Exam 3 Flashcards
1
Q
Postural Stability
A
the ability to control the center of mass in relationship to the base of support
2
Q
Components of the Systems Model of Development
A
- musculoskeletal
- neuromuscular response synergies
- somatosensory, visual, and vestibular systems
- sensory strategies for organizing multiple inputs
- internal representation for mapping of perception to action
- adaptive and anticipatory mechanisms
3
Q
Balance and Protecting Reactions
A
- tilting reactions
- parachute response
4
Q
Law of Developmental Direction
A
developed by Arnold Gesell in 1946; development occurs from head to foot and proximal to distal within segments
5
Q
What are the action systems in postural control?
A
- higher-level planning
- co-ordination
- generation
6
Q
Components of Postural Control
A
- musculoskeletal
- internal representation
- adaptive mechanisms
- anticipatory mechanisms
- sensory strategies
- individual sensory systems
- neuromuscular synergies
7
Q
Musculoskeletal Components of Postural Control
A
- joint ROM
- strength
- base of support
- alignment and posture
- muscle tone
- postural tone
8
Q
What senses contribute to postural control?
A
- visual
- somatosensory (proprioception, cutaneous, joint receptors)
- vestibular
9
Q
Visual input
A
static and dynamic visual acuity
10
Q
Normal Eye Aging
A
- sensitivity to glare
- dark adaptation
- shifting focus between near/far
- require more light
- slower reaction time
- difficulty distinguishing color
- peripheral vision somewhat smaller
11
Q
Normal Eye Aging
A
- sensitivity to glare
- dark adaptation
- shifting focus between near/far
- require more light
- slower reaction time
- difficulty distinguishing color
- peripheral vision somewhat smaller
12
Q
Somatosensory Input
A
- muscle spindle/GTO
- joint receptors
- cutaneous mechanoreceptors
13
Q
Vestibular Input
A
information regarding position of head relative to gravity and inertial forces
14
Q
Semicircular Canals
A
anterior, posterior, and horizontal (lateral) canals; important for detecting angular movement
15
Q
Otoliths
A
- utricle: detects horizontal movement
- saccule: detects vertical movement
16
Q
Normal Aging of the Vestibular System
A
- loss of hair cells
- calcification of otolithic membranes
- micro vascular ischemia
- less effective vestibulo-ocular reflex
- less efficient sensory reweighting/prioritization
- hyposensitivity related to sedentary lifestyle
17
Q
What are the visual limitations in terms of postural control?
A
- exocentric vs. egocentric motion
- dark environment
- eyes closed/visual deficits
18
Q
What are the somatosensory limitations in terms of postural control?
A
- moving support surface
- non-horizontal surface
19
Q
What are the vestibular limitations in terms of postural control?
A
- in isolation cannot provide CNS with true picture of how body is moving in space
- dysfunction in system
20
Q
Patterns of Recovery
A
- ankle strategy
- hip strategy
- stepping strategy
21
Q
Ankle Strategy
A
low frequency sway of ≤ 1 Hz; trunk and legs are in phase; most commonly used when the perturbation is small and the support surface is firm
distal to proximal muscle activation;
22
Q
Hip Stretegy
A
higher frequency sway of ≥ 1 Hz; trunk and legs are out of phase; most commonly used when the perturbations are larger and faster, and compliant or BOS smaller than feet
23
Q
Stepping Strategy
A
elicited when hip is not efficient to maintain or re-establish BOS; most commonly used when ankle or hip strategy is insufficient for recovery
reach or step is used to realign the BOS under the COM
24
Q
Adaptive Postural Control
A
modifying sensory/motor systems in response to task and environmental demands
25
Goals for training postural control
- choose the appropriate training task
- structure the environment
- vary the task
- progressively increase the complexity
- try new tasks
- repeat
26
Benign Paroxysmal Positional Vertigo
mechanical disorder of the inner ear caused by abnormal stimulation of one of more of the three semicircular canals; caused by movement of calcium carbonate crystals from utricle to semicircular canal; most common cause of dizziness and is characterized by:
- vertigo/dizziness which typically lasts less than 1 minute
- mild postural instability in between episodes of vertigo (> 50% of affected individuals)
27
What are the common movements that precipitate symptoms of vertigo?
- transitioning from sit to/from supine
- bending over
- rolling over
- looking up
28
Characteristics of BPPV
- insidious onset
- brief duration (≤ 1 min)
- described as room spinning, lightheadedness, unsteady (10% elderly negative c/o vertigo)
29
Precautions with BPPV positioning testing
- limited cervical ROM
- severe Rheumatoid arthritis
- Down syndrome
- cervical radiculopathies
- Paget's disease
- low back dysfunction
- spinal cord injuries
- torn or detached retina
- glaucoma
30
What are the two types of BPPV?
1. Canalithiasis - free floating calcium carbonate crystals
| 2. Cupulolithiasis - calcium crystals adhered to cupula
31
Upbeating nystagmus with torsional component
posterior canal
32
Downbeating nystagmus with torsional component
anterior canal
33
Right torsion
right side involvement
34
Left torsion
left side involvement
35
Apogeotropic nystagmus
cupulolithiasis
36
Geotropic nystagmus
canalithiasis
37
Canalith Repositioning Manuever (Epley)
anterior or posterior canalithiasis
38
Liberatory Maneuver (Semont)
anterior or posterior canalithiasis or cupulolithiasis
39
Canalith Repositioning Maneuver for Horizontal Canal (BBQ Roll/Lempert Maneuver)
horizontal canalithiasis
40
Post-Treatment Precautions
- collar for 24 hrs. (no longer used)
- avoid head movement
- sleep with head elevated for 1 night
- do not roll onto affected side for 1 night
41
What are the important factor to considers in UE control?
- age
- experience with the task
- any limitations
- type of task
- environmental constraints
42
When does the trunk begin to develop?
4 months old
43
Eye-Hand Coordination
vision is key for target location, while vision and neck mm. are important for accuracy
44
Reach and Grasp
parietal cortex is important for interpreting vision; perceptual pathway - visual to temporal; localization - visual to parietal
45
Superior and Inferior Parietal Lobes
important for spatial awareness
46
Dorsal Stream Visual Pathway
focused on all phases of movement; posture, structure, orientation, etc.
47
Ventral Stream Visual Pathway
focused on our perception; visual percention
48
The visual cortex loop occupies the:
posterior occipital lobe and is connected to the eye via the optic nerve
49
Central vs. Peripheral Vision
central vision aids grasp and manipulation, and guides accuracy; peripheral vision aids reaching
50
Visual perception and motor skills develop:
simultaneously
51
Reach Component is controlled by:
parietal lobe and premorot cortex
52
Corticospinal tract vs. Pyramidal tract
corticospinal tract affects finger control for grasping, while pyramidal tract affects fine motor control of grasp
53
Power Grasps
finger and thumb pads are facing the palm to transmit a force to an object; consists of cylindrical, spherical, and hook grasps
54
Precision Grips
forces are between the pads of the thumb and fingers, and involves more in hand manipulation; consists of pad to pad, tip to tip, and lateral grips
55
What are the four phases of grasp and lift?
1. contact with fingers and object
2. determining grip force and load force
3. movement of the object when load > weight of object
4. end of lift when grip and load forces change to lower an object
56
Reaction time involves what three strategies?
1. stimulus identification
2. response selection
3. response programming
57
Fitt's Law
MT = a+b log2, 2D/W; movement time increases lineraly with the index of difficulty; that is, the more difficult the task, the longer it takes to make the movement
58
Lateral Infraparietal Lobe
sensorimotor planning
59
Inferior Parietal Lobe
eye movement
60
Superior Parietal Lobe
planning center
61
Dexterity and Fine Motor Tests
- 9 hole peg test
- Purdue pegboard test
- Minnesota Rate of Dexterity test
- Box and Block test
62
Visual extinction
inability to detect stimulus in contralateral field
63
Vestibular ocular reflex involves:
1. detection of rotation
2. inhibition of extraocular muscles on one side & excitation of extraocular muscles on the other side
3. compensating eye movement
64
Dorsal visual pathway
- visual cortex to parietal lobe
- good perception & orientation
- difficult with picking up objects
65
Ventral visual pathway
- visual cortex to temporal lobe
- poor perception & orientation
- no difficulty with picking up objects
66
According to Dr. McCallum, what are the suggested components of rehab in patients with fine motor control deficits?
- closed chain before open chain
- sensory input
- functional activities
67
Anterior parietal lobe
- limit precision grip and in-hand manipulation skills
| - tactile apraxia
68
Posterior parietal lobe
- spacial disorientation and misreaching
| - important for organizing object-oriented action
69
What are the sensory deficits with precision grip?
- impaired friction
- timing
- force adjustment of grip
70
When does anticipatory control and tip to tip grasp develop?
age 6-8
71
What are functional outcome based measures?
Barthel Index and Katz Index
72
Wolf-Motor Function test
- 15 timed items
| - quantifies single or multiple joint movement (items 1-6) and functional tasks (items 7-15)
73
Jebsen-Taylor Hand Function test
- 7 timed subtests: writing, card turning, picking up small items, simulated feeding, stacking checkers, picking up light cans, picking up heavy cans
- tests dominant & non-dominant hands
74
CVA Motor Deficits During Reach & Grasp
- difficulty adjusting reach
- overshoots close targets
- undershoots far targets
- lack of fractionated movement
75
Cerebellar Pathology During Reach & Grasp
- difficulty adjusting to change of load
| - impaired with multi joint coordination
76
Cerebral Palsy Motor Deficits During Reach & Grasp
coordination deficits
- compensate with trunk
- did well with reach
77
Parkinson's Disease Motor Deficits During Reach & Grasp
- slow to move (bradykinesia)
| - Levodopa?
78
Motor Impairments with Reach
- timing
- interjoint coordination
- synergies
79
Abnormal synergistic coupling involves:
- poor individuation
| - abnormal torque coupling
80
Individuation
difficulty isolating movement in the shoulder, elbow, and hand
81
Global Synkinesis
- motor irradiation
| - involuntary and unintentional movement of one limb when the opposite limb is active
82
Sensory deficits and reaching
- optic ataxia
| - visual control of the hand impacts ability to reach and grasp
83
Left CVA in Reach and Grasp
transform of grasp
84
Right CVA in Reach and Grasp
transport of grasp
