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
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
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
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
5
Q
Theory of Rood
A
- Neuromuscular Facilitation/Inhibition
- Proposed using sensory stimuli to facilitate (create) or inhibit (decrease) movement responses
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
7
Q
Activation
A
- Actual production of movement
8
Q
Inhibition
A
- Decreased capacity to initiate movement response
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
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- Once desired response is achieved, stimulus is withdrawn; goal is to integrate into functional activity
11
Q
Facilitation Techniques (9)
A
- Approximation
- Joint compression
- Icing
- Light touch
- Quick stretch
- Resistance
- Tapping
- Vibration
- Brushing
12
Q
Inhibition Techniques (7)
A
- Deep pressure
- Prolonged pressure
- Prolonged stretch
- Warmth (inhibit muscle spasm)
- Prolonged cold
- Carotid reflex
- Traction
13
Q
Light Work
A
- Focuses on extremities
- Develop controlled movement and skilled function by performing activity without resistance
14
Q
Heavy Work
A
- Focuses on strengthening of postural muscles
- Develop stability by performing activity against gravity or resistance
15
Q
Key Patterns (Patterning)
A
- Sequence that directs pt’s mobility recovery from synergy patterns through controlled motion
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
