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Physical Rehabilitation > Lecture 4-- Impairment Interventions > Flashcards

Lecture 4-- Impairment Interventions Flashcards

1
Q

Without correcting ________, continued functional training has the potential of delaying recovery or promoting faulty movement patterns

A

Impairments

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2
Q

Patients undergoing neurorehabilitation commonly present with disruption of _____ _____ from central pathways and reductions in muscle force production which is a direct result from what??

A

motor neurons

UMN lesion

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3
Q

Hemiparesis, hemiplegia?

A

weakness on one side of the body
Hemiplegia–paralysis
hemiparesis–weakness

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4
Q

Paraparesis, paraplegia?

A

Weakness or paralysis of both lower extremities

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5
Q

Tetra paresis, Tetraplegia, quadriparesis, quadriplegia ?

A

Weakness or paralysis of all four limbs

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6
Q

Prolonged periods of disuse and mobility result in?

A

diminished neural activity, atrophy and weakness

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7
Q

What are the benefits of strength training in patients with disorders of motor function?

A
  • -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
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8
Q

T/F the basic principles of strengthening exercise apply to neurorehabilitation?

A

TRUE

–Overload, specificity, cross training

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9
Q

What should early training focus on?

A

Isometric and eccentric contractions

–because muscle tension is better maintained c concentric contractions

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10
Q

Eccentric control produces _______ muscle force with _____ rates of motor unit discharge than concentric contractions.

A

greater, lower

more happens with less

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11
Q

When can a patient move from eccentric exercises to concentric?

A

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.

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12
Q

A patient with a UMN lesion usually exhibits??

A

Spasticity, hypertonia

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13
Q

What is spasticity?

A

Motor disorder characterized by a velocity-dependent increase in muscle tone and increased resistance to stretch

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14
Q

What is chronic spasticity associated with?

A

contractors, abdominal posturing, deformity

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15
Q

T/F strength training and high resistance were contraindicated because they were viewed as likely to decrease spasticity and abdominal movement patterns?

A

FALSE

Increase spasticity, but no longer supported by scientific literature

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16
Q

A ______ muscle is generally a _____ muscle?

A

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

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17
Q

Gains in strength can be made through…..?

A
  • 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
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18
Q

How do we maximize transfer of gains to functional skills?

A

combining strength and functional task-specific practice

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19
Q

What are the parameters in order to gain muscle strength?

A

Same as a healthy person

2-3 sets, 3-4 days per week, expect soreness (educate patient ahead of time)

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20
Q

What are the parameter for improving muscle endurance?

A

Resistance level that is tolerated for 15-20 reps
Multiple sets
3-4 days per week

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21
Q

How is fatigue defined?

A

Inability to contract muscle repeatedly over time

-exercise tolerance is reduced

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22
Q

What are the three sites that fatigue can arise from neuromuscular disease?

A
  1. CNS (MS, Guillain-barre, chronic fatigue, post-polio)
  2. Peripheral nerves or neuromuscular junction
  3. The muscle itself
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23
Q

What is the danger of exercise training in neuro patients?

A

Risk of acute exercise overdose producing exhaustion and possible injury

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24
Q

What is overtraining?

A

chronic overdose of exercise

25
Q

What is overuse weakness?

A

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

26
Q

Management of patients with Fatigue?

A
  • 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
27
Q

What are some benefits of aerobic training for patients with disorders of motor function?

A
  • Improved cardiovascular and peripheral endurance
  • Decreased anxiety and depression
  • Enhanced physical function
  • Enhanced sense of well-being
28
Q

T/F moderate intensities are not ok for patient in acute rehab

A

FALSE…… ARE OK for patients in acute rehab

***high intensities are contraindicated

29
Q

What are the parameters for aerobic training?

A

3-5 days per week with 30 minute session

10 minute sessions can be used and are effective

30
Q

Using the BORG RPE what names should we stay below?

A

14 and lower is recommended (using the 6-20 scale)

31
Q

What is the importance of improving flexibility?

A

to allow for normal functional excursions of muscle and biomechanical alignment

32
Q

Immobility and motor dysfunction associated with neurological insult and can lead to changes in muscle such as….?

A
  • Muscle tightness
  • Atrophy
  • Contracture
  • Joint ankylosis (joint fusions)
  • postural deformities
33
Q

What are some techniques for improving flexibility include?

A
  • ROM exercises
  • Passive stretching
  • Joint mobilization
34
Q

Progression should be to ____ exercises whenever possible

A

AROM

35
Q

What are the static stretching parameters?

A

Low load long duration

  • hold 20-30 seconds x4-5 reps
  • adequate rest time, avoid muscle soreness
  • USE it or LOSE it
36
Q

What are the parameters for ballistic stretching?

A

High load, short duration

contraindicated for the elderly, chronically ill, patients underling active rehab

37
Q

How long is low-load prolonged stretching help

A

15-30 min

applied using special orthotic devices

38
Q

What is serial casting?

A

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

39
Q

Contraindications for serial casting?

A
  • 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
40
Q

What is facilitated stretching?

A

Use of neuromuscular inhibition techniques to relax (inhibit) and elongate muscles in conjunction with stretching

  • hold relax
  • contract relax
41
Q

T/F Research shows effectiveness of facilitated stretching over static stretching

A

True

–especially when active contractions are used

42
Q

What do you do when stretching or positioning pt with spasticity?

A

constant firm manual contacts positions over bony or non spastic areas and avoid direct pressure on spastic muscles

43
Q

What is postural control?

A

Ability to control the body’s position in space for stability and orientation

44
Q

What is postural orientation?

A

Ability to maintain normal alignment relationships between the various body segments and between the body and the environment

  • Static postural control
  • Dynamic postural control
45
Q

Postural _____ begins with demonstration of correct posture

A

Re-education

46
Q

What are some reasons why a patient may not be able to hold a steady position?

A
  • Decreased strength
  • Tone imbalances
  • Impaired voluntary control
  • Sensory hypersensitivity
  • Increased anxiety or arousal
47
Q

What are some signs in instability with static postural control?

A
  • Excessive postural sway
  • Wide BOS
  • Low or high guard hand position
  • Holding onto object in the environment
  • Falls or loss of balance
48
Q

How do you improve static postural control?

A

WB posture
prone on elbows, quadruped, sitting, kneeling, standing, etc.
Obtain symmetrical, balanced WB

49
Q

What are some techniques to enhance stabilizing muscle contractions?

A

-quick stretch, tapping, resistance, approximation, manual contacts, verbal cues

50
Q

When do you use static postural control?

A

when patient is unable to actively stabilize

51
Q

When do you use dynamic postural control?

A

patients are unable to control postural stability and orientation while moving segments of the body

52
Q

What kind of impairments contribute to lack of dynamic postural control?

A
  • Tone imbalances (spasticity, hypotonia)
  • ROM restrictions
  • Impaired voluntary control
  • Impaired cerebellar function
  • Impaired proximal stabilization
53
Q

T/F Developing dynamic postural control can be done in any weight bearing position

A

True

usually sitting and standing

54
Q

When does LOB occur?

A

when LOS has been exceeded, when CO

55
Q

How do you improve reactive balance control?

A
  • Therapist can utilize manual pushes and pulls
  • Small perturbations for ankle and hip strategies
  • Large perturbations for stepping strategies
  • Vary input so not predictable
56
Q

What is agility?

A

The ability to perform coordinated movements combined with upright standing balance

57
Q

What are some training goals when improving coordination?

A

improve postural stability and balance
improve accuracy of limb movement
improve function
improve safety awareness and use compensatory strategies as appropriate for fall prevention

58
Q

What do patients with ataxia benefit from?

A

light resistance to slow limb and trunk movements

weight cuffs, elastic bands, weighted vest, weighted walkers and canes, water resistance

59
Q

What are two important elements for relaxation response?

A

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

Physical Rehabilitation (18 decks)

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