CVA, Motor Control, PNF, and Synergies Flashcards
Agonistic Reversals
- Controlled mobility, skill
- Isotonic concentric contraction against resistance followed by alternating concentric and eccentric contractions with resistance.
Alternating Isometrics
- Stability, strength
- Isometric contractions are performed alternating from muscles on one side of the joint to the other side without rest.
Contract-relax
- Mobility
- Passive movement to point of limitation, then maximal ISOTONIC contraction of antagonist muscle group through full ROM against resistance.
- You are contracting and relaxing the range limiting muscle.
Hold-relax
- Mobility
- Passive movement to point of limitation, then maximal ISOMETRIC contraction of antagonist muscle group through full ROM against resistance.
- Holding (isometric) and relaxing the range limiting muscle.
Hold-Relax Active Movement
- Mobility
- Passive movement to shortened range within the pattern and isometric hold of range limiting muscle in its shortened position there.
- Relaxation and passive movement to lengthened muscle position to stretch.
- Pt isotonically moves exxtremity back to shortened muscle position.
Joint Distraction
- Mobility
- Constant manual traction to joint, usually in combo with other joint mobs.
- Proprioceptive technique to increase range at a particular joint.
Repeated Contractions
- Mobility, strength
- Quick stretch then isometric or isotonic contraction of range limiting muscle.
- Used to initiate movement in a weak movement pattern or a weak point in the pattern.
Rhythmic Initiation
- Mobility
- Movement through pattern progressing from passive, to active-assisted, to active, to resisted.
- Used for hypertonia
Rhythmic Stabilization
- Mobility, Stability
- Isometric contractions of all muscles around a joint with perturbations by the therapist.
Slow Reversal
- Stability, Controlled mobility, Skill
- Slow resisted concentric contractions of agonists and antagonists around a joint through the full ROM within the pattern.
- No break between reversals
- Improve control of movement and posture
Slow Reversal Hold
- Stability, Controlled mobility, Skill
- Same as slow reversal + isometric hold at each extreme of ROM to gain stability.
Sensory Facilitation Techniques
- Joint approximation
- Joint compression
- Icing
- Light touch
- Quick stretch
- Resistance
- Tapping
- Traction
Sensory Inhibition Techniques
- Deep pressure
- Prolonged stretch
- Warmth
- Prolonged cold
How many stages are in Brunnstrom’s stages of recovery (CVA)?
7
Brunnstrom Stage 1
No volitional movement initiated
Brunnstrom Stage 2
- Appearance of basic limb synergies
- Beginning of spasticity
Brunnstrom Stage 3
- Synergies performed voluntarily
- Spasticity increases
Brunnstrom Stage 4
- Spasticity begins to decrease
- Some out of synergy movement
Brunnstrom Stage 5
Further decrease in spasticity with independence from synergy patterns.
Brunnstrom Stage 6
Isolated joint movements are performed with coordination.
Brunnstrom Stage 7
Normal motor function restored.
Mobility
The ability to initiate movement through a functional range of motion.
- Can you get there?
Stability
The ability to maintain a position or posture through cocontraction and tonic holding of a joint.
- Can you hold it?
Controlled Mobility
The ability to move within a weight bearing position or rotate around a long axis.
- Can you multitask and move while you are there?
Skill
The ability to consistently perform functional tasks and manipulate the environment with normal postural reflex mechanisms and balance reactions.
- Can you put it all together into something functional?
Synergy
A group of muscles working together to produce a purposeful motion.
UE Flexor Synergy
- Scapular elevation and retraction
- Shoulder ABduction and external rotation
- Elbow flexion
- Forearm supination
- Wrist flexion
- Finger flexion and adduction
- Thumb flexion and adduction
UE Extensor Synergy
- Scapular depression and protraction
- Shoulder adduction and internal rotation
- Elbow extension
- Forearm pronation
- Wrist extension
- Finger flexion and adduction
- Thumb flexion and adduction
LE Flexor Synergy
- Hip ABduction and ER
- Knee flexion
- Ankle dorsiflexion and supination
- Toe extension
LE Extensor Synergy
- Hip extension, IR, and adduction
- Knee extension
- Ankle plantar flexion and inversion
- Toe flexion and adduction
Characteristics of Left CVA
- Weakness and paralysis of R side
- Increased frustration
- Decreased processing
- Possible aphasia
- Possible dysphagia
- Possible motor apraxia
- Decreased discrimination between R and L
- R hemianopsia
Characteristics of Right CVA
- Weakness and paralysis of L side
- Decreased attention span
- Left hemianopsia
- Decreased awareness and judgement
- Memory deficits
- Left inattention
- Decreased abstract reasoning
- Emotional lability
- Impulsive behaviors
- Decreased spatial orientation
Characteristics of Brainstem CVA
- Unstable vital signs
- Decreased consciousness
- Decreased swallowing ability
- Bilateral weakness
- Bilateral paralysis
Characteristics of Cerebellar CVA
- Decreased balance
- Ataxia
- Decreased coordination
- Nausea
- Decreased ability for postural adjustment
- Nystagmus
Anterior Cerebral Artery Occlusion
- Paraplegia
- Incontinence
- Abulic aphasia
- Personality changes due to frontal lobe damage
- Akinetic mutism due to frontal lobe damage
Middle Cerebral Artery Occlusion
- Cerebral cortex damage
- Contralateral hemiplegia and sensory impairment
- Dominant hemisphere impairment results in Broca’s, Wernicke’s, or global aphasia.
- Lobe dependent impairments due to damage to larger portion of cortex.
Posterior Cerebral Artery Occlusion
Thalamic Pain Syndrome:
- Abnormal sensation of pain, temp, touch, and proprioception.
Cortical Blindness:
- Vision loss due to damage to visual portion of occipital cortex
- Physically normal eye, still constricts and dilates with light/dark
Vertebral-basilar Artery Occlusion
- Wide variety of presentations due to complex vascularity of this artery system.
- Wallenberg Syndrome (lateral medullary infarct): ipsilateral facial pain and temp impairment, ipsiateral ataxia, vertigo, contralateral pain and temp impairment of body.
- Severe: locked-in syndrome, coma, vegetative state.
