Midterm Flashcards
What factors influence clinical decision making
Clinician factors
Patient factors
Environmental factors
What factors are considered in a prognosis
Environment Current functional status Prior level of function Motivation Capacity for change
What are the 4 P’s
Prevention
Prediction
Plasticity
Participation
What types of goals are used with neurologic patients
Task specific and activity oriented
What are the three intervention types to improve motor function
Restorative
Impairment specific
Compensatory
Describe salience
skills must be relevant to the patients
Describe transference
can the skills learned be transferred to the relevant task
Describe interference
how previously learned skills can interfere with acquisition of new knowledge
What are two augmented interventions
PNF
NDT / facilitation
What is a “key” part of the plan of care that can help with successful outcomes
respecting patient values and incorporating patient preferences
What are the compoents of a POC
goals Expected outcomes Prognosis General statement of interventions Anticipated discharge plans
What are the highest levels of evidence used to guide clinical decision making
CPG’s
Task assessment is informed by which two models
Gentile’s model
Hedman’s model
What is motor recovery
Reacquisition of motor skills lost via injury
What is a motor compensation
old movement performed in a new way
Naturally occurring functional restoration after injury is termed
Spontaneous recovery
What term describes the compensatory strategies adopted by individuals after injury as a result of hemiparesis
learned non use
When should motor recovery training be implemented to discourage development of faulty motor patterns
as early as possible
What is transitional mobility
moving from one position to another
supine to sit
What is stability
ability to maintain posture
balance
What is controlled mobility
Maintaining stability while in motion
walking
What is skill
consistent performance of coordinated movements to obtain an action goal
What is a discrete skill
recognizable beginning and end
kicking a ball
What is a serial skill
no recognizable beginning or end, walking
What is a continuous skill
series of discrete actions strung together, playing piano
The ability to apply a learned skill to the learning of another is termed_________
Adaptability
How can a therapist observe a patient’s ability to perform activities that are similar, but not exactly the same?
Transfer test
What are the three basic elements of restorative interventions
Repetitive and intense practice oriented
Enhance active motor learning and adherence-enhancing activities
Strategies that encourage the use of the more impaired body segments
What criteria would better suit compensatory stretegies
Severe impairments
Limited recovery potential
Multiple comorbidities
Give some positive characteristics of repetitive learning behaviors
Prevent degradation and atrophy Enable neuron growth Strengthen synaptic connections Alter cortical field representations Expand topographical areas of motor activity
What is constant feedback
Feedback after every trial
What is summed feedback
after set of trials
What is faded feedback
Less frequent as time goes on
What is bandwidth feedback
feedback only when outside of error range
What is delayed feedback
after a brief time delay
What is massed practice
Practice and rest intervals where the practice time is much greater than the rest
What is distributed practive
practice and rest intervals where the practice time is equal to or less than the rest time
What is blocked practice
practice sequence where only one task is performed repeatedly
What is serial practice
repeated order of multiple tasks in a row
What is random practice
tasks practiced in random order
What is parts to whole practice
task broken down into components to be practiced individually
What is mental practice
Task is visualized or imagined before physical practice
What is validity
variable that assesses weather a measure assesses what is intends to
Compare the MCID and MDC
MCID - smallest amount of change that can be perceived as significant
MDC - smallest amount of change that cannot be attributed to error
Describe the Romberg
Static standing balance
Body structured and functions
Lacks reliability / validity
Describe the sharpened romberg
Static standing balance
Body structure and function
Lacks reliability / validity
Describe the BERG
Static and dynamic standing balance
14 tasks scored out of 56
Activity
< 45 associated with fall risk
Describe the Tinetti
Static / dynamic balance and gait
Activity
< 19 means fall risk
Describe the functional reach test
Standing balance screen
Activity
Describe the TUG
screen of dynamic mobility
community adults > 13.5 = fall risk
Elderly > 32.6 = fall risk
Activity
Describe the 6 minute walk test
Walking for 6 minutes
Endurance / activity tolerance
Activity
Describe the 10 meter walk
Assistive devices used
Distance in meters (6) divided by time walked
Activity
Describe the DGI
Assesses higher level functional mobility
Activity
What does the FIM measure assess
Assesses caregiver burden of independence of the patient
Describe the levels of the FIM
0 - task does not occur
1 - total assist - >75% assist, or more than 1 person
2 - Max assist - 50-75% assist
3 - Moderate assist - patient performs 50%
4 - Min assist - patient performs 75%
5 - supervision - verbal quest or supervision for safety
6 - Mod I - no AD, extra time needed
7 - complete independence - no AD, no extra time needed
Describe Nominal, ordinal ,interval, ratio
Nominal - binary responses
Ordinal - multiple options
Interval - scored performances to be summed together
Ratio - linear scale
What are some contraindications to PNF
Significant pain
Unstable joints
Fractures
Unstable medical conditions
Describe Rhythmic initiation
Promote learning of new movement, improve coordination, promote relaxation
Passive, active assist, independently, resistance
Describe combination of isotonics
Concentric, isometric, eccentric
For strength and coordination
Describe Reversal of agonists
Agonist then antagonist contraction without pause
Describe replication
Improved ROM
Hold relax followed by active contraction into new range
Describe augmented interventions
Hands on / guided / assisted movements
Help to bridge the gap between absent movements and active movements
What are some augmented approaches
PNF
NDT
Who is a good candidate for augmented interventions
lack of voluntary control
insufficient motor recovery
difficulty initiating or sustaining movements
What is the difference between a PNF pattern and diagonal
Pattern - one plane of motion
Diagonal - two plains of motion
What is irradiation
transfer of activation from agonist to another agonist
What is the philosophy behind NDT
provide a form of therapy to optimize function by inhibiting spastic and reflex patterns
What are the indications for NDT use
Poor grading of muscle activity
Muscle imbalance
Spasticity
What are the NDT treatment strategies
Facilitation Inhibition Limited to no verbal queuing Touch is light Facilitation is slow
What must be done before upper extremity assessment and intervention application
Alignment
Gross movements
Prehension
Manipulation
What device in contraindicated for subluxation at the glenohumeral joint
Normal slings
Giv-Mohr slings are best
What are some advantages to UE weight bearing
Improves cortical excitability
Allows for the extremity to be used, predisposing movement
When is forearm weight bearing more appropriate than extended arm weight bearing
when arm is spastic or flaccid
What does extended arm weight bearing do that forearm weight bearing doesn’t
More UE stability
Useful for transitions
When would an open-chained activity of the upper extremity be inappropriate
When patient has difficulty differentiating extremity movements, like with a synergy pattern
What upper extremity concerns may occur with tonal abnormalities post-stroke
Contractures
impingement
important to get full elbow extension
What are the benefits of weight bearing for the upper extremity post-stroke
Can assist in maintaining normal length of wrist and finger extensors
Give 3 disadvantages to standard slings post-stroke
Contractures with prolonged use
contribute to body scheme disorders and neglect
may block spontaneous use and use with balance
How can obligatory synergy patterns of the upper extremity be reduced
E-stim can reduce spasticity
What muscle is primarily responsible for inappropriate GH positioning of a subluxed shoulder post-stroke
Deltoid and supraspinatus
In the spastic shoulder complex, what abnormal positioning occurs at the scapula
Elevated and retracted
What is one exercise that decreases hypertonicity that can be performed in supine
Active movements of the knees from side to side
What 2 task specific actions is bridging most appropriate for
Bed mobility
Dressing
What are some lead up activities bridging is good for
Sit to stand
Stance phase control
Stair climbing
How can an individual in the autonomous stage of learning be challenged
Duel tasking
How does UE weight bearing help patients with shoulder instability
The proprioceptive loading helps to activate shoulder stabilizers
What muscles demonstrate greater weakness after injury
Extensor muscles
What are some contraindications of joint approximation
Spinal deformity
Inability to assume upright position
Acute pain
What PNF pattern is useful for patients with HH
Chop toward more involved side
Describe reactive balance
ability to maintain or recover balance when subjected to an unexpected change
Feedback driven
What are some interventions to promote reactive balance
Perturbations in standing
Sitting and weight shifting on a board
What are the two phases of the sit to stand cycle
Pre extension - Weight shift
Extension - Vertical translation of body mass
What is the main strategy used for standing from a chair
Momentum transfer strategy
What abnormal systems may contribute to gait deficits
Abnormal tone Weakness Abnormal synergies Sensory systems Perceptual Cognitive
What are some spatiotemporal characteristics of gait
Step length
Step speed
Single limb stance time
What is the most stable phase of gait
Midstance
What muscles control foreword motion of the trunk in midstance
Paraspinals
Glutes
Quads
What muscles contribute peak activation during terminal stance of gait
Plantar flexors
How mush hip and knee flexion is needed to clear the foot in swing phase
Hip - 0-30
Knee - 35-60
What is a positive plantigrade position
All 4 extremities WB, UEs on table surface
How do you train visual balance puts
Fixed gaze while standing on progressively pliant surfaces
How do you train vestibular balance puts
Standing with eyes distracted from task (reading, looking up)
How do you train somatosensory balance puts
Distract eyes while standing on a firm surface
What are some compensatory strategies used to maintain balance
Widen BOS Lower COM Grippy shoes Assistive device Minimize head movements during difficult activities
What are the 4 foundational elements of bipedal locomotion
Alignment, strength and control of LE
Ability to generate locomotion
\Dynamic balance control
adaptability of locomotion
What are the motions of the pelvis during swing phase
Anterior elevation - initial swing
eccentric Anterior depression - heel strike
What are the motions of the pelvis during stance phase
Eccentric anterior depression - heel strike
Posterior depression - loading response to midstance to push off to heel off
posterior elevation - opposite limb heel strike
Anterior elevation - preswing
What technique is of critical importance to successful outcomes early during treadmill training
Manual assistance at the hips to provide sensory input for walking
What has been recommended for LE weightbearing during treadmill training and what is the progression
40% of weight supported
decrease in 10% increments
What is the average speed for functional community ambulation in the normal healthy population
2.8 MPH
What outcome measure can be used to quantify gait dysfunction in older adults
DGI
Give some ways that locomotor training intensity may be progressed
Speed
Belt incline
Training time
What are the 2 largest patient populations that display cognitive and/or perceptual dysfunction
Stroke
TBI
What is the lezak definition of perception
integration of sensory impressions into information that is psychologically meaningful
What is the most common visual deficit following injury to the brain
HH
What is Ideomotor apraxia and where is the lesion located
Breakdown between concept and performance
Lesion located in the left dominant hemisphere, both frontal and posterior parietal lobe lesions can result in apraxia
What is Ideational apraxia and where is the lesion located
Failure in the conceptualization of the task
Lesion on the dominant parietal lobe
