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Introduction to adapted physical activity What is adapted physical activity  The term physical activity has changed over the years and has begun on different paradigms (family based, service based, supports based, and empowerment and self-determination) o Facility based: people with disabilities were usually found in institutions (isolated) o Service based: veterans returned with injuries needed skills to prepare them for re- integration into society (school, resources, special classes) o Support based: inclusion paradigm emerged. Individuals are included in settings with support staff (teaching aid, peer etc) o Empowerment and self-determination: individual can make own choices, decisions, and live independently.  Adapted physical education was introduced (restricted to school-aged children)  APA is an umbrella term that includes education, recreation and sport settings across all ages.  Contemporary adapted physical activity is… o A cross-disciplinary body of knowledge o A philosophy and attitude of acceptance of diversity o A focus on individual differences o A process of advocacy o Programming characterized primarily by adaptations of teaching skills and techniques to accommodate individual motor differences o A process of promoting independent self-determined physical activity  APA o “adapted” suggests change, modification, or adjustment of goals, objectives or instruction o Adaptations that can facilitate physical activity across a range of individual differences. o “disability” was no longer absolutely necessary in the definition  IFAPA (international federation of adapted physical activity) o “APA is defined as a cross-disciplinary body of knowledge directed toward the identification and solution of individual differences in physical activity. It is a service delivery profession and an academic field of study that supports an attitude of acceptance of individual differences, advocated access to active lifestyles and sport, and promotes innovation and cooperative service delivery programs and empowerment systems. Adapted physical activity includes, but is not limited to, physical education, sport, recreation, dance and creative arts, nutrition, medicine, and rehabilitation” (IFAPA, 2004)  Disability almost always communicates about in negative terms o Dis-ability o Mal-adjusted o Dis-order o De-formity o Re-tared, etc  Most terms imply insufficiency, inadequacy, and being less than  Rarely does our language allow us to conceive of disability in more positive or transformative ways. First person language  The understanding of a disability had been shaped by the medical community emphasizing physical and mental functioning of the individual  People are grouped according to the etiology (cause or description)  Our society once spoke of people using the “condition” first, such as autistic child or physically handicapped body o This approach is no longer used or accepted in the professional and educational setting  Words with dignity (active living alliance for alliance for Canadians with disabilities)  Protect personhood and do not define the person by their disability  The person first and the disability second Lecture #2 Disability theories and models Theories of disability  Models of disability provide a structure for understanding the way in which people with impairments experience disability o There are two main models that have influenced the way we think about disability  Medical model  Social model o Medical model  Society’s understanding of disability has been shaped by the medical community that emphasizes the physical and mental functioning of a person  People with disabilities are grouped by the medical cause and description of their condition  Focuses in individual pathology and attempts to find ways of preventing, curing or caring for people with disabilities.  Medicine focuses purely on the body  It fails to recognize cognitive and emotional factors shaping the disability or illness  Medical model fails to recognize the defects in the environment  Ex. If a person in a wheelchair is unable to get into a building because of the steps, the medical model would suggest that this is because of the wheelchair, rather than the steps. (needs a cure, needs help, is sick, bitter attitude)  Medical approach has led to lack of appreciation of individual differences and develop programs or treatments based on the “condition” rather than the person  Assumption in the medical model- people are sick, require care, need protection, sympathy, and charity  Because of this…individuals with disabilities can be denied respect, prevented from experiencing opportunities to succeed o Central tenets of the medical model  Disability is an organic problem that resides in the body  Medical experts have the power and legitimacy to name and know disability  Diagnosis and taxonomy-disability can be named and categorized according to strict taxonomic criteria  Empiricism, positivism, objectivity, and determinism  Scientific methods are required in order to diagnosis and treat disability  Scientific inquiry produces the most true and accurate account of disability  The cause of disability can be reduced to a single variable  Disability can be understood as an objective and quantifiable category, implying that knowledge itself exists outside of our perception and apprehension of it  Disability can be cured through medical intervention  Rehabilitation is required in order to restore health  Disability is a negative state and health is a positive state  Medical model general view is that people with disabilities are a result of their own physical and/or mental impairments and are independent of the sociocultural, physical, and political environments o Social model of disability  the social model of disability is a reaction to the dominant medical model  the social model of disability identifies systemic barriers, negative attitudes and exclusion by society (purposely or inadvertently) that means society is the main contributory in disabling people  the social model theorists argue that disability does not exist in the body, but, rather, in the disabling features of social life.  Individuals do not require rehabilitation-rather, rehabilitation of society’s attitudes towards disability, is required.  Ex. The social model of disability, sees the steps as the disabling barrier. (badly designed buildings, prejudice attitudes, no parking spaces, inaccessible) o The social model of disability: barriers in the social and the cultural environment  Physical and structural barriers  The built environment  Access to opportunities  Transportation barriers  The “ableist” nature of the environment that make it difficult for people with disabilities to safely navigate through their environments  Social barriers  Negative attitudes and perceptions towards those with disabilities  Stigma, social isolation, discrimination, pity, sympathy, tragedy, hero etc  Cultural barriers  Representation of people with disability in and through cultural mediums- media, newspaper, TV etc  Media is often a powerful transmitter of how we understand disability and shapes our attitudes and beliefs  The collective cultural beliefs towards people with disabilities  Institutional barriers  Lack if representation of people with disabilities in organizations  High rates of employment  Inflexible working hours  Institutional policy’s that fail to include people with disabilities  At organizational and government levels  What institutional and policy barriers are in place, that prevent the inclusion of people with disabilities into the PEH program?  Ideological barriers: “domination by consent” o Dominant groups win consent and have the power to define what disability is o These dominant views are legitimized and normalized through cultural practices o The knowledge of dominant and powerful groups who win constant, is assumed to be natural, rather than constructed  Central tenets of the social model o Constructivism- disability is socially constructed- the meaning of disability varies culturally and historically, and disability cannot be separated from the layers of social meanings it is embedded within o People with disabilities are the experts of their own experience and should talk on their own behalf o There are inherent power imbalances between physicians and patients and the social model seeks to reduce such power differentials o Disability is associated with capitalism and the rise of industry- so long as work is a cherished cultural value, disability will always arise as a problem o Rehabilitation itself can be considered as an ”industry” in which non- disabled people sustain their livelihood off of the lives of people with disabilities o Disability and illness are metaphors, in which something is made to stand for something else…fatness/thinness o Disability is “narrative prosthesis”- it is used as a crutch to propel a story of or film but rarely interrogated as a social construct in and of itself o Disability is always portrayed as a lack, a negation, and a negative embodiment; need to look to more positive representations of disability in culture o Human rights and social justice- need to advance the rights of people with disabilities as valued citizens in society o So long as society is “ableist”, people with disabilities will continue to be denied access to full personhood and subjectivity o Disability elicits a politics of the visual-  How is disability like and unlike, other social oppressions, such as racism, sexism, etc?  What do we fear about the disabled body? o Intersectionality- need to consider the multiple other social positions and locations which disability intersects with, each of which produces its own particular experience of disability (i.e, disabled woman vs. men) o Overall, the social model removes disability from the person and allows for a social and political understanding of disability in culture o Works towards the rehabilitation of society o Has been critiqued for “losing” the body, and overlooking the “pain” of disability through the process of “social reductionism” o However, makes for environmental rather than medical conceptualization of disability o The foundation from which this course will be taught o Oscar Pistorius runner International classification of functioning, Disability and Health (ICF)  The ICF, is a classification of health and health-related domains o Classified from body, individual and societal perspectives by:  A list of body functions and structure  A list of domains of activity and participation  Environmental factors (contextual) o Disability is influenced by the interaction between all of these various components o Focus is shifted from cause to impact  Places all health conditions on an equal footing allowing them to be compared using a common metric-the ruler of health and disability o ICF takes into account the social aspects of disability and does not see disability only as a ‘medical’ or ‘biological’ dysfunction.  Includes contextual factors, in which environmental factors are listed ICF allows to records the impact of the environment on the person’s functioning o The goal of ICF is to:  Maximize the participation of people with disabilities in all aspects of social life  To increase quality of life- subjective perception of health within the context of goals and culture (which can differ from objective assessment of health)  How global bodies and governments understand disability Lecture #3- Assessments  There are different viewpoints about what is considered assessment o It can be viewed as the process of collecting data for the purpose of making decisions about people o It can be a collection of multiple sources such as screenings, standardized tests, observation, ecological surveys, or consultations/interviews  Why do we assess? o Screening o Diagnose o Placement o To get to know an individual o Determine progress o Compare to others against norms (norm referenced tests)  Formal and informal assessment o Formal assessment are typically standardized (set of instructions, script to read or instrument to use)  Focus is on isolated skills and are often used for eligibility or placement decisions  Include developmental measures and tests that are standardized (norm- referenced)  Used to assess overall achievement, to compare people, identify strengths and weaknesses with peers. (standardized tests) o Informal assessment includes criterion-referenced tests (performance is matched to a criteria measures mastery)  Usually matched to everyday tasks  Administer informal tests in the environment that best matches the setting in which the person usually performs the task  Measures performance, used to inform instruction  Measurement, Assessment, and Program Evaluation o Common assessment strategies  Standard approaches  Usually ‘store bought’ tests  Limited selection of test items  Specific directions for administration provided  Usually known validity and reliability  Generally strong psychometrically but weak authentically  Standards provided to make judgments about student test performance  Standards o Norm-referenced: allows for comparison to other people’s performance in a particular age group  Test of gross motor development (TGMD-2) o Criterion-referenced: provides levels of ‘mastery’ for the skill or ability being evaluated (ex. Certification for lifeguards)  FITNESSGRAM  Norm-referenced standards o Comparisons are made to others from a specifically defined group (age, sex, disability, etc) o ‘Norms’ are usually developed by testing large numbers, and results are tabulated o Percentiles, T scores, z scores are used o ‘Above average’ and ‘below average’ are the types of judgments made o IQ tests, older PE tests are examples  Criterion-referenced standards o Comparisons are made to predetermined ‘mastery’ scores (minimally acceptable scores for a particular purpose) o Criteria are determined by expert opinion, research data, logic, experience, and so on o ‘competent’ and ‘noncompetent’ are the types of judgments made o FITNESSGRAM is an example lifeguard test  Commonly used tests in Adapted Physical Education o Test of gross motor development (TGMD) o Adapted physical education assessment scale (APEAS) o Competency test for adapted physical education (CTAPE) o Bruininks-Oseretsky test of motor proficiency o Brockport Physical fitness test o FITNESSgram  Ethics and assessment o Assessment implies that information collected about people is essentially invading a person’s privacy  TGMD-II o Test for children 3-10 years old who are significantly behind their peers in 12 different gross motor skills patterns  Broken into 2 subtests  Locomotor (run, gallop, hop, leap, horizontal jump, slide)  Object control (striking a stationary ball, stationary dribble, catch, kick, overhand throw, and underhand roll) Lecture #4-Alternate Assessments  Links assessment to instruction  Has day-to-day applicability  Often teacher constructed  Strong authentically, but weak psychometrically (premium on subjective evaluation)  Rubrics, task analyses, and portfolios are examples o Alternative strategies for assessment o Standardized tests (controlled settings) can be criticized because many of the skills tested have little functional relevance for the person  Ex. Being asked to touch their nose as kinesthetic awareness) o Standardized test produce do not provide information on instruction (test produced individual to be below average, but there was no indication as to “why” the performance was low) o Authentic assessment o Authentic assessment is an approach that is closely linked to assessment to instruction  More applicable to instructors/teachers/coaches  Takes place in the ‘natural’ settings o Authentic assessment is designed for successful participation in physical activity and emphasizes subjective evaluation through observation o There are four techniques for authentic assessment  Rubrics  Task analysis  Functional assessment  Portfolios o Rubrics o Rubric are detailed guidelines for making scoring decisions o Rubrics match performance to one of multiple levels of achievement through a set of criteria  Ex. Karate, swimming  Individual knows what is expected to advance and can be accountable for their own learning o One advantage of rubrics is that the individual knows exactly what they have to do to get the best possible score o Rubrics can be used to develop goals and objectives o The key to incorporating rubrics into the measurement and assessment strategy is to clearly define the criteria associated with each level of performance o Ecological task analysis (ETA) o Provides individuals with choices within the environment to execute various skills  Instructor sets the parameters or objectives  Individual chooses the type of equipment, rules, pace of activity to execute the designated skill  Instructor will observe and maintain data on these behaviours o What is ecological task analysis? o One theoretical perspective used by motor development researchers is termed the ecological perspective o This perspective takes account the interrelationships between the individual, the environment and the task  You must consider the interaction of all elements (body type, motivation, temperature, ball size) to understand the emergence of a motor skill (kicking)  Consider systems that exist with the body and outside of the body o Ecological task is a method of assessment and instruction that encourages us to think about movement performance in terms of:  The independent and interactive influences of the task goal  The environment in which the goal is to be achieved  The characteristics and predispositions of the learner or performer o Affordances- are what an environment offers to a person in terms of action o Affordances are accompanied by constraints (temporary or enduring) that limit the options perceived to be available  Environments are not perceived to be the same for everyone o Ex. Open gym space o The performer perceives their affordances of the environment along with their constraints and selects the task goal to attempt to meet that goal of movement o Using ETA in the assessment o There are four basic steps to use ETA (ecological task analysis) in the assessment and instruction of skills.  Establish or identify the task goal that are of interest  Allow choices of movement by performer (to determine what is preferred by performer)  Manipulate the environment, person, or task variables that influence performance to determine conditions that goals can/ cannot be met  Introduce instruction, applying methods that maximize self-discovery to help attain goals o Step 1: Establish task goal  Identify a functional task goal. This is different from a skill, or what someone does to meet the task goal (e.g., going down a slide on the playground)  Pick a task that will contribute to an individual’s ability to engage in an active living lifestyle  Consider the constraints and affordances  When using assessment or instruction, clearly state goals  Set up the physical environment so that it affords certain functional goals and not others (to “communicate”) o If you cannot change the environment, give them instruction o Step 2: allow choices  Once a functional goal is chosen, individual is given the freedom to choose the skill or form that will be used to meet the goal (referred to as ‘solutions’)  This is different from a standardized test  It is important to determine whether an individual can generate a skill in response to a particular environment without being prompted.  Observe movement product and movement process o Step 3: manipulate variables  Assessor determines which “conditions” are of interest  What are the physical conditions to allow goal attainment?  What are the social conditions required to meet the goal? o What about the social environment? (cooperative, competitive, individualistic)  What are the affective factors?  Assessor needs to determine the conditions under which the individual can and cannot accomplish the task o Step 4: begin instruction on task goal  Use a self-report form to determine what is socially relevant  Use a recording sheet and directly ask the individual how they feel about their own skills  Parents and instructors in instructional settings give assistance to the individual in some form  Physical: minimal, partial, complete physical guidance or support  Visual: gestures, partial or full demonstrations  Verbal prompts: specific cues, general cues (directions or questions) o Summary of ecological task analysis  The assessor is aware of all the factors that can influence performance  Records and monitors these during assessment  ETA (ecological task analysis) helps instructors determine which goals can be met and under what circumstances they are achieved  Allows acceptance of different solutions to a movement problem o Newell’s Model o Movement arises from the interactions of the individual, environment and task  If any of these factors change, the movement changes o Three constraints  Individual constraint  Structural constraints (height, weight, leg length)  Functional constraints (motivation, memory, attention, focus)  Environmental constraint  Task constraint o Portfolios o Portfolios are a complication of an individual’s best work o Students can do portfolios which can reflect how closely they meet the necessary outcomes for competency Lecture # 5 Visual impairments o Definition of visual impairment o Visual impairment, including blindness, is a deficiency in vision that, even when corrected, can affect a person’s performance. The term includes both partial sight and blind-ness o The eye senses stimuli in the form of light waves, which pass through the cornea (outside covering the eye) which are focused by the lens and then projected onto the retina (rear inside surface of eye. o The retina converts light rays into nerve impulses to be carried to the brain o When this pathway is disturbed, visual impairments result o Individuals who are legally blind are described as totally blind or partially sighted o Normal vision is considered to be ‘20/20’. This means that the eye being tested is able to see an object 20ft away, as well as any eye with very good vision o If you have 20/60 vision, it means you are able to see 20ft of what someone with good vision can see 60ft. o Partial vision or low vision o 20/60 to 20/190 o Classified as blind o 20/200 or worse o Persons who are legally blind have a visual field of less than 20 degrees Types of vision loss o Congenital o Rubella- during third trimester of pregnancy, complications with rubella may cause complications. o Albinism- characterized by a total or partial lack of pigment, causing abnormal optic nerve development o Retinitis of prematurity (ROP) – occurs in some infants born prematurely, resulting in reduced acuity or total blindness o Adventitious o Note: these are also progressive eye conditions o Macular degeneration- affects central vision causing sensitivity to light and poor colour vision o Retinitis pigmentosa (RP)- progressive disorder that causes loss of peripheral vision, night blindness, tunnel vision, decreased acuity and depth perception o Glaucoma-blockage in the normal flow of fluid causing increased pressure in the eye o Cataracts- usually bilateral, lens are cloudy, restricts passage of light o Affective and social characteristics o Blindisms (self-stimulation) rocking, hand waiving, finger flicking, digging fingers in eyes. o Overprotection fearful, reduced opportunities to freely explore their environment o Increased dependence o Decreased opportunities for socialization o Inclusion strategies o Equipment modification – increase size, add sound, contrast colours o Team teaching  Peer tutors  Paraeducators  Adapted PE specialist o Curriculum inclusion of open and closed sports activities  Promotes socialization  Open sport: dodgeball, can’t predict environment, soccer, baseball  Closed sport: bowling, golf  Promote life time activities: bochy ball, golf, bowling, sailing o Fostering independence o Maintain a positive attitude about the person with the visual impairment o Encourage participation in all activities o Help parents see the child’s abilities (involve them, pictures) o Challenge the individual at all times (assessments) o Expect the individual to be independent (foster safe environment) o Other ideas to foster independence (orient them) o Teaching techniques o Verbal explanation and instruction (towards target but 10ft away) o Demonstration and modeling ( where they can see left/right) o Physical guidance and physical assistance (tell them what your doing) o Tactile modeling (break it down) o Add sound devices (disc golf- ring chain, track/field- whistle, bell, voice) o Add visual cues –color in field of view o Guide-running techniques o Sighted guide: hold elbow o Tether- shirt rope or string o Guide wire- lets them know distances o Sound source: talking o Circular running : tether ball around o Sighted guide with bright shirt: see follow o Running independently o Treadmill o Sport opportunities o Inclusive sports  Intramural sports  Interscholastic  Community based  They are encourage involvement o Canadian blind sports association o International blind sports association o Victoria Nolan guide dog story, not welcomed in gas station, A.O.D.A- accessibility Ontario act, Paralympic rower Lecture #6- Hearing disability o Hard of hearing and deaf o Any impairment to affect the ability to perceive and process audio information is a hearing disability o A person with a hearing disability can be either hard of hearing or deaf  Hard hearing: one who may have a level of hearing loss ranging from mild to profound. Primary method of communication is the spoken language  Deaf: a person in whom the sense of hearing is non-functional for the ordinary purposes of living. Primary mode of communication is visual rather than auditory in nature  Use sign language or lip-read o Degree of hearing loss (dB) o Range considered normal is the 0-25 dB range o Deaf>90 dB o Hard of hearing 27-90dB o Communication o Various types of communication depending on parental influence, education, speech therapy, technology (cochlear implants), hearing aids o Speaking and hearing o Signed language o Categories of hearing loss o Conductive  Sound is not being transmitted to the inner ear  Words are faint hearing aid o Sensory-neural  Hearing loss due to nerve damage  More severe, possible cochlear implant to make words clearer, likely use sign language o Mixed hearing loss  Combination of conductive and sensory-neural hearing loss o Motor characteristics o Sensori-neural loss: might have balance problems  Due to the vestibular damage, not deafness  Cause developmental delays o If given equal opportunity will have equal motor skills o Fitness levels equal to hearing peers o Physical activity participation and parental influence is a major factor in psychomotor development o Considerations for physical education o Students might experience..  Isolation  Social deprivation  Ridicule o Teachers and peers lack a common language o Solutions  Peer tutoring program  Teach peers sign language  Offer leadership opportunities bring athletic background to class  Make them team captain, part of the decision making process o Teaching consideration for students with cochlear implants o Cochlear implant is a surgical procedure that implants a device into the individuals inner ear o Avoid contact sports, and serious blows to the head o Use caution in winter activities o Remove device during water activities o Remove device when sweating, causes excess noise due to moisture o Avoid static electricity o Need to find other mode of communication while implant is out of ear o Inclusion strategies o Discover what they can hear o What is their preferred mode of communication o Are there any contraindications (cochlear implant) o Understand the role of the interpreter (of there is one) o Check for understanding o Promote leadership o Learn sign language o Teach sign language to hearing peers o Deaf sport contribution to hearing world o Football: huddle before plays, signs o Baseball: signals from catcher o Track and field: gun, flag, arm o Hockey: ref signs, goal light, whistle o Wrestling: points, flags, counts on mat o Bowling: scoreboard o Swimming: noise, light o Deafblindness o When a child had vision and hearing loss significant enough to affect educational performance o Does not mean the student is completely deaf and completely blind o Most individuals labeled as deafblind have some usable vision or hearing or both o Issues with children who are deafblind o Isolation o Limited incidental learning can’t pick up on things when people are gossiping o Social deprivation o Need more time to do everyday things allow extra time o Communication modes o Verbal or auditory- with or without amplification o Sign language  Close up in small space  Distant sign o Tactile sign (if no vision) o Picture symbols o Object cues o Teaching techniques for students who are deafblind o Use a multisensory approach o Use trained peer tutors o Link movement to language (promote movement)- teach word, explain the purpose o Teach age-appropriate activities o Encourage choice making Lecture 7+8 central nervous system structures and movement o Basic descending motor pathway o Central nervous system  Cerebral hemospheres  Brain stem  Spinal cord o Motor unit  Efferent neuron  Motor endplate  Muscle fiber o Cerebral hemispheres o General structure  Two cerebral hemispheres talk to each other  Corpus callosumconnects left and right cerebral hemispheres to facilitate interhemispheric communication.  Anterior commissure allows for communication  Thalamus rely centre, regulation of consciousness, sleep, and alertness o Functional divisions  4 lobes  50+ brodmann’s areas o Lobes of the cerebral cortex o Frontal lobe  Decision making, controls voluntary movements of specific body parts, retaining longer term memory.  Separated from the parietal lobe by the central sulcus, and from the temporal lobe by deep fold called the lateral sulcus. o Temporal lobe  Auditory perception, stimulus identification, speech, vision, formation of long- term memory.  Below frontal and parietal lobe o Parietal lobe  Multi-sensory integration, pulls everything together, distribution of attention, understanding touch, muscle stimulation  Above occipital lobe behind frontal lobe o Occipital lobe  Sight, visual processing  Behind temporal and parietal lobe o Cerebral hemispheres o Brodmann’s areas  50+ structural/ functional zones  Primary and secondary visual corticies  Primary somatosensory cortex  Posterior parietal cortex  Premotor motor o Supplementary motor area- planning of action  Primary motor cortex o Converts plan into series of muscle contractions to bring about action. o Outputs  Betz (pyramidal) cells  Corticospinal pathway to control distal musculature  Direct activation of motor units  Adjust gain of stretch reflex o Role  Upper motor neuron  Major structure involved in transforming movement information into behaviour o Subcortical feedback loops o Cerebellum-below cortex  Receive only sensorimotor input  Output goed directly to premotor motor and M1 o Basal ganglia  Receive input from entire cerebral cortex  Output indirectly to premotor motor, supplementary motor area and prefrontal areas through thalamus  Characteristics of actions are incomplete or damaged o Basal ganglia- anatomy o Consists of 5 parts  Caudate nucleus  Nucleus accumbens  Putamen  Clobus pallidus  External  Internal  Subthalamic nucleus  Substantia nigra  Pars compacta  Pars reticulate o Roles of movement o Cerebellum  Timing of muscle contractions  Feed-back based control of accuracy o Basal ganglia  Refine motor plan by inhibiting unwanted contractions  Disinhibit (postural) areas of the motor system to allow movement to occur o Important words of caution o Only summary and general characterizations of diseases and disorders are presented o Exercise recommendations and discussions are guidelines only  Discussions are meant to provide insight of conditions and to form discussions  These should not be used to design and implement exercise programs with anyone  Programs should be designed and supervised by trained physicians and clinicians Movement disorders 1: pyramidal system Cerebral cortex and spinal cord o Paresis and spasticityCommon but contradictory symptoms o Paresis/paralysis- incomplete loss  Loss of voluntary control of skeletal muscles  Indicative of removal of descending control of delta motor neurons o Spasticity  Uncontrolled spasms  Increased muscle tone  Hyperactive monosynaptic stretch reflexes  Especially reactive to fast dynamic stretched  Maybe indicative of removal of descending control of delta motor neurons and of stretch reflex o Stroke  Cerebrovascular accident – typically late in life  Blockage or hemorrhage of a main blood vessel causes anoxia (decreases oxygen) and/or ischemia (+ decreased glucose and decrease removal of toxic metabolic by-products) o If accident lasts longer than a few minutes, infarction occurs (neurons and supporting cells die) causing irreversible damage  Specific disturbance on behaviour is relates to area affected o i.e., stroke in right PPC leads to hemispatial neglect  person ignores left visual space  if stroke is in motor system (esp. M1), there are disturbances in motor planning and execution  can be as severe as complete paralysis to minor bradykinesia (slowing initiation and execution of motor actions) of limbs contralateral to lesion o more noticeable in distal then proximal musculature o can also be associated w/ spasticity o cerebral palsy  causes  intrauterine or postnatal brain damage from any number of factors o long/ traumatic birth, bacterial or viral infection in womb, blood type incompatibility, severe jaundice after birth  symptoms  onset is during or prior to infancy and symptoms vary with area of brain damage o muscle tightness (hypertonus) or spasticity (hyperactive reflexes)  can lead to contractures, typically stronger on flexors o involuntary movement o disturbance in locomotion or mobility (wide-base or scissor walking) o difficulty in swallowing and problems with speech o exercise and stroke/ CP  benefits  increase range of motion and flexibility  strengthen muscles and increase endurance  increase sense of well being  first two increase functional capacity  recommendations  moderate exercise recommended  lots of stretching and mobility exercises  involve a partner for social and safety benefits o especially for ppl w/ severe contractures or weakness o multiple sclerosis o cause  loss of the myelin sheath surrounding axons of some CNS tracts resulting in a slowing or complete interruption of info transfer  tends to affect upper motor neurons, optic nerve, and/or cerebellum o symptoms  symptoms similar to those of a person with an incomplete spinal cord injury, but specific pattern depends on tracts and pathways affected  spasticity, paresis, a change in sensory sensitivity, loss of vision, uncontrollable nystagmus, problems with walking and coordination (ataxia) and fatigue. o Exercise and multiple sclerosis  Benefits  Shown to ease symptoms  Increases vitality and energy  Recommendations  Moderate exercise recommended o Lots of stretching and mobility exercise  Swimming and water aerobics o Some people with MS are sensitive to heat and water helps to decrease chances of overheating o Movement disorders 2: extrapyramidal- basal ganglia o Parkinson’s disease  Symptoms:  Bradykinesia/ akinesia slowness of movements (execution)  Masked face and speech problems  Resting tremor  Rigidity- increase in muscle tone causing resistance to externally imposed joint movements  Postural instability – loss of ability to maintain an upright posture  Cause:  Genetic factors- mutation of one of several specific genes.  Causes increase excitation and decrease inhibition in globus pallidus interna, which leads to a decrease output in thalamus, which leads to a decrease in cortical output.  Exercise and Parkinson’s disease  Benefits o Improve balance o Increase range of motion and flexibility o Slow progression and bradykinesia o Increase sense of well being  Recommendations o Movements with large range of motions and different types of movements  Yoga, tai chi and perform exaggerates facial expressions o Water-based or supported exercises encouraged for latter stages because of impaired balance o Huntington’s Disease  Symptoms  Chorea (hyperkinesia) o Voluntary movements are jerky and abnormal o Abnormal involuntary movement disorder  Speech begins to slur and eventually disappears  Cause  Selective degeneration of cortical cells and GABA/encephalin neurons in striatum that project to globus pallidus externa  Eventually leads to increased output from thalamus to cortex o Likely cause of chorea  Exercise and huntington’s disease  Benefits o Slow progression
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