Biomechanical and Neurodevelopmental FoR

Question 1

Biomechanical FoR

Answer 1

Bio=life, mechanical= life (focused on life and machine of the body) borrows from physics, physiology, and Kines. FoR that focuses on how the body maintains position against gravity, concerned with how children attain and maintain proper posture. Utilized in pediatrics for children who cannot attain/maintain proper posture due to musculoskeletal problems, artificial supports can be utilized to help maintain optimal posture, emphasizes the importance of the proprioceptive sense.

Question 2

Biomechanical FoR assumptions

Answer 2

Motor patterns begin reflexively- when a movement is made, the body receives feedback, and then develops a different movement pattern in response to feedback. This leads to development of motor control. More sophisticated reflexes (righting equilibrium and protective reactions) can assist the individual in transitioning from one position to another. Reactions assist in keeping the body upright against gravity. These reflexes develop sequentially, but in an overlapping predictable manner

Question 3

Biomechanical FoR 2

Answer 3

movement create shifts in the center of gravity that require a compensatory reactions. Dysfunction of musculoskeletal or neuromuscular system interferes with postural reactions. Assessment of reflex development in different positions is critical, use components of normal development (important to review typical reflex and movement development)

Question 4

Neurodevelopmental FoR

Answer 4

Neurological intervention created by Dr. Karol Bobath, for children with cerebral palsy. Based on developmental and neuromaturation theories using a sensorimotor approach. Designed to work with children with damage to the neurological system. Assumes that muscle length and muscle strength can be changed, emphasis on typical vs. atypical movements. Promotion of normal movement patterns is performed, child actively performs goal-directed activities which will lead to improved movements for functional activities. (top-up approach, employs an stables restore type of intervention)

Question 5

NDT FoR 2

Answer 5

Concerned with (reach and grasp, planes of movement, alignment of the body, ROM, base of support, muscle strength, postural control, weight shift/weight bearing, mobility) Problems with CNS that can be treated with NDT (atypical muscle tone- spasticity, dystonia, ataxia, rigidity, hypotonia, impaired anticipatory control, poverty of movement, lack of dissociated movements, sensory processing impairments, secondary impairments, impaired muscle synergies, impaired muscle activation, insufficient force generation)

Question 6

Spasticity

Answer 6

hypertonus caused by tonic stretch, muscle contractions, and abnormal movement patterns

Question 7

Dystonia

Answer 7

a movement disorder in which involuntary sustained or intermittent muscle contraction resulting in twisting, repetitive movements or both.

Question 8

ataxia

Answer 8

lack of coordination during voluntary movements (child movements look very jerky or over exaggerated- often looks like the child can easily fall and usually does)

Question 9

rigidity

Answer 9

a type of hypertonia characterized by a resistance to externally imposed joint movements that occur at low speeds (usually takes increase effort in time for a child with rigid time to relax or move throughout the environment)

Question 10

hypotonia

Answer 10

diminished resting muscle tension and decreased ability to generate voluntary muscle force leading to postural instability and excessive flexibility (appear very floppy and have a difficult time to attaining correct postural positions and is quite frequent that they show hypotonia in the trunk with hypertenicty in UEs especially during voluntary movements)

Question 11

impaired muscular activation

Answer 11

both appropriate muscles and inappropriate muscles are activated. This over co-contraction can lead to increased stability and motor control of a joint and limit the degrees of freedom. This is an inefficient manner that can lead to fatigue (the correct muscles do not activate properly and incorrect muscles may activate)

Question 12

impaired muscle synergies

Answer 12

muscle synergy patterns emerge to develop more efficient ways of performing motor tasks. Children with impaired motor synergies use inefficient and ineffective muscle synergies to perform a task.

Question 13

impaired timing, sequence and ability to grade muscle force

Answer 13

Timing, sequencing, and the ability to grade the correct amount of pressure are essential components of motor control and performance. (children that are lacking in these skills often experience difficulty with motor control and grading of how much force they apply)

Question 14

overflow of limb contractions

Answer 14

oftentimes children with CNS impairment may utilize more muscle groups than needed to perform a task. This overflow may lead to problems especially when a child attempt to self-initiate.

Question 15

insufficient force generation

Answer 15

weakness related to in inability to generate a sufficient force in muscle for a purpose of posture and movement. This might result in a child not having enough strength to pull apart toys, pull out a chair for him/herself

Question 16

impaired anticipatory control

Answer 16

anticipatory control is the ability of the muscles to perceive how to reach to a force being placed upon it before the force is loaded (someone who hands you a very heavy book and your muscles prepare to accept the load)

Question 17

poverty of movement

Answer 17

refers to a overall decrease in movement due to CNS or musculoskeletal impairments ( a 2 year old may not be able to roll from supine and thus not able to explore the environment)

Question 18

loss of dissociated movements

Answer 18

decreased ability to produce efficient movements where there is rotation of one part of the body on another part. (baby who hasn’t integrated the body on body reflex will have to roll with the whole body and will have difficulties transitioning from supine to prone, to crawling, to pulling to a stand, and eventually walking)

Question 19

sensory process impairments

Answer 19

impairments with SP can lead to difficulty interpreting information correctly and thus the child may produce incorrect or inappropriate motoric responses.

Question 20

secondary impairments to CNS or musculoskeletal systems

Answer 20

these may occur indirectly from the primary motor impairment or environmental

Question 21

NDT FoR to Peds

Answer 21

many childhood diagnoses involve some type of CNS impairment which limits participation and engagement in childhood occupations, a therapist that understands typical motor development can better evaluate and plan intervention for children with atypical development. NDT provides a framework for structuring intervention to improve functional performance by reducing the dysfunction caused by a typical movement patterns. NDT intervention will involve: handling, preparation and facilitation, integration of activities, positioning) NDT wants to see improve quality of movement and more normal movement patterns

Question 22

Goals of NDT FoR

Answer 22

decrease abnormal tone, increase normal tone and equilibrium reactions, handling techniques to improve function, prevent contractors and deformities. Treatment principles (elongation- use stretching to increase muscle length, ROM, dissociation, rotation) Inhibition abnormal tone/facilitation normal tone, weight bearing- learning and placing body weight through the upper or lower extremities, weight shifting- activated when there is unilateral weight bearing through one arm or one LE in reaching or grasping with the other arm, handling- proximal stability leads to distal manipulation, key points of control (pelvis to help guide the client through various movements)