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DPT 620: Neuro > Intro to Neuromuscular Re-education > Flashcards

Intro to Neuromuscular Re-education Flashcards

1
Q

what is motor control?

A

the ability of the neuromuscular system to regulate or redirect the mechanisms essential to move

ability of the system to produce output

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2
Q

what is motor learning?

A

set of processes associated with practice or experience which leads to relatively permanent changes in the capability of producing skilled action

way in which we adapt/change/relearn

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3
Q

motor learning is a direct result of what?

A

neuroplastic change

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4
Q

what is neuroplastic change?

A

the expansion and/or reorganization of the cortical map

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5
Q

what drives fxnal recovery after a stroke?

A

cortical plasticity and reorganization mechanisms

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6
Q

how long can reorganization take?

A

years

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7
Q

t/f: reorganization after a stroke can be positive or negative

A

true

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8
Q

what are the 3 mechanisms of neuroplasticity?

A

1) injury driven change

2) neuronal modification

3) experience driven change

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9
Q

what is involved in injury driven change in neuroplasticity?

A

cellular level changes

recovery following CNS injury

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10
Q

what is involved in neuronal modification in neuroplasticity?

A

stimulus driven change

synaptogenesis for the development of new neural pathways

activation of parallel neural pathways (opposite hemisphere)

activation of silent and redundant neural pathways

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11
Q

what is involved in experience driven change in neuroplasticity?

A

experience-expectant plasticity

experience-dependent plasticity

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12
Q

what is experience-expectant plasticity?

A

in reference to critical periods of developmental change (important in growing babies)

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13
Q

what is experience-dependent plasticity?

A

motor learning is an example of this

use-dependent, fxn-dependent, task-dependent

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14
Q

t/f: in the performance of a motor task/activity, brain activity is linked to the phase of motor learning

A

true

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15
Q

during the initial phases of neuroplastic changes (skill acquisition), what is happening in the brain?

A

there are large and diffuse areas of the brain that are active

immediate reorganization due to unmasking of previously nonfxnal synaptic connections in neighboring areas.

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16
Q

during the autonomous phases, what is happening in the brain?

A

when tasks are repeated, the # of active areas of the brain are reduced

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17
Q

during the skilled phase, when tasks are learned, what is happening in the brain?

A

smaller, more distinct areas of the brain show an increased activity

brain areas neighboring the lesion take over those parts of the map that were occupied by damaged cells

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18
Q

during what phase of neuroplasticity is less attention required to perform the task resulting in the brain regions becoming more focal as skilled performance increases?

A

during skilled phases

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19
Q

what is dendritic aborization?

A

branching out of dendrites to take over damaged parts of the brain

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20
Q

what are regenerative and reactive synaptogenesis?

A

ways of neurons taking over damaged parts of the brain

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21
Q

neuro rehab should result in _____ ______

A

brain change

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22
Q

TMS or fMRI shows that what kind of training and environment produces long-lasting cortical reorganization?

A

task-specific training in enriched environments

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23
Q

t/f: the tasks need to be fxnal to lay down a fxnal map

A

true

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24
Q

recovery of neuronal fxn after brain injury is influenced by what?

A

the type, intensity, and timing of rehab relative to surgery

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25
Q

t/f: early rehab is necessary for improved outcomes

A

true

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26
Q

t/f: during days 1-5, intensity needs to be monitored carefully

A

true

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27
Q

would you want to do forced use for the involved UE at day 3? why or why not?

A

nope bc it is probably too intense and will be counterproductive

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28
Q

t/f: being too rigorous too early can be counterproductive

A

true

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29
Q

what are the 10 neuroplastic principles?

A

1) use it or lose it

2) use it and improve it

3) specificity

4) repetition matters

5) intensity matters

6) time matters

7) salience matters

8) age matters

9) transference

10) interference

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30
Q

what does the neuroplastic principle of use it or lose it mean?

A

failure to drive specific brain fxns can lead to fxnal degradation

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31
Q

what does the neuroplastic principle of use it and improve it mean?

A

training that drives a specific brain fxn can lead to an enhancement of that fxn

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32
Q

what does the neuroplastic principle of specificity mean?

A

the nature of the training experience dictates the nature of the plasticity

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33
Q

what does the neuroplastic principle of repetition matters mean?

A

induction of plasticity requires sufficient reps

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34
Q

what does the neuroplastic principle of intensity matters mean?

A

induction of plasticity requires sufficient training intensity

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35
Q

what does the neuroplastic principle of time matters mean?

A

different forms of plasticity occur at different times during training

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36
Q

what does the neuroplastic principle of salience matters mean?

A

the training experience must be sufficiently salient to produce plasticity

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37
Q

what does the neuroplastic principle of age matters mean?

A

training-induced plasticity occurs more readily in younger brains

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38
Q

what does the neuroplastic principle of transference mean?

A

plasticity in response to one training experience can enhance the acquisition of similar behaviors

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39
Q

what does the neuroplastic principle of interference mean?

A

plasticity in response to one training experience can interfere w/acquisition of other behaviors

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40
Q

what is motor recovery?

A

the re-acquisition of mov’t skills lost through injury

variable and individualized

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41
Q

cortical representation of mov’t can be changed in what 3 ways?

A

1) spontaneous recovery

2) task/fxn-induced recovery

3) learned non-use recovery

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42
Q

what is spontaneous recovery?

A

the initial neural repair processes that occurs immediately after injury

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43
Q

what is task/fxn-induced recovery?

A

use of dependent cortical reorganization

the NS modifies itself

includes forced paradigms such as CIMT

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44
Q

what is learned non-use recovery?

A

non-use resulting in faulty/poor mov’t patterns

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45
Q

complete recovery may not be possible, but rather skills may be modified in what 2 ways?

A

compensation and substitution

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46
Q

what is compensation/substitution?

A

adaptation of remodeling motor or use of alternative motor elements

adoption of alternative strategies to complete a task

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47
Q

t/f: motor relearning is impaired w/sensory impairments

A

true

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48
Q

while motor and sensory processing are independently adaptive, what is the driving factor of fxnal neural adaptation?

A

the interaction bw them

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49
Q

what is an important input to motor learning and skill acquisition?

A

proper sensory input

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50
Q

what is the Brunnstrom theory to motor recovery?

A

heirarchical

using primitive, synergistic patterns to facilitate mov’t

a damaged CNS regresses to an older pattern of mov’t

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51
Q

which approach to motor recovery theorizes that primitive reflexes, synergies, and abnormal mov’ts are a part of recovery b4 normal mov’t occurs?

A

Brunnstrom

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52
Q

what is the technique for Brunnstrom’s approach?

A

facilitate synergies and primitive reflexes

progress through developmental (fxnal) positions

walking delayed

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53
Q

what is the NDT (Bobath) theory to motor recovery?

A

normalize tone, inhibit primitive patterns of mov’t, facilitate automatic , voluntary motor responses and subsequent normal patterns

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54
Q

what approach is the opposite to Brunnstrom?

A

NDT

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55
Q

what are the techniques of NDT?

A

therapeutic handling

key points of control to stop reflexes

facilitate normal and inhibit abnormal inputs

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56
Q

what is the Rood approach theory to motor recovery?

A

sensorimotor

modify muscles tone and motor activity using cutaneous sensorimotor stimulation

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57
Q

what is the technique of the Rood approach?

A

proprioceptive, exteroceptive, vestibular, vision, auditory, olfactory, gustatory inputs selected

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58
Q

what is the PNF theory of motor recovery?

A

stimulation of nerve, muscle, and sensory receptors through manual stimulation

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59
Q

what approach to motor recovery uses diagonal mov’t patterns that are fxnally relevant?

A

PNF (Kabat, Knott, and Voss)

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60
Q

what are the techniques of PNF?

A

facilitation of mov’t patterns using key manual contact and techniques

resistance, irradiation/reinforcement, stretch, verbal commands, traction/approximation, timing, body position/mechanics

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61
Q

what is the MRP (motor relearning programme) approach to motor recovery?

A

task-oriented approach

dynamical systems

ecological model

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62
Q

what is the theory of the MRP approach to motor recovery?

A

appropriate sensory input will modulate motor output

eliminate all unwanted motor activity w/in a task performance

NO developmental positions

want mov’t as normal as possible

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63
Q

which approach to motor recovery aims to eliminate all unwanted motor activity w/in task performance?

A

MRP

64
Q

what are the techniques of MRP?

A

task analysis

performance of whole tasks (task specific training)

performance of task component using normal mov’t patterns

transference of learning

65
Q

what is the neuro IFRAH approach to motor recovery?

A

sensorimotor, task oriented approach similar to MRP

66
Q

what is the neuro IFRAH theory to motor recovery?

A

a combo of the approaches focused on normal fxnal task performance

67
Q

what are the techniques of neuro IFRAH?

A

similar to MRP, NDT

unique tools are utilized

proprietary technique

68
Q

which approach to motor recovery must you be trained in?

A

neuro IFRAH

69
Q

what is the CIMT (constraint induced mov’t therapy) approach to motor recovery?

A

forced use

repetitive, task-specific practice (RTP)

70
Q

what is the CIMT theory of motor recovery?

A

repeated “forced use” of an extremity results in cortical reorganization to restore normal mov’t

71
Q

what are the techniques of CIMT?

A

non-affected extremity is constrained in a mitt and the pt uses the involved extremity for a majority of the day, for an extended period of time

72
Q

what is the mirror therapy approach to motor recovery?

A

repetitive, task-specific practive (RTP) with use of a mirror for feedback

73
Q

what is the theory of the mirror therapy approach to motor recovery?

A

viewed mirror image of the non-affected limb activates pathways of normal mov’t in the affected limb

74
Q

what are the techniques of the mirror therapy approach to motor recovery?

A

non-affected extremity performs mov’t and reflection is watched in the mirror

involved extremity is similarly moved

75
Q

when is error augmentation appropriate to use?

A

in pts who are cerebellar dependent so they can correct/refine mov’t

76
Q

when is error augmentation not appropriate to use?

A

in pts who are cerebellar deficit bc they can’t correct/refine mov’t

77
Q

what is the theory behind error augmentation for motor recovery?

A

using erroneous sensory feedback to enhance adaptation to a new environment

78
Q

when is errorless learning appropriate to use?

A

in pts who are cerebellar deficient bc they can’t correct/refine mov’t

79
Q

when would we maybe not want to use errorless learning?

A

when a pt is cerebellar dependent bc they can be challenged to correct mov’ts

80
Q

t/f: there is overlap bw the different approaches to motor recovery?

A

true

81
Q

t/f: there is evidence that one technique for motor recovery is better than another

A

false

82
Q

t/f: there is limited evidence surrounding the use of the motor recovery techniques

A

true

83
Q

what does current evidence on approaches to motor recovery support?

A

using a mix of components from dif approaches appears best for promoting fxnal independence following a stroke

some treatments show promise for improving motor recovery, esp those that focus on high-intensity and repetitive task-specific practice

84
Q

there is most promise for improving motor recovery for approaches that do what?

A

focus on high-intensity and repetitive task-specific practice

85
Q

what are some commonalities among PNF and neuroplasticity principles?

A

use it or lose it

use it and improve it

specificity

reps matter

intensity matters

salience matters

86
Q

what are the 4 principles of therapeutic handling?

A

1) decrease the amount of force the client uses to stabilize body segments

2) direct (facilitate) initiation of mov’t efficiency and effectiveness of recruitment

3) guide/redirect the direction, force, speed, and timing of muscles activation for successful task completion

4) grade the input

87
Q

how do we decrease the amount of force the client uses to stabilize the body segments?

A

provide external support where/when needed to decrease effort

support (provide stability) or change alignment of the body w/respect to gravity (treatment position) if needed

88
Q

how do we direct (facilitate) initiation of mov’t efficiency and effectiveness of recruitment?

A

contrain or increase degrees of freedom needed to stabilize or move

89
Q

how do we grade input?

A

recognize when the client can recruit/fxn independently of the therapist’s input and take over control of posture and mov’t

90
Q

what part of the Brunnstrom approach do we accept now?

A

the Brunnstrom recovery stages are correlated w/neurophysiologic measures and highly correlated w/the MMAS (motor assessment scale) regarding the eval of motor recovery in pts following stroke

the recovery stages can be used for the assessment of pts w/post-stroke hemiplegia

91
Q

which approach may use reflexes, associated, rxns, or overflow moves to initiate mov’t?

A

Brunnstrom

92
Q

which approach may use synergistic mov’t to facilitate mov’t, particularly using stronger proximal segments to facilitate weaker distal mov’ts?

A

Brunnstrom

93
Q

which approach may use primitive reflexes and equilibrium rxns to achieve active motor responses to weak/absent muscles?

A

Brunnstrom

94
Q

t/f: in Brunnstrom’s approach, treatment must progress developmentally from reflex response to voluntary response to fxnal response

A

true

95
Q

which approach states that fxnal training and walking is delayed until the transition from developmental reflexes to voluntary responses has occurred?

A

Brunnstrom

96
Q

resistance to flexion of the uninvolved LE causes ___ of the ___ extremity

A

extension, involved

97
Q

resistance to extension of uninvolved LE causes ___ of the ____ extremity

A

flexion, involved

98
Q

what is mirror synkinesis?

A

resisted grasp by the uninvolved hand causes a grasp rxn in the involved hand

99
Q

an attempt to flex the involved leg or resistance to leg flexion causes a ____ response in the ____ arm

A

flexor, involved

100
Q

what is homolateral synkinesis?

A

an attempt to flex the involved leg or resistance to leg flexion causes a flexor response in the involved arm

101
Q

what is Souque’s phenomenon?

A

active or passive raising of affected arm over 100 degrees w/elbow extension causes the fingers to extend and abd

102
Q

what is Raimiste’s phenomenon?

A

resistance to add/abd of the uneffected LE results in a similar response to the opposite LE

103
Q

what are the 4 basic principles of Rood sensorimotor approach?

A

1) sensory input is required for normalization of tone and facilitation of desired motor responses

2) sensorimotor control is developmentally based

3) mov’t is purposeful; engagement in activities is required to produce a normal response

4) repetition of mov’t is necessary for learning

104
Q

which approach uses sensory stimulation to muscles and jts to normalize tone and facilitate muscles responses?

A

Rood

105
Q

which approach uses superficial cutaneous stim using stroking, brushing, tapping, icing, vibration to elicit voluntary muscle activation?

A

Rood

106
Q

t/f: cutaneous stimulation in Rood’s approach can be applied to the agonist or antagonist

A

true

107
Q

what are the techniques that can be used in the Rood sensorimotor approach?

A

neutral warmth

gentle rocking/shaking

slow rolling (rhythmic rotation) (low trunk rotation)

deep tendon pressure (bicipital tendon, ant tib tendon)

jt compression and WB (heavy jt compression)

maintained (prolonged) stretch vs quick stretch

light moving or quick touch

quick icing

fast brushing

tapping

vibration

108
Q

which approach to motor recovery focuses on the practice of missing task components and whole tasks, as well as transference of learning?

A

MRP (motor re-learning programme)

109
Q

what are the 4 steps of MRP (motor re-learning programme)?

A

1) analyze mov’t or task components

2) practice missing components of mov’t/task

3) practice part to whole mov’t or task

4) transference of learning

110
Q

when analyzing mov’t or task components in MRP, what kind of activities and environment should be used?

A

real-world activities and environment

111
Q

what do we do when practving missing components of mov’t/task in MRP?

A

prevent unwanted mov’t or compensations

provide feedback, manual guidance to the mov’t

112
Q

which technique is based upon the inhibition of abnormal reflexes and tone, undesired mov’t prior to mov’t?

A

NDT (neuro-developmental treatment)

113
Q

which approach theorizes that abnormal reflexes and mov’t interfere w/acquisition of normal mov’t patterns?

A

NDT

114
Q

t/f: we have to manage the UE to do any fxnal training

A

true

115
Q

how do we practice NDT?

A

abnormal tone is reduced by use of reflex-inhibiting postures allowing for pts to feel normal mov’t while preventing use of compensatory motions

once inhibited, the body is ready for mov’t and normal mov’t patterns are facilitated

incorporate sequential developmental positions one following by the other

116
Q

what are reflex inhibition postures/patterns (RIPs)?

A

a position that is used to inhibit spasticity by lengthening shortened muscles

117
Q

what are the foundations of facilitation in NDT?

A

1) using both sides of the body (symmetry)

2) preventing abnormal mov’t (compensations), abnormal reflexes and clinical hypertonicity during facilitation

3) avoiding use of ADs

4) using key points of control

118
Q

what are the key points of control?

A

head and trunk

humeral head

thumb

hip and femur

sternum and low back

119
Q

how do we use the head and trunk as key point of control?

A

head and trunk flexion decreases shoulder retraction, trunk and limb extension

120
Q

how do we use the humeral head as a key point of control?

A

humeral head ER and flexion to 90 degrees decrease flexion tone of the UE

121
Q

why does flexion synergy of the UE cause spasticity?

A

bc in flexion synergy, the humeral head is pushed anterior onto the biceps tendon causing a quick stretch increasing spasticity

122
Q

how can we use the humeral head to decrease UE flexion synergy?

A

in supine, put force down on the humeral head while holding the UE in ER and ext

123
Q

how do we use the thumb as a key point of control?

A

thumb abd and ext w/forearm sup decreases flexion tone of the wrist and fingers

124
Q

how do we use the hip and femur as key points of control?

A

femoral ER and abd decreases extensor/add tone of the LE

125
Q

how do we use the sternum and low back as key points of control?

A

facilitates anterior pelvic tilt/postural extension or posterior pelvic tilt/trunk flexion

126
Q

how can we break extension synergy in the LE?

A

bring the LE into flexion and ER

127
Q

which approach is generally thought to include elements of both PNF and NDT?

A

neuro IFRAH

128
Q

t/f: there is currently no independent evidence validating the neuro IFRAH approach or demonstrating improved fxnal outcomes in stroke

A

true

129
Q

what is involved in planning NMR interventions?

A

task-specific interventions

experience-dependent plasticity

130
Q

during Brunnstrom phase 1, what is the goal of interventions?

A

normal active motor recruitment

131
Q

during Brunnstrom phase 2, what is the goal of intervention

A

normal active motor recruitment

prevention of synergies when possible (may have to have them sit instead of stand)

132
Q

during Brunnstrom phase 3, what is the goal of intervention?

A

use as many reflex inhibiting postures as possible

decrease the influence of any clinical hypertonicity

try to facilitate more normal active motor recruitment

133
Q

during Brunnstrom phase 4, what is the goal of interventions?

A

trying to maximize fxn

active motor recruitment

may try to make mov’t “pretty” with error augmentation

134
Q

when would we NOT want to try to implement error augmentation for intervention?

A

when a pt is in marked spasticity

135
Q

during Brunnstrom phase 5, what is the goal of intervention?

A

strengthening

136
Q

when can we start normal strengthening in interventions with stroke recovery?

A

when the pt is outside of synergistic influence

137
Q

what are the 5 steps in changes structures though function?

A

1) prepare the brain (prime the pump)

2) prepare the body

3) promote e recovery (task specific training)

4) repeat, repeat, repeat (experience dependent plasticity)

5) transference and interference

5)

138
Q

what is inhibition facilitation?

A

preventing or redirecting components of mov’t that are unnecessary and interfere w/intentional, coordinated mov’t

139
Q

do we have more control over the underlying spasticity or the clinical hypertonicity?

A

clinical hypertonicity

140
Q

when inhibiting tone, what steps do we have to take?

A

1) know what mov’t you want, ask for it, and make certain you get it (promote positive plasticity)

2) make every mov’t count in your session (and instruct the same for home) (avoid negative plasticity)

141
Q

when inhibiting tone, if you don’t get what you want immediately, what should you do?

A

change what you’re doing (hands, technique, position, environment, task)

142
Q

how do we do mov’t and task analysis?

A

break down (deconstruct) a fxnal activity into its component parts to understand and evaluate the demands of the task

143
Q

what is involved in step 1, prepping the brain?

A

aerobic activity of moderate to high intensity to increase neurotrophin production and increase post stroke neuroplasticity and recovery of cognitive and motor processes

144
Q

what are the 3 “ingredients” for increased neurotrophin production during moderate to high intensity aerobic exercise?

A

1) brain derived neurotrophic factor (BDNF)

2) insulin-like growth factor-I (IGF-I)

3) nerve growth factor (NGF)

145
Q

what does brain-derived neurotrophic factor (BDNF) do?

A

synapse formation and neuronal growth

146
Q

what does insulin-like growth factor-I (IGF-I) do?

A

promotes better recovery

147
Q

what does nerve growth factor (NGF) do?

A

promotes growth and survival of sensory and sympathetic neurons

148
Q

what is involved in increasing post stroke neuroplasticity and recovery of cognitive and motor processes?

A

synaptogenesis in multiple brain regions

dendritic branching or arborization (only with moderate intensity exercise)

149
Q

what is involved in step 2, prepping the body?

A

biomechanical alignment (esp the pelvis and feet stable on the ground)

adequate stability

150
Q

we need to ensure the pt has adequate stability to allow for what?

A

distal mobility

controlled mobility

transitional mobility

151
Q

t/f: distal mobility requires proximal trunk stability

A

true

152
Q

how do we get controlled mobility?

A

by controlling mov’t w/in a position

weight shifting to the limits of stability

153
Q

how do we get transitional mobility?

A

by controlling as the COG changes from position to position or task to task

154
Q

what is activities/positions are involved in transitional mobility?

A

sit to stands

tall kneeling and half kneeling

gait pattern control

155
Q

how do we ensure appropriate muscular tone/activity?

A

inhibition of clinical hypertonicity

reduce the effects of spasticity or rigidity

facilitating normal muscle tonus or active motor output

156
Q

why should we avoid “splinter” exercises like LAQ and SAQ in stroke rehab?

A

bc they are ortho focused interventions that are targeting muscle strength, while in stroke rehab we need to target normal motor recruitment

DPT 620: Neuro (6 decks)

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