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MSK 2 > 3c - TBC Mvmt Control & Path > Flashcards

3c - TBC Mvmt Control & Path Flashcards

1
Q

what is mvmt control and what is it influenced by

A

way in which nervous system controls posture and mvmt to perform given motor task

influenced by:
- available mvmt of passive systems
- available mvmt of active systems
- control/timing of NM system

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2
Q

passive vs active system factors and examples of each

A

passive = no volitional control
- joint
- bone
- cartilage
- ligament
- neural structures

active = volitional, can turn on and off
- contractile structures
- endurance

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3
Q

what are 3 components of NM system control which ultimately impact mvmt control

A

ms activation
acquisition
assimilation

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4
Q

what are the 2 main components of mvmt control schema

A

local mobility
global stability

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5
Q

local mobility vs global stability

A

local mobility:
- lumbar spine and adjacent regions should (I) possess adequate neural and joint mobility and soft tissue compliance

global stability:
- ms of lumbar spine generate isolated activation can be coordinated w various joint mvmts and incorporated into ADLs

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6
Q

mvmt control vs motor control

A

mvmt control DOES NOT EQUAL motor control
- stability part of motor
- motor component of mvmt

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7
Q

what types of structures fall under local mobility and what are 3 examples

A

passive structures
- neural mobility
- joint mobility
- soft tissue

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8
Q

how does neural mobility impact local mobility and how can this be assessed

A

can nerves tolerate mechanical loading
- tension, glide, elongation, angulation

neural tension tests
- slump test, SLR, fem n. tension

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9
Q

how does joint mobility impact local mobility and how can this be assessed

A

does lumbar spine possess proper joint alignment and ability to move freely w/i physiologic limits

PPIVMS, PAIVMS, shear test

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10
Q

how does soft tissue impact local mobility and are examples of these tissues

A

can soft tissue of/around lumbar spine undergo elastic deformation when manual pressure or passive change of joint position are applied

hamstrings, quads, QL, psoas

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11
Q

what is the continuum of components which fall under global stability

A

activation
acquisition
assimilation

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12
Q

what is activation (component of global stability) and what are common examples of deficits in activation

A

ability of individual to generate isolated contraction and/or simple mvmt pattern

TrA, multifidi, scap retractors, breathing pattern

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13
Q

what is acquisition (component of global stability) and what are common examples of deficits in acquisition

A

whether mvmt is dissociated or coordinated between lumbar spine and adjacent regions
- can mvmt be maintained in higher level intensity things

active SLR, active hip ext, active hip ABD

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14
Q

what is assimilation (component of global stability) and what are common examples of deficits in assimilation

A

assesses how newly acquired skills are integrated in ADLs utilizing multiplanar mvmts under dynamic loading condition

squats, lunges, rotational mvmt

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15
Q

what are examples of activation interventions

A

training activation of hypoactive ms or isolated mvmt patterns

ex: ab hollowing, scap retraction, breathing pattern

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16
Q

what are examples of acquisition interventions

A

training to acquire skill of dissociated or coordinating mvmts of lumbar spine and adjacent regions

ex: single plane co-contraction exercises, balance, and coordination exercises

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17
Q

what are examples of assimilation interventions

A

training to assimilate loaded multiplanar mvmts into ADLs

step up/down progression
STS progression
multi-planar progression

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18
Q

is motor control different in those with LBP

A

trunk ms activity
trunk alignment, posture, and mvmt

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19
Q

how is trunk ms activity different in those w LBP, why and what is the problem with this?

A

deeper ms like TrA and multifidi more consistently inhibited
superficial ms inc

when in pain, body adaptively tenses up to protect you
- results that superficial ms are often first to engage since easiest -> creates cycle of not activated deep stabilizing structure

problem bc deep ms line of pull is best for stability w/o too much compression or shear
- superficial ms line of pull is different bc meant to move spine, not stabilize

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20
Q

how is trunk alignment, posture, and mvmt different in people w LBP

A

tend to find larger postural sway

dynamic mvmt tasks are typically performed slower

stronger coupling of thoracic and pelvic mvmts and dec variability of trunk mvmt

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21
Q

what are the 3 main ms targeted for activation interventions

A

TrA
multifidi
pelvic floor

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22
Q

screening vs clinical vs diagnostic assessments for TrA activation

A

screening:
- abdominal draw in supine
- palpation

clinical:
- abdominal drawing in prone w PBU

diagnostic:
- measure of deep ms function w fine wire EMG, real time US

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23
Q

cues for teaching action of TrA and what are considerations

A

relax abs
draw up and in
slow and controlled, hold for 10sec

avoid trunk, pelvis mvmt
dissociate breathing
- count outloud if trouble dissociating

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24
Q

what is the ab draw in test prone w PBU and why doesn’t Mr. Steve like to do this

A

PBU inflated to 70mmHg
breath out and hold
draw in slowly
hold 10sec x10reps
norm: dec of 6-10mmHg

he doesn’t do this much bc he wants them out of activation phase so don’t want to train them in activation phase

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25
Q

what are compensatory patterns for a weak TrA to watch for (7)

A

breath holding
oblique activation
inc rectus ab activity
trunk forward flex
inc WBing thru feet
post pelvic tilt
mvmt of pelvis, trunk, or LEs

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26
Q

how can you tell if there is oblique activation compensating for TrA

A

if ms pops out
- should feel ms flatten and draw out w activation

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27
Q

where is the easiest spot to palpate multifidi

A

off PSIS and move slightly in and up

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28
Q

what is a cue for multifidi activation in prone and what do you look for when palpating multifidi in standing

A

“swell out into my fingers”

activation, activity w mvmt, feedforward mechanism
- can they maintain engagement

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29
Q

most people will have problems actively engaging their multifidi, what is a cue that can help

A

draw in TrA

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30
Q

how can you teach pts to turn on multifidi themselves

A

utilize feed forward mechanism
- have them shift forward, left to right, chop arm up
- have them palpate the ms activation –> after feel the contraction w mvmt, try to have them do an isometric contraction

*don’t let them get frustrated, just try again later

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31
Q

what are cues for pelvic tilts

A

PT place hand under lower back
- have them apply pressure onto hand (post tilt)

have them put their hands on hips in C shape
- passively rock hips back and forth and pay attention to way hands move
—> external cue that can transition from supine to standing

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32
Q

at what point do we determine someone is ready to move on from activation to acquisition

A

once they have achieved TrA, pelvic tilt, and multifidi

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33
Q

what are 6 acquisition interventions

A

active SLR
dead bug w PBU
bent knee fall outs w laser
hooklying flies/OH abs w laser
anti-rotational punch (palloff)
ball sitting

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34
Q

what is the major ms are we targetting in PBU dead bugs in mvmt acquisition

A

psoas
- if unable to dissociate and hip comes up, see lumbar spine enter ext as psoas pulls eccentrically on it

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35
Q

what is a consideration w external cues like a laser being used in mvmt acquisition interventions

A

people get good at compensating
- make sure not drawing in and using rectus

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36
Q

what mvmt acquisition intervention assesses a higher level of endurance and control

A

double leg lower and isometric hold
- can they maintain a neutral pelvis

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37
Q

what are 6 mvmt assimilation interventions

A

HKE
back facing rotation
squatting w pelvic neutral
lunging w pelvic neutral
step ups
jumping

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38
Q

what is the issue w squatting w your chest out

A

stability is coming from passive structures and as a result are putting more stress on them

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39
Q

what is the bridge between TBC mvmt control and functional optimization

A

endurance

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40
Q

what is the bridge between TBC sx modulation and mvmt control

A

mobility

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41
Q

what are components to complete a higher level clinical eval of spinal control

A

lateral ms test
extensor endurance test
flexor endurance test

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42
Q

the the ratio from lateral ms endurance testing isn’t 1:1, what is this a predictor of

A

recurrent back pain

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43
Q

what is the lateral ms endurance test

A

side plank test
pt maintains position as long a possible w proper form

time length should be a 1:1 ratio b/w sides

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44
Q

who is not appropriate for an extensor endurance test

A

someone just out of sx modulation stage or w a lot of pain
- not ready and tissues not ready for it

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45
Q

what is the extensor endurance test

A

prone w lower body on table and torso off table
- pt hold in neutral as long as possible w proper form

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46
Q

what is the flexion endurance test and what is a common compensation seen

A

back is at 60deg from horizontal w hips and knees in 90deg alignment
- pt holds for as long as possible w proper form

ex: excessive flexion of spine

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47
Q

what is the flexion to extensor strength endurance ratio and why

A

flexor:extensor should be <0.75

extensors should be stronger than flexors bc often fighting gravity
- gravity is often on side of flexors w bending over, etc.

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48
Q

what does OPTIMAL stand for in the OPTIMAL Theory of Motor Performance

A

Optimizing
Performance
Through
Intrinsic
Motivation and
Attention for
Learning

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49
Q

what are the common theories for motor performance and what does Mr. Steve have qualms about their use

A

blocked vs random
variable vs constant

factors approach learner as a computer-like processor of info and not taking into account motivational factors

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50
Q

cultural vs social context to behavior

A

cultural:
- norms and stereotypes ab appropriate or expected activities for a certain age, gender, or ethnic group

social:
- motor behavior observable and often performed in public
- the presence of another person may provide reassurance or additional pressure

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51
Q

how does cognitive context impact motor learning

A

can slow or speed
- focus on coordination or intended mvmt effects respectively

52
Q

what are the 3 main things to think about when setting up exercises that will facilitate motivation

A
  1. enhance expectancies
  2. autonomy support
  3. external focus of support
53
Q

what is the concept of enhanced expectancies

A

idea of improving the learner’s forward directed anticipatory or predictive cognitions or beliefs ab what is to occur
- building their confidence and self-efficacy

54
Q

self-efficacy vs confidence

A

confidence
- past successful experiences or lack thereof
- primary theoretical determinant of self-efficacy

self-efficacy
- individual’s situation-specific confidence or prospective sense that he or she will be able to affect actions that bring about task outcomes

55
Q

what are strategies to enhance expectancies in pts

A

positive feedback
challenge them but not too much
- perceived task difficulty
- conceptions of ability
positive affect
extrinsic reward (happy in environment)
self-modeling
social comparative feedback

56
Q

what is autonomy support and what is a strategy to facilitate this

A

allowing individuals to exercise control over environment

give learners choices even if incidental
- existence of inherent reward w exercise of control

57
Q

what pt population will benefit from encouraged autonomy support as a strategy

A

chronic pain

58
Q

external vs internal focus of attention and which is more effective

A

external focus on intended mvmt effect
- ex: on an implement

internal focus on body mvmt
- ex: squeeze your glute ms

59
Q

what is the result of learners adopting an external focus

A

mvmt kinetics start to resemble those typically seen at later stages of learning (experts)

60
Q

what are directions to give to facilitate an external focus of attention

A

instructions directing attention away from one’s body parts or self and to intended mvmt effect

61
Q

age demographic of isolated acute HNP vs disc degeneration

A

isolated acute HNP = younger pts
degen = 40s-50s

62
Q

what are 4 types disc dysfunction seen

A

protrusion (bulge)
herniation/extrusion
- disruption of annular lig / PLL
sequestration (free floating)
derangement
- breakdown of integrity of annulus but no bulging

63
Q

where in the spine are disc prolapses most common

A

L4/5
L5/S1
L3/4

64
Q

what is a consideration of disc prolapses picked up on imaging

A

they can often be asymptomatic

65
Q

how can the location of disc herniation affect the presentation and what are examples

A

post lateral - nerve root
most common

post central (large)
- cauda equina syndrome
- (B) sx

far lateral
- nerve root variations (ie IVF)

66
Q

what is a consideration for a lateral disc herniation impacting the nerve root at the IVF

A

might not see all changes in the LQ scan
- but for true radiculopathy, have to see changes in all

67
Q

what TBC classification categories are disc dysfunction associated with

A

SM: traction/ active rest
SM: direction preference ext
SM: direction preference flex
SM: direction preference lateral shift
mvmt control
functional optimization

68
Q

L3-4 disc (L4 NRCS): strength, sensation, reflexes, pain

A

strength: quads, tib ant
sensation: med first toe, ant-med calf
reflexes: patellar
pain: ant thigh

69
Q

L4-5 disc (L5 NRCS): strength, sensation, reflexes, pain

A

strength: ext of big toe
sensation: lat calf
reflex: none
pain: back of thigh, lat calf

70
Q

L5-S1 disc (S1 NRCS): strength, sensation, reflexes, pain

A

strength: gastroc plantar flex
sensation: lat foot and heel
reflexes: achilles
pain: back of thigh and calf

71
Q

what is spinal stenosis and what is it on the continuum of

A

can be anything that narrows the spinal canal or intervertebral foramen

continuum of DJD/OA

72
Q

why and how can the presentation of spinal stenosis vary

A

if more lateral = nerve root
more central = spinal canal

73
Q

spinal stenosis: demographics

A

> 50yo

74
Q

spinal stenosis: MOI

A

insidious in older individuals (>50yo)

75
Q

spinal stenosis: aggravating factors

A

extension based activity
- walking, standing, standing from a chair

76
Q

spinal stenosis: relieving factors

A

sitting, leaning forward, grocery cart
- similar to flex directional preference

77
Q

spinal stenosis: ROM, joint play

A

limited/painful ext

hypomobile lumbar/thoracic spine
hypomobile fem acetabular joint

78
Q

spinal stenosis: ms strength/control/endurance, flexibility and ms length

A

weak glut max/med
poor pelvic control
poor TrA, multifidi activation

stiff psoas and/or rectus fem

79
Q

spinal stenosis: neuro exam

A

may have myotomal weakness
may have sensory deficits

depends on location of stenosis (lat)

80
Q

spinal stenosis: significant special tests

A

(+) two-stage treadmill test
possible signs of neurogenic claudication
possible signs of NRCS
- dependent on location of stenosis (lat)

81
Q

neurogenic claudication vs vascular claudication

A

neurogenic:
- intermittent pressure on the SC

vascular:
- insufficient blood supply d/t PVD

82
Q

two-stage treadmill test and how can it be used to differentiate

A

begin walking on treadmill normally, record time to sx
rest 5min
walk on treadmill w incline until sx

uphill facilitates lumbar flex
- as you flex opens up foraminal areas
- can walk longer than if PVD on incline
- early onset w no incline significant correlation to spinal stenosis

vascular
- uphill requires more work and more effort placing higher stress load on CV system
- shorter walking time on incline associated w PVD

83
Q

what are the 4 areas of intervention for stenosis

A

pain control
centralization/specific exercise and traction
mobility/manip
conditioning/stabilization

84
Q

what are 6 specific interventions for stenosis

A

traction/joint mobs
flex specific exercise (based on direction preference)
aerobic exercise (bike)
posture (neutral to flex bias)
body mechanics - post pelvic tilt
education on provocative positions

85
Q

what is the prognosis/natural course of stenosis

A

majority do not progress
- this is the stenosis itself, sx can get much better

86
Q

what are medical interventions for stenosis

A

pain control via rest & analgesics
epidural/cortisone injections
surgery
- decompression (ie laminectomy)
- discectomy for lumbar disc prolapse

87
Q

what are surgical indications for spinal stenosis

A

cauda equina syndrome
- (B) leg pain, saddle anesthesia
- urinary retention/incontinence, loss of rectal tone

pain persistent at least 6wks of non-op treatment
- leg pain >back pain at least 12wks
- (+) neuro signs, progressing
- evidence of path corresponding w levels of sx

88
Q

decompression vs laminectomy

A

decompression - shave bone out

laminectomy
- remove lamina and give more room for SC

89
Q

what spinal stenosis surgical procedure had the best outcome and what is the caveat to that

A

discectomy
- faster relief than conservative management

doesn’t appear to be a long term difference, same functional outcomes to conservative care

90
Q

what are 3 common precautions after a spinal stenosis surgical procedure

A

avoid excessive bending, lifting, twisting - 6wks
corset - prevents excessive strain across site
avoid sitting prolonged intervals (compression)

**read the post-op note!

91
Q

what types of exercises might you emphasis post surgery in spinal stenosis

A

flexion biased exercises

92
Q

what are education points for individuals post op for spinal stenosis

A

protect, ms control, body mechanics

93
Q

what TBC categories does spinal stenosis fit into

A

SM: mob/manip
SM: traction / active rest
SM: direction preference flex
mvmt control

94
Q

spondylolysis vs spondylolisthesis

A

spondylolysis
- defect in pars articularis

spondylolisthesis
- ant slippage of vertebra

95
Q

spondylolisthesis: demographics

A

adolescents (women)
gymnasts/ volleyball/swimming - ext based

96
Q

spondylolisthesis: pain patterns

A

pain d/t affected structures
- typically back pain

97
Q

spondylolisthesis: aggravating and relieving factors

A

aggravating:
- jumping (landing), running, twisting, ext motions

relieving: flex biased motions

98
Q

spondylolisthesis: posture

A

excessive lordosis
lumbosacral step

99
Q

spondylolisthesis: joint signs/mobility

A

hypermobile PA
(+) shear

100
Q

spondylolisthesis: muscle function

A

ms imbalance b/w hip flex and ABD

101
Q

what are 4 categories of interventions for spondylolisthesis

A

pain control
centralization / specific exercise and traction
mobility / manipulation
conditioning / stabilization

102
Q

what is a thought about pts w spondylolisthesis in the TBC sx modulation group

A

moves to mvmt control quickly

likely sx as a result of having trouble finding neutral

103
Q

what are specific conservative interventions for spondylolisthesis

A

restore posture and quality of ROM
flex biased exercise (TBC SM DP flex)
stabilization (neutral spine) –> TBC mvmt control
education

104
Q

when are surgical interventions indicated for spondylolisthesis and what are 2 examples of interventions

A

w neural compromise

fusion
decompression

105
Q

what TBC groups do spondylolisthesis fit into

A

mvmt control
SM DP: flex

106
Q

facet dysfunction: demographic

A

age 20-40yo
- all ages possible

107
Q

facet dysfunction: MOI

A

quick twist, SB
- “threw my back out”

108
Q

facet dysfunction: sx description

A

sharp localized pain
may relieve as day goes on
described feelings of stuck

109
Q

facet dysfunction: aggravating factors

A

ext pattern / quadrant
prolonged standing / positions

110
Q

facet dysfunction: relieving factors

A

sitting
flexion
w mvmt

111
Q

facet dysfunction: exam findings

A

+/- list (lateral shift)
para-vertebral tenderness
(+) quadrant / compensated mvmts
(+) unilateral PPIVMS/PAIVMS

112
Q

if someone has facet dysfunction what do you have to decide in order to proceed w interventions

A

if d/t:
- hypomobility
- hypermobility

113
Q

facet dysfunction d/t hypomobility interventions

A

pain control (earlier on if reactive)
mobility/manips - restore ROM
education

114
Q

facet dysfunction d/t hypermobility interventions

A

mobility/manip - restore ROM
conditioning/stabilization
- prevention
- trunk stabilization
- motor control
- aerobic exercise

115
Q

what TBC categories does facet dysfunction fit into

A

SM: manip/mob
SM: traction/active rest
mvmt control
SM DP: lat shift

116
Q

what is the pathophys of spondylosis (DJD, OA)

A

result of new bone formation in areas where structures of spine are sressed

117
Q

typical clinical findings of lumbar spondylosis

A

usually no sx
- usually no findings unless complication ensues

118
Q

spondylosis: subjective demographics and c/o

A

older person
60+ insidious
arthritic complaints
- worse in morning, better w mvmt, worse w too much mvmt

119
Q

spondylosis: exam findings

A

loss ROM ext and ipsi SB and rot
- one side more than the other
(+) joint signs multiple levels

120
Q

spondylosis interventions

A

pain control
mobility/manip
- joint mobs, ROM, flexibility
conditioning/stabilization
- aerobic program
- posture

121
Q

what is hypermobility and what can this lead to

A

loss of spinal stiffness

can result in spondylothesis

122
Q

hypermobility: demographic and pain pattern

A

age <40

recurrent pattern, switches sides, unstable

123
Q

hypermobility: aggravating factors

A

walking
STS
prolonged positions
changing positions

124
Q

hypermobility: (+) exam findings

A

thigh climbing, catch pain thru motion, reverse lumbar lordosis
(+) shear, (+) PA testing, protective spasm
poor ms patterning, dec tone
SLR >91deg
(+) prone instability test
aberrant motion present

125
Q

what TBC category does hypermobility fit in

A

mvmt control
- sx often not severe
- if severe sx, figure out direction preference and then move to mvmt control

MSK 2 (20 decks)

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