2.2- Neuro Techniques (Bag of tricks)- Lab Lecture Flashcards
Activates joint receptors, facilitates postural extensors and stabilizers
approximation (joint compression)
Apply force through joints by gravity, manual contacts or weight belts, bouncing sitting on a ball
approximation (joint compression)
Indications- instability of extensors in weightbearing, poor postural static control/weakness
approximation (joint compression)
Activates joint receptors, facilitates agonists and joint awareness especially with flexor patterns especially when pulling
joint traction (apply using manual traction)
Movements are guided or actively assisted in some way
- promotes early learning during acquisition of new motor skill
- can be graded according to needs of client
Guided movement (GM)
Indications- inability to move, poor tactile/kinesthetic perception
Guided movement (GM)
Slow isotonic shortening contraction through the range followed by eccentric lengthening contraction using same muscle group
- used with bridging, sit to stand, step up/down
Agonist reversal (ARs)
Indications- weak postural muscles, inability to eccentrically control body weight, poor dynamic postural control
Agonist reversal (ARs)
Isometric holding of agonist followed by antagonist on other side of joint
- resistance applied in any direction
Alternating isometrics (AI) (push on both sides- "Don't let me move you")
Indications- instability in weightbearing, poor static postural control, weakness
Alternating isometrics (AI) (push on both sides- "Don't let me move you")
Voluntary relaxation followed by passive movement through range, then active assistance followed by light facilitory tracking resistance (can be unidirectional or bidirectional)
Rhythmic initiation (RI) (passive to active assisted to resistance)
Indications- inability to relax, hypertonicity, inability to initiate movement, motor learning deficits
(looking for abnormal pattern of movement)
Rhythmic initiation (RI)
Isometric contractions of agonist followed by the antagonist, performed without relaxation using graded resistance resulting in co-contracture of opposing muscle groups
Rhythmic stabilization (RS)
back and forth resistance in position you want them in- push on both sides- “Don’t let me move you”
Best at shoulder girdle, pelvic girdle, trunk
Rhythmic stabilization (RS)
Indications- instability in WB, poor static postural control, weakness
Rhythmic stabilization (RS)
Provides stimulation via quick stretch to the muscle spindle, applied to the muscle belly or tendon
Tapping
Indications- weakness, hypotonia
Tapping
Activates muscle spindles which facilitates agonist contraction and antagonist inhibition
Precaution - may increase spasticity
Quick stretch
- most effective when applied in lengthened range to initiate a voluntary contraction
- actively uses the stretch reflex arc
Quick stretch
Force exerted by the muscle activates spindles and GTOs which enhances muscle contraction by facilitating agonist and inhibiting antagonist, recruits additional motor units and enhances kinesthetic awareness
Resistance
- techniques include manual resistance, body weight/gravity, weights
- can increase spasticity and cause substitution if too much resistance is used
Resistance
Applied to sensitive ares such as the hands as light strokes with fingertips, quick icing, or light pinch/squeeze to elicit withdrawal
Light touch
- patient accommodates rapidly but good to mobilize a low response pt such as TBI
- contraindicated with PT’s who have autonomic instability or are agitated/combative
Light touch
Inhibit abnormal movement and tone or reflexes, also facilitates normal tone and movement patterns
Handling
Indications- inability to move due to spasticity
Handling
- key points of control
- proximal key points (head, trunk, shoulders, pelvis) - used to develop control of proximal segments before working on distal (also help influence ton through entire limb)
- distal key points (hands and feet)
Handling
Handling~
- Head and trunk - flexion decreases ______, trunk and limb _________
- Humerous - _____ and ______ to 90 degrees decreases flexion tone of UE
- Hip - Femoral _____ and _____ decreases extensor adductor ton of LE
- Thumb - ____ and ____ with forearm _____ decreases tone of wrist and fingers
- Head and trunk- flexion decreases shoulder retraction, trunk and limb extension
- Humerous- ER and flexion
- Hip- ER and abduction
- Thumb- ABD and ext with forearm supination
Done at end of limited ROM- isometric contraction at end of range followed by voluntary relaxation and passive movement into new range
Hold-Relax (HR)
(isometric contraction against the clinician’s resistance- contraction of antagonist/tight muscle- stimulates GTO)
Autogenic Inhibition
Indications- Limited ROM due to muscle tightness and spasticity
Hold-Relax (HR) and/or Contract-Relax (CR) and/or Contract-Relax Active Contraction (CRAC)
Isomeric contraction at end of range followed by active contraction into new range (maintains inhibitory effects through reciprocal inhibition)
Hold-Relax Active Contraction (HRAC)
(after isometric contraction of antagonist, pt is instructed to concentrically contract the agonist muscle to move to new range)
Both Autogenic and Reciprocal Inhibition
Isotonic movement in rotation through available range followed by isometric hold at end of range against slowly increasing resistance, then followed by voluntary relaxation and passive movement into the new range
Contract-Relax (CR)
(pt contracts the antagonist concentrically for 10 sec against manually applied resistance)
Autogenic Inhibition
Similar to CR except movement into the new range is active not passive (maintains inhibitory effects via reciprocal inhibition)
Contract-Relax Active Contraction (CRAC)
Voluntary relaxation combined with slow, passive, rhythmic rotation of the body or body part around the longitudinal axis followed by passive range out of the spasm
Rhythmic Rotation (RRo)
(traction of the joint & rotation/wobble at the same time)
Goal: to increase mobility
Indications- hypertonia
Rhythmic rotation (RRo)
Slow and prolonged activates muscles spindles & GTOs to inhibit muscle tone
Prolonged stretch
Includes manual stretch, inhibitive casting, reflex-inhibiting positioning, and mechanical low load weights
Prolonged stretch
Maintained contact or pressure which activates parasympathetic nervous system- causes calming effect and general inhibition and desensitizes skin receptors
Maintained touch
- applied through firm manual contacts, pressure to abdomen, back, palms, or soles of feet, rubbing
- good for highly aroused pts and hypersensitive
Maintained touch
slow stroking applied over the PARAVERTIBRAL SPINAL REGION to cause generalized calming effect
Slow stroking (speed & pressure is key)
- patient is placed in supported position such as prone or sitting with head and arms supported on a table
- use flat hand to apply firm strokes down paraspinals for 3-5 min
- good for highly aroused clients with increased sympathetic (fight or flight) response
Slow stroking
Retain body heat which decreases generalized tone- includes wrapping with Ace or towel, snug clothing, air splints for 10-20 min
- good for high arousal and spasticity
Neutral warmth
