L1 Intro

Question 1

Role of EBP in Neuro PT

Answer 1

there are historical importance of traditional approaches, but to persist with these approaches that are not supported by the best available evidence runs contrary to the vision

Question 2

Traditional Approaches

Answer 2

-Rood facilitation/inhibition techniques
-Sensory integration
-Bobath techniques
-PNF
-Brunnstrom Techniques

Very little high-quality evidence about efficacy despite being around for 30 years

Question 3

Contemporary Approaches

Answer 3

-Neuroplasticity
-Dosing of interventions (FITT)
-Practice conditions

Question 4

Sensory Stimulation Techniques

Answer 4

Traditional Approach
Developed by Margaret Rood in 40s

Composed of motor development sequences and sensory stimulation techniques, which were used to facilitate or inhibit patient responses

also includes development sequence of motor

Question 5

Motor development sequence

Answer 5

(Developed by Rood)
1. Mobility–ability to move body part through space
2. Stability–ability to fix a body part to allow weight-bearing

Question 6

Heavy work (rood)

Answer 6

co-contraction of muscles to provide stability

Question 7

Light work (rood)

Answer 7

movement of agonists while antagonists relax

Question 8

Facilitation Techniques

Answer 8

1. Approximation/Joint compression
2. Quick icing
3. Light touch
4. Quick stretch
5. Resistance
6. Tapping
7. Traction

Question 9

Inhibition Techniques

Answer 9

Deep pressure
Prolonged stretch
Warmth
Prolonged cold
Slow stroking

Question 10

Sensory Integration

Answer 10

Developed by Jean Ayers in 70s

Combines hierarchical and systems models of motor control to describe how motor development is linked to learning

Also notes that issues with sensory perception can interfere with motor planning/learning

Includes neural plasticity, which allows us to use sensory cues to enhance all learning

Question 11

Movement Therapy in Hemiplegia

Answer 11

Developed by Signe Brunnstrom in 66

based on hierarchial model of motor control

defined abnormal synergistic patterns and stages of motor recovery after stroke

Still used in current clinical assessment techniques and in Fugl-Meyer Assessment

Question 12

Neuro-developmental Treatment

Answer 12

Developed by Karl and Berta Bobath in 48

Based on hierarchical model of neurophysiologic function

Included in modern motor control theories

Question 13

hierarchical model of neurophysiologic function

Answer 13

-Loss of CNS control causes abnormal postural reflex activity and muscle tone
-Pt should experience normal movement in order to regain function

Question 14

NDT and Modern Theories

Answer 14

-Motions are best learned when organized around functional outcomes
-Movement is a product of systems of the individual, task, environment
-Retention requires practice, problem-solving
-Feed-forward can influence movement

Question 15

NDT Treatment Principles

Answer 15

1. Start with postural alignment
2. Use progressive positions to promote movement further from COG and decrease BOS
3. Quality and variations will lead to efficient movements
4. Goal should be to optimize function
5. Ongoing Assessment is critical to adapt activities appropriately

Question 16

Exam of NDT

Answer 16

Observe the pt
ID the constraints and underlying dysfunction
Choose treatment strategies

Question 17

Facilitation

Answer 17

techniques to elicit voluntary muscular contraction

Question 18

Inhibition

Answer 18

techniques to decrease excessive tone or movement

Question 19

Key points of control

Answer 19

specific handling of designated areas of the body to influence and facilitate posture, alignment, and control

Question 20

Alignment

Answer 20

Can not impose normal movement on malaligned joints

Question 21

Placing

Answer 21

the act of moving an extremity into a position that the patient must hold against gravity

Question 22

Reflexive inhibiting posture

Answer 22

designated static positions that bobath found to inhibit abnormal tone and reflexes

Question 23

Proprioceptive Neuromuscular Facilitation

Answer 23

Developed by Herman Kabat, Margaret Knott, Dorothy Vass in 40s-50s

Established a rehab program

Used for pts with musculoskeletal and neuromuscular dysfunction

allows PTs to use motor learning principles in interventions, ie practice, repetition, visual guidance, verbal commands

Question 24

PNF is used to

Answer 24

Increase pt mobility or stability
guide the pts movement
facilitate more efficient and coordinate movement
increase ROM, strength, endurance

Question 25

Changes made in Neuro PT

Answer 25

1. Facilitation of normal movement is unnecessary
2. Strength, coordination (not spasticity) are what limit function
3. Need to attain postural stability before initiation of mobility

Question 26

Steps of PT Exam

Answer 26

History
Systems Review
Movement Analysis
Tests and Measures

Question 27

PT Plan of Care

Answer 27

1. Dx
2. Prognosis
3. Goals
4. Plan

Question 28

Diagnosis

Answer 28

remember to focus your diagnosis on the LIMITATIONS at the activity or participation level

Question 29

Prognosis in Neuro

Answer 29

Recovery
Compensatory
Maintenance

Question 30

Recovery Prognosis

Answer 30

return to how action was completed before the injury

Question 31

Compensatory Prognosis

Answer 31

adapting the movement

Question 32

Maintenance Prognosis

Answer 32

keeping gains made in therapy

Question 33

How to determine appropriate Prognosis

Answer 33

CPR
Injury characteristics
Natural history
Capacity for neural recovery
Patient drive
Caregiver support
resources

Question 34

Plan of Care guidelines

Answer 34

Write goals (short and long term)
Select interventions
describe the treatment frequency and duration

Question 35

Assessment of Outcomes

Answer 35

Perform a progress exam (includes subjective report, objective tests, outcome measures)

Evaluate the progress of your pt