Content for Exam 2

Question 1

Upper Extremity D1 flexion

Answer 1

Verbal cue – turn your hand up, pull up and across your body - elbow should come to touch the nose

Progressing from passive, to active-assisted to resisted (resisting the lateral side of hand during D1 flex, and resisting the lateral wrist during D1 ext w or w/o traction)

Question 2

Upper Extremity D1 extension

Answer 2

Verbal cue – turn your hand down, push down and out to your side

Progressing from passive, to active-assisted to resisted (resisting the lateral wrist during D1 ext w or w/o traction)

Question 3

Upper Extremity D2 flexion

Answer 3

Verbal cue – open your hand, lift your thumb up, lift your wrist and arm up and away from your body

Progressing from passive, to active-assisted to resisted (resisting the medial side of hand during D2 flex, w or w/o traction)

Question 4

Upper Extremity D2 extension

Answer 4

Verbal cue – open your hand, lift your thumb up, lift your wrist and arm up and away from your body

Progressing from passive, to active-assisted to resisted (resisting the medial side of hand during D2 ext)

Question 5

Scapular Patterns

Answer 5

In sidelying,
-Anterior elevation: 1 o clock
-Posterior elevation: 7 o clock
-Anterior depression: 5 o clock
-Posterior depression: 11 o clock

Anterior elevation – goes with D1 flexion – goes with protraction

Posterior depression – goes with D1 extension - goes with retraction

Question 6

Pelvic Patterns

Answer 6

In sidelying,
-Anterior elevation: 1 o clock
-Posterior elevation: 11 o clock
-Anterior depression: 5 o clock
-Posterior depression: 7 o clock

Question 7

Anterior elevation

Answer 7

“pull your pelvis up and fwd” – promotes pelvis protraction during preswing

Question 8

Posterior depression

Answer 8

“sit back into my hands” – promotes trailing limb posture

Question 9

D1 Flexion: hip flexion/add/ER

Answer 9

“Pull your foot up and in and pull your leg across”

Works against spastic patterns, promotes fractionated movements and swing phase of gait

Question 10

D1 Extension: hip extension/abd/IR

Answer 10

“Push your foot down and out”
Promotes stance phase of gait and sit-to-stand

Question 11

D2 flexion: hip flexion/abd/IR

Answer 11

“Pull your foot up and out”
Think dog and fire hydrant

Not as frequently used functionally, but a ‘good exercise’ to break abnormal synergy by combining ankle eversion with DF, stroke pts have difficulty with this

Question 12

D2 extension: hip extension/add/ER

Answer 12

“push your foot down and in”
In standing think soccer kick

Question 13

Rhythmic Initiation

Answer 13

Improves Mobility that is impaired by deficits:
-Movement initiation, or relaxation
-Helps with lower level functional tasks where there is lack of initiation due to weakness, hypertonicity

Sequence
-Initially passive movement to encourage relaxation and teach movement of task
-Then the patient is asked to assist and then assistance is slowly removed by PT but manual contacts are maintained, followed by resistance as tolerated

Question 14

Rhythmic Rotation

Answer 14

Improves mobility, Passive movement in a rotational pattern.

Slow, rhythmical movement about longitudinal axis of part, Relaxation, Tone reduction to reduce spasticity/rigidity

Question 15

Hold Relax Active Movement/Contraction

Answer 15

Improves mobility/ROM towards end range of agonist pattern by improving muscle recruitment

Position near the end range of the restricted movement
Perform a resisted isometric contraction of the agonist muscle group
Then have pt relax and move passively into lengthened position
Then have pt perform active movement into the agonist pattern.
Do this with increasing increments into lengthened position as the pt gains greater agonist range
Can also apply quick stretch at lengthened position to recruit muscle spindles
Also apply slight resistance

Question 16

Hold Relax

Answer 16

Increases passive joint ROM and decrease movement-related pain

Sequence

The patient or PT moves the joint to the limit of pain free ROM
Verbal cue of ‘hold’ as the patient maintains this position while the PT resists an isometric contraction of the antagonist (the muscles restricting the motion) - 5-8 secs
Verbal cue of ‘relax’ as the PT gradually eliminates resistance to isometric contraction and
The joint ROM is increased passively by PT or preferably actively by patient to tolerance
Alternative method - Can also be done with isometric contraction of ‘agonist’.

Question 17

Contract Relax

Answer 17

Increase passive joint ROM and soft tissue length. Most effective with 2 joint muscles contractures involving rotary component and when pain is not a significant factor

Sequence
PT or patient moves joint to end ROM, a VC to “turn and push or pull” is given to generate contraction of short muscles
Resistance overcomes all motions except for rotation resulting in isometric contraction of all muscles components except for the concentric rotary component
Held for 5 seconds, then pt relaxes and the joint is lengthened actively or passively to the new limit ROM

Question 18

Alternating Isometrics (Isotonic stabilizing Reversals/alternating holds)

Answer 18

Promotes stability, strength and endurance for postural control in specific postures
Isometric contractions of agonist and antagonist muscle groups are promoted in an alternating pattern.

Verbal cues “Don’t let me push you” or “Push against my hand” – think external perturbations
Trunk stability is often the focus

Question 19

Rhythmic Stabilization (Isometric stabilizing reversals)

Answer 19

Promotes stability through co-contraction of muscles surrounding the target joints

Rotary force is emphasized to encourage simultaneous contraction of the primary stabilizers around a joint

Pt is simply asked to ‘hold’ the position

Force increased slowly matching pt effort

Mostly used for trunk stabilizers to improve postural control/balance

Question 20

Slow Reversal (Dynamic Reversals)

Answer 20

Promotes controlled mobility

May be used to address muscle weakness, joint stiffness or impaired coordination.

Concentric muscle contraction in agonist pattern is promoted with manual contacts and verbal cues of ‘Push or Pull against my resistance’

At desired end range the manual contacts are switched smoothly to facilitate concentric contraction of the antagonist pattern

Resistance from slight to maximal

Can be performed to improve control of diagonal limb patterns or trunk movements in different postures

Question 21

Slow Reversal Hold

Answer 21

Variation of the slow reversal technique in which a resisted isometric contraction is held at the completion of range in each direction of the chosen pattern or activity

Helps in building better stability at the end ranges of movements

Question 22

Agonistic Reversals (Combination of Isotonics)

Answer 22

Improves functional movement throughout a pattern or task by promoting controlled mobility, also promotes strength and endurance

Both concentric and eccentric contractions of the agonist musculature are promoted

Concentric contraction of the agonist group is resisted through a specific direction and range of the chosen pattern or task
At desired endpoint, the pt holds with isometric contraction against resistance (briefly),
Then the clinician resists slow controlled return toward beginning of movement emphasizing eccentric control
At the other end, another isometric hold

Question 23

PREP algorithm complete

Answer 23

potential to return to normal
or near-normal hand and arm function within 12 weeks

Question 24

PREP algorithm notable

Answer 24

Potential to be using affected hand and arm in most activities of daily living within 12 weeks, though normal function is unlikely

Question 25

PREP algorithm limited

Answer 25

Potential to have some movement in affected hand and arm within 12 weeks, but it is unlikely to be used functionally for activities of daily living

Question 26

PREP algorithm none

Answer 26

minimal movement in affected hand and arm, with little improvement at 12 weeks

Question 27

E-stim for inferior subluxation

Answer 27

suprapinatus and posterior deltoid

Question 28

E-stim for anterior subluxation

Answer 28

supraspinatus and anterior deltoid

Question 29

Bridging NDT technique

Answer 29

Therapist hands on knees - knee joint compression and longitudinal traction, if needed, to lift buttocks

Therapist knees on feet for stability

Question 30

Improving lower extremity mobility NDT technique

Answer 30

Improving hip/knee flexion against synergistic patterns by holding whole foot to inhibit plantarflexion spasticity/clonus – inhibitory technique using deep pressure against foot

Question 31

Placing/loading affected LE to counteract spastic synergistic patterns NDT technique

Answer 31

Inhibitory technique against spastic synergies, weight bearing would additionally inhibit spasticity - think ‘promoting fractionated movement’.

Question 32

Improving Upper extremity mobility by counteracting spastic patterns NDT technique

Answer 32

Scapular protraction and using handshake hold with the other hand