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PHTY3140 > L1: Framework for Neurological Physiotherapy > Flashcards

L1: Framework for Neurological Physiotherapy Flashcards

1
Q

What is the current principle of neurological physiotherapy?

A

The goal of neurological rehabilitation is to regain optimal motor performance of everyday tasks, specific to the individual’s lifestyle and context.

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2
Q

What are 6 types of neurological disorders of the CNS?

A
  1. Vascular – stroke
  2. Traumatic brain injury
  3. Acquired brain injury
  4. Degenerative
  5. Viral
  6. Infective
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3
Q

What are 2 types of vascular - stroke as a neurological disorder (CNS)?

A
  1. Haemorrhagic
  2. Ischaemic
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4
Q

What are 2 types of traumatic brain injury as a neurological disorder (CNS)?

A
  1. Closed
  2. Open
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5
Q

What are 3 types of traumatic brain injury (haemotomas) as a neurological disorder (CNS)?

A

Brain bleeds

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6
Q

What are 2 types of acquired brain injury as a neurological disorder (CNS)?

A
  1. Infiltrative neoplasm (tumours, cysts, metastases)
  2. Anoxic (near drowning, asphyxiation), drug use,
  3. shock
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7
Q

What are 4 type of denegerative brain injury as a neurological disorder (CNS)?

A
  1. Parkinson’s Disease
  2. Spinal muscle atrophy
  3. Amyotrophic lateral sclerosis (ALS)
  4. Multiple
  5. Sclerosis (MS)
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8
Q

What are 3 types of viral brain injury as a neurological disorder (CNS)?

A
  1. Guillain-Barre
  2. CIDP
  3. Chronic inflammatory demyelinating neuropathy
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9
Q

What are 2 types of infective brain injury as a neurological disorder (CNS)?

A
  1. Abscess
  2. Meningitis
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10
Q

What are 3 types of neurological disorders of the PNS?

A
  1. Motor Neuron Disease
  2. Polio and post polio syndrome
  3. Guillian Barre

Needs input and provides output

  • Can cause central decay due to the lack of input
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11
Q

Disturbed CNS function depends on ____, ____, and _____.

A

lesion site; size; progression

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12
Q

Commonly, we primarily manage the problems related to altered function and poor quality movement. What are 3 things this is caused by?

A

reduced / altered (Unable to provide output because it does not receive input well)

  1. Motor recruitment - movement (what CNS sites?)
  2. Somatosensory input
    • Sensation / proprioception / vision
  3. Perceptual, Spatial, Cognitive
    • Eg. does not belong to their body
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13
Q

What is the ICF Model for Rehabilitation? What are the 4 components?

A
  1. Participation limitation
  2. Activity limitation
  3. Activity restriction
  4. Neuropathology
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14
Q

What are 2 characteristics of “Participation Limitation” of the ICF Model for Rehabilitation? What is the main focus?

A
  1. ability /difficulty that an individual has at the community / societal level
  2. 2What is it you want to be able to do within community? (home, work, shop, recreation etc)

Focus of long term goals

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15
Q

What are 2 characteristics of “Activity Limitation” of the ICF Model for Rehabilitation? What is the main focus?

A
  1. ability / difficulty an individual has performing functional motortasks (disability level)
  2. What are the specific activities (motor tasks) that you would like to improve or find difficult? (e.g. walking, reaching, grip)

Focus of short term goals, outcome measures, aim of task-oriented practice, report in chart / referrer

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16
Q

What are 2 characteristics of “Activity Restriction” of the ICF Model for Rehabilitation? What is the main focus?

A
  1. The specific impairments interfering with performances of functional motor tasks
    • Primary: positive & negative impairments (Eg. pathology)
    • Secondary: adaptive changes resulting from primary loss (eg. Disuse)
  2. Underlying problems that contribute to activity limitations (e.g. weak quads limiting knee stab mid stance or affect person (e.g. pain).

Assess / reassess and target during Rx

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17
Q

What is the Neurological rehabilitation delivered across the ‘Continuum of Care’?

A
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18
Q

What are 2 characteristics of prevention/primary care in the Continuum of Care?

A

Potential for growth for physiotherapy

  1. prevention of disease processes related to neurological
  2. dysfunction and
  3. promotion of health and life-style to minimize the decline in health with age – soft neurological signs
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19
Q

What are 2 characteristics of early diagnosis/acute care management in the Continuum of Care (early)?

A
  1. ongoing management within the community eg early stage Parkinsons disease or multiple sclerosis etc…
  2. early, effective management to ensure optimal outcomes for clients admitted to a hospital facility – eg neurosurgical ward / acute stroke unit
    • Transfer to a rehabilitation unit for ongoing rehabilitation eg Stroke/MVA
    • Return to the community for ongoing rehabilitation eg PD /TIA / Concussed athlete – mild TBI
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20
Q

What are 2 characteristics of ongoing (secondary stage) rehabilitation management in the Continuum of Care (middle)?

A
  1. hospital based rehabilitation units
  2. active management within residential care facilities

Optimise whatever they need to do to continue participating

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21
Q

What are 2 characteristics of “Community-based rehabilitation to maximise community integration” in the Continuum of Care (late)?

A
  1. Follow-up as an outpatient in a rehabilitation unit following a period of hospital based care
  2. Management within communitybased rehabilitation units eg NAB Clinic or MS Centre
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22
Q

What are 2 characteristics of “Sustaining health while ageing with a disability” in the Continuum of Care?

A
  1. Promote health practices in clients with disability & transition to community organisations - eg Acquired brain injury services
  2. Assist clients to adapt exercise programs within gyms for clients living in the community with a disability
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23
Q

Neurological Rehabiliation delivered with the ____ at the centre & _____ oriented. Patient / client is part of the decision making process across the continuum of care

A

client; goal

Involve patient / client in problem solving process

  • What is it you want to achieve from your rehabilitation program?
  • Participation level within home/ work/ community
  • Long term goal setting
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24
Q

What are the 2 things to identify imvolving patient/client in problem solving process in client centre and and goal orientated?

A
  1. Identify activity limitations related to functional motor tasks
    1. Establish short-term goals with patient / client
    2. Re-assessment demonstrates progress - shift in goals towards long term outcomes
  2. Identify the activity restrictions - impairments (positive, negative and adaptive changes occur with brain injury)
    1. Establish specific aims that address the impairments
    2. Select & apply evidenced based interventions with informed consent
    3. Re-assess impairments – improvement linked to ST goals
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25
Q

What are 2 features in identify activity limitations related to functional motor tasks involving patient/client in problem solving process in client centre and and goal orientated?

A
  1. Establish short-term goals with patient / client (Eg. can you stand up from the bed? Can you walk to the toilet?)
  2. Re-assessment demonstrates progress - shift in goals
  3. towards long term outcomes (eg. able to go to the toilet)
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26
Q

What are 3 features in identify the activity restrictions - impairments (positive, negative and adaptive changes occur with brain injury) involving patient/client in problem solving process in client centre and and goal orientated?

A
  1. Establish specific aims that address the impairments
  2. Select & apply evidenced based interventions with informed consent
  3. Re-assess impairments – improvement linked to ST goals
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27
Q

What are 4 examples of short term physiotherapy goals?

A
  1. the patient will be able to roll over with the assistance of the spouse and be made comfortable in side lying in 1 week;
  2. (the patient will be able to independently sit for 5

minutes in 1 week) – able to sit in chair to eat dinner

  1. (the patient will be able to stand up holding a cup

independently 3 times in 10 seconds in 2 weeks) – able

to stand up without hand holding an object

  1. (the patient will be able to perform activities in standing for 10 minutes in 2 weeks.) – able to clean teeth, have ashower while standin

SMART goal

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28
Q

What are 2 examples of long term physiotherapy goals?

A
  1. the patient will be able to walk independently on firm surfaces at discharge home with a self rated confidence of 8/10. – Able to walk around the home independently without fear
  2. the patient will be able to walk independently on all surfaces prior to discharge from the active rehabilitation phase – walk from the rehab facility to the shops and move around the shops – self rated confidence 7/10.
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29
Q

What are 3 ways that a goal / task oriented approach to retraining functional motor tasks is used?

A
  1. relevant context / stage for rehabilitation
  2. addresses the activities / movement problems identified by the client
  3. Applies motor learning principles during task practice

Functional motor tasks relevant to the patient / client are identified

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30
Q

What are 3 ways to foster self-management, where both the patient/client & the client/carer are empowered to self-manage)?

A
  1. establish an active role for the client rather than use practices where the client is a passive recipient of the program eg independent practice of tasks/exercises or mental / verbal rehearsal of steps to master whole task
  2. work with spouse/carer as early as practical following diagnosis of a neurological disorder
  3. encourage responsibility for health / life-style issues
  • 5-6 hours of rehab/day –> self management and independence
  • Needs to feel hard and tired
  • Once medically stable –> need to encourage independence
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31
Q

What are the 4 Neurological Rehabilitation Devlivery Models?

A
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32
Q

What does the clinical reasoning for neurological rehabilitation involve?

A
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33
Q

What is a common problem with a patient with a right hemiplegia?

A

Knee hyperextends in mid stance of gait

34
Q

What are 4 possible causes for a patient with a right hemiplegia whose knee hyperextends in mid stance of gait?

A
  1. Weak inner range quads?
    • Poor co-contraction of quads and hamstrings
  2. Poor proprioception at knee?
  3. Tight gastroc?
  4. Spasticity / overactivity of gastroc or quad?
    • Snaps knee back

Mid-stance for walking

  • Highest point but knee is not fully extended
  • Some PF and DF (2 degrees)
    • Need movement in ankle but don’t need a lot of range
  • Hip Trendelenburg
  • Hip extension

Faster the walking –> more range needed

35
Q

What is 5 things that clinical reasoning enables?

A
  1. Identification of the problems interfering with functional motor tasks to provide a basis for discussion with the client
  2. Prioritising the problems to be addressed so that a program can be developed with the client and empowers the client to work towards immediate (short term) and long term goals.
  3. Implementation of a program that facilitates the client/carer to take some/all responsibility for execution of the program.
  4. Reflection and evaluation of the efficacy of the strategies applied to address the dysfunction
  5. Prediction of likely outcomes for clients (forward planning process)
36
Q

What are 8 featueres of the assessment?

A
  1. Gathering information from client records
  2. Initial observations of client / movement
  3. Patient interview
  4. Functional task and movement analysis/observation (ORDER)
  5. Impairment assessment
    • Differentially diagnose contributions to movement dysfunction
  6. Objective outcome assessment- Gives a number but doesn’t give a “WHY” –> only do at the end
  7. Gather info from other team members
  8. Problem list
37
Q

What are the 5 features in the Mangement?

A
  1. Plan short and long term goals in conjunction with client
  2. Plan *reassessment
    1. functional task analysis / recording to re-evaluate motor control
    2. outcome measures to reflect these goals
    3. Review of impairments to capture change
  3. Develop & implement intervention program
    1. select strategies that are appropriate / effective / with established efficacy
    2. discuss options/benefits etc with client & gain informed consent before proceeding
    3. determine the frequency and timing of treatment
  4. Intervention program
    • Task and high dose oriented
      • Functional task limitations – contributing factors
        • Primary impairment (eg hemiparesis, bradykinesia)
        • Secondary impairment (eg pain)
      • Prevention of secondary changes (eg contracture)
  5. Reassess with *outcome measures planned
    • Assess with movement observation – improved movement to nearer normal?
    • Assess with * tests – achieving ST / LT goals?
38
Q

What are 3 characteristics of the “plan reassessment” section of management?

A
  1. functional task analysis / recording to re-evaluate motor control
  2. outcome measures to reflect these goals
  3. Review of impairments to capture change
39
Q

What are 3 characteristics of the “develop and implement intervention program” section of management?

A
  1. select strategies that are appropriate / effective / with established efficacy
  2. discuss options/benefits etc with client & gain informed consent before proceeding
    • Getting them onboard with the rehab (eg. are you happy and understanding what’s going on at the moment
  3. determine the frequency and timing of treatment
    • Eg. 5 mins every hour​
40
Q

What are 2 characteristics of the “ task and high dose oriented” section of management?

A
  1. Functional task limitations – contributing factors
    1. Primary impairment (eg hemiparesis, bradykinesia)
    2. Secondary impairment (eg pain)
  2. Prevention of secondary changes (eg contracture)
41
Q

What are 2 characteristics of the “ task and high dose oriented” section of management of “functional task limitations- contributing factors”?

A
  1. Primary impairment (eg hemiparesis, bradykinesia)
  2. Secondary impairment (eg pain)
42
Q

What are 3 characteristics of the “reassess with outcome measures planned” section of management?

A
  1. Assess with movement observation – improved movement to nearer normal?
  2. Assess with * valid tests – achieving ST / LT goals?
    • But not always sensitive to changes (eg, improvements)
43
Q

What to do next if short term goals are achieved in management?

A

progress goals & Rx program

44
Q

What are 4 steps to take if short term goals are not achieved in management?

A
  1. change goal
  2. change treatment method
  3. patient may have reached ‘a plateau’ in recovery
  4. ? Discharge or continue treatment.
45
Q

What are 4 steps to take if long term goals are achieved in management?

A
  1. discharge / long term follow -up
  2. consider home program / adapted physical program
  3. discharge letter to referral source / alternate service
  4. refer to community resources / services
46
Q

_____ based on motor learning principles and basic science

A

Task Oriented Training

47
Q

Task Orientated Training s consistent with a systems approach to regaining ____ with the integration of the individual, the task and the given environment

A

motor control

48
Q

What are 3 things that task orientated trainning needs to address? What is the main purpose?

A

Functional needs of the clients

  1. Basic functional motor tasks (roll/sit/stand/walk)
  2. Work-related tasks
  3. Recreational tasks

Integrates physiotherapy handling skills and specificstrategies that address the cause of movement dysfunction

49
Q

When does treatment commence in task orientated training?

A

Treatment commences as early as possible after diagnosis or recognition of a movement disorder

50
Q

_____ in context of function in task orientated training

A

Active learning

51
Q

___ and ____ are important to learning in task orientated learning.

A

Motivation; environment

52
Q

_____ is used to identify components of movement that have poor / reduced control in task oriented training.

A

Functional movement analysis

53
Q

Applied ____ and ____ guide task training

A

biomechanics; kinesiology

54
Q

What are the 4 key components in the process of optimizing skill in clients following a neurological injury?

A
  1. Focusing attention
  2. Feedback
  3. Practice
  4. Transfer of learning
55
Q

What are 3 characteristics of “focusing attention” in task oriented training (optimising skill following a neurological injury)?

A
  1. Demonstration
  2. Instruction
  3. Ensuring tasks are concrete and goal oriented rather than abstract
56
Q

What are 3 characteristics of “ feedback” in task oriented training (optimising skill following a neurological injury)?

A
  1. Visual
  2. Auditory
  3. Proprioceptive
57
Q

What are 5 characteristics of “practice” in task oriented training (optimising skill following a neurological injury)?

A
  1. Practice of relevant components of functional tasks- Break the task into smaller components
  2. Followed immediately by practice of the whole task
  3. With part practice simulating load demands of whole task
  4. Multiple repetitions with feedback (gradually withdrawn)
  5. Retraining of affected side is stressed during task practice – minimise compensatory behaviour
  6. Motivation of client to be a responsible independent learner
58
Q

What are 5 characteristics of “active learners” in task oriented training (optimising skill following a neurological injury)?

A
  1. Practice of relevant tasks
    • Emphasise functional tasks that are of immediate use in the ward environment and later in the home/work/community environments
  2. Goal setting
    • use of relevant short and long term goals that have been set by actively involving the patient
    • useful so that the patient is committed to
  3. Practising the movements to be learnt
  4. Patient responsibility for independent practice
    1. The patient needs to become responsible for the execution of practice outside formal therapy time
  5. Patient responsibility for independent practice
    1. The therapist needs to identify what and how such practice should be carried out and to review the efforts of the patient
    2. Practice books or any set of clear instructions, provide the guide for practice
59
Q

What are 2 characteristics of active learners in task orineted training?

A
  1. Measurement and charting of progress and repetitions attempted to master task
  2. Positive attitude by patient, family and therapist, and a therapist who is committed with a genuine interest in clients
60
Q

What are the 4 steps involved in the transfer of learning across functional tasks in task oriented training?

A
  1. Simple, closed skill performance
  2. Task variation
  3. Added task variation from external factors
  4. Complex, open ended tasks
61
Q

What does of “simple, closed skill performance” in the transfer of learning in task oriented training involved?

A

involves a predictable environment in which the movements are easy to reproduce

  • e.g. practice of walking in a well-lit gymnasium on a level non-slip floor surface
62
Q

What does “task variation” in the transfer of learning in task oriented training involved?

A

Task variation is introduced that requires demand on movement execution but in a predictable environment

  • walking at increased speed
  • stopping and starting and changing direction
  • (dual task)
63
Q

What does “added task variation from external factors” in the transfer of learning in task oriented training involved?

A

Added task variation comes from an external factor in relation to the task, but still the environment is predictable and allows for movements to be reproduced

  • walking could now be practiced over different surfaces e.g. carpet, grass
  • walking up slopes or stairs
  • walking while holding a stationary object and later a moving object such as a child
  • walking while throwing and catching a ball

Can still assist –> feedback (provide tactile, verbal)

64
Q

What does “complex, open ended tasks” in the transfer of learning in task oriented training involved?

A

Complex, open ended tasks involve demanding environments that can be unpredictable and require diversifying movements

  • walking in a crowded area e.g. a shopping centre or busy footpath near traffic
  • crossing roads
  • walking on a travelator or a bus or train while it is in motion
65
Q

In the transfer of learning, to a large extent the gym environment can be manipulated but at later stages of training the ______ environmental context needs to be introduced into the practice for optimal results.

A

actual

66
Q

What is the task-oriented approach to practice?

A
  1. Normal movement requires selective activation of muscles with appropriate force & specificity to meet task demand
67
Q

What are 5 things you need to have to achieve a task in the task-oriented approach to practice?

A
  1. Reduce stereo-typed movement patterns
  2. Elicit correct timing, selection, specificity and force generation of muscle function
    • Activation and deactivation of muscles
  3. Use techniques to drive muscle spindle activation..Stretch or FES
  4. Promote alignment & attention to body & space during movement
  5. Use effective & sensitive handling to support, regain alignment & control, guide the body / body parts during whole / part practice of motor tasks
68
Q

What are the 2 characteristics of “retrain” in task oriented approach?

A
  1. postural stability and control of body segments while a position is held
  2. control of the body during postural adjustments & at the limits of stability with selective activation & recruitment of muscles
69
Q

What are 3 characteristics of “retrain neuro-motor control during functional task demands” in task oriented approach?

A
  1. Practice relevant functional motor tasks for home / immediate outdoor environment & access
  2. Use specific cues / strategies with established efficacy to improve performance of motor tasks – eg Parkinson Disease
  3. Use validated outcome measures &/or measurable outcomes
70
Q

What are 3 factors influencing potential for recovery?

A
  1. Pathophysiology (cause) of the brain injury and neural plasticity
  2. Secondary changes in peripheral tissues
    1. Rapid changes occur secondary to loss of motor control; habitual resting positions and learned non-use.
  3. Cognitive and emotional factors
71
Q

What is pathophysiology and neural plasticity?

A

There is increasing evidence that rehabilitation can affect brain reorganisation – PET, TMS studies post stroke

  • Note brain reorganisation can be maladaptive e.g learned non-use
72
Q

What are the 10 key principals of Neuroplasticity?

A
73
Q

What are the 4 implications for training in pathophysiology/neural plasticity?

A
  1. Use learning capacity / adaptability of brain
  2. Initiate effective early intervention to maximise potential for recovery
  3. Anticipate and avoid maladaptive changes
  4. Recovery can occur years after the event
74
Q

What are the 5 things that early intervention prevents in pathophysiology/neural plasticity?

A
  1. Learned non-use of affected limbs
  2. Soft tissue changes / injury
  3. Disuse effects
  4. Muscle over-activity /imbalance
  5. Incorrect motor learning - compensatory strategies (synergies)
75
Q

What are 7 secondary changes in peripheral tissues?

A
  1. muscle mutability: length associated changes according to immobilised position/habitual resting position
    • shortening
    • lengthening
  2. decreased muscle and connective tissue compliance (Thyxotrophy)
    • decreased yield of muscular and collagen fibres
    • increased tension
  3. soft tissue changes: decreased / less efficient force generation
  4. loss of joint mobility (stiffness) secondary to immobilisation
  5. decreased bone density associated with decreased WB / load
  6. decreased cardiorespiratory fitness
  7. pain secondary to changes / injury
    • influences the resting / active tension generation (force)
    • interferes with quality of movement
    • influences emotional attitude to body part / movement
76
Q

What are 5 implications for management of secondary changes in peripheral tissues?

A
  1. actively manage residual pain/ stiffness/ length changes to enable ‘normal’ generation of tension
  2. regain optimal length of muscles for efficient tension generation to meet task demand
  3. introduce WB / appropriate load as early as tissue repair permits
  4. develop specificity of force generation (related to task demand)
  5. re-develop optimal musculoskeletal and cardiorespiratory endurance
77
Q

What are 4 cognitive and emotional factors for management?

A
  1. Motivation (Eg. controlled anxiety/depression –> brain injury –> anxiety/depression reappears (brain unable to cope)
  2. Attention /concentration
  3. Responsibility for self care / responsiveness to information
  4. Influence of previous injury / emotional response to treatment
78
Q

What are 6 implications for rehabilitation in terms of cognitive and emotional factors for management?

A
  1. Use of relevant tasks that address client needs
  2. Plan goals with the client to foster responsibility for the rehabilitation program
  3. Negotiate tasks to be addressed when noncompliance presents
  4. Flexibly deliver task related programs for sustained attention during task practice
  5. Actively listen and respond to client needs
  6. Provide a supportive environment that is client focused.
79
Q

What are the 4 requirements as for muscle control varies according to the demand on the musculo-skeletal system posed by the type task / environmental demand?

A
  1. Mobility & stability requirements of a task varies
  2. Task demands vary re joint ranges / muscle length / flexibility / type of muscle contractio
  3. Varying forces / speed demands required during tasks
  4. Endurance of muscle function is required for functional task performances
80
Q

What are the 5 characteristics of “ Apply knowledge from studies of motor control & skill acquisition”?

A
  1. Sensory systems feed-forward for anticipatory motor responses (vision, auditory, somatosensory & vestibular mechanisms) –apply this knowledge when assessing / retraining motor tasks after ABI
  2. Vision most critical early in training
    • Maximise use of visual cues early in training
    • Less critical once motor programs are established
  3. Place progressive demand on somatosensory/vestibular systems as motor control is reestablished
  4. Ongoing use of sensory information is required in new environments / novel tasks – apply when progressively re-training motor tasks / progressing to new environs
  5. ABI may interfere with effective use of some sensory mechanisms – specific strategies required to
    • Identify & select strategies to manage primary sensory deficits
    • Manage problems associated with perceptual / visuo-spatial mechanisms (inattention, neglect)
    • Minimise adaptive changes – eg learned nonuse
81
Q

What happens when using the current principles of neurological physiotherapy?

A

Will assist to regain optimal motor performance of everyday tasks, specific to the individual’s lifestyle and context.

PHTY3140 (28 decks)

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