The phenomenon of Diaschisi , is a topic crucial to understanding the evolution of a stroke. Following a brain injury, some areas of the brain are directly affected by the lesion, others cease to function properly, because it occupies the space involved by the edema around the lesion, while other facilities, that are not anatomically related to the areas directly affected, are inhibited at a distance. Let's try to understand the reason for this strange phenomenon called inhibition diaschisi .
Why nature needs to put to rest the system?
It is a biological defense strategy, which tends to avoid overloading of the structures affected by injury, so the areas and structures that are anatomically related to those injured, but that there are functionally related , or with which they participate together in some functions through the continuous exchange of information, are inhibited.
inhibition is because some areas of the brain does not receive more information from the affected areas now remained "mute " because of the injury, and probably to protect the same areas affected by information overload hardly gestibile.All 'internal diaschisi , then you have an acute phase of "shock ", where the inhibition is very broad and involves many areas of the brain and nervous systems. It is for this reason that following a stroke, the acute phase is characterized by a flaccid paralysis, so named because of the almost total inability of the patient to move a half part of the body, the opposite the lesion.
This phenomenon is called Diaschisi , etymologically from the greek DIA '(a cross) and SCHIZO (division), " division through ", " division, as we have seen The diaschisi fact, represents a process of disconnection and inhibition even at a distance between different brain structures. It is not only involved the cerebral cortex, but also many other structures including the thalamus and the cerebellum, which functions as we will see will be crucial for organizing motor. But how much is diaschisi ?
Generally, the neurologist to answer this question by quantifying the duration of the phenomenon of diaschisi in 3-4 weeks, although in the diaschisi a phenomenon that can last a lifetime!
try to understand why ...
diaschisi The phenomenon is a phenomenon and an inhibitory synapse. This means that the inhibition occurs in areas of nerve junction, a kind of highway that connects different rami di traffico, ed è come se tutti i caselli autostradali scioperassero nello stesso momento, l’intera rete autostradale andrebbe in tilt. Lo “ sciopero ” delle sinapsi rappresenta una situazione di ipoeccitabilità , ovvero una situazione in cui i processi di trasporto e mediazione delle informazioni che avviene a questo livello sono decisamente limitati.
Per quale motivo allora si parla di sole 3-4 settimane ?
Effettivamente in genere, dopo questa finestra di tempo, alcuni circuiti neuronali, quelli formati da poche sinapsi si deinibiscono ,ovvero, " toll started to resume their activities ," is what the neurologist in the department and work towards passing the gavel to the tendon reflexes, like the classic knee, gets the reflex response of the movement that previously did not exist. But this does not mean that diaschisi is completely regressed, meaning that the diaschisi STA regressing, and is doing from the most basic circuits, ie those reflections.
the body is tending to the reorganization after the injury!
This is the most delicate moment of diaschisi and recovery, because this process of deinibizione diaschisi , it should be properly guided through a specific rehabilitation program. The choice of rehabilitation experience will determine to a large percentage of the future recovery.
Let's try to understand what happens ...
The first key concept for understanding the diaschisi is that it is a synaptic phenomenon. Another fundamental concept is that the first diaschisi regresses from the channels with few synapses ( paucisinaptici ) “ le reti autostradali con meno caselli ”. Questi sono i circuiti che fanno capo ai movimenti più elementari, infatti il riflesso del ginocchio e gli altri sono movimenti poveri che avvengono al di fuori del controllo cosciente ed hanno delle possibilità limitate e stereotipate.
Di fondamentale importanza per comprendere il tipo e la modalità di trattamento adeguato per un ottimale superamento della diaschisi , è che le sinapsi vengono deinibite solo attraverso stimoli semplici, ovvero riprendendo la nostra metafora; " i caselli in sciopero riprendono la loro attività regolare solo attraverso una mediazione pacata e ragionevole ". Abbiamo detto che the agency is reorganizing and this is happening at the synaptic level, there was a period of inhibition, to avoid information overload, not by chance that inhibited the major brain structures are represented by the thalamus and cerebellum, two "bodies "Fundamental to the acquisition, construction, analysis, processing and smistaggio information. Following this period of inhibition, however, the body finds it necessary to provide the most fertile ground for the reorganization and plasticity of the central nervous system, and then you will have a situation of synaptic excitability, "after the toll strike start doing double shifts , "but this hyperexcitability is a double-edged sword, I will try to explain better why it is one of the concepts on which you will base the rehabilitation process.
Why?
As we said the first to deinibirsi circuits are the most simple, basic ones, those reflections, this situation adds a fertile ground for hyperexcitability very delicate to manage, in fact if you are not careful to manage the situation, giving the patient the situation " information " simple and appropriate, si rischia di rinforzare l’utilizzo dei soli circuiti elementari deinibiti , negando la possibilità di acquisire ed apprendere livelli di motilità più evoluti, che fanno capo a circuiti nervosi più complessi, " reti autostradali più articolate ". Quali saranno allora le esperienze adeguate per un adeguato superamento della diaschisi ? Dobbiamo considerare che il problema in seguito ad un ictus non è solo motorio, il deficit motorio rappresenta solo il fenomeno visibile delle alterazioni biologiche e cognitive che il sistema nervoso centrale ha subito, infatti la stessa contrazione muscolare, rappresenta un aspetto importante del movimento, ma non l’unico ! L’organizzazione movement is a complex process at the base of which there is an activation of cognitive and mental processes as attention, perception, memory and others. Even non-professionals are aware that in many cases, both serious and nuanced, after brain injury there are changes to these cognitive aspects mentioned above. It therefore seems reasonable after an accident in the brain, involved in the rehabilitation treatment, those cognitive functions altered by the lesion directly and indirectly determine the motor alterations visible. Within the various methods proposed for the hemiplegic patient rehabilitation and brain injury in general, the only approach that takes into account these Rehabilitation is the fundamental premise Neurocognitive Rehabilitation , what is commonly referred to as "perfect method". I conclude this delicate subject of diaschisi which in part will continue when we talk about spasticity, saying that unfortunately often times dictated by the hospitals and rehabilitation are not identical to the patient's recovery time and unfortunately time to get back in the state convention, which often is about sixty days, the treatment options are directed at fundamental compromise: " set up the sick and let's do ambulatory ! "really often through questo tipo di atteggiamento il paziente riuscirà molto probabilmente a deambulare , ma attraverso quella motilità elementare di cui parlavamo prima, spesso l’arto superiore rimane flesso, rigido e paretico, stessa cosa per l’arto inferiore rigido ed utilizzato come un “ pilone” elevando l’anca per far avanzare il piede che spesso appoggerà sul suolo, non con il tallone, ma con la parte laterale ed anteriore del piede.
Purtroppo la causa di una motilità elementare come quella appena descritta, non è determinata solo dagli schemi elementari, ma da altri elementi cognitivi e biologici che danno forma al profilo a quella che viene definità Spasticità , Which is a phenomenon that threatens to establish whether within the phenomenon of diaschisi the person is subjected to stimuli and excessive loads. To summarize the above acts and trying to translate it into rehabilitation, we can conclude by saying that the
rehabilitative treatment must involve the cognitive processes, must meet the times and the possibility of the patient, trying not to structure the motility grade, must involve the perception.
INDICE EMIPLEGIA
5. EMIPLEGIA DESTRA
................5.1 APRASSIA
................ 5.2 ................ AFASI
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