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NEUROMUSCULAR I (POTTER) > EXAM 1 COMBINED LECTURES > Flashcards

EXAM 1 COMBINED LECTURES Flashcards

1
Q

in the PNF task classification, what is stability

A

Maintaining a position or posture (statically)

Often refers to stability of proximal muscle groups (requires core activation for posture)

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2
Q

In PNF task classification, what is controlled mobility

A 
Ability to shift COG over stable BOS (dynamic) 
Distal segments (UE or LE) fixed; proximal segments move (ex: wt shifting)
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3
Q

IN PNF task classification, what is skill

A

A goal-oriented action
Requires coordinated movement sequences
Characterized by fluency, consistency, precise timing, and efficiency (open chain ex: pnf patterns)

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4
Q

what is MDC

A

minimally detectable change

MDC is real change without error

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5
Q

what is MCID

A

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)

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6
Q

what things do predictive OM focus on

A

sensitivity and specificity, predictive values and likelihood

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7
Q

main domains of OM

A

motor function, balance, transfers, cognition

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8
Q

purposes of OMs (they either aim to ___, __ or ___)

A

discriminate, predict, evaluate

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9
Q

types of OMs

A

generic vs disease specific

self reported vs performance

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10
Q

feasibility components of OMs

A 
cost 
equipment
training
space
time
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11
Q

fallers vs non fallers is an ex of what type of OM

A

discriminative (its this or it’s that)

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12
Q

fall risk, or DC desination are what type of OM

A

predictive

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13
Q

type of OM that is useful in determining the effect of the intervention

A

evaluative

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14
Q

Consistency when one person takes repeated measures over time

A

intra-rater reliabilty

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15
Q

Consistency of repeated measures across time

A

test retest reliability

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16
Q

Consistency between >1 persons

A

inter rater reliability

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17
Q

The assumption of validity based on appearance as a reasonable measure of the given construct

A

face validity

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18
Q

A comparison of one measure to another, previously validated, measure

A

concurrent validity

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19
Q

Ability of the measure to indicate some future event

A

predictive validity

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20
Q

The conceptual /theoretical basis for using a measurement to make an inferred interpretation

A

construct validity

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21
Q

The degree to which the measure’s items reflect the domain being measured.

A

content validity

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22
Q

Minimal Detectable Change
Minimally Clinically Important Change
these are most important with what types of OMs

A

evaluative

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23
Q

sensitivity or specificity are more important with what type of OMs

A

disc or predictive

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24
Q

true +

Proportion of people w/ a + test result who have the condition

A

sensitivity

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25
Q

true –

Proportion of people w/ a negative test result who do not have the condition

A

specificity

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26
Q

Majority of true non-fallers correctly identified

is an ex of (sens or spec)

A

ruled out so sensitivity

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27
Q

true fallers correctly identified is an ex of (sens or spec)

A

ruled in so specificity

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28
Q

what is responsiveness

A

ability of the test to measure change
Minimal detectable change (MDC)
Minimally important difference (MID) or minimal clinically important difference (MIDC)

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29
Q

explain MDC

A

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

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30
Q

explain MCID

A

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

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31
Q

the likelyhood of a ceiling or floor effect depends on

A

Patient capability
Instrument used
(20% have either the highest or lowest score -its too easy or too hard)

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32
Q

EDSS normal is

A

0-3.5

6-8 is max

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33
Q

acute care settings, do they usually do team meets

A

no

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34
Q

acute care uses a ___ disciplinary approach

A

multi (very distinct and separate roles)

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35
Q

when does screening for rehab begin (where to place them)

A

as soon as pt is stable

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36
Q

for an in pt rehab, pt must be able to do what 2 things and require what things

A

must be able to learn and sit for 1 hour, must require at least 2 services

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37
Q

long term goals for in pt would be what time frame

A

2-3 weeks (dc)

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38
Q

short term goals for in pt rehab are done

A

week to week

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39
Q

what is worst/best FIM scores

A

18 worst best 126

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40
Q

what determines length of stay in rehab (what test)

A

FIM score

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41
Q

what setting typically does have weekly meetings ofr grand rounds

A

in pt rehab

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42
Q

DC occurs when

A

goals are met or pt platues

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43
Q

requirements for home care

A 
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
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44
Q

STroke triage scale is based on

A

FIM score

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45
Q

mild, mod, severe stroke triage scales

A

mild :126-80 FIM

mod: 40-60 FIM
severe: 18-40 FIM

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46
Q

what team approach is best

A

InterDisciplinary (overlapping roles)

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47
Q

what is a multi disciplinary approach

A

separate functions/roles

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48
Q

what is a transdisciplinary approach

A

no set roles, every health care provider does same jobs

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49
Q

walking ___ft is necessary for full independence

A

1000

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50
Q

every pt assessment should always include what 4 things

A

env at home
goals
chief CO
prior LOF

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51
Q

mini mental eval of scores is influenced by what 2 things

A

age, education

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52
Q

dev Hx is important with children, but what 2 pathos are also included for adults

A

downs, CP

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53
Q

what can sinemet for PD do

A

cause ortho hypotension

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54
Q

we need to know if PD pts are on what meds

A

antispastic (sinemet)

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55
Q

what 2 things are need to knows in regards to pts with swallowing issues

A

hydration, nutrition

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56
Q

endurance/aerobic test best for neuro pts

A

2mwt

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57
Q

stroke pts get edema where

A

UE

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58
Q

what factors effect functional reach

A

age, ht

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59
Q

when testing/assessing integration status, look at what 3 things

A

community social and civic involvement

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60
Q

the DGI identifies what

A

identifies ability to modify gait in response to changes

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61
Q

DGI is only for what pts

A

high functioning

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62
Q

mini mental reliablity and validity relies on

A

pt pop

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63
Q

injury to frontal lobe would cause what sx

A

lack of judgement

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64
Q

PASS stands for

A

posture assessment of stroke scale

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65
Q

PASS is best performed when

A

early - within 90 days of stroke

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66
Q

what does PASS test for

A

balance and position change ability

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67
Q

STREAM stands for

A

stroke rehab assemeent of movement

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68
Q

STREAM tests what

A

measurement of motor function and mobility (tests initiation, modification, and control of movement)

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69
Q

if pts dont show normal motor control/strength, what HAS to be assessed

A

PROM (Muscle length, soft tissue extensibility, and flexibility - Important given musculoskeletal contributions to spasticity)

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70
Q

what is tone

A

R to passive stretch

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71
Q

modified ashworth scale tests what

A

spacticity only (not rigidity or flaccidity)

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72
Q

shopping, family roles are considered ADL or IADL

A

IADL

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73
Q

FIM is about what

A

level of assistance needed for all constructs

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74
Q

peak age of MS onset

A

30 (15-50)

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75
Q

farther away from the ___ it increases your chance of MS

A

equator (however, if you move before you are 15 you assume that geographical locations risk)

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76
Q

virus possibly linked to MS

A

Epstein Barr

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77
Q

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

A

Relapsing remitting

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78
Q

invovlement of the oligodentrocyte cells is what type of MS

A

secondary progressive

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79
Q

main difference btwn relapsing remitting and secondary progressive MS

A

SP they don’t improve after an exacerbation

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80
Q

most common 1st sx of MS

A

optic neuritis

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81
Q

____matter is effected by MS

A

white

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82
Q

what tracts carry sensory info to brain

A

corticospinal

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83
Q

what is CIS

A

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

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84
Q

to diagnose MS you have to have dissemination of __ and __

A

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)

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85
Q

4 types of MS

A

relapsing remitting
secondary progressive
primary progressive
progressive relapsing

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86
Q

EDSS

A

expanded disability status scale (#1 OM for MS)

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87
Q

downfall of EDSS

A

doesn’t respond to changes in intervention

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88
Q

sensitivity to heat with MS is known as

A

Uthoff sx

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89
Q

biggest c/o for MS pts

A

fatigue

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90
Q

which type of MS has more severe fatigue early on,

A

PPMS (it decreases over time though bc they stop being active)

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91
Q

2 types of fatige with MS

A

peripheral and central (muscular vs true exhaustion)

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92
Q

cause of fatigue for MS

A

BG or widespread axonal damage. overactivation of frontal cortical areas.

bottom line: motor planning takes alot out of them

93
Q

weakness in MS is more common in the ___extremeties

A

Lower

94
Q

MS weakness effects both ___ and __

A

muscle contraction/performance and endurance

95
Q

incoordination of mvmt dt sensory or cerebellar issues

A

ataxia

96
Q

ataxia is a prob with ___ control

A

anticipatory

97
Q

co contractures and decompensation are compensatory methods for

A

ataxia

98
Q

timing, scaling, accuracy, (coordination) are done by what part of brain

A

cerebellum

99
Q

pts with cerebellar issues have a hard time ___ and ___ movement

A

predicting and adapting

100
Q

does life exp with MS decrease

A

no

101
Q

5 main issues of MS

A

fatigue, weakness, spacticity, ataxia, posture

102
Q

prognositc indicators of MS

A

sphinctor control, cognition

103
Q

is higher or lower EDSS better

A

higher is worse

104
Q

primary dx tool for MS

A

MRI (can also do CSF draw to test for antibodies)

105
Q

drugs for MS

A

interferons (decrease the inflammatory process)

106
Q 
Betaseron
Avonex 
Rebif
Copaxone
Novantrone
 these are all what types fo drugs
A

interferons

107
Q

drug that improves gait speed

A

K channel blocker (AMpyra - or dalfampridine)

108
Q

what is a pseudo exacerbation

A

happens after exercise, tell pts it will go away (they have an increase in their sensory sx)

109
Q

PD is a disease of the ___NS

A

CNS

110
Q

tell tell signs of PD

A

rididity, bradykinesia, tremors (resting), posture probs

111
Q

what anatomical location is the issue with PD

A

BG (basal ganglia) specifically the substansia nigra

112
Q

3 types of PD

A

ideopathic (most pts have this kind)
identifiable (secondary)
Parkinsons plus

113
Q

identifiable AKA secondary PD is dt

A

drugs or tumors or illness (virus)

114
Q

would reflexes for PD be normal

A

yes

115
Q

what would be good walking tests for PD

A

TUG or DGI

116
Q

dopamine comes from the

A

subs nigra

117
Q

2 tracts/loops of the basal ganglia

A

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

118
Q

what happens with PD (what causes it)

A

decreased dopamine, decreases excitation, which decreases movement

119
Q

rigidity of PD happens more

A

proximal

120
Q

with PD, there is a(n) ____ in tone

A

increase (they are rigid)

121
Q

2 subgroups of PD

A

posture/gait

tremor

122
Q

highest form of increased resistance to a passive stretch

A

rigidity (rigidity is the highest form of tone)

123
Q

rigidity is vel ___

A

independent

124
Q

shuffling gate of PD is aka

A

festination

125
Q

sudden stopping with PD is aka

A

freezing

126
Q

why are toppling falls common with PD

A

bc festinated gate changes their COM as they shuffle

127
Q

micrographia

A

poor control of handwritting

128
Q

PD #1 assessment

A

Hoen and Yar

129
Q

how is PD dx

A

if they have 2/3 sx (there is no imaging)

130
Q

another tx for PD

A

deep brain stimulation

131
Q

list the 3 models of motor control

list the 3 models of neuro rehab

A

models of motor control: Reflex, heirarchial, systems

models of neuro rehab: muscle re-ed, neuro therapeutic facilitation, task oriented

132
Q

ATNR is an ex of what model of motor control

A

heriarchial

133
Q

downfall of reflex theory and heirarchial

A

they dont’ include how human mvmt is variable

134
Q

sx theory use what model of neuro rehab

A

task oriented approach only

135
Q

what are the 3 models of neuro rehab

A

muscle re-education (no one uses)
Neuro therapeutic facilitation
Task oriented rehab

136
Q

goal of neurotherapeutic facilitation is

A

to get pts out of a synergy pattern and to normalize mvmt

137
Q

plus of task oriented

A

variability and adaptability, there is no 1 right way, pts are the prob solvers, we dont always normalize

Emphasizes high repetition intensive task practice

138
Q

neurotherapeutic facilitation utilizes

A

PNF, NDT, Brunnstrom

139
Q

what is Brunnstrom stages

A

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

140
Q

NDT

A

neuro develpmental tx

141
Q

goal of NDT

A

enhance normal movement or normalize tone

142
Q

NDT uses

A

handling (sensory feedback)

143
Q

downfalls to NDT

A

takes a lot of time, and typically doesnt progress until pt has mastered a skill

144
Q

what is PNF task classification scale, and list the progression

A

it is a progression we are supposed to follow when doing PNF (mobility, stability, controlled mob, and skill)

145
Q

downfall with PNF task classification scale

A

not all pts can follow that progression (ex: PD dont need to work on stability, ataxic pts dont need mobility)

146
Q

3 components of task or approach

A

effects that pt, env, and task have on mvmt

147
Q

all movement is comprised of 3 things

A

progression, stability, adaptability

148
Q

which type of therapist always tries to correct abnormal mvmt

A

NDT

149
Q

2 ways to retrain mvmt

A

force control or momentum

150
Q

force control requires

A

strenght

151
Q

momentum requires __ and __

A

strenght and coordination

152
Q

which is best for ataxic pts, force control or momentum

A

force control

153
Q

restorative vs compensate

A

one you improve the issue back to normal,the other uses adaptive techniquies

154
Q

constraint induced therapy is _____ oriented

A

task

155
Q

clear start and finish is a ___ task

A

discrete

156
Q

no clear start and finish is a ___ task

A

continuous

157
Q

3 essential tasks of mobility

A

Progression
Stability
Adaptability

158
Q

stages of motor learning

A

cog
associative
autonomous

159
Q

progression part of mobility task is what (describe)

A

its all the movement of the body (ex: in sit to stand it’s hip flexion, trunk flexion, knee ext)

160
Q

explain stability as an essential task of mobility

A

controlling balance, maintaining COM

161
Q

what are the 3 steps to using a task orientied approach in mobility

A
  1. initial considerations
  2. movement analysis
  3. plan the intervention
162
Q

what does initial considerations mean in task oriented approach (with mobility)

A

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?

163
Q

adaptation of movement is hardest for what type of pts

A

ones stuck in a synergy pattern

164
Q

in step 3 of task oriented approach of mobility (plan the intervention) what may you have to do be for actual movement

A

tx underlying impairments (ex: stretch plantar flexors)

165
Q

what is different about STS vs supine to stand or rolling in bed

A

STS is not really variable (you stand up)

supine to stand and rolling both have variable ways to do it

166
Q

2 months post stroke, would you work on more compensatory or restorative

A

restorative (still acute)

167
Q

is it better to do random or blocked practice in associative stage

A

do random

168
Q

4 steps to assessment part of soap note

A

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

169
Q

A label to describe the dimensions of the patient

A

diagnosis

170
Q

diagnosis directs what

A

plan of care

171
Q

ataxia dismetria-celebellar

are what PT diagnosis

A

movement pattern coordination deficit

172
Q

weakness is what PT diagnosis

A

force production deficit

173
Q

force production deficit PT dx has 2 components (list them)

A
  1. improvment expected

2. no improvement expected

174
Q

lack of ROM or diminished ROM is what PT dx

A

biomechanical deficit

175
Q

one thing is off so they “weigh” one sensation over the other (what PT dx)

A

sensory selection deficit

176
Q

severe Hypokinesia PT dx would be related to

A

PD

177
Q

SCI (cannot sit upright) would be what PT dx

A

monitored mobility

178
Q

left neglect would be what PT dx

A

perceptual deficit

179
Q

proprioceptive issues would be what PT dx

A

sensory detection deficit

180
Q

decreased muscle tone with inability to initiate movement is what PT dx

A

Paresis

181
Q

Significant signs of hyperexcitability with associated inability to initiate movement is what PT dx

A

spacticity without mvmt

182
Q

significant signs of hyperexcitability with associated inability to fractionate movement against gravity is what PT dx

A

spacticity with mvmt

183
Q

if pt simply cannot participate in mobility training, their PT dx is

A

mobility consult

184
Q

how to word a prognosis for a SCI pt who will not return motor function, but is motivated

A

pt has poor prognosis for motor return, but good prognosis for learning compensatory strategies for functional activity

185
Q

what is neuroplasciticy

A

brain remodels and adapts after a stroke (can take months), at about 6 months it stops

186
Q

what strokes have best prognosis

A

lacunar

187
Q

what is best predictor of prognosis post stroke

A

initial recovery of motor function

188
Q

most motor recovery occurs when (post stroke)

A

1st month -6 months

189
Q

what does research say about UE vs LE prognosis of motor function post stroke

A

less UE involvment (better prognosis for UE)

190
Q

what is a good predictor for prognosis of stroke for UE

A

shoulder shrug ability

191
Q

what is orpington scale

A

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

192
Q

goal time frame for OP setting (long term is how long, short term is how long)

A

LTG reflect DC, short term are 3-4 weeks

193
Q

SMART goals

A 
specific
measurable
acheivable
relavent
time
194
Q

when formulating prognosis, we must consider both ___ and ___ factors

A

pos and neg

195
Q

walking and talking is an ex of a ____type of task

A

cognitive dual

196
Q

walking and lifting something is a ___ type of task

A

motor dual

197
Q

considerations when setting gait related goals

A 
distance variables
Amount of assistance needed
Use of assistive device
Ability to ambulate in various environments
Safety
Cognition
198
Q

what test would you do to determine gait speed

A

10m walk

199
Q

community ambulatory would need to walk at what pace

A

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

200
Q

5 main impairments constraining gait

A 
Weakness
Spasticity
Loss of ROM
Dyscoordination/Ataxia
Rigidity/bradykinesia
201
Q

1 muscle group needed for progression, that gives power for push off in walking progression.

A

gastroc soleus (decreased plantarflexors lessons push off and even their speed and power)

202
Q

how does weakness effect stabilty in walking

A

if glut med is weak, their single leg stance is poor

203
Q

how does weakness effect adaptabilty in walking

A

if quads are weak, they cannot change directions or alter gait well

204
Q

weakness can impact what tasks of mobility

A

all (progression, stability, and adaptabilty)

205
Q

post stroke, these muscles are most weak on pts

A

pts will have the most problem with dorsiflexion, hip flexion, knee flexion

206
Q

post stroke, pts have more probs with what tasks of mobility

A

pts have More difficulty with progression, decreased push off, and adaptability (stepping over things in the env

207
Q

weak quads post stroke, what compensations might you see

A

Knee hyperextension

Forward trunk lean

208
Q

spacticity can effect what tasks of mobility

A

all

209
Q

how can spacticity specifically effect gastroc/soleus during gait

A

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

210
Q

which type of walker is better for ataxic pts

A

rolling (standard they would have to pick up, increasing their chance of fall)

211
Q

Tx options for ataxic pts with gait

A 
Weighting
Balanced Based Torso Weighting 
assistive device
Exercises to increase stability (pnf)
Balance-retraining
Compensatory strategies
212
Q

tx options for PD with gait

A 
Balance and gait retraining
Use of visual and auditory cues
Lee Silverman Voice Treatment (LSVT) BIG program
Assistive device
Stretching/flexibility exercises
213
Q

key ingredients to locomotive training

A 
high reps
speed
salience-meaningful to them
make it challenging
incorporate paretic side
task specific-walking improves walking
whole task
know env
214
Q

what does speed offer as a key ingredient to locmotive training

A

taps into CPG

215
Q

gait is a ___task

A

whole

216
Q

2 main types of body supported treatmill devices

A

harness

robotic

217
Q

BWSTT (harness) is as effective as __

A

a task oriented training program (robotics not so much)

218
Q

in regards to the big chart she keeps showing, what does cog demands mean

A

is it dual task vs single (walking and talking or just walking)

219
Q

difference btwn blocked and random tasks

A

random-all in random order

blocked-practicing each task in a block before progressing to a new task.

220
Q

explain the MDC results (how do you know if it’s reliable test)

A

The more reliable the test, the smaller the MDC

221
Q

the goal of this model of rehab is to alter CNS,
Reduce stereotypical movement patterns and reflexes
Facilitate normal movement

A

neuro therapeutic facilitation

222
Q

ave age onset of PD

A

Average age at onset 50-60 years

223
Q

one of the most prevalent issues with PD (decreases their QOL)

A

postural instabilty that causes falls

224
Q 
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

A

NDT

225
Q

surgical txs for parkinsons

A

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

226
Q

models used by NTF (neuro therapeutic facilitation)

A

Proprioceptive Neuromuscular Facilitation (PNF)
Neurodevelopmental Treatment (NDT)
Brunnstrom

227
Q

This tx approach progresses pts through phases of synergistic patterns to hopefully get them to normal movement

A

Brunnstrom

228
Q

what are the 4 PNF task classifications (the progression that you are supposed to follow)

A

mobiliy
stability
controlled mobility
skill

NEUROMUSCULAR I (POTTER) (4 decks)

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