.4. Observationeel leren ................................................................................................................. 19
3.1.5. Procedureel/Motor leren.......................................................................................................... 19
3.1.6. Cognitief leren ........................................................................................................................... 19
3.2. Tien fundamentele principes............................................................................................................. 20
3.3. Motor learning ................................................................................................................................... 22
3.3.1. Taak ............................................................................................................................................ 23
3.3.2. De omgeving .............................................................................................................................. 24
3.3.3. Patiënt ........................................................................................................................................ 24
4. Leren in neurorevalidatie: toepassingen ................................................................................................. 28
1
, 4.1. Duur, specificiteit en intensiteit van de training .............................................................................. 28
4.1.1. Inducerende therapie met dwangmiddelen ............................................................................ 28
4.1.2. (Robot-geassisteerde) lichaamsgewicht ondersteunde therapie ......................................... 28
4.2. Feedback ............................................................................................................................................. 29
4.2.1. Therapeut ................................................................................................................................... 29
4.2.2. Machine...................................................................................................................................... 29
4.2.3. Virtual reality ............................................................................................................................. 29
4.3. Geestelijke praktijk............................................................................................................................. 30
4.3.1. Observationeel leren ................................................................................................................. 30
4.3.2. Spiegeltherapie .......................................................................................................................... 30
4.3.3. Motorische beeldvorming ........................................................................................................ 31
4.4. Conclusie ............................................................................................................................................. 31
5. Veelvoorkomende stoornissen ................................................................................................................. 33
5.1. Verzwakking........................................................................................................................................ 34
5.1.1. Upper motor neuron laesie ...................................................................................................... 34
5.1.2. Lower motor neuron laesie ...................................................................................................... 35
5.2. Vermoeidheid ..................................................................................................................................... 35
5.2.1. Algemene vermoeidheid ........................................................................................................... 35
5.2.2. Motorische vermoeidheid ........................................................................................................ 35
5.3. Aandoeningen van de spiertonus ..................................................................................................... 36
5.3.1. Hypertonie ................................................................................................................................. 36
5.3.2. Hypotonie................................................................................................................................... 36
5.3.3. Dystonie ..................................................................................................................................... 36
5.3.4. Onwillekeurige spierspasmen................................................................................................... 37
5.3.5. Dyskinesie .................................................................................................................................. 37
5.3.6. Rigiditeit ..................................................................................................................................... 37
5.4. Coördinatieproblemen....................................................................................................................... 38
5.4.1. Cerebrale ataxie......................................................................................................................... 38
5.4.2. Sensorieke ataxie ....................................................................................................................... 38
2
, 5.4.3. Rust tremor ................................................................................................................................ 39
5.4.4. Spanning tremor ........................................................................................................................ 39
5.4.5. Verlies aan vaardigheid ............................................................................................................. 39
5.5. Stoornissen motorplanning ............................................................................................................... 39
5.5.1. Apraxie ....................................................................................................................................... 39
5.5.2. Bradykinesie/Akinesie ............................................................................................................... 40
5.5.3. Freezing of gait (FOG)................................................................................................................ 40
5.6. Vestibulaire stoornissen .................................................................................................................... 40
5.6.1. Perifere vestibulaire stoornissen.............................................................................................. 40
5.6.2. Centrale vestibulaire stoornissen ............................................................................................. 40
5.7. Visuospatiale stoornissen .................................................................................................................. 41
5.7.1. Hemianopia ................................................................................................................................ 41
5.7.2. Unilaterale spatiale neglect ...................................................................................................... 41
5.7.3. Contraversieve pushing............................................................................................................. 41
5.8. Sensorieke stoornissen ...................................................................................................................... 42
5.8.1. Sensitiviteitsverlies .................................................................................................................... 42
5.8.2. Paresthesieën en dysesthesieën .............................................................................................. 42
5.8.3. Pijn .............................................................................................................................................. 42
5.9. Secundaire complicaties .................................................................................................................... 43
5.9.1. Contracturen .............................................................................................................................. 43
5.9.2. Fysieke inactiviteit en deconditionering .................................................................................. 43
5.9.3. Aangeleerd niet-gebruik ........................................................................................................... 43
6. Beroerte/CVA: de revalidatie .................................................................................................................... 45
6.1. Beroerte of cerebrovasculair accident (CVA) ................................................................................... 45
6.2. CVA versus TIA .................................................................................................................................... 45
6.3. Types van beroerte ............................................................................................................................ 46
6.3.1. Ischemie en subtypes ................................................................................................................ 47
6.3.2. Hemorragie en subtypes ........................................................................................................... 48
6.4. Vroegtijdige signalisatie beroerte ..................................................................................................... 48
3
, 6.5. Diagnose van een beroerte ............................................................................................................... 48
6.5.1. Klinisch onderzoek..................................................................................................................... 48
6.6. Behandeling ........................................................................................................................................ 49
6.7. Oorzaken en risicofactoren ............................................................................................................... 49
6.8. Symptomatologie na een CVA ........................................................................................................... 50
6.8.1. Senso-motorische stoornissen ................................................................................................. 50
6.8.2. Communicatieve stoornissen ................................................................................................... 51
6.8.3. Cognitieve en gedragsmatige veranderingen .......................................................................... 51
6.9. Revalidatie na CVA ............................................................................................................................. 52
6.10. Prognose functioneren na CVA ......................................................................................................... 54
6.11. Relevante uitkomstmaten/Meetinstrumenten ............................................................................... 55
7. Dwarslaesie ................................................................................................................................................. 58
7.1. Etiologie en incidentie ....................................................................................................................... 58
7.2. Vormen van dwarslaesie.................................................................................................................... 58
7.3. ASIA-schaal ......................................................................................................................................... 59
7.3.1. Sensorische functies .................................................................................................................. 60
7.3.2. Motorische functies .................................................................................................................. 60
7.4. Bijzondere klinische beelden ............................................................................................................. 61
7.5. Pathogenese ....................................................................................................................................... 63
7.6. Acute fase na trauma ......................................................................................................................... 63
7.7. Prognose ............................................................................................................................................. 65
7.8. Speciale problemen bij SCI ................................................................................................................ 66
7.9. Kinesitherapie en revalidatie............................................................................................................. 66
7.9.1. Doelstellingen ............................................................................................................................ 66
7.9.2. Onderzoek .................................................................................................................................. 67
7.9.3. Respiratoire kinesitherapie ....................................................................................................... 67
7.9.4. Passieve en geassisteerde mobilisatie ..................................................................................... 69
7.9.5. Preventie van decubitus/doorligwonden ................................................................................ 70
7.9.6. Spasticiteit .................................................................................................................................. 71
4
,8. Parkinson ..................................................................................................................................................... 73
8.1. Inleiding .............................................................................................................................................. 73
8.2. Epidemiologie ..................................................................................................................................... 73
8.3. Etiologie .............................................................................................................................................. 73
8.4. Pathofysiologie ................................................................................................................................... 74
8.5. Basale ganglia en het frontostriataal netwerk ................................................................................. 74
8.6. Motor symptomen van PD ................................................................................................................ 77
8.7. Niet-motorische symptomen ............................................................................................................ 79
8.8. Beoordeling symptomen ................................................................................................................... 80
8.9. Behandeling van PD ........................................................................................................................... 87
8.9.1. Medicamenteuze behandeling ................................................................................................. 87
8.9.2. Kinesitherapeutische behandeling ........................................................................................... 87
9. Multiple Sclerose ........................................................................................................................................ 90
9.1. Inleiding .............................................................................................................................................. 90
9.2. Epidemiologie en etiologie ................................................................................................................ 90
9.2.1. Pathofysiologie .......................................................................................................................... 91
9.2.2. Plaques in de hersenen/RM bij MS .......................................................................................... 91
9.3. Het ziekteproces ................................................................................................................................. 91
9.3.1. Progressie ................................................................................................................................... 93
9.4. Evalueren ............................................................................................................................................ 93
9.5. Klinische symptomatologie................................................................................................................ 93
9.6. Medisch onderzoek en diagnosestelling .......................................................................................... 95
9.7. Medicamenteuze behandeling.......................................................................................................... 95
9.8. Kinesitherapie behandeling ............................................................................................................... 95
9.8.1. Muskuloskeletale integriteit ..................................................................................................... 96
9.8.2. Aërobe oefeningen .................................................................................................................... 96
9.8.3. Omgaan met de vermoeidheid................................................................................................. 96
9.8.4. Coping met beperkingen en handicaps ................................................................................... 97
10. Traumatic brain injury ........................................................................................................................... 99
5
, 10.1. Terminologie....................................................................................................................................... 99
10.2. Pathologische en traumatische oorzaken ........................................................................................ 99
10.3. Epidemiologie ................................................................................................................................... 100
10.4. Risicofactoren ................................................................................................................................... 100
10.5. Preventiemaatregelen ..................................................................................................................... 101
10.6. Invloed comadiepte en duur ........................................................................................................... 101
10.7. Acute aanpak van patiënten met TBI.............................................................................................. 101
11. Bewustzijnsstoornissen en coma ....................................................................................................... 103
11.1. Niveau van bewustzijnsdaling ......................................................................................................... 104
11.2. Evaluatieschalen ............................................................................................................................... 107
11.3. Elementen kinesitherapeutische behandelplan ............................................................................ 109
11.4. Kinesitherapeutische doelstellingen ............................................................................................... 110
12. Evaluatie en behandeling patiënten met BPPV ................................................................................ 113
12.1. Definitie............................................................................................................................................. 113
12.2. Het evenwichtsorgaan ..................................................................................................................... 114
12.3. Nystagmus ........................................................................................................................................ 116
12.4. Epidemiologie ................................................................................................................................... 117
12.5. Pathogenesis..................................................................................................................................... 117
12.6. Kliniek, symptomatologie ................................................................................................................ 119
12.7. Evaluatie............................................................................................................................................ 119
12.7.1. Dix-Hallpike maneuver ............................................................................................................ 120
12.7.2. Sidelying test ............................................................................................................................ 122
12.7.3. Roll test .................................................................................................................................... 122
12.8. Behandeling ...................................................................................................................................... 123
12.9. Effectiviteit........................................................................................................................................ 124
13. Klinische neuropsychologie ................................................................................................................ 126
13.1. Neuropsychologie ............................................................................................................................ 126
13.2. Belangrijke aspecten ........................................................................................................................ 127
13.3. Specifieke etiologieën ...................................................................................................................... 127
6
, 13.4. Executieve dysfunctie ...................................................................................................................... 129
13.5. Taal-en of spraakstroonissen .......................................................................................................... 130
13.6. Aandachts-en concentratiestoornissen .......................................................................................... 132
13.7. Ruimtelijke verwerkingsstoornissen ............................................................................................... 132
13.7.1. Unilateraal spatieel neglect .................................................................................................... 132
13.7.2. Pusher syndroom..................................................................................................................... 134
13.8. Geheugenstoornissen ...................................................................................................................... 135
13.9. Agnosie.............................................................................................................................................. 137
13.10. Apraxie.......................................................................................................................................... 138
13.11. Stemmingsstoornissen ................................................................................................................ 138
13.12. Gedragsstoornissen ..................................................................................................................... 140
14. Technologie in neurorevalidatie ........................................................................................................ 142
14.1. Gebruik van technologie en robotica ............................................................................................. 142
14.2. Onderste lidmaat systemen ............................................................................................................ 142
14.3. Bovenste lidmaat systemen ............................................................................................................ 144
14.4. Sociale robots in neurorevalidatie .................................................................................................. 145
14.5. Virtuele realiteit en serious gaming ................................................................................................ 145
14.6. Trends en evoluties .......................................................................................................................... 146
15. Valproblemen bij neurologische patiënten ...................................................................................... 149
15.1. Oorzaken en risicofactoren ............................................................................................................. 150
15.2. Onderzoeksmethodes registratie vallen......................................................................................... 150
15.3. Specifieke focus: vallen bij parkinson ............................................................................................. 151
16. Fysieke activiteit in de neurorevalidatie ........................................................................................... 155
16.1. Fysieke activiteit ............................................................................................................................... 155
16.2. World Health Organisation (WHO) ................................................................................................. 155
16.3. Fitheid ............................................................................................................................................... 156
16.4. Effect van beweging op cognitieve vermogens ............................................................................. 156
16.5. Experimenten bij dieren .................................................................................................................. 157
16.6. Experimenten bij mensen ................................................................................................................ 158
7
, 16.7. Epidemiologische studies ................................................................................................................ 160
16.8. Omstandigheden en hoeveelheid beweging.................................................................................. 161
16.9. Beweging bij hersenaandoeningen ................................................................................................. 161
1. Framework
1.1. Definitie neurorevalidatie
Neurorevalidatie: “Proces dat personen met een beperking helpt bij het bereiken en behouden van een
optimale functie en gezondheid in interactie met hun omgeving”
→ Het vereist een actief partnerschap tussen de patiënt, zijn familie en een hele reeks gezondheids- en
sociale zorgverleners
o Je moet dat op een andere manier aanpakken dan een gewoon sportletsel, je moet veel meer
mensen bij betrekken in de revalidatie
o Niet enkel fysiek functioneren moet verbeteren, ook het mentaal en daar kunnen we als kiné
niet alleen aan werken, het vraagt veel engagement en interactie en dus vraagt om een
multidisciplinair team
1.2. Klinisch redeneren in neuro revalidatie
Het klinisch redeneren is nodig voor de
behandeling van neurologische patiënten. Dit
gebeurt in een aantal stappen:
1) Informatieverzameling:
• Subjectief
• Objectief
• Gebruik maken van
meetinstrumenten
2) Hypothesevorming
3) Revalidatieplan opmaken
4) Evalueren en aanpassen
8
, 1.3. De principes van neurorevalidatie
Er zijn in de neurorevalidatie 10 belangrijke
principes:
→ ICF, participatie: Je wil de kwaliteit van
leven omhoog krijgen door de participatie te
verbeteren
→ Team work: multidisciplinair werken
→ Preventie: Voorkomen van ernstige co-
morbiditeiten, of het toch behandelen en
controleren ervan
1.4. RAMP: doelstellingen neurorevalidatie
RAMP: Recovery/Restore, Adaptation, Maintenance, Prevention
Vertaling: Verbeter, Leren omgaan en aanpassen, Behouden, Preventie
Conclusies/Vragen:
9
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