L3 Plan of Care

Question 1

principle #1–inductive and deductive reasoning

Answer 1

PT Prognosis

Inductive: creating a theory of the pt’s prognosis and use this to develop a PT POC

Deductive: you use continually, to test your theory and make adjustments to the patients POC based on pt response

Question 2

Four Principles of Neurologic Rehab

Answer 2

1. Effective neuro rehab involves a continuous cycle of deductive and inductive reasoning
2. The goal of neuro rehab is functional competence
3. Functional competence is promoted by basing rehab strategies on embedded models of motor behavior and neuro rehab
4. Functional Competence requires motor learning and self-efficacy

Question 3

Principle #2–Functional Independence

Answer 3

1. Recovery
2. Compensatory
3. Maintenance

Question 4

How do you know your pts prognosis?

Answer 4

-CPR
-Injury/Disease characteristics and natural hx
-Capacity for neural recovery
-Pt drive and engagement
-caregiver support
-pt resources

Question 5

What should the plan of care include?

Answer 5

Goals
Interventions
Treatment frequency and duration

Question 6

Restorative POC

Answer 6

1. Goals should target improvement in function and selected outcome measures
2. Intervention should optimize recovery

Question 7

Compensatory POC

Answer 7

1. Goals should target increased independence, with compensatory strategies or use of medical equipment
2. Interventions involve training in compensatory strategies and use of equipment, addressing impairments that would stop them using equipment

Question 8

Maintenance POC

Answer 8

1. Goals target maintaining function and impairments
2. Interventions involve training in home to maintain function and ensure no further worsening of body structure impairments

Question 9

DME

Answer 9

Durable medical equipment

Question 10

Principle #3–Embedded ICF Model

Answer 10

PT should select a task that is important to the patient at the activity/participation

Make sure to address body structure/function impairments

Question 11

Principles of Neuroplasticity

Answer 11

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

Question 12

Aerobic Exercise and Neuro

Answer 12

-Aerobic exercise can increase the capacity for motor learning and for neuroplastic changes
-helps with stroke, SCI, parkinson’s, MS
-Brain-derived neurotrophic factor helps with motor learning and neuroplasticity is released with aerobic exercise

Question 13

Principle #4–OPTIMAL Theory

Answer 13

Optimizing
Performance
Through
Intrinsic
Motivation (and)
Attention (for)
Learning

Question 14

Enhanced Expectancies

Answer 14

-Individual ‘s expectation of performance is based on experiences
-Positive or negative past experiences can impact their performance

Question 15

Self-Efficacy

Answer 15

an individual’s situation-specific confidence or prospective sense that he or she will be able to affect the actions that bring about task outcomes

important to promote in patients

Question 16

Positive Feedback

Answer 16

-emphasize successful performance, while ignoring less successful attempts benefits learning
-feedback after good trials increases competence and self-efficacy

Question 17

Social-comparative feedback

Answer 17

positive feedback about comparison to normative information has positive effects on motor learning

Question 18

Self-modeling

Answer 18

watching edited video feedback of learners best performance demonstrated enhanced learning, intrinsic motivation, and satistfaction with performance

Question 19

Perceived task difficulty

Answer 19

providing a cue, prior to practicing a novel balance task, improves learning and self-efficacy

Question 20

Conception of ability

Answer 20

view of ability as reflecting a fixed capacity versus being amenable to change with practice can affect motivation to practice, performance, and learning. Focusing on change is better!

Question 21

Extrinsic rewards

Answer 21

expectation of an external reward have been shown to improve motor performance and learning

not super practical for clinics

Question 22

Autonomy

Answer 22

allowing individuals to exercise control over the environment improves intrinsic motivation and motor skill learning

Patients should be given choices in regard to practice conditions, the extent of practice. Language should focus on autonomy!

Question 23

External vs Internal Focus of attention

Answer 23

External focus have an enhancing impact on performance and learning

Question 24

Benefits of External Focus of Attention

Answer 24

1. Effectiveness in motor control
2. Efficiency in energy consumption
3. Enhanced movement/speed/endurance
4. Enhanced coordination and kinematics
5. Promotes automaticity

Question 25

Goal Action Coupling

Answer 25

Motor learning is associated with structural changes in neuroanatomy and functional connections across brain regions

practice under optimal motivational and attentional focus conditions helps with the development of more effective neural connections in support of better performance and more efficient learning

Question 26

Key Points of Optimal learning

Answer 26

-Provide feedback at the request of the learner
-highlight good aspects of performance
-provide feedback focused n the goal
-Extrinsic rewards
-success will promote self-efficacy
-patient is an active participant

Question 27

How do you recognize if an activity is too easy or too hard?

Answer 27

Patient perception of exertion
Therapist observation
-More errors than desirable
-Can’t complete task
-Can only do activity once
-Activity causes pain or other distress

Question 28

Intervention Progression

Answer 28

-Single joint movements should be mastered before multijoint
-Stability should be mastered before mobility
-Part to whole task training is not always appropriate
-Tasks are not always more difficult, just different