Contrived techniques Flashcards
“Artificial” or “deliberately created” rather than arising naturally or spontaneously; Purpose is to use a sensory system to get a motor response; Use early on as an adjunct to treatment
Contrived treatment technique
- intervention is temporary; PT needs to fade back use of techniques
- uses input system to get motor response
What are the types of input systems?
- proprioceptive
- vestibular
- exteroceptive (hearing, smell, vision, sound etc)
When would you stop using contrived techniques?
Since it’s use is temporary..
- Pt is gaining more conscious control/volitional control
- If it’s not working
What are the proprioceptive deep sensory receptors?
- Muscle Spindle - found in belly of muscle; use for facilitation
- GTO - Found at ends of muscle (PROX/DIST); Used for inhibition
- Joint Receptors - joint capsule, ligaments; Used for facilitation; ex. approximation to help postural muscles kick in and they stand
What sensory receptors are type Ia, Ib, II, III, and IV affarents?
Ia = m spindle, annulospiral ending Ib = GTO II = m spindle, flower spray III = pain and temp IV = Pain and other receptors
Toward the middle of the spindle; Annulospiral nerve endings; Respond to change in velocity (quick stretch)
Type Ia, m spindle
- dampen spasticity in shortened position
Toward the end of the spindle; Flowerspray nerve endings; Respond to increase in muscle length
Type II, m spindle
- dampen spasticity in shortened position
Sensory receptor that responds to tension; Located in the muscle tendon – at proximal and distal tendons; Used for inhibition
Type Ib, GTO
- contract/relax technique
How do use the GTO to get more ROM in a person who has spasticity?
- Stretch the muscle - SLOW/ PROLONGED stretch, so spastic m. has a chance to respond might feel m. “let go” at some point, and get more range
- have to evaluate if it’s worth it in terms of PT progress (incr ROM may only last 10 mins), BUT if pt feels better after/for the rest of the day after, it might be useful to add to ther ex
What does clonus interplay between?
M spindle and GOT
- indicates UMN lesion
What are the types of joint receptors?
- Golgi type endings - largest, respond to rate of joint movement and gravity
- Paciniform endings - respond to rapid joint movements, deep pressure, and vibration
- Rufinni’s endings - respond to rate and direction of joint movement
- Free nerve endings - signal joint pain
Joint receptors are used for facilitation; Exert strong influences on the motor system
What are they sensitive to?
- Movement
- Position
- Traction
- Compression
What are the proprioceptive facilitation techniques?
- Tapping
- Quick stretch
- Resistance
- joint approximation
- joint traction
- high frequency vibration
what type of m. contractions usually come back first when weakness is present?
Eccentric, then isometric, then concentrec
- less m units for eccentric
What does joint approximation facilitate?
postural extensor and stabilizing responses (co-contraction
- enhances joint awarenec
- contraindication = inflamed joints
What does joint approximation facilitate?
- Activates joint receptors
- Facilitates joint motion
- Enhances joint awareness
- Improve mobility, relieve muscle spasm, reduce pain
- Contraindication: hypermobile or unstable joints
What are the proprioceptive inhibitory techniques?
- inhibitory stretch
- Hold-relax method/ contract relax
- full body rotation - helps with widespread rigidity/ spasticity; disassociate the body
- oscillations - inhibits spasticity
- Low frequency vibration (<75 Hz)
Deep, maintained stretch along the longitudinal axis of tendons with positioning; Prolonged positioning in lengthened range; Activates GTO; Prolonged weight bearing to dampen tone; Weight bearing on a spastic arm; Inhibitory (serial) casting
inhibitory stretch
What ROM position should you use for inhibition? facilitation?
inhibition = midrange to shortened position facilitation = lengthened position
What spinal column contains exteroceptive input?
Dorcal column
- large, well myelinated
- apply to gate theory to inhibit stimuli from spinothalamic tracts
What are exteroceptive facilitation techniques?
- Intermittent Contact - Facilitate contraction, sensory awareness, directional cues, security/support; NDT approach comes from this
- Light Touch - Brief, light contact with the skin can facilitate; brief swipe of ice cube, light pinch; used in more involved pts
What are exteroceptive inhibitory techniques?
- maintained firm pressure
- slow repetitive stroking - paravertebral stroking 3-5 mins
- neutral warmth
- prolonged cooling - dr. m firing, inhibits tone or spasm (but can incr spasticity)
What are visual facilitation techniques?
- bright lights
2. bright colors
What are visual inhibitory techniques?
- dim lights
2. calm colors
What are auditory facilitation techniques?
- loud and excited voice
2. upbeat music
What are auditory inhibitory techniques?
- soft and calm voice
2. relaxing, soft music
In the middle ear ______ detects horizontal movement, while ______ detects vertical movement. _______ detects rotation.
utricle; saccule (otoliths)
semicircular canals
What type of vestibular stimulation inhibits tone, relaxes, and decreases arousal?
Slow vestibular movements
- slow rhythmic movements
- rolling or rocking
What type of vestibular stimulation increases tone, and arousal, while improving motor coordination and posture?
rapid vestibular stimulation
- useful in pts with hypotonia and bradykinesia (DS, PD pop)
- can activate sympathetic response
Reflex maintiaing the stability of an image during rapid head movements (keeps it in focus, etc)
Vestibuloocular reflex
Reflex of head, neck, trunk m. activation movements to keep head upright during movement of the body
vestibulospinal reflex
What causes stimulation of parasympathetic system?
relaxation/ inhibitory
- Maintained firm pressure
- Slow repetitive stroking
- Prolonged icing
- Neutral warmth
- Deep breathing
- Relaxation exercises
What are the possible PNF techniques that can be used?
- Rhythmic Initiation
- Alternating Isometrics or Rhythmic Stabilization
- Slow Reversals
- Agonist Reversals
Passive movements; Progressing to active assistive and active movements; Move the patient through the desired movement; “1, 2, 3, and up”; Indicated for spasticity, rigidity, difficulty initiating movements, motor planning and learning deficits, aphasia
Rhythmic initiation
Apply resistance with hands and change placement; Patient maintains a position using isometric contraction; Build up resistance gradually; PT moves hands quickly; Use command – “don’t let me move you”; Avoid holding breath; Indicated for impaired strength, coordination, and control, if ROM limitations
Alternating isometrics or rhythmic stabilization
- improves stability
Concentric contraction of agonist then antagonist against resistance; Move through full ROM; Indicated for impaired strength and coordination between muscle groups or if patient fatigues quickly; PT moves hands
Slow reversal
Concentric contraction through available ROM followed by a hold then eccentric contraction moving slowly back to starting position; Used in antigravity activities; Indicated for weak postural muscles, difficulty with eccentric control of body weight, poor dynamic postural control; Hands stay in same place
Agonist reversal
