EXAM REVIEW Flashcards
What system supports upright posture?
*lateral vestibulo pathway (linear movement, gravity); inversion affects otilith organs
In clinic, working with low tone kiddo:
- linear movement on platform swing
- back and forth barrel or therapy ball, throw bean bags at targets
- Tarzan swing over barrier of “alligator” pillows
- activate postural extensors
Activate postural flexors
*reticulospinal pathway
Tripping scenario:
2 upright posture pathways and additional structure
- reticulospinal pathway
- lateral vestibulospinal
- cerebellum (smoothing out movement, balance, righting = vestibulocereballar functions)
Tripping scenario:
- What allows you to notice the visual stimulus?
- What systems are in play?
- superior colliculi
- vestibular system, semicircular canals, oculomotor/abduscens/trochlear CN = visual system
- vestib/visual system allows you to keep stable visual field as you turn your head
Tripping scenario:
What keeps your body from following your head movement?
basic primitive reflex integration of body on head, head on body
Tripping scenario:
What peripheral functions facil. ability to stay upright?
*reflex arc (before cerebellum!) = too much stretch resulting in contraction
Tripping scenario:
What central system played a role in regaining balance?
visual, vestibular, proprioception (VPL to 3-1-2)
Phone rings after you trip:
What allows you to bend you neck to find your pocket?
medial vestibulospinal pathway (bend neck);
dorsal column (tactile discrimination)
lateral corticospinal
visual/tactile (stereognosis to find phone)
New considerations:
What regions involved in motor control play a role in your response?
cerebellum (stored a previous plan from experience) basal ganglia (to initiate movement) limbic overlays (expecting a phone call, excited for a call)
New considerations:
Neurotransmitters
Dopamine: excitement
Norepi: change arousal
Saratonin: change arousal
*monoamine bodies with nuclei in RF
New considerations:
Function of PFC in tasks that follow the ring?
dorsal lateral dlPFC - executive function, judgment
New considerations:
As you plan to return the call?
ventral medial PFC (impulse control to return call)
Reactive neuroplascticity
Developmental neuroplascticity
post hemispherectomy, OTs can work with people because of this neuroplasticity
Spina bifida (2 types) *Why would you see OT?
Oculta: cord does not come out and does not require surgery
Cystica: cord comes out and requires surgery
*OT = developmental concerns; motor planning; visual perception problems
TENS
maintain pain; has not been shown to be very clinically effective
Vestibular Rehabilitation
positioning therapy; exercise based intervention so OTs usually shy away from it but it is a technique that works so consider using it and attach to functional occupational engagement
Pt: middle age man, admitted to hospital secondary to right face, arm and leg weakness & inability to speak or understand what is being said. Hx hypertension
- temporal
- motor: frontal (primary motor cortex)
- middle cerebral artery b/c it goes to regions of primary motor cortex supplying language/speech areas and if you look at humunculus leg, arm, and face internal areas
Pt: some voluntary movement with leg, UE still problematic
*looking at humunculus, pulls you back towards middle artery a bit
Pt: follow simple commands and responds “yes”
motor speech issue, some resolution with Wernicke’s area and may be more of an issue in frontal lobe (Broca’s)
Pt 2: involuntary, flinging movement in L arm and leg; spontaneous jerkiness R leg
NOT cerebellum, sounds like basal ganglia problem; more than likely a neurochemical issue and MD will medicate; OT can work on safety (remove throw rugs, uncluttered environ)
Pt 3: 27 female, gradual develop emotional lability and increasing risk taking behavior, no specific even around behaviors
prefrontal impact (perhaps tumor, seizures)
Pt 3: friends have been increasingly concerned about personality change; what might be reason?
PTSD (most assoc with behavior changes)
