,Inhoudstafel HOC en WPO
HOOFDSTUK 1: Theoretische basis neurorevalidatie – FRAMEWORK.................................................. 8
A. Definitie neurorevalidatie............................................................................................................... 8
B. Why is a conceptual framework important ? ................................................................................. 8
C. Klinische redeneren in neurologische revalidatie ........................................................................... 8
D. 10 principes van de neurorevalidatie ............................................................................................. 9
E. Doelstellingen van de neurorevalidatie .......................................................................................... 9
HOOFSTUK 2: Neuroplasticiteit ............................................................................................................ 10
A. Plasticiteit van het gezonde brein ................................................................................................. 10
B. Onderhoud en verfijning van connecties ...................................................................................... 11
C. Neuroplasticiteit ............................................................................................................................ 11
D. Plasticiteit in de spier .................................................................................................................... 14
E. Plasticiteit van beschadigde hersenen .......................................................................................... 14
F. Therapeutische toepassingen ........................................................................................................ 16
HOOFDSTUK 3: Neurorevalidatie als leerproces + veelvoorkomende stoornissen ........................... 17
A. Rehabilitation as a relearning proces............................................................................................ 17
B. Clinical examples ........................................................................................................................... 17
C. Different modalities of learning .................................................................................................... 17
D. What happens in het CNS during learning? .................................................................................. 20
E. Motor relearning program ............................................................................................................ 22
F. Neuropsychological conditions for learning .................................................................................. 24
G. Some didactal applications in neurohabilitation .......................................................................... 26
1. DURATION,SPECIFICITY AND INTENSITY OF TRAINING ............................................................. 26
2. FEEDBACK .................................................................................................................................. 28
3. MENTAL PRACTICE..................................................................................................................... 29
Common neurological impairments .................................................................................................. 32
A. Weakness ...................................................................................................................................... 33
B. Fatigue ........................................................................................................................................... 34
C. Disorders of muscle tone .............................................................................................................. 34
D. Disorders of coordination ............................................................................................................. 36
E. Disorders of motor planning ......................................................................................................... 39
F. Freezing of gait .............................................................................................................................. 40
G. Vestibular disorders ...................................................................................................................... 40
H. Visuospatial disorders ................................................................................................................... 40
I. Sensory disorders ........................................................................................................................... 41
J. Secondary complications ............................................................................................................... 42
2
,HOOFDSTUK 4 : Klinische neuropsychologie ....................................................................................... 43
A. Neuropsychologie ..................................................................................................................... 43
B. Cognitieve screening tests......................................................................................................... 45
C. Executieve dysfuncties .............................................................................................................. 46
D. Taal en/of spraakstoornissen .................................................................................................... 48
D. Aandachts- en concentratiestoornissen ................................................................................... 49
E. Ruimtelijke verwerkingsstoornissen.......................................................................................... 49
F. Geheugenstoornissen ................................................................................................................ 53
G. Agnosie...................................................................................................................................... 54
H. Apraxie ...................................................................................................................................... 54
I. Stemmingstoornissen: depressie ............................................................................................... 55
J. Gedragstoornissen ..................................................................................................................... 57
HOOFDSTUK 5: Beroerte of CVA .......................................................................................................... 58
A. Beroerte of cerebrovasculair accident (CVA) ................................................................................ 58
B. Definities ....................................................................................................................................... 58
C. Types van beroerte........................................................................................................................ 58
D. Cerebrale circulatie ....................................................................................................................... 58
E. Verschillende types ischemische beroerte ................................................................................... 59
F. Vroegtijdige signalisatie................................................................................................................. 60
G. Diagnose van een beroerte: klinisch onderzoek ........................................................................... 60
H. Snelle medische behandeling ....................................................................................................... 60
I. Oorzaken en risicofactoren ............................................................................................................ 61
J. Symptomatologie na een CVA........................................................................................................ 61
K. Herstelpatroon .............................................................................................................................. 64
L. Prognosticeren van het functioneren ............................................................................................ 64
M. Stadium ........................................................................................................................................ 67
N. Een probleemgerichte aanpak ...................................................................................................... 68
O. Specifieke problemen ................................................................................................................... 69
P. Secundaire complicaties ................................................................................................................ 69
HOOFDSTUK 6: Vestibulo- oculair reflex.............................................................................................. 70
A. Inleiding ......................................................................................................................................... 70
B. Het evenwichtsorgaan : perifeer vestibulair apparaat Labyrinth ................................................. 70
C. Ampulla ......................................................................................................................................... 71
D. Stereocilia...................................................................................................................................... 72
E. Otoliet organen ....................................................................................... Erreur ! Signet non défini.
F. Labyrinth ........................................................................................................................................ 73
3
, G. Nystagmus..................................................................................................................................... 73
A. Definitie ......................................................................................................................................... 75
B. Epidemiologie ................................................................................................................................ 75
C. Pathogenesis ................................................................................................................................. 76
D. Symptomatologie .......................................................................................................................... 76
E. Evaluatie ........................................................................................................................................ 77
F. Behandeling ................................................................................................................................... 83
HOOFSTUK 7: Verworven hersenletsels en coma................................................................................ 90
A. Inleiding & terminologie ............................................................................................................... 90
B. Pathologische en mechanische oorzaken ..................................................................................... 90
C. Epidemiologie ................................................................................................................................ 91
D. Risicofactoren ............................................................................................................................... 91
E. Preventiemaatregelen ................................................................................................................... 92
F. Invloed van comadiepte en duur op ernst van TBI (hersenletsel)................................................. 92
G. Acute aanpak van patiënten met TBI............................................................................................ 92
A. Bewustzijn en bewustzijnstoornissen ........................................................................................... 93
HOOFDSTUK 8: Dwars laesie/spinalcord injury ................................................................................. 101
A. Definitie en oorzaken .................................................................................................................. 101
B. Incidentie in Europa .................................................................................................................... 101
C. Vormen ........................................................................................................................................ 101
D. Prognose ..................................................................................................................................... 103
E. Bijzondere klinishe beelden......................................................................................................... 105
F. Pathogenese ................................................................................................................................ 107
G. Acute fase na trauma .................................................................................................................. 107
H. Kinesitherapie id acute fase ........................................................................................................ 110
I. Kinesitherapie id revalidatiefase .................................................................................................. 111
HOOFDSTUK 9: Multipele sclerose ..................................................................................................... 115
A. Definitie ....................................................................................................................................... 115
B. Epidemiologie en etiologie .......................................................................................................... 115
C. Pathofysiologie ............................................................................................................................ 116
D. Het ziekteproces ......................................................................................................................... 117
E. Evalueren ..................................................................................................................................... 119
F. Klinische symptomen................................................................................................................... 120
G. Medisch onderzoek en diagnosestelling ..................................................................................... 123
H. Medicamenteuze behandeling ................................................................................................... 123
I. Kinesitherapie: een overzicht! ...................................................................................................... 123
4
,HOOFDSTUK 10: De ziekte van Parkinson.......................................................................................... 125
A. Parkinson disease ........................................................................................................................ 125
B. Epidemiology ............................................................................................................................... 125
C. Ethiology ...................................................................................................................................... 125
D. Pathophysiology .......................................................................................................................... 126
E . The Basal Ganglia ........................................................................................................................ 126
F. The Frontostriatal Network ......................................................................................................... 128
A. Symptoms of PD .......................................................................................................................... 130
A. Assessment of PD ........................................................................................................................ 136
A. Medical treatment ...................................................................................................................... 144
B. Core Areas ................................................................................................................................... 144
C. Treatment Goals – GENERAL ....................................................................................................... 144
A. Key Points .................................................................................................................................... 153
B. Treat-respons .............................................................................................................................. 153
C. Identificatie patiëntengroepen met hoog risico voor vallen....................................................... 153
D. Oorzaken vallen .......................................................................................................................... 154
E. Onderzoeksmethoden om vallen te registreren ......................................................................... 154
F. Specifieke focus: vallen bij Parkinson .......................................................................................... 157
HOOFDSTUK 11: Hydrotherapie bij neurologische patiënten ........................................................... 162
A. Inleiding ....................................................................................................................................... 162
HOOFDSTUK 12 : Revalidatiepsychologie .......................................................................................... 171
A. Inleiding ....................................................................................................................................... 171
B. Inhoud ......................................................................................................................................... 171
HOOFDSTUK 13: Fysieke activiteiten id neurologische revalidatie .................................................. 180
A. Inleiding ....................................................................................................................................... 180
B. Indeling ........................................................................................................................................ 182
Module neurologie II: Werkcolleges .................................................................................................. 190
HOOFDSTUK 1: Positionering en transfers .................................................................................... 190
1. CVA-patiënten (cerebrovasculair accident)................................................................................. 190
A. Technieken .............................................................................................................................. 190
B. Karakteristieken CVA- patiënt ................................................................................................. 190
C. Positionering + organisatie kamer........................................................................................... 190
D. Basisprincipes positionering ................................................................................................... 191
2. Dwarslaesie patiënten ................................................................................................................ 193
A. Karakteristieken ...................................................................................................................... 193
B. Positionering van dwarslaesi patiënten .................................................................................. 193
5
, C. Basisprincipes transferts CVA ...................................................................................................... 193
HOOFDSTUK 2 : Klinische testen .................................................................................................... 197
DEEL 1 : Algemene testen ............................................................................................................... 197
A. Aandachtspunten .................................................................................................................... 197
B. Overzicht van testen volgens het ICF-model........................................................................... 197
C. Algemene testen ..................................................................................................................... 197
DEEL 2: Rompstabiliteit ................................................................................................................... 203
A. Overzicht van testen volgens het ICF-model .............................................................................. 203
B. Testen voor rompstabiliteit ..................................................................................................... 203
HOOFDSTUK 3: Klinische testen ......................................................................................................... 206
DEEL 1: Balans ................................................................................................................................. 206
A. Overzicht ................................................................................................................................. 206
B. Testen .......................................................................................................................................... 206
DEEL 2: Bovenste lidmaat ................................................................................................................ 211
A. Overzicht ................................................................................................................................. 211
B. Testen ...................................................................................................................................... 211
HOOFDSTUK 4: Oefentherapie beroerte/ CVA .................................................................................. 216
A. Algemeen .................................................................................................................................... 216
B. Principes van motorisch leren ..................................................................................................... 216
C. Behandeldoelen .......................................................................................................................... 216
D. Oefentherapie CVA ..................................................................................................................... 216
HOOFDSTUK 5: Oefentherapie beroerte/ CVA .................................................................................. 220
HOOFSTUK 6 : Schouderpijn bij CVA-patient ................................................................................. 225
A. Normale schouderbiomechanica ................................................................................................ 225
B. Schouderpijn na CVA- patient ..................................................................................................... 226
C. Preventie en behandeling van schouderpijn ............................................................................... 227
D. Klinisch onderzoek ...................................................................................................................... 232
E. Voorbeelden ................................................................................................................................ 234
F. Tips om te oefenen bij personen met pijn .................................................................................. 236
G. Casussen...................................................................................................................................... 236
HOOFDSTUK 7: Multipele sclerose ..................................................................................................... 240
A. Voorbeeldcasus ........................................................................................................................... 240
B. Tijdslijn- klacht............................................................................................................................. 240
C. Klachten van de patient............................................................................................................... 241
D. Onderzoeksdoelen ...................................................................................................................... 242
E. Kinesitherapeutische diagnose.................................................................................................... 243
6
, F. Prognose ...................................................................................................................................... 243
G. Symptomatische behandeling .................................................................................................... 244
HOOFDSTUK 8: Ziekte van parkinson ................................................................................................. 246
HOOFDSTUK 9: Cognitieve therapeutische handelingen (PERFETTI) ................................................ 252
A. Ontstaan ...................................................................................................................................... 252
B. Waarnemen ................................................................................................................................. 252
C. Hypothese ................................................................................................................................... 252
D. Leerproces................................................................................................................................... 252
E. Aandoening.................................................................................................................................. 252
F. Perceptuele hypothese ................................................................................................................ 254
G. Therapie ...................................................................................................................................... 254
HOOFDSTUK 10 : Neglect, diagnose & behandeling .......................................................................... 257
A. Inleiding ....................................................................................................................................... 257
B. Diagnose ...................................................................................................................................... 257
1. BIT- conventionele subtests .................................................................................................... 257
2. BIT- gedragsmatige subtest ..................................................................................................... 260
C. Therapie....................................................................................................................................... 260
7
,HOOFDSTUK 1: Theoretische basis neurorevalidatie – FRAMEWORK
A. Definitie neurorevalidatie
“Proces dat personen met een beperking helpt bij het bereiken en behouden van een optimale
functie en gezondheid in interactie met hun omgeving” → vereist een actief partnerschap tussen de
patiënt, zijn familie en een hele reeks gezondheids- en sociale zorgverleners
B. Why is a conceptual framework important ?
• Late jaren ’80: grote toename in kennis
• Evidentie concepten?
• Overzichtsartikelen en richtlijnen voor specifieke aandoeningen
“Components selected within therapy sessions should be evidence based rather than based on
therapist preference for a specific treatment approach. However, it is also important to realise that
there are still many key areas of clinical practice with no evidence or conflicting evidence; therefore
therapists will always need to rely on their clinical reasoning skills to select treatment techniques
appropirate to the needs, wishes and goals of patients and their carers. This meets the requirements
of EBP, which is defined as the integration of best evidence with clinical expertise and patient
values (Sackett et al. 1996)”
C. Klinische redeneren in neurologische revalidatie
Klinisch redeneren is nodig voor de behandeling bij neurologische patiënten!
Informatieverzameling – hypothesevorming – revalidatieplan opmaken – evalueren en aanpassen
8
,D. 10 principes van de neurorevalidatie
E. Doelstellingen van de neurorevalidatie
RAMP: recovery – adaptation – maintenance – prevention
Wat is het verschil tussen een computer en de hersenen?
Hersenen = levend weefsel, constant in verandering (ontstaan van nieuwe netwerken)
Neuroplasticiteit = vervormbaarheid, vermogen van neuronen en het zenuwstelsel om te veranderen
qua eigenschappen (structureel, chemisch en fysiologisch)
Plasticiteit is de biologische basis voor ontwikkeling, leren en herstelvermogen
Bij de geboorte heb je afzonderlijke netwerken = PRIMAIR NETWERK of ontwikkeling
Later zal je connecties creëren = SECUNDAIR NETWERK of leren
Bij schade zullen de netwerken zich verplaatsen en leiden tot nieuwe netwerken = HERSTEL of re-
organisatie “re-outing”
A. Plasticiteit van het gezonde brein
Nature and nurture
• Ontwikkeling van de hersenen
• Leren
• Kritische periode: periode waar leermogelijkheden veel groter zijn na deze periode wordt
het moeilijk om specifieke taken te leren vb: talen, pianospelen ideaal rond 6 jaar (grootste
vermogen om te leren en nieuwe netwerken te maken)
10
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