Incorporating Treatment Strategies P2 Flashcards
Motor Control Issues in Cortical Lesions
- Voluntary Movement Dysfunction
- Disturbances of Postural Control
- Disorders of Locomotion
voluntary movement dysfunction
- weakness
- loss of fractionation and incoordination
- disorders of tome (spasticity, hypotonicity)
Disturbances of postural control
proactive, reactive, steady state
disorders of locomotion
problems of progression, stability, adaptability, long-term viability
initial conditions assumptions
- The closer postural alignment is to the range of
normal, the better the potential for typical movement –>
This is based on biomechanical factors of muscle
and connective tissue - The closer the patient is to a quiet alert behavioral
state, the better they will be able to perceive and act.
Normal Postural alignment
that alignment that affords efficient movement (minimum effort or compensation) for goal achievement
Decreased Arousal
- Increase auditory and visual input
- Olfactory stimulation
– CN1: noxious smells – facilitatory
– Application less than 10 seconds due to fast adaptation - Tactile – light stroking, brushing, cold
- Vestibular stimulation
Increased arousal
- Decrease auditory and visual input
- Pleasant smells
- Tactile – slower stroking, rhythmic inputs, deep pressure, warmth
- Vestib – slow rhythmic
Attention
- Adapt environment
- Verbal cueing - short, simple
- Adapt tasks - simplify
Affect
- Depression
– Verbal support, positive goal setting, appropriate referral - Disinhibition
– Prevention, ignore, redirect, reinforce positive behavior
Body Orientation
- Verticality or midline orientation problems –> Reorient, recalibrate
- Visual feedback –> Movement in general
Neglect
- Verbal cues
- Tactile stimulation
- Positioning of PT in environ.
- Movement into neglected space
Abnormal Alignment due to decreased tone interventions
- Vestibular stim – generalized (fast)
- Tactile - tapping
- Vibration – quick stretches to muscle –> 100-200Hz from 30s-2min
- Approximation – joint compression thought to facilitate co-contraction –> Maybe used after cueing for reinforcement.
- Weight bearing – increase potential for contraction around weight bearing joints; weight shifting keeping muscles in an active state
- Resistance
- Biofeedback
- Cold
Abnormal Alignment due to increased tone
- Vestibular – slow movement of head in space with rotation of limbs around body axis
- Tendon pressure (specific to muscle)
- Vibration - <75Hz
- Traction – prolonged
- Rotation – slow stretch
- Slow stretch - prolonged
- Biofeedback
preparation
- Set up task and environment to maximize success.
- Understanding of goal.
- Offer movement strategies but be careful.
Initiation timing: Too Fast
Alterations in preparation; perceptual abilities
(impulsivity?): Provide instructions; External cues; Repetition
Initiation Timing: Delayed
- Delays in APAs
– Provide practice of tasks of increasing difficulty which require APAs while minimizing support and providing feedback - Behavioral: decreased arousal / attention
– Optimize IC
– Simplify task and make task as automatic as
possible
Delayed Timing - Sensation interventions
– Augment: increase sensory perception by repetitive stimulation of senses
– Recalibrate: teach to equate new sensations with
reality
– Substitute: teach to use another form of sensory
information to replace modality with deficits
– Prediction: use advanced information for guidance
Execution - reduced speed or amplitude of simple movements
- Force generation (weakness)
- Muscle tone (hyper)
Execution: Reduced Speed or Amplitude of
Simple Movements –> Force Generation (weakness)
– Estim, Biofeedback, PRE
– Change type of muscle contraction, optimize muscle length, moment arm
– Facilitation
Execution: Reduced Speed or Amplitude of
Simple Movements –> Muscle Tone (hyper)
– Inhibition if neural
– Slow stretch if mechanical
Execution: What is Altered direction / abnormal
synergy pattern due to?
loss of fractionation/selective control
Loss of Fractionation/Selective Control (impaired coordination)
– Involve individual in activities where limb movements are slightly more isolated than present capabilities
* Shape movements (these are progressions)
– Bilateral symmetrical activities
– Exploit mechanics: gravity, L-T relationship
– Closed chain activities
– Constraint induced movement therapy
– Mental practice
Execution: Multi-segmental Movements:
Coordination
- APAs/ Proactive Control
– Practice tasks of increasing difficulty (progressions) which
require APAs while minimizing external support
Progressions for working on APAs
- Cognitive: Single to DT; predictable to unpredictable movements
- Movement characteristics: Increase speed, distance, direction, body part (eyes, head, UE, trunk, LE, add resistance).
- Environment: progress to lower lighting; support surface (less stable or narrower)
- Can make this into variable practice. Starting with constant
Delayed timing in termination
- Use of sensory information –> Augment, substitute, use predictive strategies
- Use of general information/external focus when terminating on an object in the environment (pre-cues for motor planning- preparation)
Outcome
- When you set up the task, the outcome should be obvious to the patient (Goal oriented)
- Can the patient use internal feedback for perceiving task
success? - Extrinsic feedback: quantity and timing; phasing out over
time - Chart outcome / positive reinforcement: especially later in
skill learning.
what does your movement analysis reveal?
problems across the stages of movement in the form of lack of function (can’t do the task) and/or atypical movement strategies
What should you use the movement constructs as?
- indicators of the movement problem
- Address impairments appropriate to the stage of movement when it interferes with function
