L1 Intro Flashcards
Role of EBP in Neuro PT
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
Traditional Approaches
-Rood facilitation/inhibition techniques
-Sensory integration
-Bobath techniques
-PNF
-Brunnstrom Techniques
Very little high-quality evidence about efficacy despite being around for 30 years
Contemporary Approaches
-Neuroplasticity
-Dosing of interventions (FITT)
-Practice conditions
Sensory Stimulation Techniques
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
Motor development sequence
(Developed by Rood)
1. Mobility–ability to move body part through space
2. Stability–ability to fix a body part to allow weight-bearing
Heavy work (rood)
co-contraction of muscles to provide stability
Light work (rood)
movement of agonists while antagonists relax
Facilitation Techniques
- Approximation/Joint compression
- Quick icing
- Light touch
- Quick stretch
- Resistance
- Tapping
- Traction
Inhibition Techniques
Deep pressure
Prolonged stretch
Warmth
Prolonged cold
Slow stroking
Sensory Integration
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
Movement Therapy in Hemiplegia
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
Neuro-developmental Treatment
Developed by Karl and Berta Bobath in 48
Based on hierarchical model of neurophysiologic function
Included in modern motor control theories
hierarchical model of neurophysiologic function
-Loss of CNS control causes abnormal postural reflex activity and muscle tone
-Pt should experience normal movement in order to regain function
NDT and Modern Theories
-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
NDT Treatment Principles
- Start with postural alignment
- Use progressive positions to promote movement further from COG and decrease BOS
- Quality and variations will lead to efficient movements
- Goal should be to optimize function
- Ongoing Assessment is critical to adapt activities appropriately
Exam of NDT
Observe the pt
ID the constraints and underlying dysfunction
Choose treatment strategies
Facilitation
techniques to elicit voluntary muscular contraction
Inhibition
techniques to decrease excessive tone or movement
Key points of control
specific handling of designated areas of the body to influence and facilitate posture, alignment, and control
Alignment
Can not impose normal movement on malaligned joints
Placing
the act of moving an extremity into a position that the patient must hold against gravity
Reflexive inhibiting posture
designated static positions that bobath found to inhibit abnormal tone and reflexes
Proprioceptive Neuromuscular Facilitation
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
PNF is used to
Increase pt mobility or stability
guide the pts movement
facilitate more efficient and coordinate movement
increase ROM, strength, endurance
Changes made in Neuro PT
- Facilitation of normal movement is unnecessary
- Strength, coordination (not spasticity) are what limit function
- Need to attain postural stability before initiation of mobility
Steps of PT Exam
History
Systems Review
Movement Analysis
Tests and Measures
PT Plan of Care
- Dx
- Prognosis
- Goals
- Plan
Diagnosis
remember to focus your diagnosis on the LIMITATIONS at the activity or participation level
Prognosis in Neuro
Recovery
Compensatory
Maintenance
Recovery Prognosis
return to how action was completed before the injury
Compensatory Prognosis
adapting the movement
Maintenance Prognosis
keeping gains made in therapy
How to determine appropriate Prognosis
CPR
Injury characteristics
Natural history
Capacity for neural recovery
Patient drive
Caregiver support
resources
Plan of Care guidelines
Write goals (short and long term)
Select interventions
describe the treatment frequency and duration
Assessment of Outcomes
Perform a progress exam (includes subjective report, objective tests, outcome measures)
Evaluate the progress of your pt
