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PHTH 528 - Neuro Midterm > CIMT > Flashcards

CIMT Flashcards

1
Q

What is neuroplasticity?

A

It’s the brain’s ability to reorganize and form new neural connections
- it responds to training and practice to compensate for an injury or disease

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2
Q

What is motor skill learning dependent on to make changes in the motor cortex?

A

An enriched environment with intensive motor training to help regain the motor control

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3
Q

What is the theory of learned non-use for early CVA?

A

Stroke pts try to use their affected limb = reinforces the use of the affected limb

happens into the chronic stage to keep the training going

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4
Q

What are the proposed mechanism of CIMT?

A

taking away learned non-use
using dependent cortical reorganization

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5
Q

Why does CIMT want to take away learned non-use?

A

constricting encourages the use of the affect limb thru conditioning

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6
Q

What is the premise of cortical reorganization?

A

repeated and sustained practice = increased cortical representation of the involved UE

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7
Q

What is the premise of learned non-use theory?

A

a low sudden hand use and poor functional ability is because:
- suppression of the ability because of sub-acute conditioning and learning compensation with the unaffected hand

= dimished cortical limb representation because of the theory (!!)

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8
Q

What is the premise behind CIMT?

A

increased spontaneous hand use and better functional ability through:
- increased motivation and specific task practice

= altered cortical limb representation because of increased use

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9
Q

What is the traditional programing for CIMT?

A

patients will participate in:
- 4-6 hrs
- 5x a week
- 2-3 weeks

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10
Q

What is the programing for the UE for CIMT?

A

they’ll weak a mitt on the uninvolved UE for 90% that they are awake for 2-3 weeks

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11
Q

What is the programing for the LE for CIMT?

A

NO constraints but activities are focused on reliance on the involve LE

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12
Q

What is the frequency of the modified program CIMT?

A

1-2 hours of PT and OT
3-5x a day over 3-4 weeks

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13
Q

What is the programing for modified program CIMT?

A

focuses on CIMT activies
BUT
mitts only for 5-6 hours during waking hours

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14
Q

What are the elements of CIMT?

A
  1. intensive task-oriented training
  2. behavioral strategies
  3. restriction of the uninvolved extremity
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15
Q

What are the components of task practice?

A

tasks are functionally relevant
global feedback
task is challenging
with contextually appropriate tasks

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16
Q

What is the purpose of global feedback for the patient?

A

PT gives feed given the overall performance

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17
Q

Why is it important to have challenging tasks in regard pt improvement?

A

variety and difficulty is needed to regain movement control

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18
Q

What is the frequency regarding functionally relevant tasks?

A

done continously for 15-30 minutes
- tasks like grooming, setting the table, etc.

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19
Q

What is shaping?

A

reps of a specific movements ina series of trials
- also known as adapted task practice

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20
Q

How is functional activities practiced in regards to shaping?

A

practiced for a set of 10 timed trials
- explicit feedback from PT in regard to performance in each trial

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21
Q

What is the progression for functional activities in regard to shaping?

A

if they are too good :0 -
- either increase reps or decrease time

22
Q

How are shaping tasks chosen?

A

based on movement goals
potential for improvements
patient preference

23
Q

What is massed practice?

A

practicing a motor skill with little or no rest breaks between consant repetition of the skill

24
Q

How is massed practice set up?

A

more work - less rest

25
Q

Who is apart of the behavioral contract?

A

Contract between the patient, caregiver and therapist

26
Q

What does the patient agree on for the behavioral contract?

A

wearing a mitt 90% of them being awake
using the involved limbs as much as possible
commitment to the HEP
if there is a safety concern = take the mitt off

27
Q

What does the caregiver agree on for the behavioral contract?

A

HEP accountability
daily supervision regarding daily activities
make sure no mitt during unsupervised times

28
Q

What are the instructions given for functional tasks on a nightly basis?

A

to do with or without the mitt
have constant supervision
making sure to practice bilaterally

29
Q

What is the purpose of the home diary?

A

Pt is asked to write in a diary daily while listing out:
- activities being done with affected limb
- when in the day was being performed
- success or unsuccessful?
- mitt compliance
- any other comments

30
Q

What is a motor activity log?

A

it is a subjective self-report of the amount and quality regarding the involved UE for 30 specific task
- also an outcome measure

31
Q

What is the goal of constraint of the uninvolved extremity?

A

avoid any future compensation but to encourage the use of the involved extremity

32
Q

With non-dominant UE, how should functional activities be chosen?

A

with non-dominant UE then we want to make sure we are chosing them comfortably

33
Q

What are the fine motor skills activity needed for non-dominant UE?

A

to help increase strength, ROM and coordination

34
Q

What are the functional activities programed for non-dominant UE?

A

activities not expected of the non-dominant UE should be used carefully like writing

may need to be bilateral activities
i.e using non-dominant to stabilize the paper during writing or cutting food

35
Q

What is the traditional UE movement criteria?

A

20 deg of wrist extension
10 deg extension of IP/MCP of each finger

36
Q

What are the modified UE movement criteria?

A

all 10 deg of:
- wrist extension
- thumb abduction
- IP/MCP extension of 2 fingers

37
Q

What is the actual amount of use test (AAUT)

A

Video of a set of task scenarios while the patient is unaware they are being recorded

Lookin at:
- use fo involved limb and the quality of the movement

38
Q

Score - 0
for functional ability scale

A

doesnt even try with the affected arm

39
Q

Score - 1
for functional ability scale

A

affected arm was moved during the task but not really helpful

very poor

40
Q

Score - 2
for functional ability scale

A

affected arm has some use during a task but needed some help from the normal arm
- very slow
- difficult
- needed more than 2 tries to finish

Poor

41
Q

Score - 3
for functional ability scale

A

affected arm was used purposely but the movements were influenced by some synergy
- movements were slow
- only some effort

Fair

42
Q

Score - 4
for functional ability scale

A

affected arm were almost normal
- not as fast
- not as accurate

Good

43
Q

Score - 5
for functional ability scale

A

Affected arm is normal as it use to be
- normal speed
- normal accuracy

44
Q

What is the wolf-motor function test?

A

17 functional tasks that test bilaterally
- each movement is timed and assessed to look for movement quality

45
Q

What are other considerations for CIMT?

A

balance issues
aphasia
cognitive status
pain
contractures
sensation
hearing/visual status
Sit to stand
medical stability
TBI
SCI
peds
MS
PD
Amputee
LE surgery

46
Q

Score - 0
Motor activity log

A

didn’t even try to use the weaker arm

never

47
Q

Score - 1
Motor activity log

A

occasionally used the weaker arm

very rarely

48
Q

Score - 2
Motor activity log

A

sometimes used my affected arm
- still used my stronger arm tho

rarely

49
Q

Score - 3
Motor activity log

A

half the time, i used my weaker arm

50
Q

Score - 4
Motor activity log

A

Used my weaker arm almost as much

51
Q

Score - 5
Motor activity log

A

used it as much as before the stroke

PHTH 528 - Neuro Midterm (8 decks)

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