Lecture 4-- Impairment Interventions Flashcards
Without correcting ________, continued functional training has the potential of delaying recovery or promoting faulty movement patterns
Impairments
Patients undergoing neurorehabilitation commonly present with disruption of _____ _____ from central pathways and reductions in muscle force production which is a direct result from what??
motor neurons
UMN lesion
Hemiparesis, hemiplegia?
weakness on one side of the body
Hemiplegia–paralysis
hemiparesis–weakness
Paraparesis, paraplegia?
Weakness or paralysis of both lower extremities
Tetra paresis, Tetraplegia, quadriparesis, quadriplegia ?
Weakness or paralysis of all four limbs
Prolonged periods of disuse and mobility result in?
diminished neural activity, atrophy and weakness
What are the benefits of strength training in patients with disorders of motor function?
- -increase in the production of maximal force due to changes in neural drive
- -Changes in muscle (strengthening)
- -Increases in connective tissue tensile strength and bone mineral density
- -Improved body composition
- -Improved functional performance and activity level
- -Improved sense of well-being and self-confidence
T/F the basic principles of strengthening exercise apply to neurorehabilitation?
TRUE
–Overload, specificity, cross training
What should early training focus on?
Isometric and eccentric contractions
–because muscle tension is better maintained c concentric contractions
Eccentric control produces _______ muscle force with _____ rates of motor unit discharge than concentric contractions.
greater, lower
more happens with less
When can a patient move from eccentric exercises to concentric?
When the patient can hold the position at midrange then have them slowly lower it. Once they can do these things they can move onto a concentric motion. Then when they can actively do it you can add weight.
A patient with a UMN lesion usually exhibits??
Spasticity, hypertonia
What is spasticity?
Motor disorder characterized by a velocity-dependent increase in muscle tone and increased resistance to stretch
What is chronic spasticity associated with?
contractors, abdominal posturing, deformity
T/F strength training and high resistance were contraindicated because they were viewed as likely to decrease spasticity and abdominal movement patterns?
FALSE
Increase spasticity, but no longer supported by scientific literature
A ______ muscle is generally a _____ muscle?
spastic, weak
(spasticity helps to give the muscle some rigidity, once that is gone the muscle is weak)
abnormal firing but very limited voluntary control
Gains in strength can be made through…..?
- progressive resistance exercises using free weights or fixed machines
- proprioceptive neuromuscular facilitation (PNF) uses manually resisted patterns to improve strength
- functional training using task-related practice
- Resistance provided by gravity, body weight
- Can add manual resistance to activities or movements
- Resistance of water during pool therapy
How do we maximize transfer of gains to functional skills?
combining strength and functional task-specific practice
What are the parameters in order to gain muscle strength?
Same as a healthy person
2-3 sets, 3-4 days per week, expect soreness (educate patient ahead of time)
What are the parameter for improving muscle endurance?
Resistance level that is tolerated for 15-20 reps
Multiple sets
3-4 days per week
How is fatigue defined?
Inability to contract muscle repeatedly over time
-exercise tolerance is reduced
What are the three sites that fatigue can arise from neuromuscular disease?
- CNS (MS, Guillain-barre, chronic fatigue, post-polio)
- Peripheral nerves or neuromuscular junction
- The muscle itself
What is the danger of exercise training in neuro patients?
Risk of acute exercise overdose producing exhaustion and possible injury
What is overtraining?
chronic overdose of exercise
What is overuse weakness?
aching on exertion and a prolonged decrease in absolute strength and endurance as a result of excessive activity
–Fatigue that does not recover with rest
Management of patients with Fatigue?
- Use of energy conservation technique(doing things more effectively)
- Activity pacing (build in rest periods)
- Lifestyle changes (prioritized activities)
- Regular rest periods during the day
- Improved sleep through the use of relaxation technique and medications
What are some benefits of aerobic training for patients with disorders of motor function?
- Improved cardiovascular and peripheral endurance
- Decreased anxiety and depression
- Enhanced physical function
- Enhanced sense of well-being
T/F moderate intensities are not ok for patient in acute rehab
FALSE…… ARE OK for patients in acute rehab
***high intensities are contraindicated
What are the parameters for aerobic training?
3-5 days per week with 30 minute session
10 minute sessions can be used and are effective
Using the BORG RPE what names should we stay below?
14 and lower is recommended (using the 6-20 scale)
What is the importance of improving flexibility?
to allow for normal functional excursions of muscle and biomechanical alignment
Immobility and motor dysfunction associated with neurological insult and can lead to changes in muscle such as….?
- Muscle tightness
- Atrophy
- Contracture
- Joint ankylosis (joint fusions)
- postural deformities
What are some techniques for improving flexibility include?
- ROM exercises
- Passive stretching
- Joint mobilization
Progression should be to ____ exercises whenever possible
AROM
What are the static stretching parameters?
Low load long duration
- hold 20-30 seconds x4-5 reps
- adequate rest time, avoid muscle soreness
- USE it or LOSE it
What are the parameters for ballistic stretching?
High load, short duration
contraindicated for the elderly, chronically ill, patients underling active rehab
How long is low-load prolonged stretching help
15-30 min
applied using special orthotic devices
What is serial casting?
for patients who have or are at risk for contractors as a result of decreased PROM and or spasticity
-keep this position for a week
Contraindications for serial casting?
- Severe heterotypic ossification
- skin surface not intact
- impaired circulation
- edema
- uncontrolled hypertension
- pathological inflammatory conditions such as arthritis
- those at risk for compartment syndrome or nerve impingement
- those with long standing contractures
- highly agitated pts may be at risk of injuring themselves
- patients with cognitive impairments must be monitored closely
What is facilitated stretching?
Use of neuromuscular inhibition techniques to relax (inhibit) and elongate muscles in conjunction with stretching
- hold relax
- contract relax
T/F Research shows effectiveness of facilitated stretching over static stretching
True
–especially when active contractions are used
What do you do when stretching or positioning pt with spasticity?
constant firm manual contacts positions over bony or non spastic areas and avoid direct pressure on spastic muscles
What is postural control?
Ability to control the body’s position in space for stability and orientation
What is postural orientation?
Ability to maintain normal alignment relationships between the various body segments and between the body and the environment
- Static postural control
- Dynamic postural control
Postural _____ begins with demonstration of correct posture
Re-education
What are some reasons why a patient may not be able to hold a steady position?
- Decreased strength
- Tone imbalances
- Impaired voluntary control
- Sensory hypersensitivity
- Increased anxiety or arousal
What are some signs in instability with static postural control?
- Excessive postural sway
- Wide BOS
- Low or high guard hand position
- Holding onto object in the environment
- Falls or loss of balance
How do you improve static postural control?
WB posture
prone on elbows, quadruped, sitting, kneeling, standing, etc.
Obtain symmetrical, balanced WB
What are some techniques to enhance stabilizing muscle contractions?
-quick stretch, tapping, resistance, approximation, manual contacts, verbal cues
When do you use static postural control?
when patient is unable to actively stabilize
When do you use dynamic postural control?
patients are unable to control postural stability and orientation while moving segments of the body
What kind of impairments contribute to lack of dynamic postural control?
- Tone imbalances (spasticity, hypotonia)
- ROM restrictions
- Impaired voluntary control
- Impaired cerebellar function
- Impaired proximal stabilization
T/F Developing dynamic postural control can be done in any weight bearing position
True
usually sitting and standing
When does LOB occur?
when LOS has been exceeded, when CO
How do you improve reactive balance control?
- Therapist can utilize manual pushes and pulls
- Small perturbations for ankle and hip strategies
- Large perturbations for stepping strategies
- Vary input so not predictable
What is agility?
The ability to perform coordinated movements combined with upright standing balance
What are some training goals when improving coordination?
improve postural stability and balance
improve accuracy of limb movement
improve function
improve safety awareness and use compensatory strategies as appropriate for fall prevention
What do patients with ataxia benefit from?
light resistance to slow limb and trunk movements
weight cuffs, elastic bands, weighted vest, weighted walkers and canes, water resistance
What are two important elements for relaxation response?
Quiet breathing
–breath deeply with diaphragm moving downwards as air fills lungs, hold breath for a few seconds and slowly exhale
Attention on a single focus (thought, word, object)
–concentrate on a specific focus while disengaging from all other thoughts and distractions
