Exam 5: PNS vs CNS, Motor Assessment, Learning and Sensorimotor Approaches Flashcards
Hand Therapy, Splinting, PAMs, PNS vs. CNS deficits, Theorists of Functional Movement
sensori =
input through the senses
- used with those with CNS damage
motor =
muscle movement
- used with those with CNS damage
PNS vs. cns damage
- problem with the receptors (sensory or motor), muscle quality and function (muscular dystrophy), or tissue (tendons, joints, cartilage, ligaments, etc)
- does not DIRECTLY involve the BRAIN
- brain may make errors based on faulty input
CNS vs. pns damage
- damage to the BRAIN or SPINAL CORD, but impacts peripheral function
- causes changes to the peripheral tissue and structures
- causes changes in muscle tone and coordination
- causes recurrence of primitive reflexes
- because brain is involved, can also have cognitive, perceptual, and motor planning deficits along with weakness and motor change
FOR for PNS damage
- BIOMECHANICAL for REMEDIATION
or…. REHABILITATIVE for COMPENSATION - prognosis depends on amount and cause of dysfunction
FOR for CNS damage
- SENSORIMOTOR for REMEDIATION
or…. REHABILITATIVE for COMPENSATION - prognosis depends on the amount of the brain impacted and where the areas of damage are
goals of sensorimotor approaches (5)
- REDUCE abnormal changes in movement patterns
- NORMALIZE muscle tone
- FACILITATE symmetrical posture
- IMPROVE balance
- uses neuroplasticity
motor control def. + associated factors (5)
the ability to regulate or direct movement
- perception (making sense of input)
- motor planning (processing input)
- motor execution (carrying out movement)
- feedback (internal and external)
- biomechanics (relationship of muscles and joints to one another)
postural tone def.
muscle tension in the neck, trunk, and limbs
- must be HIGH enough to resist gravity
- must be LOW enough to allow movement
normal postural tone allows: (3)
- automatic and continuous adjustments
- proximal stability allowing for distal mobility
- base for voluntary, selective movements
postural mechanisms def. + associated factors (5)
automatic, involuntary movements that together provide stability and mobility during activity
- postural tone
- muscle tone
- reflexes
- automatic reactions
- coordination
causes of hypotonicity/ low muscle tone
- peripheral nerve injury
- cerebellar disease
- frontal lobe damage
- neuromuscular junction impairment
shock phase of stroke or SCI - often turns into hypertonicity eventually
characteristics of hypotonicity/ low muscle tone
- muscle soft, mushy
- no resistance to PROM
- limb heavy
- limb must be protected
- hypermobile joints
- easily fatigued
- can’t maintain positions
causes of hypertonicity/ increased muscle tone
- any condition impacting upper motor neuron pathways
characteristics of hypertonicity/ increased muscle tone
- hyperactive stretch reflex
- greater than normal resistance to PROM
- clonus: quick, alternating agonist/ antagonist contractions
- decreased mobility
- pain or stiffness
external factors impacting hypertonicity (2)
- postural position
- environment (temp. extremes, noises, light; pain, emotional stress, infection)
areas to consider for assessing muscle tone (3)
- client position: preferably seated
- therapist handling: hand proximal and distal to joint and moves in slow, even movement
- classification of tone: modified ashworth scale
reflexes def.
innate motor responses elicited by specific sensory stimuli
primitive reflexes def.
reflexive patterns found throughout the development cycle that integrate as voluntary movement is gained (in normal development)
- can often reemerge after a CNS injury such as TBI, or CVA
protective extension reactions def.
automatic extension of arms to preserve balance
righting reactions def.
maintaining head in space with eyes parallel to ground with postural movements
equilibrium reactions def.
- balance reactions-trunk elongates on weight-bearing side
- impacts seated or standing ADLs involving B UE
sensorimotor approaches (4) and key words
- ROOD: inhibition/ facilitation
- BRUNNSTROM: synergies
- PNF: diagonal
- BOBATH/ NDT: developmental patterns, proximal control - feeling the movements
ROOD
- focus: tone regulation
- theme: appropriate sensory stimulation can elicit specific motor responses; provide structured, developmentally sequenced motor patterns; multi-sensory approach
- assumptions: motivation, repetition
ROOD key points
- INHIBITION = of tone
= neutral warmth, resistance (manual resistance; weight of body and gravity), joint compression (weight bearing in extension) and traction (slow, sustained stretch) - FACILITATION = of tone
- quick stretch/ tapping (short lived), vibration, olfactory/ gustatory stimuli
ROOD PROPRIOCEPTIVE techniques
- quick stretch/ tapping
- resistance
- joint compression
- joint traction
ROOD EXTEROCEPTIVE techniques
- light touch; icing
- fast brushing
- manual contact of therapists hands over muscles
how ROOD is used
CNS FACILITATION or INHIBITION techniques prepare the muscles to breakout of reflexive patterns and into more normal movement patterns
- always follow up with functional activity!
BRUNNSTROM APPROACH FOR HEMIPLEGIA
focus: progression of abnormal tone and movement synergies (stages of recovery)
assumptions:
- CNS damage results in “regressed” movements
- result is abnormal movement patterns called SYNERGIES
- synergies are heavily influenced by reemergence of primitive reflexes
- synergies ALWAYS precede return to normal patterns
BRUNNSTROM stages of UE motor recovery
- no motion
- reflex response
- associated reactions
- mass response (synergistic)
- flexion pattern response
- extension pattern response - deviation from pattern
- wrist stability
- individual finger movement
- selective pattern with overlay
- selective movement
7 BRUNNSTROM stages of recovery
- flaccidity
- emergence of synergies
- spasticity increased
4.decline of spasticity, beginning of voluntary isolated control - refinement of voluntary motor control, synergies now less apparent
- spasticity absent
- return to normal motor control
how BRUNNSTROM is used
stages 1&2: facilitation techniques, ROM
stages 2&3: try for voluntary control of synergy movements
stages 4&5: encourage movement out of synergy patterns
stage 6: increase isolated movements, try to go faster
- USE FUNCTIONAL ACTIVITIES whenever possible
additional considerations for BRUNNSTROM (3)
- position to break up synergies (bed and w/c positioning)
- presence of associated reactions on hemiplegic side when other side is working
- use of mirrors for visual feedback
PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF)
focus: movement patterns that are used in occupation
assumptions:
- the brain registers normal movement patterns, NOT individual muscle actions
- limbs do not move in linear patterns
- cephalocaudal and proximodistal development of movement
- trunk is an important part of limb use in activities
- functional activities consists of movement patterns, often in diagonal motions; can be done unilaterally or bilaterally
PNF diagonals
D1 FLEXION: closed fist at midline above head
D1 EXTENSION: open hand at side below waist
D2 FLEXION: open hand at side above head
D2 EXTENSION: closed fist at midline below waist
how PNF is used
- use manual contact, tone of voice, and short “commands”
- incorporate diagonals into as many functional activities as possible (crossing midline)
NEURODEVELOPMENTAL TREATMENT (NDT)
focus: relearning normal movements
assumptions:
- pts must experience normal movement patterns
- quality of movement is more important than quantity
- emphasis on proximal control
- weight bearing normalizes tone
- bilateral use of extremities whenever possible
- crossing midline
- trunk symmetry and pelvic mobility/ stability
- relying only on compensatory strategies alone may lead to overuse of unaffected side and underuse of the involved side
- pts avoid weight-bearing on affected side, when that is a good tool for faciliation
