lecture 3: tradtional treatment approahes and evidence based practive Flashcards
what are movements synergies
group of mm that work together as a bound unit in a primitive/automatic way
where are movements synergies present at
spinal cord level
what is the resting LE synergy
Pelvis: elevation and retraction
Hip: flexion and adduction
Knee: extension
Ankle/foot: PF with inversion
what are the UE resting synergy
Scapula: Scapular depression & retraction
Shoulder: Extension, adduction, & internal rotation
Elbow: Flexion
Forearm: Pronation
Wrist/Hand: Wrist & finger flexion
who are postural/ attitudinal reflexes present in
adults with/wtihout brain damage
what are associated reactions of the brunnstrom approach
automatic movements that change the position of a body part
an associated reaction is an automatic movement that changed tha position of body part when …. (5 things)
- another body part moves voluntarily
-increased effort is used
-patient sneezes , coughs
-artificially simulated - can include raimiste’s phenomenon (1st lab)
When we sneeze our arm moves but when a pateint sneezes their arm doesn’t move this is an example of what reaction
associated
do you use brunnstroms stages of recovery for stroke or TBI patients
stroke
pertaining to Brunnstroms stages of recovery for strokes …. what are the 5 rules
- recovery can stop at any stage
- stages are never skilled
- may see aspects of more primitive stages when patients under stress
- motor recovery reflects CNS
- UE and LE staged SEPARATE
• Flaccidity
• No voluntary or reflexive activity is present
• No associated reactions elicited
• No DTRs
this describes what stage for Brunnstrom Approach
stage 1
- Spasticity is developing.
- DTRs present
- Min voluntary movement, all within synergy
- Partial limb synergies elicited reflexively
this represents what stage for the Brunnstrom Approach
2
are DTR’s presents for stage 1 for the Brunnstroms Approach
no
- Can perform basic movement synergies voluntarily
- May not be able to complete within full PROM
- Spasticity increases to maximum/peak levels
what stage of the Brunnstrom Approach does this represent
stage 3
what stage of the Brunnstroms Approach does spasticity increase to maximum levels
stage 3
what stage is basic movement shown for the Brunnstrom Approach
3
- Spasticity starts to decrease.
- Can voluntarily perform min movements out of synergy
this describes what stage of the Brunnstroms Approach
stage 4
what happens during stage 4 of the Brunnstrom Approach
spasticity starts to decrease and performed voluntary movements out of synergy
- Spasticity continues to decrease.
- Basic synergies losing their dominance over movement
- Can perform some movement combinations outside of synergies
this describes what stage of the Brunnstrom Approach
stage 5
what stage of the Brunnstroms APproach is there 2 joints doing differen things at 2 different times and spasticity and synergies is decrease
stage 5
- Slight remnants of spasticity
- Isolated muscle action with variety of movement patterns
- Slow speed/coordination
what stage of the Brunnstrom Approach does this describe
stage 6
what happens during stage 6 of the brunnstrom approach
-decreased spasticity
-isolated mm action w variety of movement patterns
-slow speed/coordination
what happens during stage 7 of the Brunnstrom Approach
-no spasticity
- restoration of normal movemtn and function
what is the definition of PNF
the activation of the neuromuscular system through stimulation of proprioceptors
patients need ___ for motor learning
reps
what are the 4 main purposes of PNF
- mm strength
- develop increased mobility
-promote motor learning
-improve functional movement
what is the agonists mm
most hat are shortengin while contracting
it is the direction of the movements desired
ex: shoulder flexion … what is the agonist and antagonist mm
agonist is the anterior delt and antagonist is the lats
what is the antagonists mm
mms that are lengthening within the diagonal
opposite to the desires direction of movement
what is reciprocal innervation/inhibiton
facilitation of alpha motor neurons of agonist will inhibit antagonist
what id autogenic inhibiton
contraction of antagonist will allow immediate relaxation of same mm
what is successive induction
max effort of antagonist will overflow into agonists if reversal of direction is quick
what is max effort of stronger muscles within a pattern facilitate or overflow into
weaker muscles.
irradiation
what are the 7 commandments of PNF
- manual contacts
- commands/communcations
3.stretch - traction/approximation
5.maximal resistance - normal timing
- reinforcement
what is the 1. manual contact used to stimulate for PNF
stimulate specific groups of mm and to direct the line of movement
what is 2. commands/communcation of PNF
-tone of voice
-preparatory instruction
-action commands
for teh Stretch commandment of PNF what is activated to stimulate the agonist
mm spindles
for teh Stretch commandment of PNF how is the body part positioned before starting the pattern
in a lengthened range
for teh Stretch commandment of PNF what kind of stretch is applied to elongate mms to add reflexive components to movement initiation
quick
for the 4. traction/approximation commandments of PNF what does traction and approximation facilitate
traction facilitates movement
approximation facilitates stability
- normal timing of the commandments of PNF .. how is the movement and when do u allow rotation to occur
distal to proximal movemtn and allow rotation to occur earliest in patttern
- reinforcement commandments for PNF .. we can use what to increase the strength of a response
“timing for emphasis”
what are the stages of motor control in PNF
- mobility
- stability/ static postural control
- controlled mobility/ dynamic postural control
- skill / skilled mobility
what are the 3 PNF techniques to enchance mobility
- strengthening
- lengthening shortened mm
- getting the full motion going
what are the 4 strengthening PNF technihgues to enhance mobility
- Repeated contractions
- Hold-relax-active-motion
- Reversal of antagonists/slow reversals
- Timing for emphasis
what are the 2 lengthening shortened mm PNF technihgues to** enhance mobility**
- Hold/contract-relax (with passive repositioning)
- Hold/contract-relax active contraction
what PNF technique to enhance mobility is used for getting the full motion going
rhythmic initiation
what are the 2 PNF TECHNIQUES TO ENHANCE STABILITY
- Reversals of isometrics/alternating isometrics
- Rhythmic stabilization
what PNF techniques are used for controlled mobility / dynamic postural control
slow reversals / reversals of isotonic
what are techniques for skilled/skilled mobility for stags of motor control in PNF
normla timing
agonist reversals
are developmental activities just for babies
nooooo
what are developmental activities
movemtn that progressively challenges the patient to control more body weight aginast gravity
what is plantigrade
bear walking basically
for the application of developmental concepts ___ control needs to happen before ___ skill movements
proximal
distal
for the application of developmental concepts , once th movement is mature then the timing will be ___ to ___
distal to proximal
what is the goal for NDT conceptual framework
to minimize activity limitation and impairments with in the context of a patients environment and participation goals
based on the NDT conceptual framework clinical practice is based upon what understanding
the understanding that sensation , action , perception , cognition and emotion are interlinked and interactive
what is viewed as the range of motor behavior available to people without
a CNS lesion.
typical motor behavior
what does NDT allow the person to do and not to do
alllows the person to be an active co participant in therapy and does not just do it for the patient as a passive participant
t/f: you can superimpose efficient movement on abnormal postural alignment
FALSE u cant
when do u consider alignment
at the beginning of movement
during execution of movement
after completion of movement
what are the 5 elements of postural control
- trunk
- midline orientation
- weight shift over the base of support
- head control
- limb function
for the elements of postural control what control is required in order to have controle elewhere
trunk control
does lower or upper trunk control happen first
lower
what is midline orientation and what is it needed f
point of reference from movement over the base
need to be able to
- stabilize in midline
-move away from and back to it
-cross midline
for the elements of postural control , for weight shift over the BOS does smaller increments precede larger ?
yes
what control evolves out of trunk control
head control
Postural control in a position precedes ability to move ____ with control.
transitionally
what movements are easier to harder ?
isometric > eccentric > concentric
