Lecture 3 Flashcards
T or F: There are specific named approaches for physical therapy of neuro conditions that are better than others
F, according to Cochrane review there’s no evidence that one is better than the other
T or F: according to the Brunnstrom approach, Patient’s can skip stages of recovery
F, they will progress through each phase no matter what
Patient’s can also plateau at any stage
What is a movement synergy
Group of muscles that work together as a bound unit in a primitive/automatic way
What is an associated reaction and what can cause it?
Automatic movements of one bodypart due to
-another bodypart moving
-increased effort
-sneeze/cough
-artificially stimulated
-raimiste phenomenom
T or F, in brunnstrom stages of recovery the UE and LE are staged together
F, they are staged separately
What stage has flaccidity, no reflexes, and no associated reactions?
Brunnstrom’s stage 1
What brunnstrom stage is the first where you can ilicit reflexes
Stage 2
Stage 2 of brunnstrom includes what kind of movement
minimal voluntary movement only within synergies
How much spasticity does stage 2 of brunnstrom have?
Developing spasticity
What brunnstrom stage has peak spasticity?
Stage 3
Which Brunnstrom stage can the patient preform basic movement synergies voluntarily
stage 3
At what brunnstrom stage can a patient break synergies “1 joint out of synnergy with spasticity”
stage 4
at what brunnstrom stage does a patient start to have decreasing synnergy
stage 4
At what brunnstrom stage can a patient have multiple joints moving outside of synergies, with spasticity also decreasing
stage 5
What is the difference between Brunnstrom stage 4 and stage 5 synergies?
Stage 4 can only minimally move outside of synnergies
stage 5 can move 2+ joints outside of the synnergies
At what stage do you start to see minimal spasticity with simularity between the affected and non-affected side with slow speed/coordination
stage 6
At what stage is spasticity completely gone and normal movement recovered
stage 7
How are brunnstrom classifications used?
Descriptively in research and in the clinic to describe limbs
“Pt has a brunnstrom stage 5 R UE”
What theory states that you can activate the neuromuscular system through stimulation of proprioceptors
PNF
T or F, PNF states that patients need repetitions for motor learning
T
What is successive induction
maximal efforts of antagonist muscles will overflow into the agonist muscles if reversal of direction is quick
what is irradiation
maximum effort of stronger muscles within a pattern will overflow into weaker muscles
What are the 7 elements of PNF
1. Manual contacts- hands are used to stimulate muscles
2. Commands - short and directive instructions timed with movement
3. Stretch - Activation of muscle spindles
4. Traction/approximation - Traction facilitates movement, approximation facilitates stability
5. Maximal resistance - depends on patient, apply the max they can take without breaking
6. Normal Timing - Distal to proximal movement, allow rotation to occur earliest
7. Reinforcement - can use timing for emphasis to increase strength of response
What are the 4 stages of motor control in PNF
- Mobility - pt needs adequate ROM
- Stability
- Controlled mobility/ dynamic posture control
- Skilled mobility - coordinated movements that allow interaction with environment
What is quadruped?
on hands and knees
What is plantigrade
Weight bearing through the feet and hands
What is modified plantigrade?
PT is weightbearing with feet on floor and hands on a raised surface
What is the prone progression of developmental activities in PNF
Prone on elbows -> quadruped -> plantigrade -> Modified Plantigrade
T or F: In PNF, developmental concepts must be fully mastered before moving onto the next progression
F, you should simultaneously work on multiple stages at the same time, whatever the patient can manage
example: Pt can work on walking even if they havent mastered sitting balance
In PNF, ___________ needs to happen before skilled distal movement
In PNF, when a movement is mature the timing will be ________________
proximal control
Distal to proximal
the NDT approach emphasizes what?
Neuroplasticity
How does NDT technique’s teaching differ from what we know about motor learning
A therapist gradually gives over control to the patient (which minimizes mistakes)
With motor learning we should be letting the patient make mistakes
You cannont super impose _________________ on abnormal postural alighment
efficient movement.
Meaning you can’t force patients with abnormal posture to move perfectly throughout their therapy activities
When must alignment be considered during therapy activities in NDT
At beginning/initiation
during execution of movement
after completion/termination of movement
What is the first element of postural control in NDT
Trunk
Which part of the trunk is emphasized first in postural control
Lower Trunk progressing to upper trunk
What is the second component of postural control in NDT
midline orientation
pt must be able to stabilize in midline, move away and back to midline
Before a patient has midline orientation, they have to have ___________
trunk control
What is the 3rd element of postural control in NDT
Weight shift over base of support
-through straight planes and diagonals
-smaller incriments first
what is the 4th element of postural control in NDT
head control
-evolves out of trunk control
What is the 5th element of postural control in NDT
Limb function
-establish selective movements in WB before non-WB
-LE to support full bodyweight
What are the 5 elements of postural stability in order
-trunk
-midline orientation
-weight shift over BOS
-head control
-limb function
What is easiest and what is hardest amongst these 3:
Isometric, concentric, eccentric
Easiest: Isometric
Eccentric
Hardest: Concentric
___________ in position precedes the ability to move transitionally with control
postural control
What is NEURO-IFRAH
different approach for treating neuro patients with no evidence
5 Elements of postural control:
Trunk -> ______ -> weight shift over BOS -> head control -> limb function
Midline orientation
NDT posture control:
________ -> Midline orientation -> Weight shift over BOS -> Head control -> __________
Trunk
Limb Function
