CVA III: Discussion of General Principles for Neuro Tx

Question 1

Definition of “Posture” (2 things)

Answer 1

1. Orientation of the body in space.

2. The relationship of the body parts to the support surface and to one another.

Question 2

Definition of “Postural Control”

Answer 2

“The ability to maintain equilibrium in a gravitational field by either keeping or returning the center of mass over it’s BOS”.

Question 3

Postural control depends on 2 things. What are they?

Answer 3

1. Feedforward control. 1° form of control, based on prior activity and experience.
2. Feedback. helps control postural reactions to PERTURBATIONS.

Question 4

Postural control is. . . (4 things).

Answer 4

1. Automatic and subcortical
2. Dynamic
3. Graded
4. Related to the Size of the BOS

Question 5

Definition of Transitional Movement Patterns

Answer 5

1. Mvmt patterns that require a change of posture.

2. Mvmt on a changing BOS.

Question 6

In Tx of Transitional Movement Patterns, which of the following is easiest? Which is hardest?

1. Concentric contractions
2. Isometric contractions
3. Eccentric contractions

Answer 6

Isometric < Eccentric < Concentric

Question 7

In Tx of Transitional Movement Patterns, should you begin working in middle ranges or end ranges?

Answer 7

middle ranges, increasing the range over Tx until one can get to end ranges.

Question 8

In Tx of Transitional Movement Patterns, how can a therapist gradually decrease the BOS (4 things)?

Answer 8

1. Narrow the stance
2. remove or partially remove an upper extremity from BOS
3. remove or partially remove a lower extremity from BOS
4. Perch them in a position where they MUST control or else lose balance.

Question 9

Definition of Functional Tasks

Answer 9

The capacity to utilize postural control and control of transitional movement patterns for function.

Question 10

What are 4 requirements for the therapist to know before teaching functional tasks to a pt?

Answer 10

1. Analyze the task - projected outcome, mvmt components.
2. Know the person involved in the task - behavioral and physical abilities/factors.
3. Identify missing movement components through movement analysis
4. Determine how to make the task more pleasureable, efficient, etc.

Question 11

Why do NDT practitioners and other therapists argue that trunk control is the key to neuro rehab? (2 notions)

Answer 11

1. Distal mobility is dependent on proximal stability.

2. Distal mobility and “stable” proximal mobility occur together.

Question 12

Which of these 2 things is the starting point for trunk control therapy if they cannot perform them?

1. Can pt. initiate and sustain trunk co-contraction?
2. Can the patient “dissociate” upper from lower trunk functions?

Answer 12

1. Can pt. initiate and sustain trunk co-contraction?

Question 13

Explain the concept of “Zigs and Zags” in trunk control therapy.

Answer 13

If you move a body part in one direction you change the COM, therefore you must compensate by either:
a. moving something else to counter balance OR
b. produce muscular contraction somewhere to counter balance.
Therefore, in tx, if pt is not showing feedforward control of trunk muscles when moving UE or LE out of the BOS, we must facilitate that control verbally or manually.

Question 14

If a pt demonstrates loss of trunk ROM, what should the therapist do and why?

Answer 14

Mobilize the appropriate segments because functioning at end range is usually painful in a short time. Therefore, having increased ROM will ensure that the pt stays within a functional ROM for the tx and does not go to end range and increases risk of injury.

Question 15

Midline Orientation problems occur in pts with 2 types of problems, what are they?

Answer 15

1. Perceptual problems (pushers, neglect)
2. Motor control problems (can cause alteration of midline until it becomes “normal” to them).
   With both of these pts, address the deficit causing the midline alteration in order to establish a new, more correct midline.

Question 16

What are the two major components of Head Control on the Trunk?

Answer 16

1. Righting reactions - mvmts generated by the pt automatically to keep the head centered.
2. Selective head mvmts - ability to separate mvmt/stability of the head from the trunk.
   Similar to trunk co-contraction and dissociation respectively.

Question 17

What is the correct order of types of function to train in extremities?

a. closed chain - open chain - modified closed chain.
b. closed chain - modified closed chain - open chain.
c. open chain - closed chain - modified closed chain.
d. modified closed chain - closed chain - open chain.

Answer 17

b. closed chain - modified closed chain - open chain.

Question 18

In neuro rehab, what do PT’s do mostly, management or treatment?

Answer 18

Management. Recovery happens over a lifetime, long after therapy is done. We are more of a coach or facilitator to help the patient cope with the problem and guide them toward living as normal lives as possible.

Question 19

Why should PT’s make tasks meaningful for the patient?

Answer 19

1. Meaningful tasks are motivating

2. They engage the areas of the brain involved with long term memory versus short term memory.

Question 20

If you practice the parts of a skill individually, what is crucial for you to do or else the skill will not transfer?

Answer 20

Put them together in the whole movement.

Question 21

What type of practice (blocked or random) is better for early learning of new tasks (and “performance”)? What is better for learning vs. performance?

Answer 21

blocked better for performance & early learning.

random better for learning.

Question 22

What type of feedback (summary or continual) is better for learning?

Answer 22

summary

Question 23

What is the concept of “bandwidth” in motor learning and should you widen or narrow it as a pt improves?

Answer 23

The concept of how far from normal will you allow the movement to go before you make corrective feedback. Narrow it as pt. improves (allow them to realize their mistakes).