Incorporating Treatment Strategies P2

Question 1

Motor Control Issues in Cortical Lesions

Answer 1

• Voluntary Movement Dysfunction
• Disturbances of Postural Control
• Disorders of Locomotion

Question 2

voluntary movement dysfunction

Answer 2

• weakness
• loss of fractionation and incoordination
• disorders of tome (spasticity, hypotonicity)

Question 3

Disturbances of postural control

Answer 3

proactive, reactive, steady state

Question 4

disorders of locomotion

Answer 4

problems of progression, stability, adaptability, long-term viability

Question 5

initial conditions assumptions

Answer 5

• 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.

Question 6

Normal Postural alignment

Answer 6

that alignment that affords efficient movement (minimum effort or compensation) for goal achievement

Question 7

Decreased Arousal

Answer 7

• 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

Question 8

Increased arousal

Answer 8

• Decrease auditory and visual input
• Pleasant smells
• Tactile – slower stroking, rhythmic inputs, deep pressure, warmth
• Vestib – slow rhythmic

Question 9

Attention

Answer 9

• Adapt environment
• Verbal cueing - short, simple
• Adapt tasks - simplify

Question 10

Affect

Answer 10

• Depression
  – Verbal support, positive goal setting, appropriate referral
• Disinhibition
  – Prevention, ignore, redirect, reinforce positive behavior

Question 11

Body Orientation

Answer 11

• Verticality or midline orientation problems –> Reorient, recalibrate
• Visual feedback –> Movement in general

Question 12

Neglect

Answer 12

• Verbal cues
• Tactile stimulation
• Positioning of PT in environ.
• Movement into neglected space

Question 13

Abnormal Alignment due to decreased tone interventions

Answer 13

• 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

Question 14

Abnormal Alignment due to increased tone

Answer 14

• 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

Question 15

preparation

Answer 15

• Set up task and environment to maximize success.
• Understanding of goal.
• Offer movement strategies but be careful.

Question 16

Initiation timing: Too Fast

Answer 16

Alterations in preparation; perceptual abilities
(impulsivity?): Provide instructions; External cues; Repetition

Question 17

Initiation Timing: Delayed

Answer 17

• 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

Question 18

Delayed Timing - Sensation interventions

Answer 18

– 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

Question 19

Execution - reduced speed or amplitude of simple movements

Answer 19

• Force generation (weakness)
• Muscle tone (hyper)

Question 20

Execution: Reduced Speed or Amplitude of
Simple Movements –> Force Generation (weakness)

Answer 20

– Estim, Biofeedback, PRE
– Change type of muscle contraction, optimize muscle length, moment arm
– Facilitation

Question 21

Execution: Reduced Speed or Amplitude of
Simple Movements –> Muscle Tone (hyper)

Answer 21

– Inhibition if neural
– Slow stretch if mechanical

Question 22

Execution: What is Altered direction / abnormal
synergy pattern due to?

Answer 22

loss of fractionation/selective control

Question 23

Loss of Fractionation/Selective Control (impaired coordination)

Answer 23

– 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

Question 24

Execution: Multi-segmental Movements:
Coordination

Answer 24

• APAs/ Proactive Control
  – Practice tasks of increasing difficulty (progressions) which
  require APAs while minimizing external support

Question 25

Progressions for working on APAs

Answer 25

• 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

Question 26

Delayed timing in termination

Answer 26

• 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)

Question 27

Outcome

Answer 27

• 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.

Question 28

what does your movement analysis reveal?

Answer 28

problems across the stages of movement in the form of lack of function (can’t do the task) and/or atypical movement strategies

Question 29

What should you use the movement constructs as?

Answer 29

• indicators of the movement problem
• Address impairments appropriate to the stage of movement when it interferes with function