Brunnstrom and NDT Flashcards

Question

Associated Reactions***: | What does Brunnstrom say about it

Answer 1

• We can use the tone/movement created by these abnormal reflexes to facilitate movements in an otherwise flaccid extremity

Answer 2

Commonly elicited when spasticity is present • However occasionally found in pts with little to no spasticity • More pronounced when moving against resistance

Answer 3

Flexion = Flexion Extension = Extension

Answer 4

Flexion = Extension Extension = Flexion

Answer 5

• Movement of affected UE/LE elicits movement of other extremity of affected side in the same direction at the same time * Both UE/LE move into flexion or extension direction * Occurs in patients with spastic hemiplegia

Answer 6

Abd or add of the unaffected LE (just hip) results in the same motion of the affected LE

Answer 7

Abd or add of the unaffected UE results in the same motion of the affected UE

Answer 8

Reflex finger extension when the affected arm is passively flexed past 90° of shoulder flexion

Answer 9

• Another form of an associated reaction • Capitalize on bilateral symmetrical activity ``` • Ask patient to pull back with non-involved arm • Hope to see involved arm move as well • Use of thumb grip or “shake hands” with patient ```

Answer 10

* Present during normal development * Become integrated during infancy/youth * Can reappear after damage to brain

Answer 11

Think as SAATT like a posture "sat" * Symmetrical Tonic Neck Reflex (STNR) * Asymmetrical Tonic Neck Reflex (ATNR) * Tonic Labyrinthine Reflex (TLR) * Asymmetrical Tonic Labyrinthine Reflex (ATLR) * Tonic Lumbar Reflex

Answer 12

"seal stretch posture" • Neck flexion results in • UE Flexion • LE Extension * Neck extension results in * UE Extension * LE Flexion

Answer 13

"Mr. Olympia posture" • Neck rotation (or lateral flexion) results in * Flexion of the “skull” limbs * Extension of the “jaw” limbs

Answer 14

"like a ragdoll" • Head position in space * Supine* * Maximal extension * Prone* * Minimal extension

Answer 15

• Head position in side-lying facilitates * Ceiling side * UE and LE flexion * Floor side * UE and LE Extension

Answer 16

* Receptors in lumbar spine * Trunk Rotation Facilitates: * Extension UE and Flexion LE * Opposite side * Flexion UE and Extension LE * Same side ``` • Tennis Serve: • Body is right rotated • RUE (elbow) flexion, RLE (hip) extension • LUE extension, LLE flexion ```

Answer 17

CVA/TBI • As compared to normal subjects.

Answer 18

interval period between onset of stimulus and onset | of response

Answer 19

how you set a patient up can either increase or decrease a given response • .i.e. with supine with neck flexion will increase LE extensor response (STNR) but we often ask for hip/knee flexion in this position and then wonder why it is so difficult for the patient.

Answer 20

* For reinforcing treatment/particular movement * To create and set up background tension for movement. Gradually wean patient from influence of reflexes • i.e. working on elbow extension

Answer 21

* Head turned to side looking for extension * Head in neutral * Head to opposite side looking for elbow extension

Answer 22

``` • NOT a postural reflex • Quick movement into plantarflexion and inversion causes a reflex dorsiflexion at the ankle and flexion of the hip ```

Answer 23

* To help the patient progress thru the recovery process | * To facilitate as normal and functional movement as possible

Answer 24

* Quick stretch to facilitate response * Manual contact for guidance * Resistance may be used to reinforce a response * Elicit overflow * Proximal to distal * Stronger to weaker

Answer 25

* Contraction Type * Isometric * Eccentric * Isotonic • Easier for Pt with CVA to hold a contraction/position than to have to move it.

Answer 26

• To try and get patient out of abnormal synergy pattern into something more desirable OR • To change it to make it more functional.

Answer 27

``` - In sitting, hold affected elbow - Actively shift weight and facilitate trunk forward and obliquely forward ```

Answer 28

Outcomes Measure to assess recovery of movements after stroke - Incorporates movements from the Brunnstrom’s recovery stages Includes: - Voluntary Movement of the limbs (20 pts for UE, 20 pts for LE) - Basic Mobility (30 pts) - Max score 70; higher score indicates more normal movement

Answer 29

The Bobath Approach • A therapeutic approach to the assessment and management of dysfunction in people with neurological impairments • The ultimate goal: To maximize the person’s functional ability. • Developed to be used primarily with: • Children who have cerebral palsy (CP) • Adults with cerebral vascular accidents (CVA)

Answer 30

• Provide patient with the sensation of normal movement by inhibiting abnormal postural reflex activity

Answer 31

* Alignment * Handling * Placing * Practice

Answer 32

Postural Control ``` • Maintain alignment ex:correct sitting alignment • For the functional task • Vertical relationship between body segments to oppose gravity • Create a stable reference frame for extremities & head. ```

Answer 33

``` A process in which a therapist puts his/her hands on a patient in a specific region (key point of control) to facilitate a targeted movement ```

Answer 34

``` • Observation: • Use your eyes to scan the whole person • Your eyes will also help you to communicate with the patient, so you need to arrange yourself as a handler to give and take feedback visually ``` • YOUR EYES NEVER NEED TO BE WHERE YOUR HANDS ARE.

Answer 35

Dependent on desired movement outcome • Offers patient feedback and element of control. ``` • Handle through: • Muscle: in correct synergies • Bone - to maintain better alignment or disallow movements extraneous to the desired movement outcome. ``` ``` • The choices you make here are directly related to your patient's problems, tendencies in movement as based on those problems. • The key points that you choose should make movement easier! ```

Answer 36

``` • Cover greater amount of body surface • NO Grasping • Elicits counter resistance Move Slowly! ```

Answer 37

``` • Less noxious input • Build input gradually • More natural output • Using • skin receptors for facilitation or inhibition • Joint receptors (approximation) Move Slowly! ```

Answer 38

• Only use manual cues if visual, verbal and all other forms of input are not working or are not enough! • Do not overuse manual cues!!!!

Answer 39

``` • A technique utilized to decrease excessive tone and movement. - Restore normal alignment in the trunk and extremities by lengthening spastic muscles • Stop unwanted movements and associated reactions from occurring • Teach methods for decreasing the abnormal posturing of the arm and leg during task performance. ```

Answer 40

``` • A technique that is utilized to elicit a voluntary muscle contraction. SEQUENCING- • Weight bearing with control precedes non-weight bearing movement without control. • Isometric-eccentric-concentric. -Progression of activity in skeletal muscle that moves from easier to more difficult. ``` • Proximal to distal key points. -To withdraw your feedback or control over the movements in a gradual way • Small ROM to larger ROM of movement with control - Once pt. has control in small movement – increase ROM • Slow to fast movement - Once pt. has control in slow – increase speed

Answer 41

• Specific handling of certain areas of the body ``` • Influence and facilitate posture, alignment, and control. • Shoulder • Pelvis • Hand • Foot/ankle • Toes • Fingers/wrists ```

Answer 42

• Designated static positions that Bobath found to: • Inhibit abnormal tonal influences and reflexes.

Answer 43

shoulder in ER, elbow in extension

Answer 44

hip in abduction, ER, and extension; knee in extension, ankle and toes in DF, great toe in abduction (therapist places finger btwn great toe and second toe)

Answer 45

rotate the shoulder girdle against the | pelvis

Answer 46

``` • The act of moving an extremity into a position that the patient must hold against gravity • Patient must be taken care of 24/7 if carryover is expected • Practice increases retention • Functional • Sensory functional • Sensory-motor experiences ```

Answer 47

``` use trunk righting reaction and protect the affected arm - Head and trunk stay in midline - Hold affected arm by the elbow or the wrist ```

Answer 48

- Maintain trunk elongation - Weight bear through UE as tolerated

Answer 49

``` Sitting (upright posture indicates anti-gravity control) - Upright sitting posture (equal weight bearing) and elongate trunk on the affected side - Sitting balance (use protective extension of arms) - Facilitate trunk control laterally, forward/backward, and rotationally (use arms) ```

Answer 50

- Consider quadruped, but difficult for an elderly person - Consider kneeling, half kneeling - Sit to stand

Answer 51

``` - Ankle, knee, and hip control in bed - Bring the leg into flexion and hold at different angles - Prevent hip adduction and internal rotation ``` - Bridging exercises - Facilitate control of the affected hip - Avoid lifting the trunk too high - Transfer (Mat to Wheelchair) from the affected side - LE control in sitting (both feet on the ground) - Facilitate active knee and ankle control in sitting - Flex the affected knee beyond 90 degrees - Swiss ball exercises (in sitting) to facilitate upright posture - Standing posture (equal weight bearing) - Weight shifting in standing with different base of support and feet positions

Answer 52

- Facilitate affected leg to bear weight - Move the sound leg forward/backward - Standing will cause weight bearing and compression→ will increase the extensor tone of the affected leg - Facilitate pelvic movement (prevent protraction or retraction)

Answer 53

``` - Cue hip extension during mid to terminal stance - Cue may include assist for forward progression of trunk over stance limb ```

Answer 54

- Tap over hip flexor muscle/tendon at | toe off. Timing is important!

Answer 55

``` - Walk backward in front of the patient or behind them - Therapist’s hand should be on ASIS - “Push into my hand” cue given at initial swing ```