FINAL - info from first half of semester Flashcards
the ability to move the body from one position to another position in a safe, efficient and independent manner.
mobility
the ability to maintain the body at rest where the center of mass (COM) is over the person’s base of support (BOS).
stability AKA static postural control
name 5 dysfunctions indicating a lack of stability.
- Person may widen their base of support (BOS)
- Lowered center of mass (COM)
- Increased use of postural sway (ankle, hip strategies)
- Need for external support or device
- Loss of balance or falls
the ability to sustain or maintain postural stability and the body’s COM over the BOS while the body is in motion.
Controlled Mobility AKA dynamic postural control
When you weight bear, you’re always in ____ on weight-bearing side and ____ on unweighted side
extension, flexion
The dynamic ability to shift weight on weight bearing side while unweighting non-weight bearing side involves which types of control?
Controlled Mobility AKA dynamic postural control
The ability to stabilize one’s posture without losing postural control (Ex: maintain upright sitting while weight shifting when scooting)
Controlled Mobility AKA dynamic postural control
name 3 indicators of dysfunction of Controlled Mobility AKA dynamic postural control.
- Falling due to postural instability
- Poor ability to control dynamic limb movements
- Limited or decreased use of core or trunk muscles and proximal limbs which affects the ability to stabilize the core while performing distal use of limbs. (Ex: unable to maintain upright sitting position or proximal shoulder while reaching and then grasping/releasing small objects).
describe the 3 steps of bridging.
- Therapist asks pt. to bend knees and provides tactile input into quads while asking pt. to push up on bottom (hip extension).
- Therapist provides physical assist on pelvis (weak side) as needed.
- Pt. asked to move bottom up and over and then to move feet and shoulders.
- Therapist assists with weak side as needed
describe the 4 steps of supine to sidelying or rolling: roll to WEAK side.
- Therapist positions weak UE in slight abduction and shoulder protraction and
- Pt. asked to bend knees into flexion and therapist assists with weak LE as needed.
- Pt. asked to bring strong UE across chest/trunk while turn head and LES to sidelying position.
- Pt. asked to push off with strong LE to roll into sidelying.
describe the 3 steps of supine to sidelying or rolling: roll to STRONG side
- Pt. asked to use strong UE to clasp/bring weak UE across chest/trunk.
- Pt. asked to bend knees into flexion and assists weak LE as needed.
- Therapist assists pt. with roll to strong side by providing physical assist at key points of control (pelvis, knee, or shoulder).
describe the 6 steps of sidelying to sitting up on edge of bed: from WEAK side
- pt. instructed to do three things: 1. Push off with strong hand/arm on bed/mat and come up on weak elbow if
able. 2. Lift head into lateral flexion as sit up. 3. Hook weak LE with strong LE and push off bed/mat. - Therapist assists with physical support under weak scapula/trunk into sitting.
- Therapist assists with pushing knees off bed/mat as needed.
describe the 6 steps of sidelying to sitting up on edge of bed: from STRONG side.
- pt. instructed to do three things: 1. Push off with strong hand/arm on bed/mat and come up on elbow if able.
Use weak UE to push off if able. - Lift head into lateral flexion as sit up.
- Hook weak LE with strong LE and push off bed/mat.
- Therapist assists with physical support by providing physical cue at pelvis by pushing down into pelvis while pt. is sitting up.
- Therapist assists with pushing knees off bed/mat as needed.
describe the 3 steps of sitting on edge of bed into sidelying/supine: onto the WEAK side.
- Pt. asked to lower trunk onto weak UE/elbow if able while therapist provides physical assist under weak scapula/lateral trunk.
- Pt. also asked to hook strong LE under weak LE.
- Therapist will assist with lifting LES as needed.
describe the 3 steps of sitting on edge of bed into sidelying/supine: onto STRONG side.
- Pt. asked to lower trunk onto strong UE/elbow if able while therapist provides physical assist under scapula/lateral trunk as needed.
- Pt. also asked to hook strong LE under weak LE.
- Therapist will assist lifting with LES as needed.
describe the 3 steps of scooting and weight shifting in a seated position (bed/mat/wheelchair seat).
- Pt. asked to weight shift to one side and lift opposite LE (flex trunk) while moving LE into anterior forward position. Pt. asked to weight shift to other side and lift opposite LE (flex trunk) while moving LE into anterior forward position.
- Therapist assists with physical cue to weak side of trunk to elongate trunk on weight bearing side. Therapist assists with physical cue to weak side on posterior pelvis to move LE into anterior forward position.
- Therapist allows pt. to both weight bear/weight shift with strong side and move strong LE into anterior forward position without assistance.
name the 2 phases of sit to stand.
- pre-extension
- extension
weight shift anteriorly or forward (horizontal translation of body mass)
pre-extension
extension of trunk and LEs into stance (vertical translation of body mass)
extension phase
point when thighs come off surface (point of instability)
transition phase
name 4 aspects of stand to sit.
- COM is lowered and maintained with proper hip flexion and trunk extension (head/neck in slight extension)
- Weight is still forward (watch posterior weight shift)
- Watch “fear of falling” so pt. may rush or fall into seated surface
- Use of UE to reach for arm rest or seat to assist with descent, when indicated.
name 5 key aspects of positioning the hemiplegic limb.
- support
- alignment
- joint preservation
- prevent muscle tightness
- promote limb awareness through weight bearing
describe the incorrect and correct head positioning for a patient with hemiplegia or hemiparesis.
incorrect: do not use a stack of pillows; never stack pillows under the head
correct: use one flat pillow
describe the incorrect and correct knee positioning for a patient with hemiplegia or hemiparesis.
incorrect: do not put pillows under the knees that hold them flexed (can promote knee flexion and contracture and inhibit proper knee extension/stance)
correct: keep the knees straight
describe the incorrect and correct ankle positioning for a patient with hemiplegia or hemiparesis.
- incorrect: do not let the heel cord (gastrocnemius muscle) shorten; avoid plantarflexion - keep ankle at 90 degrees
- correct: keep ankle flexible to at least a 90 degree angle
describe the correct UE positioning for a patient with hemiplegia or hemiparesis.
- keep arms abducted from body
- extend elbow, wrist, and fingers in the safe position - inhibitory position of synergy
- protract scapula
name 6 aspects of the therapist’s body mechanics.
- mirror patient’s direction of movement either in anterior/posterior, diagonal, rotational, or vertical direction.
- straight back and bent knees
- avoid rotary motions (twisting of spine)
- provide sound and comfortable tactile or physical support - lumbrical grip
- stay close enough to provide safe support.
- give patient space to move (move with them).
name the 3 theoretical foundations of NDT.
- motor control theory
- motor learning theory
- motor development
-treatment focused on sensory input and motor output
NDT
what is the primary mode of treatment of NDT?
based on therapeutic handling techniques
___ or ___ inputs to influence motor output or motor responses in NDT.
facilitation and inhibition
what is the primary goal of NDT treatment?
to retrain normal movement on the hemiplegic side.
which exercises/activities should you avoid in NDT?
activities/exercises that increase muscle tone and avoid abnormal movement patterns.
___ & ___ of the trunk and pelvis are necessary for good alignment and symmetry of the extremities.
alignment, symmetry
directs, regulates, and organizes tactile, vestibular or proprioceptive input.
manual contact
facilitate proper __ __ __ before and during movement patterns.
base of support
used to facilitate effective movement patterns in pts. with neurologic impairments
PNF
what is the basis of PNF patterns?
synergistic patterns of movement
the synergistic movement of performance involves which 2 motions?
- rotation
- diagonals
___ stability of the trunk for adequate ___ control of the limbs in PNF.
proximal, distal
in PNF, movement patterns occur across all __ ___.
3 planes
PNF utilizes ___ or ___ limb patterns.
unilateral, bilateral
use of ____ is key when using PNF techniques.
proprioception
motor learning principles such as what 3 things are also used to enhance movement in PNF.
- repetition
- feedback
- practice
therapist engages the patient via which 5 principles in PNF.
- manual contacts
- verbal commands
- body positioning
- body mechanics
- visual guidance of movement patterns
coordination of movement and timing are enhanced via which 6 things in PNF?
use of :
- resistance
- stretch
- irradiation
- reinforcement
- traction
- approximation
what is the goal of PNF?
to enhance muscle contraction
describe the D1 flexion movement patterns.
- shoulder adduction & external rotation
- supination
- radial deviation
- wrist flexion
- finger flexion/adduction
describe the D1 extension movement patterns.
- shoulder abduction and internal rotation
- pronation
- ulnar deviation
- wrist extension
- finger extension/abduction
describe the D2 flexion movement patterns.
- shoulder abduction and external rotation
- supination
- radial deviation
- wrist extension
- finger extension/abduction
describe the D2 extension movement patterns.
- shoulder adduction and internal rotation
- pronation
- ulnar deviation
- wrist flexion
- finger flexion/adduction
- teaching that occurs in the actual context or environment in which the task will be performed
- patient/client learns targeted behavioral sequences
- the use of the environment, objects, and other surroundings become the “cues” to complete a task.
- assumption that with constant repetition, the routine will be carried out automatically.
task-specific skills training
the ability to carry out the same task and sequence of skills in a new or different environment
transfer of learning skills training
application of the same skill in very similar environments
near transfer
application of the same skill in different environments
intermediate transfer
application of different skills in different environments
far transfer
application of different skills in different environments
far transfer
requires learning rules or principles that can be broadly applied. ex: dress the weak side first which can then be applied when donning both upper and lower body clothing items
acquisition of strategies
-occurs when pt/client can apply newly learned skill for a task to new tasks and in different environments. ex: safety techniques when performing walker to tub bench transfer in the hospital, and then doing the same safety techniques for walker to tub bench at home and then walker to toilet at home
generalization of learning
theoretical bases: static theories - neuroscience/neuropsychology/cognition and psychology
neurorehabilitation frame of reference
- normal phenomena describing brain structures and functions.
- describes underlying skill areas (impairment areas) on a continuum to be assessed
neurorehabilitation frame of reference
name the 4 specific underlying skill areas on a function-dysfunction continuum for neurorehabilitation frame of reference.
- motor skills
- sensation
- perception
- cognition
- grip that places an object in contact with the palm and palmar surface of the digits
- gross thumb and finger flexion and extension are needed to grasp and release large objects
gross grasp
hand position that allows for finger and thumb opposition and manipulation of objects
prehension patterns
thumb opposes one or more fingers (ex: the index and long fingers)
palmar prehension
thumb and the radial side of the index and long fingers meet
lateral prehension
reduce __ __ in wrist and fingers; required for facilitation of grasp/release and prehension patterns.
flexor spasticity
inhibition techniques are used to do what 3 things?
- decrease abnormal muscle tone during task performance.
- restore normal alignment in the trunk.
- decrease unwanted movements or associated reactions
describe the components of the UE flexor synergy pattern.
- scapular retraction
- shoulder elevation
- shoulder abduction (90 degrees)
- shoulder external rotation
- elbow flexion
- supination
- wrist and fingers variable
opposite pattern of the spastic upper limb to lengthen spastic muscles
reflex inhibiting postures
describe the components of the reflex inhibiting postures (aka out of pattern).
- shoulder protraction
- shoulder abduction (as tolerated)
- shoulder external rotation
- elbow and wrist extension
- finger extension and abduction
- thumb abduction
what is used to decrease increased muscle tone?
weight bearing
describe the components of the UE extensor synergy patterns.
- scapular protraction
- shoulder horizontal adduction and internal rotation
- elbow extension
- pronation
- wrist and fingers variable
- no underlying muscle tone
- irreflexive or loss of all reflexes
- hypermobile joint
flaccidity
- no resistance to PROM
- some slight muscle tone
- floppy
hypotonicity
increased resistance with increased velocity of movement during passive stretch
hypertonicity or spasticity
- cogwheel or lead pipe
- increased stiffness of movement as opposing muscle groups become active and “bind movement”
rigidity
an abnormal muscle tone is due to which 2 things….
- a break down in muscle spindle activity and coordination of the alpha and gamma co-activating system
- an imbalance in agonist and antagonist muscle activity or a problem with inhibitory/excitatory actions between muscle groups.
an increase in muscle tone due to hyperexcitability of the tonic stretch reflex, characterized by velocity (speed) dependent increase in phasic stretch reflexes; all encompassing phrase for UMN lesions
spasticity
neuromuscular facilitation and PNF are useful for development or enhancement of __ __ __.
lead up skills
name the 4 general UE lead up skills movements.
- stabilization
- reach
- grasp
- prehension patterns
- stabilization at the shoulder and elbow; normal movement patterns for forward, side, overhead reach
- support for distal use of hand
proximal control
wrist stabilization to approx. how many degrees of extension for control?
20-30 degrees
use ___ ___ to promote proximal shoulder stabilization via weightbearing activities.
joint approximation
weight bear on affected UE in ___ ___ and supported by the therapist or by another support surface (ex: a platform mat).
elbow extension
____ can be used to facilitate shoulder/scapular stabilizers and elbow extensors.
approximation
what is required before dynamic distal movement in space against gravity?
sufficient shoulder stability
- address once shoulder stabilization established.
- facilitate with active scapular protraction, shoulder flexion, and elbow extension.
- may then begin practice of higher-level skill of reaching (against gravity) into space to grasp object.
- once lead-up skills have been performed, may guide in use of these skills to perform reaching movements in self-feeding, hygiene, and dressing activities.
reach (forward, overhead, side)
- reduce flexor spasticity in wrist and fingers; facilitation of grasp/release and prehension patterns
- functional grasp and prehension patterns
- require voluntary active finger and thumb flexion.
- require voluntary active finger, thumb, and wrist extension.
grasp and prehension
position in which the hand can function most optimally
functional position of hand
describe the specific positioning of the functional position of the hand.
- wrist in slight extension, ulnar deviation
- moderate MCP, PIP flexion
- slight DIP flexion
- moderate thumb flexion
the ability to organize all sensory information into meaningful wholes or patterns
perception
The ability to distinguish between one side from the other and the right from left sides
right-left discrimination
The ability to recognize subtle variation in form, size, color or direction of objects
form constancy
The ability to distinguish the foreground from the background
figure-ground discrimination
The ability to distinguish features and/or position of objects relative to one another and/or to oneself
spatial relations/position in space
The ability to identify forms or objects from an incomplete array of features or stimuli
visual closure
The ability to distinguish relative distances between objects and requires intact binocular vision
depth perception
The ability to distinguish location of physical landmarks or settings and routes from various locations
topographical orientation
The ability to coordinate information from the visual system with body movements during and activity or task
visual-motor integration
The ability to sustain focus on a visual stimulus
visual-attention
The ability to understand motor demands and the characteristics needed to perform a task by using motor plans
ideational praxis
The ability to initiate/execute a motor plan from a stored memory engram
ideomotor praxis
a method used by therapists or the use of oneself as an effective tool during the therapeutic process.
conscious use of self
involves perception that other is knowledgeable and worthy of respect and trust
rapport
- involves the ability to create an opportunity or situation in which the client/patient becomes aware of how their potential and progress affects their ability to improve.
- goes beyond having a background in skills, theory, or sound practice.
- client/patient may feel someone finally understands what they are going through.
- diminishes the isolation of the individual; which reaffirms the power of the mind, body and spirit; which assists the individual in discovering meaning in existence.
art of practice
when does practice become an art?
when a therapist is able to transcend sympathy and translate empathy into a process that brings the individual to a state of renewed sense of self and a deeper understanding of one’s place in a community of others
client/pt. are routinely made aware of their ___ in healthcare settings.
patient rights
name the 7 general concepts of concern in conscious of self.
- respect
- rights
- empathy
- compassion
- unconditional positive regard
- flexibility
- awareness
- the ability to view the other person’s situation without losing site of your own separateness as a different individual
- separation of oneself from the client/patient allows for sound problem-solving, sound judgments, and objectivity
- allows the therapist to be open to all of the client/patient’s values, feelings, and ideas.
empathy
having the ability to provide kindness and gentleness in one’s approach bc of possessing compassion from the client/patient.
compassion
often gained by an awareness of one’s own limitations in knowledge
humility
- the ability to be straightforward, candid, and truthful
- doing so fosters more trust from the client and respect from the therapist.
honesty
- concern for the client/patient without any restrictions, limitations, requirements, or qualifications.
- acceptance of the client/patient in totality even in trying situations when the client/patient may demonstrate hostility, disrespect, or other disagreeable behavior.
- maintaining a nonjudgmental attitude and refraining from expressing personal judgments at all times.
unconditional positive regards
- modify your behavior to meet the circumstances that may have changed or to meet the needs of the client/patient
- avoid being overly rigid, unwilling to accept another’s view, or unable to accommodate schedules as this may also be viewed negatively be the client/patient.
flexibility
- the ability to make appropriate or necessary changes in one’s behavior if and when indicated.
- having a solid sense of one’s own views, values, ideas, or feelings and the effects of these on others, allows for more appreciation of another’s feelings or needs.
self-awareness
the ability to recognize limitations and strengths in oneself (metacognitive skill)
self-awareness
- the unconscious process where the client/patient may respond to the therapist in a similar manner as their response to a significant person in their life.
- may occur with the therapist if the person reminds them of a family member or significant person (flag: feelings of either extreme liking or aversion/impatience with the client/patient)
transference
transference is a type of ___ ___ that allows the patient to cope with their situation.
defense mechanism
- an unconscious cognitive process characterized by a response that is expected and desired by the individual who has formed the transference relationship with oneself.
- the therapist may assume the role that the client/pt has desired the therapist to be
- imperative to not engage in this response with the pt.
countertransference
name 2 elements of the non-human environment.
- all specific pieces or types of equipment of the activity.
- specific setting (bedside, mat, clinic, bathroom, etc.)
name 5 elements of the human environment.
- patient positioning (seated/standing, static/dynamic, supported/unsupported)
- therapist and/or other (therapist or caregiver) positioning
- specific verbal instructions/directions for the patient or other
- physical handling or guiding techniques: hand placement, type of support, contact guarding, tactile cues
- additional verbal, visual or tactile cues (type and number)
