Exam I Flashcards
what are the components of patient/client management? (6)
(1) examination (2) evaluation (3) diagnosis (4) prognosis (5) intervention (6) outcomes
what is the ICF model? what is one of the main advantages of the ICF model?
provides a common language to describe how people with a health condition function in their lives; it’s interdisciplinary
what are the components of the ICF Model?
what is involved with hypothesis oriented practice?
PTs hypothesize the cause of functional movement problems
what is motor control?
the ability to regulate or direct the mechanisms essential to movement
what are the 3 components that make up movement, based on the systems theory of motor control?
(1) individual
(2) task
(3) enviornment
what are the 3 systems that make up the individual?
(1) motor/action - neuromuscular
(2) sensory/perception - peripheral sensory and higher level processing (interpretation of stimulus)
(3) cognitive - attention, problem solving, emotional aspects
what are the 3 aspects that make up task constraints?
(1) mobility
(2) postural control
(3) UE function
what is the difference between a discrete and continuous task?
(1) discrete tasks have a recognizable beginning and end (ex. sit to stand)
(2) continuous tasks don’t have a defined end point (ex. walking)
what is the difference between an open and closed task?
(1) open: a constantly changing enviornment; patient is required to continually adapt (ex. sports)
(2) closed: fixed enviornment with much less variability
what is the difference between a mobility and stability task?
(1) stability: the base of support doesn’t move during task (ex. static standing)
(2) mobility: base of support moves during task (ex. walking/running)
what are the two factors that contribute to enviornmental constraints? what do each entail?
(1) regulatory - shape how the movement is performed (ex. type of cup being picked up or height of the stair step)
(2) non-regulatory: may affect movement, but doesn’t shape the movement (ex. background noise or distractions)
what is a theory?
interconnected statements used to describe unobservable processes and relate them to each other; used to generate hypotheses tested through research
What is the value of theory to clinical practice?
(1) framework for interpreting patient’s behavior
(2) guide for clinical action based on understanding of normal movement
(3) base to develop new ideas about nature of movement
who came up with the reflex theory? what is basis of this theory?
Sir Charles Sherrington; complex behavior is result of combined reflexes chained together
what are the 3 components of the reflex theory?
receptor >> conductor >> effector (muscle)
(BOTTOM UP)
what is the Hierarchal theory of motor control?
organizational control from the (TOP DOWN); cortical function of the brain is at the top and sensory and reflexive control is at the bottom
what is the motor programming theory?
CNS can produce motor plans based on sensory or central processes (BOTH top-down and bottom-up control)
what is the Systems Theory of motor control?
motor control is distributed across neural sub-systems; result of dynamic interaction between perception, cognition and action systems
what is the best current theory of motor control we have?
no theories have it all, but the systems theory combines elements of other theories and is the most comprehensive
how do scientific theory and clinical practice work together?
(1) scientific theory provides framework that allows integration of practical ideas
(2) clinical practice evolves in parallel with scientific theory; scientific theory is then applied in practical settings
what is motor learning?
the acquisition (and reacquisition) and/or modification of a skilled action; hopefully creating permanent changes in motor function and behaviors
what is the difference between motor performance and motor learning?
motor performance: temporary change in motor performance observed during practice
motor learning: permanent change
what are 3 ways motor learning is assessed?
(1) retention test: reassesment of an individual’s performance at a later date
(2) transfer of learning: testing a skill in a variety of enviornments
(3) generalizability: applying the skills from one task to another similar task
according to the Fitts and Posner Three-Stage Model, what are the 3 stages of motor learning?
(1) cognitive stage
(2) associative stage
(3) autonomnous stage
what is involved with the cognitive stage of motor learning?
(1) develop an understanding of the task
(2) develop strategies to carry out the task
(3) trial and error process
(4) requires the most attention of all the stages
what is involved with the associative stage of motor learning?
(1) patient has learned the skill and is demonstrating more consistent performance
(2) refining the strategy for the task
(3) proprioceptive cues more important than visual cues
what is involved with the autonomous stage of motor learning?
(1) patient demonstrates automatic performance of the movement; refined
(2) able to accomplish task in variety of settings
(3) requires the least attention of all stages
what training strategies should be employed during the cognitive stage of motor learning?
demonstrations, verbal instruction, manual guidance, mental practice, lots of extrinsic feedback; patient develops a reference of correctness
what training strategies should be employed during the associative stage of motor learning?
video self assessment, more proprioceptive cues and less verbal cues
what training strategies should be employed during the autonomous stage of motor learning?
variety of environmental situations; continue to modify feedback and practice
what is intrinsic feedback?
feedback through a person’s sensory system (ex. somatosensory, visual, vestibular, auditory)
what is extrinsic feedback?
feedback that supplements intrinsic feedback (ex. verbal, tactile, visual feedback cues)
what is concurrent feedback?
feedback given during the task
what is terminal feedback?
feedback given at the end of a task
what is the difference between knowledge of performance and knowledge of results?
knowledge of performance (KP): feedback provided throughout the task
knowledge of results (KR): terminal feedback given at the end of a task
what is immediate feedback?
given immediately after movement
what is delayed feedback?
given after brief delay to allow performer to first evaluate their performance
what is summary feedback?
given after a set number of trials
what is faded feedback?
as patient improves, you gradually fade (reduce) the amount of feedback
what is bandwidth feedback?
given only if the performance falls outside of a predetermined error range (no cueing for minor mistakes)
how does frequent feedback affect motor performance and motor learning?
frequent extrinsic feedback may IMPROVE motor performance, but SLOW motor learning
how does less frequent feedback affect motor performance and motor learning?
less extrinsic feedback may SLOW motor performance, but may IMPROVE motor learning
during what stage of motor learning will the most extrinsic feedback be required? what stage will the least be required?
cognitive will require the most to develop a reference of correctness; autonomous stage requires the least
what is the goal when it comes to feedback?
gradually withdraw extrinsic feedback and
promote the use of intrinsic
feedback
what is the difference between massed and distributed rest times? what is a main factor that helps determine which to use with a patient?
(1) massed: amount of practice time is greater than the rest between trials
(2) distributed: amount of practice time is equal or less than the rest between trials
- fatigue is a main factor to determine which to use
what is the difference between constant and variable practice?
(1) constant: practicing the same task in the same way each time (facilitates motor performance)
(2) variable: practicing a task with variations; vary the speed, enviorment, difficulty (facilitates motor learning)
what is the difference between blocked and random practice of a task?
(1) blocked: task is performed in segments; once the first segment is performed adequately, then you add on or move to next segment of the task (facilitates motor performance)
(2) random: task is performed in different settings, with alterations of the task (facilitates motor learning)
what is contextual interference?
when multiple skills are practiced at once, which makes inital performance more challenging, but leads to greater retention for learning
what type of feedback should be used during the cognitive stage of motor learning?
(1) Initial learning stage may benefit from more frequent and immediate feedback
(2) concurrent KP feedback with tactile, verbal, and/or visual cueing
(3) immediate KR feedback
during the cognitive stage, how is initial performance improved?
(1) practice schedule may be needed depending on endurance/attention
(2) blocked and constant practice to improve initial performance
what type of feedback should be used during the associative stage of motor learning?
(1) delayed
(2) summary
(3) faded
(4) bandwidth
what type of feedback does the patient rely on within the autonomous stage?
intrinsic feedback since they are able to perform tasks alone
when will the PT intervene in the autonomous stage?
ONLY when the patient makes an error
what is neuroplasticity?
ability of the brain to regenerate itself; plastic changes that occur in the brain
what are factors that influence neural plasticity?
(1) age
(2) characteristics of the neurological lesion
(3) effect of experience
(4) effect of training
what are the ten principles of experience-dependent plasticity?
(1) use it or lose it
(2) use it and improve it
(3) specificity
(4) repetition matters
(5) intensity matters
(6) time matters
(7) salience matters
(8) age matters
(9) transference
(10) interference
what are early transient events that depress brain function? (2)
(1) diaschisis
(2) edema
what does ataxic movement do in regards to degrees of freedom?
typically increases the degrees of freedom with a given task (less controlled)
what are synergist patterns?
normal movement patterns that are energy efficient and executed in an organized manner, regardless of the complexity of the task
what is ataxia?
an abnormal synergist pattern
what acts as a thermostat for the body and controls temperature regulation?
hypothalamus
what does the CNS do in response to a heat load?
dialates peripheral blood vessels; redistributes blood to periphery and skin
what does the CNS do in response to cold stress?
peripheral vessels constrict; shunts blood to deep body cavities
what are hormones that conserve water and electrolytes?
aldosterone and vasopressin (ADH)
what are hormones that stimulate heat production?
epi and nor-epi (non-shivering thermogensis via brown adipose tissue) and thyroxin
what are examples of radiation?
sunlight, road surface, sand
what is conduction
loss or gain of heat by direct contact
is conduction more effective in air or water? by how much?
heat loss through water is 25x greater than air
what is convection?
transfer of heat to moving air or water
what is evaportation?
heat transfer from water (on skin) that vaporizes to air
what is the major defense against overheating / hyperthermia?
evaporation
when are evaportation and conduction ineffective for heat loss?
when ambient temperture is greater than skin temperature
what is the most important factor of effective heat loss through evaportation?
relative humidity; the more humid it is, the less effective evaportation becomes
what happens during prolonged aerobic exercise in the heat with regards to CO, HR & SV?
SV decreases due to loss of water, causing an increase in HR, which maintains CO
clinically, what is considered dehydration?
2% loss of body mass (pre and post exercise)
what are some of the effects of dehydration?
(1) decreased exercise performance
(2) increased circulatory strain
(3) decreased skin blood flow (causing hyperthermia)
(4) altered CNS function
(5) heat illness
how much fluid should be replaced for every pound of body weight lost?
1 pint per pound lost (loss of 450mL or 15oz)
how long does it take for adaptations to heat to occur?
10-14 days
what is the risk stratification for risk of heat injuries?
very high: >82 degrees F
high: 73-82 degrees F
moderate: 65-73 degrees F
low: <65 degrees F
what are the signs and symptoms with the various heat illnesses?
what are the factors that influence heat cramps and treatment?
(1) factors: muscle fatigue, water and sodium loss in sweat
(2) : rest, fluid replacement, sodium replacement, IV saline
what are the factors that influence heat syncope and treatment?
(1) factors: usually occurs in unfit, sedentary people; decreased BP and inadequate blood flow to brain
(2) treatment: supine with feet elevated, fluid replacement, cooling
what are the factors that influence heat exhaustion and treatment?
(1) factors: fatigue and weakness without severe hyperthermia, inability to continue exercise
(2) treatment: oral or IV fluids, cooling
what are the factors that influence heat stroke and treatment?
(1) factors: severe hyperthermia (core temp. >40 C), CNS disturbances, wet pale skin (exertional), dry, hot, flushed skin (non-exertional)
(2) treatment: immediate whole body cooling, cold water and ice water immersion; life threatening
what are two ways the body combats cold stress?
(1) CNS initiates shivering (increased heat production by 3-6 METS)
(2) piloerection of hair - traps air and forms insulator area
why should clothes be dry when trying to prevent heat loss?
wet clothing contributes to conductive heat loss
does the body have a greater capacity to adapt to the heat or cold?
the heat; body doesn’t adapt as well to cold
where does frostbite usually occur?
exposed skin and extremeties
what are the symptoms and treatment for frost bite?
(1) symptoms: frostnip (no long-term damage), numbness, pallor, pain
(2) treatment: move to warm place, re-warm gently, hospitalization
what are the symptoms and treatment for hypothermia?
(1) symptoms: shivering, numbness, weakness, confusion, pale (cyan) skin, decreased CO & BP, unconciousness
(2) treatment: remove wet clothing, move to warm enviorment, warm fluids
significant impairments involved with hypothermia occur when the core body temp. drops below what?
95 F / 35 C
what do high ventilation rates while exercising in cold weather cause?
water and heat loss
what are norms for HR in adults, children, and newborns?
adults: 60 - 100
children: 80 - 120
newborns: 100 to 130
what are normal respiration rates for adults and infants?
adults: 8 - 12
infants: 30 - 50
why does exercise with arms produces higher SBP and DBP than leg exercise performed at a given percentage of VO2max?
smaller arm muscle mass and vasculature offer greater resistance to blood flow than activation of larger leg mass and blood supply
what happens to BP following a single bout of submaximal exercise?
BP temporarily falls below pre-exercise levels
