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ATTH 3130 > Chapter 6: Neuromuscular Control > Flashcards

Chapter 6: Neuromuscular Control Flashcards

1
Q

Define neuromuscular control:

A

The efferent (motor) response to sensory information

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2
Q

Name the 3 sources of sensory information that are essental for producing adequate muscle activity and dynamic joint stability.

A
  • proprioception
  • kinesthesia
  • force sense
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3
Q

Define proprioception

A

Conscious and unconscious appreciation of joint position

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4
Q

Define kinesthesia

A

The sensation of joint motion or acceleration

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5
Q

Define force sence

A
  • perception of force

- ability to estimate joint and musculotendinous loads

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6
Q

Conscious awareness of joint motion, position, and force is essential for….

A
  • otor learning

- anticipation of movements

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7
Q

Unconscious proprioception modulates ______ function and initiates _____ ______ stabilization.

A
  • muscle

- reflexive joint

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8
Q

Neuromuscular control encompasses _____ output that is responsible for producing ______ and providing _____ _____ stability and _____ stability.

A
  • motor
  • movement
  • dynamic joint
  • postural
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9
Q

What are the 2 motor control mechanisms that are involved with interpreting afferent information and coordinating efferent responses?

A
  • feedforward

- feedback

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10
Q

Define feedforward neuromuscular control.

A

Planning movements based on “real-time” sensory information that is integrted with learned somatosensory patterns from past experiences.

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11
Q

Define feedback neuromuscular control.

A

Continuous regulation of muscle acitivity through reflex pathways.

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12
Q

Feedforward mechanisms are responsible for what type of muscle activity? What about feedback processes?

A
  • preparatory muscle activity

- reactive/reflexive muscle activity

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13
Q

Dynamic restraint is achived through _____ and _____ neuromuscular control.

A
  • preparatory

- reflexive

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14
Q

Muscle activity enhances dynamic joint stability by:

A
  • increasing joint congruency
  • providing eccentric absorption of external forces applied to the body
  • increasing muscle stiffness
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15
Q

Many joint (eg. ______ and _____) possess limited bony congruency and are, therefore, reliant on ____ _____ to limit loading of passive _______ structures.

A
  • GH and tibiofemoral
  • muscle activation
  • capsuloligamentous
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16
Q

An enhancement in joint stability can be achieved via muscle activity by…

A
  • Increasing compressive force across the joint
  • increasing joint contact area
  • limit loading of passive tissues by providing eccentirc absorption
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17
Q

The level of muscle activation, whether it is preparatory or reactive, reatly modifies the muscle’s ______ _____.

A

Stiffness properties

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18
Q

From a mechanical perspective, muscle stiffness refers to…

A

The ratio of the change of force to the change in length

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19
Q

Muscles that are stiffer resist lengthening more ______ and provide more effective _____ ______ to joint pertubation.

A
  • effectively

- dynamic restraint

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20
Q

Muscle stiffness generated by _____ neuromuscular activity prior to joint loading is one of the most mechanisms for _____ _____ of joints. However, high levels of muscle stiffness would restrict the _____ joint motions necessary.

A
  • feedforward
  • dynamic restrant
  • fast
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21
Q

The objective of neuromuscular control activities is to…

A

Refocus the patient’s awareness of peripheral sensations and process these signals into more coordinated motor strategies.

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22
Q

Neuromuscular control muscle activity serves to protect joint structures from excessive _____ and provides a ______ mechanism to reccurent injury.

A
  • strain

- prophylactic

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23
Q

Peripheral mechanoreceptors within _____ and ______ structures mediate neuromuscular control by conveying joint motion and position sense to the ______.

A
  • articular
  • tensomuscular
  • CNS
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24
Q

Injury to articular structures results not only in a mechanical disturbance that manifests a joint laxity, but also in …

A

A loss of joint sensation

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25
Q

Define deafferentation.

A
  • Damage to microscopic nerves arising from peripheral mechanoreceptors within articular structures.
  • disruption of sensory feedback necessary for effective neuromuscular control and joint stabilization
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26
Q

Injury to the joint reduces _____ stability and often diminishes the capability of the _____ _____ system, rendering the joint functionally unstable.

A
  • mechanical

- dynamic restraint

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27
Q

Explain the concept of mechanical vs functional stability using ACL-deficient and ACL-reconstructed patients.

A
  • some ACL-deficient patients are capable of high levels of function and dynamic joint stability (via rehab), even though there is mechanical instability
  • ACL-reconstructed patients have increased mechanical stability, but sensations of “giving way” which is indicative of functional instability
  • Sx + rehab = dynamic restraint system
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28
Q

Rehabilitation of the pathological joint should address the ______ and ______ neuromuscular control mechanisms required for joint stability.

A
  • feedforward

- feedback

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29
Q

The 4 elements crucial for reestablishing neuromuscular control and functional stability are:

A
  • joint sensation (position, motion, and force)
  • dynamic stability
  • preparatory and reactive muscle characteristics
  • conscious and unconscious functional motor patterns
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30
Q

The dynamic restraint system is informed by specialized nerve endings called ______.

A

Mechanoreceptors

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31
Q

How does a mechanoreceptor work?

A

Transducing mechanical deformation of tissue (eg. stretching, compression) into frequency modulated neural signals

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32
Q

Mechanoreceptor signals provide sensory information concerning what?

A

Internal and external forces acting on the joint

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33
Q

3 morphological types of mechanoreceptors in joints:

A
  • Pacinian corpuscles
  • Meissner corpuscles
  • free nerve endings
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34
Q

Quick adapting mechanoreceptors:

A

Cease discharging shortly after the onset of a stimulus

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35
Q

Slow adapting mechanoreceptors:

A

Continue to discharge as long as the stimulus is present

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36
Q

In healthy joints, quick adapting mechanoreceptors are believed to provide ….., while slow adapting mechanoreceptors are believed to provide…..

A
  • conscious and unconscious kinesthetic sensations in response to joint movement or acceleration
  • continuous feedback. Proprioceptive information relative to joint position
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37
Q

Muscle spindles embedded within skeletal muscle detects what information to send to the CNS?

A
  • muscle length
  • changes in muscle length
  • rate of muscle lengthening
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38
Q

Type Ia afferent neurons carry what information? What does it contribute to?

A
  • changes in muscle length
  • rate of change in muscle length
  • contributes to the sensation of kinesthesia
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39
Q

Type II afferent neurons carry what information? What does it contribute to?

A
  • input regarding muscle length

- contributes to proprioception

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40
Q

Muscle spindles are also innervated by small motor fibres called _____ _____.

A

Gamma efferents

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41
Q

Activity of gamma efferents permits the muscle spindle to become more ______, and accommodates for changes in _____ _____ while continuously transmitting _____ _____.

A
  • sensitive
  • muscle length
  • afferent signals
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42
Q

Muscle spindle afferents project directly on skeletal motorneurons through ______ ______. When muscle spindles are stimulated, they elicit a _____ contraction in the _____ muscle.

A
  • monosynaptic reflexes
  • reflex
  • agonist
  • eg. knee jerk reflex
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43
Q

GTOs are _____ detectors and are able to protect the tenomuscular unit by ….

A
  • force

- reflexively inhibiting muscle activation when high tension might cause damage

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44
Q

Generally, with high muscle tension, GTOs would have the ______ effect of muscle spindles by producing….

A
  • opposite

- a reflex inhibition (relaxation) in the muscle being loaded.

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45
Q

What receptors located in the skin are thought to contribute to proprioception, kinesthesia, and force sense?

A

Pressure and stretch

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46
Q

Research demonstrates improvements in proprioception and neuromuscular control with the use of _____ devices.

A

Compression (eg. bandages, neoprene sleeves, athletic tape).

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47
Q

Encoded signals concerning joint motion, position, and force are transmitted from ______ receptors, via _____ pathways, to the spinal cord.

A
  • peripheral

- afferent

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48
Q

Within the spinal cord, ______ link ascending pathways to the _____ _____ to permit conscious appreciation of ______, ______ and _____.

A
  • interneurons
  • cerebral cortex
  • proprioception
  • kinesthesia
  • force
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49
Q

2 reflexive pathways couple articular receptors with ____ nerves and _______ receptors in the spinal column. A third _____ reflex pathway links the muscle spindles directly with motor nerves.

A
  • motor
  • tenomuscular
  • monosynaptic
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50
Q

Sensory information from periphery is used by the cerebral cortex for ______ awareness and ______ neuromuscular control, whereas balance and postural control are processed at the ______.

A
  • somatosensory
  • feedforward
  • brainstem
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51
Q

Balance is influenced by the same peripheral afferent mechanisms that mediate ____ ______ and is partially dependent on the inherent ability to integrate ______ _____ with _____ and the _____ apparatus.

A
  • joint proprioception
  • somatosensory input (jt position sense and kinesthesia)
  • vision
  • vestibular
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52
Q

What is frequently used to measure sensorimotor integration and functional joint stability? Why?

A
  • balance

- deficits can result from aberrations in the afferent feedback loop of the lower extremity

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53
Q

What in the spinal cord links afferent fibres from articular and tenomuscular receptors with efferent motor nerves?

A

Synapses

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54
Q

What within the spinal column connects articular receptors and GTOs with large motor nerves innervating muscles and small gamma motor nerves innervating muscle spindles?

A

Interneurons

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55
Q

What is the final common input?

A

Muscle spindles integrate peripheral afferent information and transmit a final modified signal to the CNS.

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56
Q

The final common input feedback loop is responsible for…

A

Continually modifying muscle activity during locomotion via the muscle spindle’s stretch reflex arc.

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57
Q

By coordinating reflexive and descending motor commands, ____ ______ is modified and _____ _____ is maintained.

A
  • muscle stiffness

- dynamic stability

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58
Q

Increases in muscle length excite ____ ____ ____. The resulting afferent volleys results in spinal medium-latency and long-latency _____ ______ responses.

A
  • muscle spindle afferents

- stretch reflex

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59
Q

Mechanoreceptors in ligament have been demonstrated to elicit _____ responses in the musculature ______ to the imposed loading.

A
  • reflexive

- antagonistic

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60
Q

Define nueromuscular control.

A

The efferent response of muscles transforming neural information into physical energy

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61
Q

Preactivated muscle tension suggests that prior ____ _____ (experience) concerning the task is used to ______ muscle activation patterns.

A
  • sensory feedback

- preprogram

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62
Q

Feedforward neuromuscular control uses ______ information about a task, usually from ______, to determine the most ______ strategy for executing the impending functional task.

A
  • advance
  • experience
  • coordinated
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63
Q

Name the functions of preparatory muscle activity that contribute to the dynamic restraint system.

A
  • incresed stiffness of the tenomuscular unit
  • improved stretch sensitivity of the muscle spindle system
  • reduced electromechanical delay
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64
Q

What is electromechanical delay (EMD)?

A

The period that elapses between the arrival of a neural impulse (electrical) initiating muscle contraction and the development of force (mechanical).

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65
Q

Heightened stretch sensitivity and stiffness could improve the reactive capabilities of muscle by …

A

Providing additional sensory feedback and superimposing stretch reflexes onto descending motor commands.

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66
Q

Preactivated muscles provide quick compensation for _____ _____ and are critical for _____ _____ stability.

A
  • external loads

- dynamic joint

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67
Q

What factors leads to voluntary muscle activation failure following capsuloligamentous injury (Arthrogenic muscle inhibition)?

A
  • partial differentiation
  • inflammation
  • joint effusion
  • joint laxity
  • pain
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68
Q

Arthrogenic muscle inhibition (AMI) can be present ______ following ________ injury.

A
  • billaterally

- unilaterl

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69
Q

Both feedforward and feedback neuromuscular control can enhance dynamic stability if…

A

The sensory and motor pathways are frequently stimulated

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70
Q

Frequent facilitation of pathways enhances:

A
  • the memory about taxks for preprogrammed motor control

- reflex pathways for reactive neuromuscular control

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71
Q

NMC rehab exercises must be executed in what way for physiological adaptations to occur?

A
  • technical precision
  • repetition
  • controlled progression
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72
Q

In the acute phase of healing, joint ______ and ______ can compound sensory deficits, however, this cannot account for the chronic deficits in ______ and _______ associated with pathological joints.

A
  • pain
  • inflammation
  • proprioception
  • kinesthesia
73
Q

Capsuloligamentous ______ and ______, coupled with traditional rehabilitation is one option that appears to restore some kinesthetic awareness, although not equal to that of ______ limbs.

A
  • retensioning
  • reconstruction
  • noninvolved
74
Q

The objective of neuromuscular rehabilitation is to…

A

Develop or reestablish afferent and efferent characteristics that enhance dynamic restraint capabilities with respect to in vivo loads

75
Q

4 basic elements for reestablishing NMC and functional stability:

A
  • proprioceptive and kinesthetic sensation
  • dynamic joint stabilization
  • reactive NMC
  • functional motor patterns
76
Q

Name the 7 afferent and efferent characteristics that contribute to the efficient regulation of the basic elements and the maintenance of NMC.

A
  • sensitivity of peripheral receptors
  • facilitation of afferent pathways
  • muscle stiffness
  • onset rate and magnitude of muscle activity
  • agonist/antagonist coactivation
  • reflex muscle activation
  • discriminatory muscle activation
77
Q

The ______ of the neuromuscular system to change is what permits rapid modifications during rehab that ultimately enhance ______ and _____ muscle activity.

A
  • plasticity
  • preparatory
  • reactive
78
Q

NMC techniques include:

A
  • open/closed kinetic chain
  • balance training
  • eccentric and high reps/low-load exercises
  • reflex facilitation through reactive or “pertubation” training
  • stretch-shortening activities
  • biofeedback training
79
Q

To restore dynamic muscle activation necessary for functional stability, one must employ simulated positions of ______ that necessitate ____ _____ stabilization.

A
  • vulnerability

- reactive muscle

80
Q

Closed kinetic chain exercises create _____ loads that maximally stimulate _____ receptors, especially near the end ROM while _______ receptors are excited by changes in length and tension.

A
  • axial
  • articular
  • tensomuscular
81
Q

Open chain activities require more ______ awareness of limb position because of the non-constrained and free moving distal segment.

A

Conscious

82
Q

How can chonic athletic participation enhance proprioceptive and kinesthetic acuity?

A

By repeatedly facilitating afferent pathways from peripheral receptors.

83
Q

Muscle stiffness has a significant role in preparatory and reactive dynamic restraint by ______ and ______ joint loads.

A
  • resisting

- absorbing

84
Q

What types of loading should be used to increase muscle stiffness?

A
  • eccentric

- isometric

85
Q

The GTO receptor is normally associated with muscle _____, and thus protects the tenomuscular unit from ____ ____.

A
  • inhibition

- excessive strain

86
Q

Chronic overloading of the musculotendinous unit may result in ______ ______ ______ around GTOs that desensitizes this ______ to muscle tension.

A
  • connective tissue proliferation

- mechanoreceptor

87
Q

During functional activities, GTO inhibition ______ and may actually ______ muscle recruitment.

A
  • reverses

- enhance

88
Q

Increased muscle stiffness resulting from low loads and high repetitions can be attributed to…

A

Fibre type transition

89
Q

How does endurance training enhance stiffness?

A

Increasing the baseline motor tone and cross-bridge formation time

90
Q

How does power training enhance muscle stiffness?

A

Alters the rate and magnitude of muscle tension during preactivation

91
Q

Which type of athlete has more vigorous reflex responses?

A

Sprint and/or power trained individuals

92
Q

What types of training has been found to improve reflex muscle activation in studies?

A
  • pertubations to patients on unstable platforms

- agility type training

93
Q

The key instructions during pertubation is to…

A

Match the pertubation but not under or over react.

94
Q

Overstiffening of a muscle/joint complex may provide stability but is not _______, while understiffening may permit episodes of _____ _____ or _____.

A
  • functional
  • giving way
  • buckling
95
Q

What is ligamentization after surgical reconstruction?

A

Controlled loading of the graft via rehab starts the morphological properties of a tendon autograft gradually reflecting those of the ligament, and mechanical stability is restored.

96
Q

Why is sensory information compromised after surgical reconstruction?

A

Due to the loss of mechanoreceptors in the native ligament

97
Q

Why is the rehab process important after surgical reconstruction?

A
  • Facilitate reinnervation of graft tissue by peripheral receptors.
  • reestablishment of ligament stress-elicited reflexes
98
Q

In addition to reactive muscle firing, unconscious control of muscle activity is critical for _____ and _____ _____ ____.

A
  • coordination

- balancing joint forces

99
Q

Restoring the force couples of agonists and antagonists might initially require ______, ______ muscle activation before unconscious control is reaquired.

A
  • conscious

- discriminative

100
Q

Benefit of biofeedback training:

A
  • Provides instantaneous sensory feedback concerning specific muscle contractions.
  • can help patients correct errors by consciously altering or redistributing muscle activity
101
Q

The objective of biofeedback training is to…

A

Reaquire voluntary muscle control and promote functionally specific motor patterns, eventually converting these patterns from conscious to unconscious control.

102
Q

The objective of kinesthetic and proprioceptive training is to…

A
  • Restore the neurosensory properties of injured capsuloligamentous structures
  • enhance the sensitivity of uninvolved peripheral afferents
103
Q

Joint compression is believed to maximally stimulate ______ receptors and can be accomplished with _____ _____ exercises throughout the available _____.

A
  • articular
  • closed chain exercises
  • ROM
104
Q

Why are early joint repositioning tasks important?

A
  • Enhance conscious proprioceptive and kinesthetic awareness,
  • eventually leads to unconscious appreciation of joint motion and position.
105
Q

How does applying a neoprene sleeve or elastic bandage provide additional proprioceptive and kinesthetic information?

A
  • By stimulating cutaneous receptors

- enhanced somatosensory function leads to improved neuromuscular function during motor tasks

106
Q

Exercises that simultaneously involve the non-injured limb may help reestablish ______ awareness of ______ ______, ______ and ______ in the injured extremity. To increase level of difficulty, these can be performed under _____ loads.

A
  • conscious
  • joint position
  • motion
  • load
  • moderate
107
Q

The objective of dynamic joint stabilization exercises is to…

A

Encourage preparatory agonist/antagonist coactivation.

108
Q

Efficient coactivation restores the ____ _____ necessary to balance ____ ____ and increase ____ ____, thereby reducing the loads imparted to the _____ structures.

A
  • force couples
  • joint forces
  • joint congruency
  • static
109
Q

Dynamic stabilization from muscles requires _____ and _____ to joint loads.

A
  • anticipating

- reacting

110
Q

Dynamic stabilization includes placing the joint in positions of vulnerability where….

A

Dynamic support is established under controlled conditions

111
Q

What kind of exercises require both preparatory and reactive muscle activity through feedforward and feedback systems?

A
  • balance

- stretch-shortening exercises (plyometrics)

112
Q

What type of exercise is excellent for inducing coactivation and compression?

A

Closed kinetic chain

113
Q

Reactive neuromuscular training focuses on stimulating the reflex pathways from _____ and _____ receptors to _____ muscle.

A
  • articular
  • tenomuscular
  • skeletal
114
Q

What is the objective of reactive neuromuscular training?

A

To generate joint pertubations that are not anticipated, stimulating reflex stabilization.

115
Q

Why is persistant use of reflex pathways important in reactive neuromuscular training?

A

Can decrease response time and develop reactive strategies to unexpected joint loads

116
Q

All reacctive neuromuscular training exercises should induce….

A

Unanticipated joint pertubations.

117
Q

What is the objective of functional rehabilitation?

A

To return the patient to preinjury activity levels while minimizing the risk of reinjury.

118
Q

The goals of functional rehab include:

A
  • restoring functional stability and sport-specific movement patterns or skills
  • using functional tests to assess the patient’s readiness to RTP.
119
Q

Functional activities incorporate all of the available resources for…

A
  • stimulating peripheral afferents
  • muscle coactivation
  • reflex and preprogrammed motor control
120
Q

In functional rehab, emphasis should be placed on what?

A
  • Sport-specific techniques

- positions and maneuvers where the joint is vulnerable

121
Q

In functional rehab, the use of repetition and controlled intensity can lead to…

A

Muscle activity (preparatory and reactive) gradually progressing from conscious to unconscious motor control.

122
Q

LE NMC techniues should focus on ______ muscle groups that require attention and progress from no weight to ____ ____.

A
  • individual

- weight assisted

123
Q

How can you do PWB in open and closed chain environments?

A
  • in pools

- unloading devices

124
Q

Closed chain exercises creates joint compression, enhancing joint ______ and ______ feedback, while minimizing ______ forces on the joints.

A
  • congruency
  • neurosensory
  • shearing
125
Q

Early dynamic joint stabilization exercises begin with _____ training and ______ weight bearing on stable surfaces, progressing to _____ weightbearing on _____ surfaces.

A
  • balance
  • partial
  • partial
  • unstable
126
Q

Strength exercises should focus on ______ and _____-type activities in a _____ kinetic orientation.

A
  • eccentric
  • endurance
  • closed
127
Q

How do strength exercises further enhance dynamic stability?

A
  • increases in preparatory muscle stiffness

- Increases in reactive characteristics

128
Q

LE eccentric loading is accomplished by activities such as…

A
  • forward and backward stair climbing

- backward downhill walking

129
Q

LE strength and balance exercises can be combined and executed with ______ _____ _____ to increase the level of difficulty.

A

light external forces

130
Q

How does biofeedback help with developing coactivation?

A
  • provides additional information concerning muscle activation
  • encourages voluntary muscle activation by facilitating efferent pathways
131
Q

Why is stretch-shortening exercises important for NMC rehab?

A
  • plyometrics
  • conditioning the neuromuscular apparatus to respond more quickly and forcefully
  • permit eccentric deceleration followed immediately by explosive concentric contractions
132
Q

Should stretch-shortening exercises be withheld until the late stages of rehab?

A

No. Modify intensity and type.

133
Q

How can you control the intensity of stretch-shortening exercises?

A
  • load
  • ROM
  • reps
134
Q

Stretch-shortening movements require what type of muscle activity?

A

Both preparatory and reactive

135
Q

In stretch-shortening exercise, the preparatory muscle activation prior to ______ loading is considered to be a combination of _______ and ______ motor commands.

A
  • eccentric
  • preprogrammed
  • reactive
136
Q

List some examples of plyometric activities that can be done right after WB is achieved (easy).

A
  • unweighted walking in a pool

- low impact hopping

137
Q

List some examples of intermediate LE plyometric exercises:

A
  • double leg bounding
  • alternate-leg bounding
  • single leg hopping
138
Q

List some examples of advanced LE plyometric exercises:

A
  • hopping with rotation
  • lateral hopping
  • hopping onto various surfaces
139
Q

Why should rhythmic stabilization exercises be included during early rehab?

A

To enhance LE neuromuscular coordination and reaction to unexpected joint pertubations.

140
Q

How is the intensity of rhythmic stabilization increased?

A

Applying greater joint loads and displacements

141
Q

What type of equipment is used to manually induce linear and angular pertubations to the joint?

A

Unstable platforms

142
Q

The use of unstable platforms for pertubations can facilitate adaptation to _____ pathways mediated by ______ afferents, resulting in _____ _____ ____.

A
  • reflex
  • peripheral
  • reactive muscle activation
143
Q

Why does incorporating ball tossing in conjunction with balance exercises increase the difficulty?

A
  • creates cognitive loads that may disrupt concentration and help promote reactive adaptations
  • induces greater changes in location of the center of mass by requiring UE motion, making the task more challenging to the sensorimotor system
144
Q

During the later stages of rehab, reactive neuromuscular activity incorporates _____ hopping.

A

Trampoline

145
Q

Describe progressions of tramploline hopping.

A
  • hopping and landing on both feet
  • hopping on 1 foot
  • hopping with rotation
  • hopping while catching a ball
  • hopping off of a trampoline onto various landing surfaces
146
Q

Functional activities in LE always start with …

A

Restoring normal gait

147
Q

How can we help with restoring normal gait?

A
  • verbal instructions or mirror to internalize normal kinematics during stance or swing phases
  • backwards walking
  • pool or unloading device for crossover walking and figure 8s
  • progress to jogging and hopping as tolerated
148
Q

LE functional activities during PWB can help restore motor patterns without compromising ____ ______.

A

Static restraints

149
Q

LE functional activities can be progressed on land by…

A
  • acceleration/deceleration
  • pivot
  • jogging
  • cutting
  • cariocas
  • gradually increasing speed
150
Q

The most difficult functional activities are designed to stimulate…

A

The demands of individual sports and positions.

- may require input from the coaching staff

151
Q

Give some examples of difficult LE functional activities integrated with sports/position demands.

A

Shuttle runs, carioca crossovers, retro sprinting and forward sprinting implemented with sport specific drills such as fielding a ball, receiving a pass, and dribbling a soccer ball.

152
Q

Why are dynamic mechanisms even more crucial for maintaining functional stability in the UE vs the LE?

A

GH jt lacks inherent stability from capsuloligamentous structures

153
Q

What is the function of the rotator cuff muscles?

A
  • not suited for creating joint motion

- responsible for steering the humeral head in the glenoid fossa

154
Q

Why do larger muscles with insertion sites further from GH joint work well initiating joint motion?

A

Greater mechanical advantage

155
Q

Maintaining proper GH joint kinematics requires…

A
  • Balancing the external forces and internal moments
  • limiting excessive translation of the humeral head
  • restoring appropriate coupling of rotator cuff and prime movers
156
Q

Injuries to the static structures in the shoulder can result in diminished _____ _____ and altered kinematics of the _____ and _____ joints.

A
  • sensory feedback
  • scapulothoracic
  • GH
157
Q

Failure of the dynamic restraint system in the GH joint exposes the static structures to ______ or _____ loads, jeopardizing joint ______ and predisposing the patient to _____.

A
  • excessive
  • repetitive
  • integrity
  • reinjury
158
Q

What is the most effective means of restoring sensorimotor function long term in the shoulder?

A

Surgery

159
Q

In the UE, there is general agreement that having _____ ____ early in the rehab program is imperative.

A

Scapular control

160
Q

In the UE, the starting position for all activities should be exercises that focus on….

A

Scapular retraction

  • LFT
  • serratus anterior
  • minimize activation of UFT
161
Q

Name some accessory exercises for scapular retraction:

A
  • side lying ER
  • side lying forward flexion
  • prone extension
  • prone horizontal abduction with ER
  • push up plus
162
Q

Why is closed kinetic chain activities early in UE rehabilitation prefered? Give some examples.

A
  • to promote afferent feedback and coactivation
  • introduces axial loads and muscle coactivation
  • joint approximation stimulates capsuloligamentous mechanoreceptors
  • ex. Weight shifts, table slides, wall slides
163
Q

UE Stretch-shortening exercises in the overhead athlete has been shown to improve ______.

A

Proprioception

164
Q

How can muscle stiffness be enhanced in the UE?

A
  • using elastic tubing
  • using plyoball with an inclined trampoline
  • concentrating on eccentric phase
  • high repetitions with low resistance
165
Q

To complement elastic tubing exercises, what can we use for endurance training in the UE?

A

Upper extremity ergometers

166
Q

Dynamic stabilization exercises for the shoulder use ______ _____ to create _____ and ______ joint displacement, maximally stimulating _____.

A
  • unstable platforms
  • linear
  • angular
  • coactivation
167
Q

The intensity of dynamic stabilization exercises of the UE with unstable platforms is controlled by manipulating…

A
  • the degree of joint displacement

- loading

168
Q

Name 3 closed chain exercises that have been described to stimulate coactivation in the shoulder. Why are these exercises good?

A
  • push ups
  • horizontal abduction on a slide board
  • tracing circular motions on a slide board
  • progressing froma quadruped to a push up position
  • multidirectional slide boards require dynamic stabilization while concurrently using feedforward and feedback neuromuscular control.
169
Q

Plyometric exercises with varying ball weights and distances for advancement are excellent for conditioning _______ and _______ muscle _______.

A
  • preparatory
  • reactive
  • coactivation
170
Q

Reactive neuromuscular characteristics in the UE are facilitated by…

A

Manually pertubing the UE while the patient attempts to maintain a permanent position

171
Q

How should rhythmic stabilization exercises for the UE change in the different phases of rehab?

A
  • early phases: light loads with rhythmic stabilization exercises
  • late stages: resistance added to maximize muscle activation
172
Q

Rhythmic stabilization for the GH joint should incorporate positions where the joint is inherently ______, but under ______ _____.

A
  • unstable

- controlled intenstiy

173
Q

Functional training for the UE ost often involves developing _____ _____ in the _____ position.

A
  • Motor patterns

- overhead

174
Q

Describe the characteristics that UE functional activities must have:

A
  • combination of strength training, balance, core stability
  • multiple planes of movement
  • incorporate the entire kinetic chain
  • reproduce the demands of specific events
175
Q

UE functional activities should begin with what types of activities? What should it progress to?

A
  • Begin with slower velocities and conscious control.

- progress to functional speeds and unconscious control

176
Q

What should the outcome measure be for UE functional activities?

A

Technique rather than speed

177
Q

The speed and complexity of movements in athletic competition requires rapid integration of _____ ______ by _____ and ______ NMC systems.

A
  • sensory information
  • feedforward
  • feedback
178
Q

Dynamic joint stabilization is contingent upon both _____ _____ activation and _____ ______ activation.

A
  • cortically programmed

- reflex-mediated muscle

ATTH 3130 (4 decks)

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