Before Midterm Flashcards
What type of practice is this: Pt types for 15 minutes then rests for 2 minutes
massed
What type of practice is this: pt practices grasp of multiple types of objects cup, water, pitcher, spoon in one OT session
random
What type of practice is this: Pt performs entire bathing routine during morning ADL session
whole
What type of practice is this: pt cuts vegetables for 5 minutes and rests for 10
distributed
What is the systems model of motor control?
the interactions between a person and their environment. Suggests that a persons motor behavior emerges from a persons’ multiple systems interacting with unique tasks and environmental contexts.
What is the ecological approach to perception and action?
“emphasizes the study of interaction between the person and the environment during everyday, functional tasks and the close linkage between perception and action (i.e., purposeful movement).”
What is dynamical system theory?
Dynamical systems theory proposes that behaviors emerge from the interaction of many systems and subsystems. Because the behavior is not specified but is emergent, it is considered to be self-organizing.
What are phase shifts in the theory of dynamic systems?
transitions in behavior during times of instability (ex. stroke)
What is the systems view of motor development?
changes over time are caused by multiple factors or systems such as maturation of the nervous system, biomechanical constraints and resources, and the impact of the physical and social environment.
Neuro Developmental Treatment NDT
To help pts be able to use their postural control with as little compensation as possible. help them reach more normal functional motor motion.
Historical significance to ROOD
Margaret Rood. wanted to make the theory more purposeful and meaningful activity.
Augmented feedback:
information about task performance that is fed back to the patient by artificial means; sometimes called extrinsic feedback.
Blocked practice:
a practice schedule in which many trials on a single task are practiced consecutively and uninterrupted by practice of other tasks.
Continuous task:
a task in which the action is performed without a recognizable beginning or end.
Discrete task:
a task that has a recognizable beginning and end.
Distributed practice:
a practice schedule in which the duration of rest between practice trials is equal to or greater than the time spent in practice.
External focus of attention:
attention directed outside the body to an object or environmental goal.
Inherent feedback:
information that is normally received during performance of a task; sometimes called intrinsic feedback.
Internal focus of attention:
attention directed to locations inside the body (e.g., motor or sensory information).
Knowledge of performance (KP):
augmented feedback about the nature of performance (movement patterns).
Knowledge of results (KR):
augmented feedback about the outcome of the performance with respect to the task goal.
Massed practice:
a practice schedule in which the amount of rest between practice trials is relatively short, often less than the length of the practice trial.
Serial task:
a task consisting of several discrete tasks strung together to make a whole; order of the actions is usually critical for successful performance.
Task-oriented approaches assume that
people learn or relearn motor skills by actively attempting to solve motor problems during the performance of functional tasks.
Motor learning is defined as:
“a set of processes associated with practice or experience leading to relatively permanent changes in the capability for skilled movement.”
Reflex theory for motor control
stimulus response view of motor theory. Complex patterns of movement are the result of combining individual reflexes.
hierarchical theory for motor control
Top–down organizational control of movement with higher levels always exerting full control over lower levels
motor programming theory for motor control
Central motor program contains the “rules” for generating an action. Program can be activated by sensory input or by central processes.
system theory for motor control
Describes the body as a mechanical system that is subject to both external (e.g., gravity) and internal forces (e.g., inertial forces) Self-organization: movement emerges from an interaction of multiple systems—no need for “higher centers” or “central motor program”
Nonlinearity: motor output is not proportional to input—variability expected and needed in the system Control parameters: a variable that regulates a change in behavior (e.g., velocity may be considered the control parameter that shifts the action of walking to running) Attractor states: preferred patterns of movements that are highly stable Attractor wells: the degree of flexibility to change an attractor state: shallow well—unstable pattern that is easy to change; deep well—stable pattern that is difficult to change
ecological theory for motor control
Motor control evolved so that animals can cope with their environment: perception–action coupling. Gibson’s theory of affordances—perception of environmental factors that are critical to the task
Schmidt’s schema theory for motor learning
Draws heavily on motor programming theory of motor control Emphasize on open-loop control processes and the development of the generalized motor program (GMP), which contains the rules for creating the pattern of muscle activity needed to perform the movement After a movement is made, there are four elements available for short-term memory storage: (1) initial movement conditions, (2) parameters used in the GMP, (3) outcome of the movement (knowledge of results), and (4) sensory consequences of the movement (knowledge of performance). This information is stored as two schemas: recall schema (motor) and recognition schema (sensory). Recall schema is used to select a specific set of responses and the response schema is used to evaluate the responses.
Learning occurs as a result of the updating of the two schemas each time a movement is attempted, and it is augmented by the amount of practice and variability of practice.
ecological theory for motor learning
During practice, there is a search for optimal strategy to solve the task problem—search for most salient perceptual cues and optimal motor response.
Fits and Posners 3 stage model for motor learning
Cognitive stage: learner is figuring out what is to be done; determining appropriate strategies to complete the task. Effective strategies are maintained and ineffective ones are discarded. Performance is variable, but improvements are large. High cognitive demands are placed on the learner. The therapist uses instructions, models, feedback, etc., to assist in learning the task at hand.
Associative stage: learner determines the best strategy for the task and is now refining it. Performance is less variable and improvements are slower. Cognitive demands decrease.
Autonomous stage: skill is performed automatically requiring little attention.
Bernstein’s three-stage model for motor learning
Draws heavily on the systems theory of motor control and solving the degrees of freedom problem
Stage 1: reduction in the number of degrees of freedom that must be controlled—learner will constrain the degrees of freedom and develop an effective strategy for task performance, but the strategy is not energy-efficient or flexible. Stage 2: release of additional degrees of freedom and muscle synergies are used across multiple joints resulting in well-coordinated movement that is more efficient and flexible. Stage 3: release of all the degrees of freedom needed for task performance; performer has learned to exploit external and internal forces acting on the system to produce the most coordinated and efficient movement pattern.
Gentile’s two-stage model learning
Initial stage: learner develops an understanding of the task and generates a movement pattern that
enables some degree of success; key element of this stage is learning to discriminate between regulatory features (characteristic of environment that determine movement requirements) and nonregulatory features in the environment; high cognitive load. Later stage: (aka: fixation/diversification) learner is refining the movement so that it can be performed to meet the demands of any situation, and so that it is performed consistently and efficiently. Closed tasks: environmental conditions are stable and little variability is needed—fixation. Open tasks: environmental conditions are changing requiring multiple movement patterns—diversification.
OPTIMAL (optimizing performance through intrinsic motivation and attention for motor theory)
Goal-action coupling: learning is associated with structural brain changes and task-specific neural connections across brain regions (functional connectivity). Evidence demonstrates strong motivational and attentional focus influences motor performance and learning—enhances goal-action coupling. Key motivational variables include enhanced expectancies for future performance (need high expectancies of success) and learner autonomy (choices and a sense of control). External focus of attention (concentration on task goal) is critical during practice.
what is irradiation
allow the stronger muscles in a functional pattern to influence the weaker ones.
in PNF all patterns have a
reversing pattern
What is the continuum of care for PNF
ROM, stability, controlled movement
slow rolling of hips and pelvis helps to
reduce tone
what is sensory motor control
is vibration used for low tone or high tone?
typically it is for someone with low tone.
how do you balance agonist with antagonist muscles?
Here in lies the problem solving
Rood approaches
has a combination of balance control within a movement pattern. used in the context of ADLs and functional activities.
Rood deals heavily with
sensory
NDT deals heavily with
postural shifts and core strength for functional movement and balance. It’s a hands on approach to help enhance movement
Rood pioneered what key concepts?
The use of a frame of reference to guide practice
meaningful activities to promote motor function
importance of repetition
deep connection between sensory system and skilled movement
therapeutic use of self
that therpists can influence the variable that effect tone
Stability, mobility, postural control and skill
What the key concepts pioneered by Brunnstrom
Motor return is proximal to distal
Progress goes through stages and can stall at any stage
Flexion comes back first of primitive movement patterns then extension
Gross motor comes back first then selective fine motor
Stages may overlap
Movement patterns are practiced within the context of daily activities
PNF contraindication
crepidis of the shoulder.
Ways to facilitate muscle tone:
brief rapid icing, high frequency vibration, fast stroking over skin, joint approximation
Ways to inhibit muscle tone:
Prolonged ice, low frequency vibration, slow stroking over the skin
coordination disorders that are hyperkinetic
ataxia, hemiballismus, chorea, tremor, tics
coordination disorders that are hypokinetic
Bradykinesia, parkinsons
ataxia
without motor control
hemiballismus
intermittent, sudden, violent, involuntary, flinging, or ballistic high amplitude movements
what is bradykinesia
slowness of movement
What are some motor interventions to help ataxia
static balance (e.g., standing on one leg) dynamic balance (e.g., sidesteps, climbing stairs) whole-body movements to train trunk–limb coordination steps to prevent falling and falling strategies, movements to treat or prevent contracture
Different presentation of MS and what they mean
Primary progressive
relapsing remitting
__________________
relapse remitting
most new cases. Mostly stable, periods of relapse followed by remission where improvement occurs
secondary progressive
Initial relapse remitting that converts to slow, steady decline without periods of remission
primary progressive
when diagnosed later in life. continuous worsening in disease symptoms. disability without exacerbation.
How would you assess a pt with MS
visual screens, sensory assessment if it’s indicated after asking, upper quarter screen, fine motor (9hole peg), MMT, hand strength (grip and pinch), cognition (informal or cognitive assessment - Mini-mental or moca), ADLs and IADLs
Name some interventions for MS
Mobile arm support (for feeding, oral care etc.), weighted items (vest, cups, utensils), core strengthening with core like you would with Rood and NDT, positioning strategies (elbow on table),
What do interventions for MS depend on
settings
for MS weight helps to even out ________
ataxia
What are barriers for people with MS
heat and fatigue
what are some kitchen strategies for MS
rocker knife, weight spoon, curved plate edges. heavier cookware.
Parkinsons is generally diagnosed
later in life but some poeple are diagnosed early 30’s
cardinal signs of parkinsons
resting tremor
rigidity of trunk, arm, legs (typically posture is pitched forward), bradykinesia or slowed movements
secondary parkinsons symptoms
retropulsion - tendency to fall backwards
micrographia - small cramped handwriting
hypophonia - loss of volune of speech or muffled voice
-masked facial expressions,
-freezing or being stuck when trying to walk
-shuffled gait
-postural instability
-automatic reflexes impaired.
Acquired Brain Injury (ABI)
Head injury that can include traumatic and non-traumatic injuries caused by cardiovascular defects, tumors, substance abuse, environmental exposure, anoxia, bacteria, viruses, nutritional deficiencies, genetic, congenial and degenerative diseases
Agitation:
excessive behavior including aried degrees of aggression,, disinhibition, restlessness, and confusion. person may present in an altered state of consciousness.
Concussion.
A type of TBI usually caused by a blow to the head, usually reported in sports activities. may cause headaches problems with concentration, memory, balance and coordination.
Diffuse axonal injury
Extensive lesions in white matter tracts over a widespread area following traumatic acceleration / deceleration or rotational injuries. usually results in loss of consciousness and could result in persistent vegetative state after severe head trauma
Disorder of consciousness (DOC)
a state of reduced wakeful ness and awareness due to brain damage
Mid brain injury
A traumatically induced physiological disruption of brain function, as manifested by at least one of the following: 1. loss of consciousness, 2. any loss of memory before or after trauma, 3. Any alteration in mental state. 4.
Moderate brain injury
a brain injury resulting in a loss of consciousness from 20 minutes to 6 hrs and a GCS of 9-12. or 1-24 hrs of unconsciousness
Severe brain injury
a brain injury resulting in a loss of consciousness or coma for more than 24hrs. Post traumatic amnesia for more than 24hrs.
Spasticity
A continuous state of muscular contraction that if left untreated can limit muscle and joint motion
traumatic brain injury
a form of ABI following an external trauma to the head; a TBI occurs when the head suddenly and violently hits an object or when an object pierces the skull and enters brain tissue.
What is an open brain injury
When something enters the cranial cavity
What is a closed brain injury
direct or indirect impact
A dynamic loading injury occurs when
rapid acceleration and deceleration of the brain
Static load injury
also known as a crush injury. Slow mechanical force is applied to the brain.
Focal brain injury
result from brain contusions, lacerations and hematomas. typically seen at anterior poles and inferior surfaces of the frontal and temporal lobes. occurs when the brain hits the skull and scrapes over the bony structures.
Diffuse injuries
rapid movements of the head, when brain accelerates and decelerates and rotates inside the skull.
Focal brain damage to the prefrontal and anterior cause issues with
memory, emotion and drive.
Focal brain damage to the orbitalfrontal areas can cause
hemiparesis, impulsivity and attention impairments as well and decreased mental flexibility
What happens to the brainstem in diffuse injuries (back and forth)
cerebrum rotates around the brainstem which places stretch or shear force on the long axons that transmit information throughout the brain and brainstem.
in severe TBI cases it is typical to find diffuse or focal damage?
both
After a coma from TBI that causes axonal injury, what are some symptoms
foggy, diminished mental processing speed, Post traumatic amnesia, difficulty with divided attention, memory loss, impulsivity, irritability and exaggerated premorbid traits to apathy and poor initiative.
cranial nerve damage associated with brain injury symtoms
cranial nerves can be torn, stretched or contused.
loss of function associated with that nerve.
what is stage II brain tumor
the cancer has grown but hasn’t spread
What is a stage 0 & 1 brain tumor
at it’s original origin, small and hasn’t spread
What is stage III brain tumor
The cancer is larger and may have spread to surrounding tissues
what is stage IV brain tumor
secondary or metastatic. Has spread to another body organ.
what is a benign brain tumor
small, slow growing and does not spread to other organs
primary brain tumors ______
originate in the brain
secondary brain tumors
originate as cancer in another part of the body
Grade I tumor
considered benign and grow at a slower rate
Grade II tumor
slow growing and are less likely to spread. relapse and recurrance can happen
Grade III tumor
cancerous tumors and tend to spread to other parts of the brain
Grade IV brain tumor
most malignant tumors. They grow and spread most rapidly. response to treatment is minimal.
Attention
The ability to direct mental processes toward information
Cognition
the mental action or process of acquired knowledge and understanding through thought
Executive functions
The cognitive skills required for high level thinking
Immediate recall / sensory register
The cognitive ability to recall information without any lapse in time from processing
Long term memory
the cognitive ability to recall infromation that is stored somewhat permanantly
Memory
the mental storage of information and the processing involved
Orientation
The cognitive ability to understand ones self and ones surroundings
processing
The cognitive ability to quickly and accurately decode elements of information into meaningful terms
self awareness
the cogntive ability to know ones own capacity, skills, limitations and level of function
Working memory
The cognitive ability to use information that is currently held in mind
Cognitive abilities are conceptualized in a hierarchy with
arousal, orientation, attention, and processing at the base, the varied types of memory next, and executive functions and self-awareness at the top of the hierarchy
Automaticity
initiation and execution of a behavior with minimal conscious decision-making in response to a stimulus; when a behavior is automatic conscious effort is required if the response is to be inhibited.
Chaining
a method for training task performance in which tasks are broken down into component steps; a functional task can be thought of as a stimulus–response chain in which the completion of each activity acts as the stimulus for the next step in the chain.
Cognitive Rehabilitation
a wide range of therapeutic interventions designed to address neurocognitive impairment in one or more cognitive domain (e.g., attention, memory, or executive functions) and as a result to improve an individual’s functioning in everyday life.
Compensatory cognitive strategies:
tools or methods that are used by clients to help them overcome, circumvent, or minimize the load placed on an impaired cognitive domain, such as using alarm prompts on a smartphone to keep track of time-critical activities.
Errorless learnings
a method of learning in which errors are prevented and sufficient cueing is provided to achieve correct performance on each occasion a task is practiced.
Functional Cognition
how people use and integrate their thinking and processing skills to perform everyday activities in clinical and community settings.
Metacognition strategy instruction
direct instruction to teach clients to regulate their own behavior by using internal thinking procedures that are applicable to many realms of everyday functioning such as specifying goals, breaking tasks into steps, self-monitoring, modifying behavior if upon reflection, the goal is not met.
Post traumatic Amnesia
the period following trauma in which the acquisition of new declarative knowledge is severely impaired; PTA is said to be resolved when continuous memory for ongoing events is restored.
Press
Aspects of the person’s physical or or social environment that influence the challenge of an activity (activity demand); reducing the press can make an activity easier to perform.
Routines
semiautomatic sequences of activities that are prompted by physical context and are fairly consistent for each individual on a day-to-day basis (e.g., a person’s morning activities of daily living [ADL] routine).
Self awareness
the ability to perceive one’s strengths weaknesses, and vulnerabilities with relative objectivity
Someone who is considered coma might present with
Eyes do not open
cannot follow commands
does not mout or uter words
lack of intentiaonl movement
cannot sustain visual persuit
Some who is in a vegetative state
chronic condition, basic arousal and life sustaining.
absence of meaningingful interaction with environment
Minimally responsive
responses are inconsistant . no longer vegetative or comatose
treatment for comatose
positioning
PROM
Splinting
Cognitive Stimulation
manage agitation leve IV
family education
Apraxia
absense of motor planning ability. lack of purposeful, skillful movement
Dyspraxia
impaired motor planning
ideational apraxia
loss of ability to conceptualize, plan & perform the sequence of steps in tool use or common objects of daily life
ideomotro apraxia
pt understands the idea or purpose but their movement and planning is impaired. movements look clumbsy.
Assessment for apraxia
asking patients to do certain gestures.
Patients with global aphasia have greater incidence of
apraxia
25% of patients with left brain impairment have
apraxia
Strong association between expressive aphasia &
ideomotor apraxia
The # of errors made during B & IADL’s is predictive of the severity of
the apraxia
Those with ideomotor apraxia have > dependence in
toileting, dressing & bathing compared to age matched controls
Apraxia severity is moderately predictive of
meal prep competency
The absence of apraxia is a significant predictor of the ability to
return to work
Learning new skills and relearning old skills in those with apraxia requires more
repetition
Agnosia
Inability to recognize incoming sensory information; sensory reception is intact.
Loss of ability to recognize objects, people, sounds and shapes
Tends to be single sensory modality specific
less common dx
different types of agnosia
object agnosia
posopagnosia - poor face recognition
simultanagnosia - inability to recognize whole visual scenes
alexia - inability to recognize letters or words
astereognosia
inability to recognize objects tactile
agnosia assessment
Test of exclusion of other issues
Rule out sensory & memory loss, inattention, language deficit, or dementia
Encourage object identification through alternative sensory system
If more than 1 sensory modality is involved, it is most likely NOT
agnosia
Visual discrimination deficits
Depth perception (stereopsis) – 3-d understanding of objects
Figure ground – foreground from background distinction
Spatial relations – relationship of objects to each other and self
PNF
The term Proprioceptive Neuromuscular Facilitation (PNF), in its literal sense, means techniques that use an awareness of body position and movement, through specific commands and cues directed at muscles and nerves, to help a client achieve new movement patterns. PNF is a useful tool to assist with both the assessment and intervention for clients with orthopedic or neurological diagnoses, which lead to movement problems.
The clinician using PNF employs a multisensory approach:
Visual: Vision assists in initiation and coordination of patterns of movement. Auditory: Tone of voice and specific verbal commands. A calm, quiet voice may soothe; whereas a loud, direct tone may excite. Tactile: Manual contacts and client’s own touch provide tactile stimulation for movement. The facilitation of specific movement patterns provides consistent proprioceptive input to improve functional movement patterns for each client.
what are examples of PNF techniques for strengthening
Rhythmic initiation: Cue “relax and let me move you” passive range of motion (PROM) repeat movement active assisted range of motion (AAROM) several times, then cue “Now you do it.” Active range of motion (AROM)32 Repeated contraction Slow reversal: The reverse of the diagonal movement. If D1 flexion is desired movement, reversal is D1 extension. Slow reversal hold Rhythmic stabilization: mid-range isometric contraction of the agonist followed by an isometric antagonist (co-contraction). No movement occurs. Effective for static strengthening and for clients with pain
Examples of PNF Techniques for Stretching
Contract relax
Hold relax
NDT was started by
Bobath
Stages of motor learning
Autonomous, associate and cognitive
What is Fitts and Posners Cognitive stage?
Cognitive stage: learner is figuring out what is to be done; determining appropriate strategies to complete the task. Effective strategies are maintained and ineffective ones are discarded. Performance is variable, but improvements are large. High cognitive demands are placed on the learner. The therapist uses instructions, models, feedback, etc.,
What is Fitt’s and Posner’s Associative stage:
learner determines the best strategy for the task and is now refining it. Performance is less variable and improvements are slower. Cognitive demands decrease.
What is Fitt’s and Posner’s Autonomous stage:
skill is performed automatically requiring little attention.
