Biomechanical Limitations

Question 1

Contraindications for stretching

Answer 1

bony block
recent #
acute inflammatory process of the joint 
sharp or acute joint pain
hematoma or tissue trauma
contracture or soft tissue is providing stability to area or function (ex tenodesis grip)

Question 2

PNF indications

Answer 2

increase ROM and strength in multi-joint/muscle involvement, used to ax abnormal movement patterns

Question 3

PNF D1

Answer 3

• shoulder ER (consider feeding, upper cut) - IR with elbow extension
• hip IR - ER (cross leg/kick ball)

Question 4

PNF D2

Answer 4

• shoulder ER- IR (reach and pick apple and then put in bag)

- hip IR- ER (fire hydrant)

Question 5

Can you add resistance to PNFs?

Answer 5

yes

Question 6

Why would you add quick stretch at the beginning of a PNF movement

Answer 6

to elicit contraction of a weak muscle

Question 7

What are PNF Contraindications

Answer 7

The same as resistance exercises

Question 8

PNF Precautions

Answer 8

avoid quick stretch on hypertonic muscles
gentle stretch and care on hypotonic muscles
care to not promote invariant movement patterns
watch for substitution

Question 9

What are UE and LE flexor synergies

Answer 9

UE = flexion of elbow, ER and ABD of shoulder, flex of wrist

LE = hip flex, knee flex, DF and INV of foot

Question 10

What are UE and LE extensor synergies

Answer 10

UE = shoulder adducts and internally rotates, elbow extends and pronates, wrist extends

LE = hip extends and internally rotates, knee extends, ankle PF and inverts

Question 11

What is muscle tone

Answer 11

Resistance force in response to lengthening (stiffness), a continuum

Question 12

Does tone occur from neural or non-neural factors

Answer 12

both

Question 13

What causes non-neural ton

Answer 13

muscle length
thixotrophy (extra CT between muscles)
CT and muscle fiber changes
immobilization
weakness
abnormal postures
abnormal movement patterns

Question 14

What causes neural tone

Answer 14

Inc. input to alpha motor neuron
emotion, fear
pain
infection
full bladder
altered excitability of alpha motor neurons
loss of functioning motor units
altered motor unit firing rate
Loss of orderly recruitment
impaired motor unit synchronization (inappropriate co- contraction of agonist/antagonist

Question 15

What is spasticity

Answer 15

Velocity dependent increase in resistance to passive stretch

Question 16

What is rigidity?

When do you normally see rigidity

Answer 16

• velocity independent resistance to passive stretch

- usually seen with a head injury (decorticate or decerebrate rigidity)

Question 17

LMN Lesions

• Hypotonia or Hypertonia?
• Hyporeflexia or hyperreflexia?

Answer 17

Hypotonia

Hyporeflexia

Question 18

UMN Lesions

• Hypotonia or Hypertonia?
• Hyporeflexia or hyperreflexia?

Answer 18

hypotonia and hyperreflexia
OR
hypertonia and hypereflexia

Question 19

Tone + Spasticity assessment

Answer 19

modified Ashworth scale: 0=5 scale

ask them to AROM, feel muscle, then PROM, then PROM with quick stretch, then reflexes DT and long tract

Question 20

What are exaggerated proprioceptive reflexes

Answer 20

Clonus, tendon jerk, and pendulum test

Question 21

What are exaggerated cutaneous reflexes

Answer 21

• touch to palmar and plantar surfaces

- Babinski response

Question 22

Tone and spasticity treatment

Answer 22

• postural control
• prevent and treat biomechanical limitations (positioning, ROM, mobility, etc.)
• promote strength, endurance, and coordination
• maintain extensibility/PROM
• address potential factors contributing to tone (agitation, motivation, pain, infection, full bladder)
• provide sustained pressure on tendons
• referral to health care team (meds, Botox, etc.)

Question 23

Treatment for clonus

Answer 23

teach them to contract the muscle with the clonus then relax

Question 24

Treatment for cutaneous hyperreflexia

Answer 24

Desensitize, promote active movements within limits of individual’s capacity, strap legs when in wheelchair to prevent falling