EXAM 1 COMBINED LECTURES Flashcards
in the PNF task classification, what is stability
Maintaining a position or posture (statically)
Often refers to stability of proximal muscle groups (requires core activation for posture)
In PNF task classification, what is controlled mobility
Ability to shift COG over stable BOS (dynamic) Distal segments (UE or LE) fixed; proximal segments move (ex: wt shifting)
IN PNF task classification, what is skill
A goal-oriented action
Requires coordinated movement sequences
Characterized by fluency, consistency, precise timing, and efficiency (open chain ex: pnf patterns)
what is MDC
minimally detectable change
MDC is real change without error
what is MCID
MCID (minimally clinically important difference)
The smallest change in an OM that is perceived as beneficial by the patient, and that would lead to a change in the patient’s medical management
MCID is patient notices improvement)
what things do predictive OM focus on
sensitivity and specificity, predictive values and likelihood
main domains of OM
motor function, balance, transfers, cognition
purposes of OMs (they either aim to ___, __ or ___)
discriminate, predict, evaluate
types of OMs
generic vs disease specific
self reported vs performance
feasibility components of OMs
cost equipment training space time
fallers vs non fallers is an ex of what type of OM
discriminative (its this or it’s that)
fall risk, or DC desination are what type of OM
predictive
type of OM that is useful in determining the effect of the intervention
evaluative
Consistency when one person takes repeated measures over time
intra-rater reliabilty
Consistency of repeated measures across time
test retest reliability
Consistency between >1 persons
inter rater reliability
The assumption of validity based on appearance as a reasonable measure of the given construct
face validity
A comparison of one measure to another, previously validated, measure
concurrent validity
Ability of the measure to indicate some future event
predictive validity
The conceptual /theoretical basis for using a measurement to make an inferred interpretation
construct validity
The degree to which the measure’s items reflect the domain being measured.
content validity
Minimal Detectable Change
Minimally Clinically Important Change
these are most important with what types of OMs
evaluative
sensitivity or specificity are more important with what type of OMs
disc or predictive
true +
Proportion of people w/ a + test result who have the condition
sensitivity
true –
Proportion of people w/ a negative test result who do not have the condition
specificity
Majority of true non-fallers correctly identified
is an ex of (sens or spec)
ruled out so sensitivity
true fallers correctly identified is an ex of (sens or spec)
ruled in so specificity
what is responsiveness
ability of the test to measure change
Minimal detectable change (MDC)
Minimally important difference (MID) or minimal clinically important difference (MIDC)
explain MDC
due to actual change and not just error (smallest amt of change that is not due to error) is based off of test/retest reliability.
The more reliable the test, the smaller the MDC
explain MCID
Minimally clinical important diff
The smallest change in an OM that is perceived as beneficial by the patient, and that would lead to a change in the patient’s medical management
the likelyhood of a ceiling or floor effect depends on
Patient capability
Instrument used
(20% have either the highest or lowest score -its too easy or too hard)
EDSS normal is
0-3.5
6-8 is max
acute care settings, do they usually do team meets
no
acute care uses a ___ disciplinary approach
multi (very distinct and separate roles)
when does screening for rehab begin (where to place them)
as soon as pt is stable
for an in pt rehab, pt must be able to do what 2 things and require what things
must be able to learn and sit for 1 hour, must require at least 2 services
long term goals for in pt would be what time frame
2-3 weeks (dc)
short term goals for in pt rehab are done
week to week
what is worst/best FIM scores
18 worst best 126
what determines length of stay in rehab (what test)
FIM score
what setting typically does have weekly meetings ofr grand rounds
in pt rehab
DC occurs when
goals are met or pt platues
requirements for home care
under care of a Doc cannot leave the house dt med cond leaving is too taxing on pt home env (ex: too many stairs) illness progression family at home
STroke triage scale is based on
FIM score
mild, mod, severe stroke triage scales
mild :126-80 FIM
mod: 40-60 FIM
severe: 18-40 FIM
what team approach is best
InterDisciplinary (overlapping roles)
what is a multi disciplinary approach
separate functions/roles
what is a transdisciplinary approach
no set roles, every health care provider does same jobs
walking ___ft is necessary for full independence
1000
every pt assessment should always include what 4 things
env at home
goals
chief CO
prior LOF
mini mental eval of scores is influenced by what 2 things
age, education
dev Hx is important with children, but what 2 pathos are also included for adults
downs, CP
what can sinemet for PD do
cause ortho hypotension
we need to know if PD pts are on what meds
antispastic (sinemet)
what 2 things are need to knows in regards to pts with swallowing issues
hydration, nutrition
endurance/aerobic test best for neuro pts
2mwt
stroke pts get edema where
UE
what factors effect functional reach
age, ht
when testing/assessing integration status, look at what 3 things
community social and civic involvement
the DGI identifies what
identifies ability to modify gait in response to changes
DGI is only for what pts
high functioning
mini mental reliablity and validity relies on
pt pop
injury to frontal lobe would cause what sx
lack of judgement
PASS stands for
posture assessment of stroke scale
PASS is best performed when
early - within 90 days of stroke
what does PASS test for
balance and position change ability
STREAM stands for
stroke rehab assemeent of movement
STREAM tests what
measurement of motor function and mobility (tests initiation, modification, and control of movement)
if pts dont show normal motor control/strength, what HAS to be assessed
PROM (Muscle length, soft tissue extensibility, and flexibility - Important given musculoskeletal contributions to spasticity)
what is tone
R to passive stretch
modified ashworth scale tests what
spacticity only (not rigidity or flaccidity)
shopping, family roles are considered ADL or IADL
IADL
FIM is about what
level of assistance needed for all constructs
peak age of MS onset
30 (15-50)
farther away from the ___ it increases your chance of MS
equator (however, if you move before you are 15 you assume that geographical locations risk)
virus possibly linked to MS
Epstein Barr
an immune response that produces T lymphocytes and macrphages which cause antigens to activate. Creating cytotoxic responses to the CNS and T lymp cells attack myelin. is what type of MS
Relapsing remitting
invovlement of the oligodentrocyte cells is what type of MS
secondary progressive
main difference btwn relapsing remitting and secondary progressive MS
SP they don’t improve after an exacerbation
most common 1st sx of MS
optic neuritis
____matter is effected by MS
white
what tracts carry sensory info to brain
corticospinal
what is CIS
clinically isolated syndrome- it’s like an MS precursor- it’s the first episode they’ve ever had and it goes away. typically monofocal. Imaging doesn’t always show
to diagnose MS you have to have dissemination of __ and __
time and space (time meaning you have to have episodes happen at diff times - over a month apart) space meaning have to have 2 lesions in different spots)
4 types of MS
relapsing remitting
secondary progressive
primary progressive
progressive relapsing
EDSS
expanded disability status scale (#1 OM for MS)
downfall of EDSS
doesn’t respond to changes in intervention
sensitivity to heat with MS is known as
Uthoff sx
biggest c/o for MS pts
fatigue
which type of MS has more severe fatigue early on,
PPMS (it decreases over time though bc they stop being active)
2 types of fatige with MS
peripheral and central (muscular vs true exhaustion)
cause of fatigue for MS
BG or widespread axonal damage. overactivation of frontal cortical areas.
bottom line: motor planning takes alot out of them
weakness in MS is more common in the ___extremeties
Lower
MS weakness effects both ___ and __
muscle contraction/performance and endurance
incoordination of mvmt dt sensory or cerebellar issues
ataxia
ataxia is a prob with ___ control
anticipatory
co contractures and decompensation are compensatory methods for
ataxia
timing, scaling, accuracy, (coordination) are done by what part of brain
cerebellum
pts with cerebellar issues have a hard time ___ and ___ movement
predicting and adapting
does life exp with MS decrease
no
5 main issues of MS
fatigue, weakness, spacticity, ataxia, posture
prognositc indicators of MS
sphinctor control, cognition
is higher or lower EDSS better
higher is worse
primary dx tool for MS
MRI (can also do CSF draw to test for antibodies)
drugs for MS
interferons (decrease the inflammatory process)
Betaseron Avonex Rebif Copaxone Novantrone these are all what types fo drugs
interferons
drug that improves gait speed
K channel blocker (AMpyra - or dalfampridine)
what is a pseudo exacerbation
happens after exercise, tell pts it will go away (they have an increase in their sensory sx)
PD is a disease of the ___NS
CNS
tell tell signs of PD
rididity, bradykinesia, tremors (resting), posture probs
what anatomical location is the issue with PD
BG (basal ganglia) specifically the substansia nigra
3 types of PD
ideopathic (most pts have this kind)
identifiable (secondary)
Parkinsons plus
identifiable AKA secondary PD is dt
drugs or tumors or illness (virus)
would reflexes for PD be normal
yes
what would be good walking tests for PD
TUG or DGI
dopamine comes from the
subs nigra
2 tracts/loops of the basal ganglia
direct -exitation
indirect -inhibition
direct: excitatory -excited by dopamine
decrease production decreases movement
indirect: inhibitory -inhibited by dopamine
decreased production decreases excitation and decreases movement
what happens with PD (what causes it)
decreased dopamine, decreases excitation, which decreases movement
rigidity of PD happens more
proximal
with PD, there is a(n) ____ in tone
increase (they are rigid)
2 subgroups of PD
posture/gait
tremor
highest form of increased resistance to a passive stretch
rigidity (rigidity is the highest form of tone)
rigidity is vel ___
independent
shuffling gate of PD is aka
festination
sudden stopping with PD is aka
freezing
why are toppling falls common with PD
bc festinated gate changes their COM as they shuffle
micrographia
poor control of handwritting
PD #1 assessment
Hoen and Yar
how is PD dx
if they have 2/3 sx (there is no imaging)
another tx for PD
deep brain stimulation
list the 3 models of motor control
list the 3 models of neuro rehab
models of motor control: Reflex, heirarchial, systems
models of neuro rehab: muscle re-ed, neuro therapeutic facilitation, task oriented
ATNR is an ex of what model of motor control
heriarchial
downfall of reflex theory and heirarchial
they dont’ include how human mvmt is variable
sx theory use what model of neuro rehab
task oriented approach only
what are the 3 models of neuro rehab
muscle re-education (no one uses)
Neuro therapeutic facilitation
Task oriented rehab
goal of neurotherapeutic facilitation is
to get pts out of a synergy pattern and to normalize mvmt
plus of task oriented
variability and adaptability, there is no 1 right way, pts are the prob solvers, we dont always normalize
Emphasizes high repetition intensive task practice
neurotherapeutic facilitation utilizes
PNF, NDT, Brunnstrom
what is Brunnstrom stages
only use this when there is absolutely no mvtmt, she has stages of recovery that she progresses pts through. not good for goal writing, uses associateive movement
NDT
neuro develpmental tx
goal of NDT
enhance normal movement or normalize tone
NDT uses
handling (sensory feedback)
downfalls to NDT
takes a lot of time, and typically doesnt progress until pt has mastered a skill
what is PNF task classification scale, and list the progression
it is a progression we are supposed to follow when doing PNF (mobility, stability, controlled mob, and skill)
downfall with PNF task classification scale
not all pts can follow that progression (ex: PD dont need to work on stability, ataxic pts dont need mobility)
3 components of task or approach
effects that pt, env, and task have on mvmt
all movement is comprised of 3 things
progression, stability, adaptability
which type of therapist always tries to correct abnormal mvmt
NDT
2 ways to retrain mvmt
force control or momentum
force control requires
strenght
momentum requires __ and __
strenght and coordination
which is best for ataxic pts, force control or momentum
force control
restorative vs compensate
one you improve the issue back to normal,the other uses adaptive techniquies
constraint induced therapy is _____ oriented
task
clear start and finish is a ___ task
discrete
no clear start and finish is a ___ task
continuous
3 essential tasks of mobility
Progression
Stability
Adaptability
stages of motor learning
cog
associative
autonomous
progression part of mobility task is what (describe)
its all the movement of the body (ex: in sit to stand it’s hip flexion, trunk flexion, knee ext)
explain stability as an essential task of mobility
controlling balance, maintaining COM
what are the 3 steps to using a task orientied approach in mobility
- initial considerations
- movement analysis
- plan the intervention
what does initial considerations mean in task oriented approach (with mobility)
you have to consider the task itself and the env
ex: Task complexity, Task characteristics, Cognitive demands of task, In what environments are the movement typically performed? Environmental characteristics?
adaptation of movement is hardest for what type of pts
ones stuck in a synergy pattern
in step 3 of task oriented approach of mobility (plan the intervention) what may you have to do be for actual movement
tx underlying impairments (ex: stretch plantar flexors)
what is different about STS vs supine to stand or rolling in bed
STS is not really variable (you stand up)
supine to stand and rolling both have variable ways to do it
2 months post stroke, would you work on more compensatory or restorative
restorative (still acute)
is it better to do random or blocked practice in associative stage
do random
4 steps to assessment part of soap note
Brief intro to the patient Male/female, age dx, admitted to,_
Summarize exam data
Explains impairments and relates to activity and participation
Identify prognostic indicators (pos or neg)
Explain the need for PT… make it clear that the patient will benefit from PT
A label to describe the dimensions of the patient
diagnosis
diagnosis directs what
plan of care
ataxia dismetria-celebellar
are what PT diagnosis
movement pattern coordination deficit
weakness is what PT diagnosis
force production deficit
force production deficit PT dx has 2 components (list them)
- improvment expected
2. no improvement expected
lack of ROM or diminished ROM is what PT dx
biomechanical deficit
one thing is off so they “weigh” one sensation over the other (what PT dx)
sensory selection deficit
severe Hypokinesia PT dx would be related to
PD
SCI (cannot sit upright) would be what PT dx
monitored mobility
left neglect would be what PT dx
perceptual deficit
proprioceptive issues would be what PT dx
sensory detection deficit
decreased muscle tone with inability to initiate movement is what PT dx
Paresis
Significant signs of hyperexcitability with associated inability to initiate movement is what PT dx
spacticity without mvmt
significant signs of hyperexcitability with associated inability to fractionate movement against gravity is what PT dx
spacticity with mvmt
if pt simply cannot participate in mobility training, their PT dx is
mobility consult
how to word a prognosis for a SCI pt who will not return motor function, but is motivated
pt has poor prognosis for motor return, but good prognosis for learning compensatory strategies for functional activity
what is neuroplasciticy
brain remodels and adapts after a stroke (can take months), at about 6 months it stops
what strokes have best prognosis
lacunar
what is best predictor of prognosis post stroke
initial recovery of motor function
most motor recovery occurs when (post stroke)
1st month -6 months
what does research say about UE vs LE prognosis of motor function post stroke
less UE involvment (better prognosis for UE)
what is a good predictor for prognosis of stroke for UE
shoulder shrug ability
what is orpington scale
stroke prognostic scale
Measures UE motor function, proprioception, balance, and cognition (highly recommended by EDGE website)
under 3.2 they usually go home, over 5 they are dependent
goal time frame for OP setting (long term is how long, short term is how long)
LTG reflect DC, short term are 3-4 weeks
SMART goals
specific measurable acheivable relavent time
when formulating prognosis, we must consider both ___ and ___ factors
pos and neg
walking and talking is an ex of a ____type of task
cognitive dual
walking and lifting something is a ___ type of task
motor dual
considerations when setting gait related goals
distance variables Amount of assistance needed Use of assistive device Ability to ambulate in various environments Safety Cognition
what test would you do to determine gait speed
10m walk
community ambulatory would need to walk at what pace
community: over .8m/sec
moderate limited: .4m/s - .8 m/sec
Severe limited: if they walked under .4m/s that is severe impairment or household ambulator
5 main impairments constraining gait
Weakness Spasticity Loss of ROM Dyscoordination/Ataxia Rigidity/bradykinesia
1 muscle group needed for progression, that gives power for push off in walking progression.
gastroc soleus (decreased plantarflexors lessons push off and even their speed and power)
how does weakness effect stabilty in walking
if glut med is weak, their single leg stance is poor
how does weakness effect adaptabilty in walking
if quads are weak, they cannot change directions or alter gait well
weakness can impact what tasks of mobility
all (progression, stability, and adaptabilty)
post stroke, these muscles are most weak on pts
pts will have the most problem with dorsiflexion, hip flexion, knee flexion
post stroke, pts have more probs with what tasks of mobility
pts have More difficulty with progression, decreased push off, and adaptability (stepping over things in the env
weak quads post stroke, what compensations might you see
Knee hyperextension
Forward trunk lean
spacticity can effect what tasks of mobility
all
how can spacticity specifically effect gastroc/soleus during gait
If gastrocs are tight, in mid to late stance gastrocs cannot do stride position very well bc they feel very unsteady (in order to get into terminal stance, the gastroc needs full extension – they cannot do this) = instablity
which type of walker is better for ataxic pts
rolling (standard they would have to pick up, increasing their chance of fall)
Tx options for ataxic pts with gait
Weighting Balanced Based Torso Weighting assistive device Exercises to increase stability (pnf) Balance-retraining Compensatory strategies
tx options for PD with gait
Balance and gait retraining Use of visual and auditory cues Lee Silverman Voice Treatment (LSVT) BIG program Assistive device Stretching/flexibility exercises
key ingredients to locomotive training
high reps speed salience-meaningful to them make it challenging incorporate paretic side task specific-walking improves walking whole task know env
what does speed offer as a key ingredient to locmotive training
taps into CPG
gait is a ___task
whole
2 main types of body supported treatmill devices
harness
robotic
BWSTT (harness) is as effective as __
a task oriented training program (robotics not so much)
in regards to the big chart she keeps showing, what does cog demands mean
is it dual task vs single (walking and talking or just walking)
difference btwn blocked and random tasks
random-all in random order
blocked-practicing each task in a block before progressing to a new task.
explain the MDC results (how do you know if it’s reliable test)
The more reliable the test, the smaller the MDC
the goal of this model of rehab is to alter CNS,
Reduce stereotypical movement patterns and reflexes
Facilitate normal movement
neuro therapeutic facilitation
ave age onset of PD
Average age at onset 50-60 years
one of the most prevalent issues with PD (decreases their QOL)
postural instabilty that causes falls
Emphasizes sensory feedback HANDLING! Therapist guides therapeutic process Tendency to focus on one way of moving Tendency to aim for mastery of one skill before moving on to another
This describes what type of rehab approach
NDT
surgical txs for parkinsons
Thalamotomy- takes out ventral intermediate nucleus —> decreases sx
Pallidotomy -Decreases sx but can cause speech/swallow problems
Deep brain stimulations -estim implantion that doesn’t damage the brain
models used by NTF (neuro therapeutic facilitation)
Proprioceptive Neuromuscular Facilitation (PNF)
Neurodevelopmental Treatment (NDT)
Brunnstrom
This tx approach progresses pts through phases of synergistic patterns to hopefully get them to normal movement
Brunnstrom
what are the 4 PNF task classifications (the progression that you are supposed to follow)
mobiliy
stability
controlled mobility
skill
