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10 - Rehabilitation > 10-02 Theories of Neuro Rehab > Flashcards

10-02 Theories of Neuro Rehab Flashcards

1
Q

PT Intervention: Reality

A
  • Integration of theories and techniques
  • Combine therapies to treat pt
  • Applies to both neuro and ortho
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2
Q

Augmented interventions (7)

A
  • Used with insufficient recovery and lack of voluntary movement control
  • Inability to initiate or sustain movement
  • Intensive hands-on approach
  • Neuromuscular/sensory stim to start
  • Biofeedback and E-stim can be used
  • Focus on active exercise and task-oriented training
  • Contraindicated for those with active movement control
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3
Q

Reasons PT Interventions integrate approach (4)

A
  • Address individual needs
  • Focus on minimizing or eliminating functional limitation, physical disabilities
  • Optimize functional recovery
  • Enhance quality of life
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4
Q

Theories of Neuro Rehab (8)

A
  • Rood: Neuromuscular facilitation/inhibition
  • Bobath: Neurodevelopmental Treatment (NDT)
  • Brunnstrom: Movement Therapy in Hemiplegia
  • Kabat, Knott and Voss: PNF
  • Motor Control: Task-oriented approach
  • CIMT (Constraint induced movement theory)
  • BWSTT (Body weight support treadmill training)
  • Functional, task-oriented training
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5
Q

Theory of Rood

A
  • Neuromuscular Facilitation/Inhibition

- Proposed using sensory stimuli to facilitate (create) or inhibit (decrease) movement responses

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6
Q

Facilitation

A
  • Enhance capacity to initiate a movement response
  • Technique may not facilitate muscle contraction
  • Intensity, duration and frequency of stimulation depends on pt
  • Target low to no tone for more response
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7
Q

Activation

A
  • Actual production of movement
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8
Q

Inhibition

A
  • Decreased capacity to initiate movement response
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9
Q

Rood (Basic Principles)

A
  • All motor output is the result of past and present sensory input
  • Takes into account the autonomic nervous system, emotional factors and motor ability
  • Rood introduced sensory input through faciliation/inhibition to elicit desired rmotor response
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10
Q

Rood (Intervention Focus)

A
  • Goals of treatment: Homeostasis in motor output, activate muscles in response to stim, perform task independent of stim
  • Once desired response is achieved, stimulus is withdrawn; goal is to integrate into functional activity
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11
Q

Facilitation Techniques (9)

A
  • Approximation
  • Joint compression
  • Icing
  • Light touch
  • Quick stretch
  • Resistance
  • Tapping
  • Vibration
  • Brushing
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12
Q

Inhibition Techniques (7)

A
  • Deep pressure
  • Prolonged pressure
  • Prolonged stretch
  • Warmth (inhibit muscle spasm)
  • Prolonged cold
  • Carotid reflex
  • Traction
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13
Q

Light Work

A
  • Focuses on extremities

- Develop controlled movement and skilled function by performing activity without resistance

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14
Q

Heavy Work

A
  • Focuses on strengthening of postural muscles

- Develop stability by performing activity against gravity or resistance

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15
Q

Key Patterns (Patterning)

A
  • Sequence that directs pt’s mobility recovery from synergy patterns through controlled motion
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16
Q

Rood (Intervention Principles)

A
  • Sensory stimulation achieves motor output
  • Movement is automatic and non-cognitive
  • Homeostasis of all systems is essential
  • Use inhibition to calm pt
  • Tactile stim facilitates normal movement
  • Exercise must provide proper sensory feedback in order to be therapeutic
17
Q

Neurodevelopmental Treatment (NDT)

A
  • Karl and Berta Bobath
  • Abnormal postural reflex activity and abnormal muscle tone is caused by the loss of CNS control at the brainstem and SC
  • Inhibit bad postures, faciltate normal postures
  • Function-induced recovery
18
Q

NDT (Intervention focus)

A
  • Learn to control movement through activities that promote normal movement patterns that integrate function
  • Abnormal movement patterns (synergies, posturing, re-emergence of primitive reflexes) not tolerated
  • Handling techniques facilitate normal movement, inhibit abnormal movement
19
Q

Facilitation

A
  • Technique that elicits voluntary muscular contraction

- Low tone

20
Q

Inhibition

A
  • Decrease excessive tone or movement

- High tone

21
Q

Placing

A
  • Moving pt extremity into position that acts against gravity or resistance
  • Ex: trunk or UE in sitting (maintain position)
22
Q

Reflex inhibiting posture

A
  • Static position that inhibits abnormal influences and reflexes
  • UE WB facilitates in low tone, inhibits in high tone
23
Q

NDT Key Points of control

A
  • Shoulder, pelvis, hand, foot

- specific handling of these areas influence and facilitate posture, alignment and control

24
Q

NDT 5 basic components of movement

A
  • Trunk control and movement (establish stability to superimpose head and limb control)
  • Head control on trunk (Head aligns over stable trunk)
  • Midline orientation (pt learns where midline is, begins moving away from and toward midline, establish symmetry)
  • Movement over BOS (WS trunk too and from midline, prep for standing)
  • Limb function on trunk (Allows contact with environment, stability allows better limb function)
25
Q

NDT Intervention Principles

A
  • Inhibit abnormal patterns, facilitate normal patterns
  • Alter abnormal tone, influence isolated active movement
  • Manual contact/handling through key points of control
  • Achieve balance between muscle groups (agonist, antagonist)
  • Developmental sequence (POE –> Standing)
  • Provide pt with sensation of normal movement by inhibiting abnormal movement
  • Dynamic reflex inhibiting patterns
  • Vary levels of difficulty in functional activities
  • Treatment should be active and dynamic (pt participates)
  • Avoid associated patterns
  • Emphasize rotation during activities
  • Orient midline control by moving in and out of midline with dynamic activity
  • Avoid compensation techniques
26
Q

NDT Current Trends

A
  • Pt controls posture and movement through sequence of progressively challenging postures and activities (POE –> stand)
  • Use physical handling and key pts of control to support body segments and assist pt in achieving active control
  • Implement sensory stimulation
  • Postural alignment and stability are facilitated, excessive tone and abnormal movements are inhibited
  • Avoid compensation
  • Carry over is promoted (incorporate caregiver)
  • Therapeutic activities are functionally relevant, but vary in difficulty and environment
27
Q

Associated Reactions

A
  • Involuntary, automatic movement as a result of an intentional (volitional) active or resistive movement in another body part
28
Q

Limb Synergies

A
  • Group of muscles that produce a predictable pattern of movement in flexion or extension patterns
29
Q

Brunnstrom

A
  • Movement therapy in Hemaplegia
  • Synergy: Primitive patterns that occur at the SC as a result of CNS hierarchial organization
  • Uses synergy patterns to restore function (during rehab)
  • Practice synergy, then develop combos of movements outside of synergy
  • Current research: Reinforcing synergies makes it difficult to change lateradaptive or mal-adaptive neuroplasticity
30
Q

Brunnstrom - 7 stages of recovery

A
  • Stage 1: No volitional movement of limbs (flaccid, no tone)
  • Stage 2: Appearance of basic limb synergies as associated reactions; minimum voluntary movements responses; beginning of spasticity (increased tone)
  • Stage 3: Spasticity increases, may be severe; voluntary control of movement synergies, although not full range
  • Stage 4: Spasticity decreases; Movement combos outside synergy is mastered
  • Stage 5: Further decrease of spasticity; more difficult movement combos independent of limb synergy patterns
  • Stage 6: Spasticity disappears and individual joint movements become possible
  • Stage 7: Normal motor function restored
31
Q

Brunnstrom: Intervention Principles

A
  • Focus on pattern of movement rather than straight plane motion
  • Sensory exam required to assist with treating motor deficits
  • Limb synergy a necessary milestone for recovery
  • Encourage overflow (use uninvolved side) to recruit active movement of weak side
  • Use repetition of task and positive reinforcement
  • PT follows stages of recovery, but may plateau any any point (preventing full recovery)
  • Movement combos that deviate from basic limb synergies should be introduced in stage 4 of recovery
32
Q

PNF: Basic Premise

A
  • Synergistic patterns are components of normal movement
  • Emphasis on practices of functional activities
  • Emphasizes diagonal patterns with rotation rather than straight plane movements
  • “True” PNF incorporates specific hand placement; originally developed for neurological conditions
33
Q

Modified Ashworth Scale

A
  • Grades muscle spasticity
  • 0: No increase in muscle tone
  • 1: Slight increase in muscle tone; catch-and-release, or min resistance at end of ROM when affected part moved in flexion/extension
  • 1+: Slight increase in muscle tone; catch, or min resistance throughout remainder (less than half) of ROM
  • 2: More marked increase in muscle tone throughout most of ROM, but affected part easily moved
  • 3: Considerable increase in muscle tone, passive movement difficult
  • 4: Affected part(s) rigid in flexion/extension

10 - Rehabilitation (25 decks)

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