FINAL EXAM REVIEW Flashcards
Remedial Treatment for U/E Coordination?
GOAL:
To achieve multi-muscle motor patterns that are smooth, fast, precise, efficient, strong and automatic
TREATMENT: Part/Whole Training Perfect components & build on sequence Start simple & slow Provide visual/tactile/prop feedback (attend to sensations) Repetition required - Single Muscles ->Multiple Muscles
Functional activities use existing motor plans
3 Components of Movement?
- Velocity (speed)
- Direction
- Force
Dysmetria - what is it & how do we test it?
= Unable to estimate ROM needed to reach a target
- “faulty distance”
To test for it we get them to touch their nose
What does the PNF focus on?
Total movement of Head, Trunk & Limbs
- Mass movement patterns in functional activities
Diagonal Patterns
- Flexion & extension combined with rotation to & from midline
- Both bilateral & unilateral
FACILITATION:
- Verbal & visual cues
- Manual stretch & contract
- Repetition & relaxation
***Stages of Motor Recovery?
Brunnstrom
STAGE 1: LOW
Initial flaccidity, Low tone - No voluntary movement
STAGE 2: EMERGING (Slightly High)
Emerging spasticity, Hyper-reflexia, Synergies (mass patterns of movement)
STAGE 3: HIGH
Voluntary movements possible, but only in synergies, Strong spasticity
STAGE 4: SLIGHTLY LOWER
Voluntary control in isolated joint movements emerging, Decline of spasticity & synergies
STAGE 5: ALMOST NORMAL
Increasing voluntary control out-of-synergy; Coordination deficits
STAGE 6: NORMAL
Control & coordination near normal
Ataxia - what is it & how do we test it?
= Gross lack of coordination of muscle movements
- Observe gait, wide BOS & no arm movement
TREATMENT:
Improve balance & postural reactions
Improve & increase postural stability
Dystonia?
Faulty muscle tone
- results in twisting and repetitive movements
Assessment for Manual Dexterity?
Standardized & Timed tests.
- Box & Block Test
- Purdue Pegboard Test
- Minnesota Rate of Manipulation Test
The 4 Stages of U/E ‘Grip’ Sequence?
- Opening
- Approaching
- Finger positioning
- Static Grip
‘Reach’ Sequence?
SCAPULA:
Upward rotation
Abduction/protraction
SHOULDER:
Elevation, flexion, depression
Abduction, external rotation
ELBOW:
Extension
Supination/pronation
WRIST:
Extension
Ulnar deviation
Scapula - Prime Movers?
ELEVATION:
Levator Scapula
Trapezius (upper fibres)
DEPRESSION:
Latissimus dorsi
Trapezius (lower fibres)
ABDUCTION (Protraction):
Serratus anterior
ADDUCTION (Retraction):
Rhomboids
Trapezius (middle fibres)
UPWARD ROTATION:
Trapezius
Serratus anterior
DOWNWARD ROTATION:
Rhomboids
Levator scapula
Pectoralis minor
Base of Support (BOS)?
The parameter of the contact area between the body & its support surface
Centre of Mass (COM)?
The point of which the body is in a perfect equilibrium
Centre of Gravity (COG)?
Projection of the center of mass (vertically) onto the ground – 2nd vertabrae
Centre of Pressure (COP)?
The ground reacts to our weight due to gravity. Ground responds with force(Newton’s law)
Reactive Balance Response?
Automatic, unconscious
Body responds to an unexpected stimulus/disruption of posture
Anticipatory Balance Response?
Automatic, unconscious
Body stabilizes segments prior to voluntary/conscious movement
Anticipatory Balance Strategies?
ANKLE STRATEGY (static BOS): - small disruptions/perturbations
HIP STRATEGY (static BOS):
- larger disruptions/perturbations
i. e.) to the limits of your BOS
STEPPING STRATEGY (dynamic):
- larger disruptions/perturbations
i. e.) beyond the BOS which elicits a step back or laterally
GRASPING STRATEGY (dynamic):
- larger disruptions of balance
- An individual may reach out to grasp a solid object for support or to regain balance/stability
Balance Treatment for someone with Neurological Deficits?
Stimulate good sitting posture:
= active sitting on Bosi ball & affected side supported with a pressure splint
To try to promote symmetry & good muscle tone,
Stimulate affected side so person can make new connections,
Neuroplasticity
The 3 components for Regulation of Postural Control?
NERVOUS SYSTEM:
–Sensory System Inputs–
Visual Inputs = highest of importance of sensory information coming in to regulate balance & posture
Vestibular Inputs = inner ear & its responses to movement & gravity to influence balance, muscle tone & eye movements
Somatosensory Inputs (proprioception, touch, pressure)
–Processing & Prioritization of information–
i.e. system’s ability to process information & recognize what’s important
–Cognition–
Attention, memory, understanding language, reasoning, ability to problem-solve
Efferent System of Response
Relaxation Time
MUSCULOSKELETAL FACTORS:
Muscle strength, muscle endurance
Joint stability
ROM, flexibility
CONTEXT FACTORS (task/enviro): Level of difficulty, quiet vs. busy atmosphere, novel (new) vs. learned task
Balance Training Principles/Treatment?
**FOCUS ON FUNCTION **
Vary BOS +/- UE support Static vs. dynamic Wide, narrow, regular Double-limb vs. single-limb support Introduce perturbations (internal or external) Vary the support surface (stable vs. unstable) \+/- vision Add speed
Treatment Principles/Goal for Neuromuscular Control?
Improve muscle strength:
- precision control of single muscles
PRECURSOR FOR COORDINATED MOVEMENT
- We must have this before work on coordination
- Guided movement of individual muscles
- Needs repetition
Nerve Distribution?
MEDIAN NERVE:
Flexors & pronators
Thenars
1st & 2nd lumbricals
RADIAL NERVE:
Extensors & supinators
ULNAR NERVE:
Wrist & deep finger flexors
Intrinsic muscles of hand
Golgi Tendon?
If too much tension it relaxes to prevent injury
Spindle (in muscle belly) reacts on contraction so muscle doesn’t tear
Strategy that works best for balance?
Ankle strategy
Where are injuries to the PNS found?
Axon & myelin sheaf
Impaired sensation of PNS is due to …..?
….localized effects of a specific nerve
Feed-forward?
Anticipating what will happen BEFORE the movement
Feedback?
Making adjustments DURING the movement
2 things needed for fine smooth movement?
Light touch & proprioception
Sensory Dysfunction terms & their meaning
ANESTHESIA:
Insensitivity to pain
PARASTHESIA: Abnormal sensation (pins & needles)
HYPOESTHESIA: Low sensation (numbness)
HYPERESTHESIA:
High sensation
ANALGESIA:
Inability to feel pain
HYPOALGESIA:
Low sensitivity to pain
Relaxes or Excites muscle (list)?
RELAXES: Vibration Warmth Rocking Swaddling Darkened room
EXCITES: Rubbing Deep pressure Traction Light touch, stroking Tapping Staccato music
BOTH:
Icing
Postural changes
Sensory nerve distribution of hand?
DORSAL SIDE:
Radial (thumb & first one & half fingers)
Ulna (little & next one & half fingers)
PALMER SIDE:
Median (thumb & first two & half fingers)
Ulna (little & half of ring finger)
Remedial tx to recover proprioception?
Use weights to increase stimulation of GMOs & spindle,
Talk through motions, observe & correct w/visual cues,
Try to mimic without visual cues, concentrate on the sensations during passive/active assisted ROM (on OP!!!!)
2 Scapular movements needed for fluid movement?
Elevation & Protraction
Most common cause of falls?
Perturbations of COM
Percentage used in Stance Phase?
60%
Order of Tx for Dysmetria following stroke?
- Postural control for dynamic sitting balance
- Neuromuscular control of shoulder muscles
- Utilize existing motor patterns for coordinated movement
- Increase endurance for coordinated muscle activity
Practice method to work on grip to reach & pick up objects ?
Random method
Shoulder stabilization Tx?
Shoulder elevation & protraction exercises
‘Reach’ sequence
Center of Mass is determined by…. ?
Point that corresponds with COM
- by finding the weighted average of each body segment
Ankle Balance Strategy?
Perturbations
stepping strategy is used if beyond BOS
