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NeuroPT 1 > Impairments: Voluntary Mvmt: Exam 1 > Flashcards

Impairments: Voluntary Mvmt: Exam 1 Flashcards

1
Q

Think about this!!!

Weakness

Dyscoordination

A
  • related to which health cond, disorder or disease?
  • related to which activity limitations?
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2
Q

When Dr. Cohen says “Coordination”

You say…..

A

Cerebellum!!!!!!!

*NOTE: also when he says “Dyscoordination” you say Cerebellum!!!

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3
Q

What is Weakness?

aka Asthenia

A
  • Inability to gen. normal lvls of mm force
    • aka Asthenia
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4
Q

Weakness leads to secondary changes in muscle

what are they?

A

Loss of type I and type II mm fibers

type I–slow twitch

type II–fast twitch

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5
Q

Weakness is a predictor of _____ ______ following stroke

A

Poor Outcome following stroke

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6
Q

Weakness may do 3 things:

A
  • INC fall risk
  • INC energy exp. during gait
  • foster activity intolerance
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7
Q

Weakness

Fosters activity intolerance

leads to….

A
  • Sedentary lifestyle
  • DEconditioning
  • Disuse atrophy
  • DEC in ADL status
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8
Q

3 other problems that present as weakness:

A
  1. Bradykinesia
  2. Akinesia
  3. Apraxia
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9
Q

Bradykinesia or….

A

EXTREME slowness of mvmt

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10
Q

Akinesia or…

A

Inability to initiate mvmt

*getting the mvmt started

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11
Q

Apraxia or…

A
  • inability to perform purposeful mvmts ALTHOUGH there are NO sensory or motor impairs.
    • ​PROBLEM W/ MOTOR PLANNING
      • ​If challenged to do it—-> becomes more diff.

ex. Dr. Cohen’s pt who was sitting in chair and stood up, but when asked to “get up” —–could NOT do it

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12
Q

Limit to Strength Testing

Traditional strength testing

A
  • Trad. strength testing assumes person being tested has normal motor control
    • ​remember if it is NOT normal—–> DESCRIBE what you see
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13
Q

Limits of strength testing….

if the pt does not have normal motor control….

A

Standard mm tests are not valid!!!

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14
Q

Strengthening acts in people w/ CNS probs is STILL beneficial in 3 ways:

A
  • Improves alpha-gamma coactivation
  • uses neural pathways
  • results in peripheral strength gains
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15
Q

Strengthening w/ CNS patho is still beneficial, but improvements in strength are NOT assoc’d w/ INC’d____________

A

NOT assoc’d w/ inc in mm tone

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16
Q

strengthening beneficial in CNS patho?

A

Strengthening programs appear to be effective in improving strength across dx groups

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17
Q

4 Interventions for Weakness

A
  1. PREs
  2. Isokinetics
  3. Biofeedback
  4. FES
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18
Q

Interventions for Weakness

Absence of active mvmt

0 or 1 on MMT scale

use….

A
  • Facilitation techniques
    • utilize stretch reflex path. for autogenic facilitation
    • tapping, vibrating, lt. touch
  • Modify functional task/environment
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19
Q

Autogenic Facilitation

A

0 or 1 MMT

Process of inhibiting the muscle that generated a stimulus (palpable contraction), while providing an excitatory impulse to the Antagonist muscle

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20
Q

Interventions for Weakness

Lack anti-gravity power

2 or 3 on MMT scale

A
  • Use gravity eliminated pos’s
    • ​begin PREs
    • functional tasks

NOTE: remember w/ gravity eliminated put them in an alternative position and you support the limb during activity!!!

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21
Q

Interventions for Weakness

Lack full mm power

<4 on MMT scale

A
  • Resistance
    • PREs w/ wts
    • manual resist. ex’s
  • Consider body pos.
    • use trunk and extremity mm power
    • endurance
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22
Q

Strength training considerations and transfer effects?

A
  • Exercise is:
    • action-specific
    • velocity-specific
    • angle-specific

***transfer effects typ. not great**

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23
Q

Research: Transfer of Training

Weiss, A., et al (2000)

High intensity strength training improves strength and functional performance after stroke

Exercise training x12 wks

A
  • Findings:
    • mm strength gains
    • rep’d chair stand times DEC’d
    • stair climb time DEC’d (not sig.)
    • 12% improve MAS
    • 12% improve Berg
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24
Q

What does the research say:

High-int. strength training

A

CAN improve strength and balance

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25
Q

What does research say:

Task-oriented strength training

A

improves task performance and inc’s strength in the relevant mm’s

improves mm extensibility and stiffness

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26
Q

what does research say:

strength training and hypertonia

A

CAN have effect on reducing hypertonia in spastic muscles/mm groups

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27
Q

PNF or

A

Proprioceptive Neuromuscular Facilitation

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28
Q

PNF orig. developed for what?

A

combat weakness assoc’d w/ polio

Polio==LMN disorder

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29
Q

UE scapular and pelvic diagonal PNF patterns:

improve what?

A
  • Specific mvmt patterns and tech’s to improve:
    • Flexibility
    • Strength
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30
Q

Principles of PNF:

Mass Mvmt

A
  • Mass mvmt is characteristic of NORMAL motor activity
    • ​brain knows only of mvmt
  • Mass mvmt req’s 2 things:
    • ​tissue shortening
    • tissue lengthening
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31
Q

Neurodevelopmental Treatment

NDT

Bobaths 1960s

challenges what?

A
  • Challenges trunk mm’s and prox. mm stability
    • ​use of resistance NOT advocated
      • causes abnorm. mm recruitment
  • Has Functional relevance
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32
Q

Constraint Induced Mvmt or

CIM

aka

A

“Forced Use”

of the affected limb

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33
Q

Constraint Induced Mvmt: CIM

“Forced Use”

Taub and Wolf, 1990’s

A
  • uses motor learning principles to INC active mvmt and function in UE
  • restricts mvmt of unaffected side
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34
Q

Specific strengthening ideas?

Gen UE/LE weakness

A
  • Gen. weakness—>
    • multiple major mm groups
    • multijoint mvmts
    • BIG, COMPLEX mvmts
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35
Q

Specific strengthening ideas?

DF weakness

Hip flexor weakness

A
  • address WHERE thes motions/mm’s will be NEEDED and treat THERE
    • keep it functional

​

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36
Q

Probs w/ coordination arise from where?

A
  • DCML
  • Cb
    • afferent and efferent tracts
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37
Q

DYScoordination is a problem w/ _______ and _______ of mvmt

A

Timing

Amplitude

*manifests in sev. ways

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38
Q

Ataxia or

A

Drunken sailor gait

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39
Q

Gen. term used to describe abnormal coordination

A

Ataxia

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40
Q

Ataxia

abnorm. coord.

demonstrated by deficits in…….

A

speed

amp. of displacement

directional accuracy

force of mvmt

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41
Q

Dysmetria or …

A

problem w/ distance

dys=problem

metria=distance

ex. putting pen cap onto pen

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42
Q

Dysmetria

over/undershooting

A

Inaccurate amp. and timing of mvmt

==> OVERshooting (hypermetria) OR

UNDERshooting (hypometria)

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43
Q

In Dysdiadochokinesia we NEED smooth reversal of agonist/antagonist

A

They LACK this

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44
Q

Dysdiadochokinesia

diff. performing something

A

Diff. performing rapid alternating mvmts

mvmts are clumsy, slow

  • TESTS:
    • sup/pro forearms fast
    • DF/PF ankle fast
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45
Q

oscillatory mvmt due to alternating contractions of agonists and Antagonists

A

Tremors

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46
Q

Tremors

A

oscillatory mvmt due to alternating contractions of agonists and Antagonists

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47
Q

Intention or voluntary Tremor

A

occurs during movement of limb

absent @ rest

coordination problem

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48
Q

This tremor is ABSENT @ rest

coordination problem

A

Intention or voluntary tremor

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49
Q

Resting Tremor

A

Present @ rest

NOT typ assoc’d w/ dyscoordination

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50
Q

This tremor is PRESENT @ rest

NOT assoc’d w/ dyscoord.

Disappears w/ voluntary mvmt

A

Resting tremor

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51
Q

Resting tremor typ. assoc’d w/

A

Basal gang

higher brain centers

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52
Q

Examining Coord:

Finger to Nose test

A
  • indiv tries to touch index finger of examiner w/ outstretched arm
  • OBSERVE FOR:
    • delay in mvmt initiation
    • terminal tremor (appears when they get there)
    • dysmetria (over/undershoot)
  • NOTE: can be done in standing to ID diff w/ posture stabilization
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53
Q

Examining Dyscoord:

Heel to Shin Test aka

Frankel’s Test

A
  • should be smooth
  • Pt places heel of one leg on shin of other, near knee, slides heel down shin towards foot then reverse
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54
Q

Examining Dyscoord:

Rebound Test

Really checking for ….

A

“Lack of Check”

55
Q

Examining Dyscoord:

Rebound Test:

A
  • Isometric contraction resisted by examiner—-suddently releases opposing force
  • In an individual w/ cerebellar dysfunction:
    • ​the mvmt of the limb continues unchecked (meaning that they don’t stop it once you let go), and the person moves the limb forcefully
56
Q

Dysdiadochokinesia

rapid alternating mvmts

A
  • testing rapidly alternating mvmts
  • performed w/ forearm Pro/Sup, finger flex/ext, DF/PF ankle
57
Q

Romberg Test aka…

A

Old-School balance test

58
Q

Romberg Test set up

A

pt stands still w/ eyes open then closed

59
Q

Romberg Test

Pts w/ Cerebellar Ataxia

A

Show an INC in observable body sway under eyes CLOSED condition

NOTE: Not a very specific test bc anyone w/ balance prob may have a positive finding

60
Q

Interventions for Coordination

A

we want Smooooooth mvmts

CUE your pts w/ this!!!

“Nice and Smoooooooth”

61
Q

Interventions for Impaired Coord.

Train when?

A

During functional mvmts

62
Q

Intervents for impaired Coord.

Training during Functional mvmts:

A
  • external constraints
  • encourage smooooooth mvmts
    • verbal cueing
    • alter lvl of diff.
  • sustained force generation—isometrics
    • ​involve production of rapid initial burst of agonist activity
      • ​followed by sustained contraction
        • quick stretch!!!
  • Open and closed tasks
    • ​closed==> pt controls timing
63
Q

Interventions for Impaired Coord.

Consider three things:

A
  1. support cond’s
  2. timing constraints
  3. environmental context
64
Q

Interventions for Impaired Coordination:

Increasing Complexity

A
  • w/draw external control and guidance
    • ​do not guide them
  • encourage inc amplitude of mvmt
    • bigger!! Larger ROM
  • add tasks which req. speed alterations, changes in amp, direction, force
    • ​change directions, add more resist.
  • INC balance req’s
  • req. that complex mvmt stopped on command
65
Q

Activities for Impaired Coord.

A
  • targeting acts.
    • targeted mvmts
    • stairs
  • darts
  • ball into hoop (basketball)
  • walking TM
  • jump/plyo’s
  • Weighting of UE/LEs

NOTE: Always consider FUNCTION!!!

66
Q

PNF initially for…

A

polio

LMN disorder

*can be used for neuro/ortho deficits

67
Q

PNF broken down

A

Proprioceptive–> regarding sensations of body pos. and mvmt

NMSK–> mm’s and nerves

Facilitation–> make easier, inc ease of performance of action or task

68
Q

Functional mvmts accomplished w/ 2 things:

A

Mass mvmt patterns of:

  1. limbs
  2. trunk mm’s
69
Q

PNF basics

Functional Mvmts

A
  • mass mvmts
  • all 3 planes
  • balance b/w agonist, antagonist, synergist
70
Q

PNF enhances: (5 things)

A
  1. stability
  2. mobility
  3. balance
  4. posture and/or coordination
71
Q

What does the effect of PNF really depend on?

A

Verbal cues!! — what you say

manual contacts!! — how you touch them

72
Q

Manual Contacts

Strength or Power

Proper manual contact does what?

A

INC strength of contraction

Can be on surface corresponding to desired direction mvmt (indirect)

OR

On skin OVER the mm in question (direct)

73
Q

Manual Contacts

Direction of Mvmt:

Tactile cues

A

Very strong!!

*specific cueing elicits MORE approp. response

mult. contacts or poor placement facilitates mvmt in WRONG DIRECTION

74
Q

In PNF

when it comes to resistance….

A
  • use the “correct” amount
    • this could just be assistance
      • ​literally having them “assist” w/ the mvmt
        • “Ok now you do it WITH me”
75
Q

In PNF…

Using the appropriate resistance elicits smooth contraction

Not too easy or too hard

results in:

A
  • INC mm fiber recruitment
  • INC kinesthetic awareness by INC force of contraction
76
Q

Types of Contraction:

Consider the type you want!!!

Concentric:

A
  • Commands
    • “push” or “pull”
77
Q

Types of Contraction:

Consider the type you want!!!

Eccentric:

A
  • Kinesthetic awareness
    • Commands:
      • “Let go slowly”
78
Q

Types of Contraction:

Consider the type you want!!!

Isometric

A
  • Intention:
    • maint. position against external resist.
  • PT matches force gen’d by pt
  • Commands:
    • ​“hold still”
    • “don’t let me move you”
79
Q

Types of Contraction:

Maintained or Stabilizing

*NOT an isometric, per se*

A
  • using a contraction to “initiate” the mvmt
  • start w/ concentric contraction in which PT allows only minimal motion FOLLOWED BY STOPPING MVMT (isometric)
80
Q

Types of Contraction:

Maintained or Stabilizing

Used to facilitate what?

A
  • facilitates stabilization
    • ​treats deficits of strength or kinesthesia t/o ROM
81
Q

Types of Contraction:

Maintained or Stabilizing

Commands:

A
  • “Keep it there”
  • “don’t let go”

so essentially… you will initiate the mvmt and bring them thru some kind of ROM….then at various points in the ROM you STOP the mvmt (isometric) and have them HOLD it in that one particular spot!!!

82
Q

4 Neurophys. basis for PNF

A
  1. Irradiation
  2. Successive Induction
  3. Reciprocal Inhibition
  4. Autogenic Inhibition
83
Q

PNF:

Irradiation

A
  • spread mm response from one mm group to another by altering emphasis of resistance
84
Q

PNF:

Successive Induction

A
  • INC’d response of agonist AFTER contraction of its antagonist
85
Q

PNF:

Reciprocal Inhibition

A
  • facilitation of agonist results in simultaneous inhibition of antagonist

Contraction an agonist RELAXES its antagonist

ex. bridging— fires EXT’s, FLEX’s relax

86
Q

PNF:

Autogenic Inhibition

A
  • STRETCH ASPECT OF PNF
  • Stimulation of GTO’s results in MM relaxation
  • This is your PNF stretching that you know already!!!
87
Q

Where can irradiation occur?

A

ipsi/contralat.

trunk to extremities

w/in same extremity

88
Q

This can facilitate contraction in desired mm’s

A

Irradiation

PNF

89
Q

If TOO MUCH resistance….

Irradiation can create

A

Undesired motions

90
Q

Approximation:

A
  • compresses jt. surfaces
  • co-contraction around jts
  • inc’s stability
91
Q

Traction or distraction

A
  • separation of jt. surfaces
  • DEC pain
  • facilitates MVMT
92
Q

Verbal Commands

A
  • simple
  • concise
  • audible
  • SPECIFIC
93
Q

Other cues/stimuli you can use….

A
  • Visual
    • eyes follow hands during UE mvmts
  • Timing for Emphasis
    • ​tactile + verbal cues MUST be timed to elicit appr. response
94
Q

2 Parts to ALL PNF Activities!!!

A
  1. Movement Pattern
  2. Exercise Technique
95
Q

UE Diagonal Patterns:

D1

A

See pics

distinguish b/w Flexion and Extension

96
Q

D1 Pattern

Shoulder

remember “Wonder Woman”

97
Q

UE Diagonal Patterns

D2

98
Q

D2 Pattern:

Shoulder

A

see pics

“think holding a tray out and up”

99
Q

What are the D1 Components of the Scapula?

A

Scapular Anterior Elevation (Up and Forward)

Scapular Posterior Depression (Down and Back)

100
Q

What are the D2 Components of Scapular motion?

A

Scapular Anterior Depression

Scapular Posterior Elevation

101
Q

Scapular Patterns

In terms of a clock face —- meaning the DIRECTION OF THE MOTIONS

What is the clock/motion for Anterior Elevation-Posterior Depression

D1 scap. pattern

A

1:00 to 7:00

102
Q

Scapular Patterns

In terms of a clock face —- meaning the DIRECTION OF THE MOTIONS

What is the clock/motion for Anterior Depression-Posterior Elevation

D2

A

11:00 to 5:00

103
Q

Pelvic PNF Patterns

A
  • Pelvic Anterior Elevation/Posterior Depression
    • 1:00 to 7:00
      • ​remember get in line w/ the motion!!!
  • Pelvic Anterior Depression/Posterior Elevation
    • 10:00 to 4:00
      • ​get in line w/ the motion!!!
104
Q

Scapular Patterns

105
Q

Pelvic Patterns

106
Q

PNF Activation Techniques

Rhythmic Initiation

A
  • Passive–> Active assist–> Resistive
    • You do it for them
    • have them help you
    • now resist them
107
Q

PNF Activation Techniques

Combination of Isotonics

A

Concentric Eccentric, stabilizing contractions

108
Q

PNF Activation techniques

Reversal of Antagonists

Isotonic Reversal

A

Alternating Concentric isotonic contractions

109
Q

PNF techniques

Reversal of Antagonists

Stabilizing Reversals

A

Alternating Isometrics OR maintained isotonics

110
Q

PNF Activation techniques

Reversal of Antagonists

Repeated Quick Stretch

A

Quick stretch–> contraction of agonist—> quick stretch–> repeat

111
Q

Quick Stretch

The stimulus:

A
  • quick elongation of a muscle to INC responsiveness
  • synch’d w/ verbal cues and IMMEDIATELY FOLLOWED BY appropriate resist. w/ desired manual contact
112
Q

Quick Stretch

The Response

A
  • DOES NOT WORK ON FLACCID MUSCLE
  • used to facilitate stronger muscle contraction
113
Q

Do NOT use Quick Stretch if….

A

if painful!!!

NO BOUNCING!!!

114
Q

PNF Stretching

Relax/Stretch Techniques

2 types

A
  1. Contract Relax
  2. Hold Relax
115
Q

Relax/Stretch PNF
Contract Relax

A
  • Contraction of agonist followed by PROM
116
Q

Relax/Stretch PNF

Hold Relax

A
  • Isometric OR Stabilizing contraction followed by PROM
117
Q

BOTH relax/stretch PNF tech’s do what?

A

Inhibition to REDUCE mm tension in muscle

118
Q

3 sensory systems @ play

A
  1. visual
  2. auditory
  3. proprio.
119
Q

Visual Input

How is it helpful?

A

Cueing where pt LOOKS can help facilitate resp.

“Where the eyes go, the head goes, and where the head goes the trunk goes!”

120
Q

Auditory Input

How is it helpful?

A
  • tone and rhythm of your voice
  • simple, precise, SPECIFIC
  • preparatory command
    • “annnddddddd…..pull down”
121
Q

Proprioceptive Input

3 elements:

A
  1. tactile
  2. therapist position
  3. appropr. resistance
122
Q

Tactile Input

A

consider pts pos. —–use gravity!!!

Lumbrical grip!!!

123
Q

Tactile Input

Helpful tips…

A
  • PT’s contact stim’s skin/pressure recepts to facilitate desired response
  • WHAT YOU TOUCH IS WHAT YOU GET
    • If you want FLEX….touch FLEXORS
  • hand place. should control and guide desired resp.
    • ​IN LINE OF MVMT DESIRED
124
Q

THERAPIST POSITION

IMPORTANT!!!

A
  • pos. yourself to move w/in the diagonal pattern of mvmt
    • ​use whole body
  • move so that pt can move w/ you
    • ​“stay in the groove”
  • prep and time mvmts to assist or resist
125
Q

Therapist’s pos.

MORE TIPS

A
  • @ either end of mvmt
  • Shoulders and hips (ASISs) FACING THE DIRECTION OF MVMT
  • Forearms should be pointed IN THE DIRECTION OF DESIRED MVMT

PRACTICE!!! YOU GOT THIS!!!

126
Q

Therapist’s Pos.

Body Mechanics

A
  • use WHOLE body to gen mvmts
  • Your mvmt should be in the arc and line of mvmt YOU DESIRE FROM YOUR pt
  • Resist. should come from your trunk/pelvis, NOT EXTREMITIES
127
Q

Appropriate resistance

A
  • smooth/coord’d effort t/o desired mvmt
  • may also be assistance
  • reinforces awareness of mvmt pattern
    • achieves desired effect
128
Q

Appropriate Resistance

Coordination:

A

LESS resistance, EMPHASIS on control

“nice and smooooooooth”

129
Q

Appropriate Resistance

AROM

A

Resistance varies to allow ROM

work them thru ROM

130
Q

Appropriate resistance

Strength

A

GRADUALLY inc resistance t/o ROM

131
Q

Appropriate Resistance

Initiation

A

Gradually inc resistance @ beginning of ROM

force them to “fight” you to get the mvmt started

132
Q

Appropriate Resistance

Stabilization

A

SLOWLY apply resistance until contraction is isometric

slowly resist them and once they have the pattern down the STOP and HOLD

133
Q

Use variety of muscle contractions that are specific to the pt’s NEEDS

A

Mvmt vs. Stabilization

Concentric vs. Eccentric

“LET THE CASE GUIDE YOU!!!!”

NeuroPT 1 (7 decks)

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