Exam 2 Flashcards
Disability
inability to perform activities usually expected in specific social roles that are customary for the individual or expected for the person’s status or role
Three components of physical therapy intervention
Coordination, communication, documentation
Patient/client related instruction
Procedural interventions
Restorative
Treat involved areas to remediate/improve function
Compensatory
Promote optimal function using residual abilities
Preventitive
Avoid potential future damage
Phase Models of Psycholsocial Adaptation
Shock, Anxiety, Denial, Depression, Internalized anger, externalized hostility, acknowledgement, adjustment
Strategies for Type A (high achievers)
Give good HEP
Strategies for perfectionists
Help patient find pleasure in accomplishing simple things
Strategies for authoritative personality
Engage in problem solving
Strategies for a passive-aggressive
Place responsibility for progress on patient, have patient make decisions about treatment, summarize progress
Positive coping strategies
Seeking control and information
Express emotion
Seeking social interactions
Negative coping strategies
Avoid control and information
Repress emotions
Withdrawal from social interactions
External locus of control
Other people or outside factors have control over outcomes
Have stress and anxiety in rehab
Internal locus of control
Person can affect his/her own circumstances
Quicker recovery, better motivation, more hope, more energy
Acute stress disorder
Symptoms that range in duration from 2 days to 4 weeks
Posttraumatic stress disorder
Acute: symptoms less than 3 mos
Chronic: symptoms beyond 3 mos
Motor control
Ability to regulate or direct the mechanisms essential to movement
Motor skills
Learned through interaction and exploration of the environment
Motor program
Abstract representation of movement that results in production of coordinated movement sequence
Motor plan
Idea or plan for purposeful movement that is made up of several motor programs
Short term change in neuroplasticity
Efficiency or strength of synaptic connections
Long term change in neuroplasticity
Organization and numbers of neural connections
Motor learning
Internal processes associated with practice or experience leading to relatively permanent changes in capacity for skilled behavior
Feedback
Response produced information received during or after the movement; monitor output for corrective actions
Feedforward
Sending signals in advance of movement to ready the system; allows for anticipatory adjustments in postural activity
Validity
Test accurately measures the parameter of performance being examined
Reliability
Consistency of results in test/retest situations
Ascending reticular activating system
Exerts an excitatory influence on the cerebral cortex to maintain the alert state
Levels of consciousness
Alert
Lethargic - slow to respond, drowsy
Obtunded - dull, blunted response, difficult to arouse, appears confused
Stupor - semiconscious, aroused only with intense stimuli
Coma - no response to stimuli
4 parts of orientation
Time
Place
Person
Circumstance
What indicates attention problems
Inability to repeat six items (short lists of numbers or objects)
Declarative memory
Recall of facts/events
Immediate memory
Recall after a few seconds
Short term memory
Recall in minutes to days
Long term memory
Recall in years (general knowledge)
Anterograde amnesia
Poor new learning
Retrograde amnesia
Unable to remember previous learning
Factors of articulation
Timing Vocal quality Pitch Volume Breath control
Neologisms
Creating new words
Circumlocutions
Talk around what it really is
Anomia
No language or stuck on word or two
Ideomotor apraxia
Have automatic movement, but not on demand
Ideational apraxia
Purposeful movement is not possible
Closed loop system of motor control
Uses feedback, somatosensation
Open loop system of motor control
Does not use feeback or error detection
Rapid movements or well learned movements so don’t have time to process
Tone
Resistance of muscle to passive stretch while attempting to maintain muscle relaxation
Spasticity
Velocity dependent resistance to passive stretch
Clasp knife response
Meet a lot of resistance, then reach a point where it is easier to move
Decorticate rigidity
UE flexion, LE extension
Disruption above superior colliculus
Decerebrate rigidity
Sustained posturing of UE & LE extension
Lesion between superior colliculus and vestibular nucleus
Opisthotonus
Sustained contraction of neck and trunk extensors
Tone grading
0 - no response 1 + decreased response (hypotonia) 2+ normal response 3+ exaggerated response 4+sustained response (rigidity)
Gold standard for spasticity
Modified Ashworth Scale
LE extensor tone actions
Hip Ext, add, IR,
Knee ext
Ankle PF and inv
Reflex grading
0 - no response 1+ decreased response (abnormal) 2+ normal response 3+ brisk response (hyperreflexia) 4+ very brisk, hyperactive, 1-3 beat clonus 5+ >3 beat clonus or sustained response
Flexor withdrawal LE
Hip flexion, ER, and abduction
Closed motor skill
Performed in a stable, nonchanging environment
Open motor skill
Performed in a variable, changing environment
Fixed support balance strategies
Ankle strategy
Hip strategy
Suspensory strategy
Change in support balance strategies
Stepping strategy
Protective extension
FIM Scores
5 and lower = need another person
6 = need AD but independent
7 = independent in a timely and safe fashion
Generalizability
Extent to which practice on one task contributes to the performance of other, related skills
Reflex theory
Sherrington
A stimulus causes a response
Hierarchial theory
Jackson
CNS organized in 3 layers: high, medial, and low and motor control proceeds in a top down direction
Highest level of hierarchy
Association cortex; elaborates perceptions and planning strategies
Middle level of hierarcy
Sensorimotor cortex along with basal ganglia, brainstem, cerebellum
Lowest level of hierarchy
Spinal cord, resulting in execution of movement
Systems theory
Bernstein
Cooperative actions of many systems
Systems model
Vereijken
Novice, Advanced, and Expert levels
Closed Loop Theory
Adams
Sensory feedback compared to stored memories
Schema Theory
Schmidt
Relationship formed on the basis of experience
Slow movement: feedback based
Fast movement: program based
Recall schema
Selects initial movement conditions
Recognition schema
Evaluate movement responses based on expected sensory outcomes
3 stages of motor learning
Fitts and Posner
Cognitive, Associative, and Autonomous
Two stage theory of motor skill acquisition
Gentile
Getting the idea of the movement
Fixation/diversification
Concurrent feedback
Given during the performance of the task
Terminal feedback
Given at the end of performance of the task
Knowledge of performance
Feedback about the quality of the movement pattern
Knowledge of results
Feedback about the end results or outcome
Summed feedback
Given after a set number of trials
Faded feedback
Given after every trial initially, then progressively less frequently
Bandwidth feedback
Given only when performance outside given error range
Delayed feedback
Given after a brief delay
Massed practice
Rest time is less than practice time
Good for high motivation, good concentration, and good endurance/energy level
Distributed practice
Rest time equal or longer than practice time
Most learning per training time
Blocked practice order
Repeated practice in a predictable order
111222333
Good for early acquisition of skills
Serial practice order
Predictable but nonrepeating order
123123123
Good for retention and generalizability
Random practice order
Nonrepeating and unpredictable order
123321231
Good for retention and generalizability
Transfer of learning
The gain (or loss) of task performance as a result of practice or experience on some other task
Parts to whole transfer
Practicing component parts of a motor activity in order to learn the whole activity
Bilateral transfer
The patient practices movement on the unaffected side first, then progresses to practice with the affected side
Regenerative synaptogenesis
Sprouting of injured axons to innervate previously innervated synapses
Reactive synaptogenesis
Collateral sprouting
Reclaiming of synaptic sites of injured axon by dendritic fibers from neighboring axons
Vicariance
Experiencing from experience from others
Neurodevelopmental Treatment
Karl and Berta Bobath
Postural control is foundation for all skill learning
Motor Relearning Programme for Stroke
Carr and Shephard
Recovery stage in patients with stroke
Signe Brunnstrom
Stage 1
Presence of flaccidity
Stage 2
Emergency of basic limb synergies
Stage 3
Voluntary performance of all or part of basic limb synergies
Stage 4
Beginning of collateral movement outside of synergistic pattern
Stage 5
Relative independence of basic limb synergies
Stage 6
Isolated, coordinated joint movement
PNF Patterns
Kabat, Knott, Voss
Neuromuscular/Sensory stimulation techniques
Maragret Rood
Reciprocal Innervation
Reflex activation for movement patterns in developmental sequence
Coinnervation
Cocontraction of agonist and antagonist to stabilize body from head to feet
Heavy work
Movement superimposed on cocontraction
What artery is most commonly infarcted in stroke? Why?
Middle cerebral artery because of its direct continuation from the internal carotid artery
Intracranial Hemorrhage
Rupture of cerebral vessel (weakened by atherosclerosis and having formed an aneurysm)
Subarachnoid Hemorrhage
Bleeding into subarachnoid space from saccular or berry aneurysm
Top risk factors for stroke
Atherosclerosis
Hypertension
Heart disease
Diabetes
Ischemic umbra
Core area of focal infarction
Irreversible cellular damage
Ischemic penumbra
Area between normally perfused tissue and ischemic tissue
Viable, but metabolically lethargic
Subclavian steal syndrome
A narrowing of the proximal subclavian artery causes blood to be shunted to the extremity instead of the full amount going to brain
Symptoms include dizziness, arm claudication, and BP difference between arms greater than 20 mmHg
Anterior cerebral artery syndrome
Artery supplies the medial aspect of the cerebral hemisphere
CL hemiparesis in LE
Middle cerebral artery syndrome
Supplies the entire lateral aspect of the cortex and sub cortical structures CL hemiparesis of UE and face CL sensory loss Aphasia Homonymous hemianopsia
Internal carotid artery syndrome
ICA supplies ACA and MCA
If circle of willis is impaired, extensive cerebral infarcction, cerebral edema, uncal herniation, and death
Lacunar syndromes
Small vessel (penetrating arteries) disease deep in cerebral white matter
Pure motor lacunar stroke
Involvement of posterior limb of internal capsule, pons, and pyramids
Purse sensory lacunar stroke
Ventrolateral thalamus or thalamocortical projections
Locked in syndrome
Complete basilar artery thrombosis and bilateral infarction of pons
Paralysis (tetraplegia) and lower bulbar paralysis (CN V-XII)
Mutism (anarthria) - unable to speak
What is preserved in locked in syndrome
Consciousness
Sensation
Vertical eye movements
Blinking
Ideational apraxia
Unable on command OR automatically
Ideomotor apraxia
Unable on command
Inpatient rehab rules? Who accredits them?
CARF
Patient must tolerate 3 hours a day for 5 days a week by 2 or more disciplines (PT, OT, SLP)
