discussion Flashcards
What is the differences between PNF and NDT and how they are administered?
PNF focuses on stretching techniques combined with isometric contractions on the target muscle in order to gain better motor control, rehabilitation and flexibility.
NDT involves a great deal of patient handling and facilitation focusing on sensorimotor processing, task performance and skill acquisition during functional/meaningful movements (such as sit to stand) in order to achieve efficient motor control
Which of the 2 treatment philosophies (PNF and NDT) adds resistance and which one reduces resistance
PNF adds resistance and NDT reduces resistance
Of NDT and PNF which would you rely on in early stages of rehab
NDT in the earlier stage of rehab for most patients and progressively add PNF into the mix as patients gain strength. PNF affords specificity of movement with a gradient-dosed “appropriate” amount of resistance. I don’t use one or the other exclusively, I’m not a purist. I find them complementary and incorporate them both.
Of NDT and PNF which affords specificity of movement
PNF affords specificity of movement with a gradient-dosed “appropriate” amount of resistance. I don’t use one or the other exclusively, I’m not a purist. I find them complementary and incorporate them both.
The NDT principles are
The NDT principles include things like verbal and manual cues and techniques are the task-specific activities such as upright sit and transfers.
PNF: Emphasis is on
on developmental sequencing of movement
NDT: based on and Emphasis?
NDT: based on normal development and movement
Emphasis on:
Normalizing muscle tone
Inhibiting primitive reflexes
Facilitate normal postural reactions
Having patients re-learn normal movement patterns
PNF Techniques
Techniques are used one at a time based on the task the clinician wants to accomplish: rhythmic initiation, replication, combination of isotonics, scapular anterior elevation, scapular posterior depression, UE D1 flexion, and UE D1 extension
Principles used in NDT
verbal and manual cues.
NDT Techniques:
Techniques: handling, weightbearing, and positions that encourage use of both side of body can inhibit / facilitate muscle tone through functional tasks such as hip hiking, forward & backward scoot, and transfers
What does unidirectional versus bidirectional mean with respect to muscles?
unidirectional movement is targeting a single group of muscle agonists to fire in one direction
bidirectional movement targets both the agonist and antagonist muscle groups to fire allowing movement in opposite directions.
What are the PNF techniques
Rhythmic Initiation- unidirectional technique
Replication- unidirectional technique
Combination of Isotonics- unidirectional technique
What is Rhythmic Initiation Goal
Rhythmic Initiation- unidirectional technique
Goal is to teach patient how to move and initiate the motion and to teach therapist proper body techniques to coordinate the motion from the patient’s stand point.
What is Replication Initiation Goal
Replication- unidirectional technique
Goal is to teach patient meet the specific ending position by moving their UE in particular pattern.
.
What is Combination of Isotonics
Combination of Isotonics- unidirectional technique
Goal is to increase AROM, strength, coordination and endurance eccentric control.
Explain Rhythmic Initiation Goal
Sequence of pain-free ROM using D2 pattern: Relax the arm -> PROM-> (command word to go up independently) AAROM-> ARROM-> AROM
Explain Replication Initiation Goal
Using D2 pattern place patients joint in end position and resist stronger agonist using isometric contraction followed by relaxation, small PROM away from end position, then ask patient to return to end position with AROM or AAROM this will teach patient to reach the end position using particular pattern
Explain Combination of Isotonics
Using D2 pattern resist agonist using following sequence: concentric, isometric then eccentric without relaxation.
Which of the 3 PNF techniques is the first one used on a given patient?
Rhythmic Initiation is the first to be used on a given patient of the 3 PNF techniques.
The PNF principles are:
Manual Contacts
Resistance
Traction
Approximation
Quick-Stretch
Body Mechanics and Position
Visual Stimulus
Verbal Stimulus
PatternsHow many PNF principles can you at once
several as many as needed
Occupational examples: diagonal movement
diagonal movement- meal prep using trunk rotation and extension and reaching for items in the cupboard above the patient
Occupational examples rotary movement
a child playing on a merry-go-round or dancing in circles
a child playing on a merry-go-round or dancing in circles
a child playing on a merry-go-round or dancing in circles
a child playing on a merry-go-round or dancing in circles
Occupational examples curvilinear movement
a person sliding down a water slide and their body moving in a curvilinear motion
Is the D2 UE pattern simultaneously a diagonal, rotary, and curvilinear movement?
s simultaneously a diagonal, rotary, and curvilinear movement. That is, the UE is moving diagonally from one’s contralateral hip toward the ipsilateral shoulder; the trunk is rotating toward the direction of the movement; and the hand is moving in a curvilinear fashion (not in straight line) as it travels across the D2 UE movement arc
What term do use to describe permanent change?
A term that describes permanent change is plasticity.
What aspects of Motor Learning should be incorporated into NDT when working with patients
Practice. Practice helps the task become an internal process and experience that eventually leads to a relatively permanent change in the capability for skilled behavior and is highly dependent upon patient familiarity.
What are other synonymous terms for task-oriented learning?
Motor learning and function-based learning
What are some impairments that contribute to functional limitation?
could be AROM strength
imbalance
incoordination
decreased sensation
so we treat the impairment with the expectation that improved strength and AROM will provide greater independence with the functional activity. I don’t think we ever directly treat the function, rather, we treat the impairment in function specific environments.
Which of the 3 motor learning steps resonates most closely with “efficiency”?
Autonomous (Success) resonates most closely with “efficiency”.
The stages of motor learning to think about when performing NDT.
understand the cognitive (what),
associative (how)
autonomous (success)
What are reasons behind facilitating proper movement patterns and relearning tasks focusing
on proximal extremities first and moving distally.
what is potentially driving improved limb and trunk movement to accomplish a given task.
neural plasticity of the CNS.
NDT :Neuro-Development Treatment was founded by
Karel and Berta Bobath in the 1940’s
NDT is a philosophy aimed
to restore and improve functional motor control in an individuals’ neuromuscular system
How is NDT done
is done so by utilizing a problem solving sequence, key points of control, and working within a suitable environment.
In terms of Problem Solving sequence, Therapist will:
For NDT
- Ask for movement
- Facilitate movement
- Assess passive movement
- Integrate movement
“appropriate environmental construct”, what motor control theory does this sound most like?
Systems theory Because this theory emphasizes that the external environment can affect movement.
provide an example of proximal key point of control for a movement of your choosing?
the pelvis to during standing to initiate better standing balance and postureif we consider that the trunk and LE’s are driving the movement and the pelvis is removed from these areas
Another example is facilitating
shoulder joint external rotation to encourage upright sitting posture.
The objectives of NDT are to:
- Normalize muscle tone
- Inhibit primitive reflexes and eliminate abnormal movements
- Facilitate normal postural reactions
- Help clients re-learn normal movement patterns
- Improve the quality of movement
What are various techniques that therapists use to achieve the above objectives. Some of these techniques include:
- Handling techniques
- Weightbearing of affected limb(s)
- Use positions that encourage the use of both sides of the body
- Avoid sensory input that adversely affects muscle tone
- Avoid activities that strengthen abnormal movement responses
NDT is goverened by:
The Problem Solving Sequence: 1) ask for movement, 2) facilitate movement, 3) passive movement assessment, 4) mobilize and/or stretch, and 5) integrate movement
Key Points of Control: proximal, distal
Working within an appropriate environmental construct
A type of intervention that works to increase quality of movement by restricting abnormal movements and promoting normal functional movements.
NDT
Why do we provide the patient the least amount of facilitation required when using NDT?
The objective is to encourage functional independence. When you provide the least amount of facilitation, you allow the patient to learn how to move with minimal dependence from another person.
How can we document the amount of assistance delivered for NDT?
We can use the FIM guidelines to determine assist level and proximal versus distal key points of control as one example of documentation.
Is it possible that the least amount of facilitation required is maximum assistance using proximal key points of control to safely transfer from sitting at bedside to a bedside chair?
It is possible for the least amount of facilitation to be the maximum assistance using the key points of control to safely transfer. A NDT transfer would require the least amount of facilitation to transfer and the manual contacts would be on the posterior trunk and the weaker anterior knee.
or if the client is not cognitively impaired they can still participate in problem solving and visualizing the correct sequence of movements in the transfer.
The client should be given an opportunity to solve the problem. How does that process influence motor learning?
Allowing opportunities for the client to problem solve facilitates the experience and practice needed for relatively permanent motor learning. Also, clients participate in active decision making as they develop the strategies needed for motor planning and function.
What motor learning term describes performing a variety of similar tasks even though there may have only been formal practice in a single environment?
generalizability
What is the term accounting for performing similar tasks in a variety of environments?
resistance to contextual change
