Module 3 Part 1 Flashcards
When people with spastic hypertonia do resistance training exercises, practitioners should adjust exercise technique so that the joints involved are in the best possible load-bearing position.
True
Name five (5) types of stereotypical movement patterns that affect people with brain impairment and describe each in your own words.
- Mirror Movements: Involuntary movements on one side of the body that mimic voluntary movements of the other, usually most pronounced in fine motor movements like that of the fingers.
- Flexor/Extensor Patterns of Movement: Flexion/extension at one joint causes similar movement at a number of other joints in the body.
- Poor Movement Differentiation: Have struggles with the specificity of the movement trying to be achieved, struggles activating the appropriate muscles, other parts of the body moving in ways not conducive to the goal movement.
- Associated Reaction: Involuntary movement of muscles on one side of the body in response to intentional activation in muscles of the opposite side of the body.
- ATNR and STNR: ATNR is where the limbs on the side on which the head is turned towards extend, while the limbs on the other side extend. STNR is when the head flexes, the arms extend the legs flex, and the opposite applies when the head extends.
People with ABI may experience difficulty when trying to become more physically active because of fatigue.
Describe two (2) separate mechanisms of fatigue in people with ABI and outline at least one (1) strategy you could use in the management of each mechanism.
Physical Fatigue: Motor disorders result in movement that is energetically inefficient, so the energetic cost of performing a task is higher for people with ABI than the general population. You can use shorter sessions or sessions with increased recovery time, transition time, and time to set up activities.
Mental Fatigue: Direct and chronic result of injury to the brain, not result of depleted physiological energy/lack of sleep. Plenty of encouragement, positive strokes and enthusiastic reinforcement success can help those affected by mental fatigue.
Identify and describe three prevalent cognitive sequelae of acquired brain injury, describe two (2) strategies and solutions for each that could be used by exercise physiologists who have clients with those sequelae.
- Memory Problems: Struggles with short-term memory and long-term memory of tasks, appointments, programs etc. Use a written program for a resource they can refer to and using physical demonstrations rather than verbal can be helpful for this population,
- Planning & Organising Problems: Difficulties with realistic goal setting and organising an activity schedule. Decrease the complexity of program especially initially to help with adherence, and structured assistance with planning and organising program and other responsibilities can be helpful for this population.
- Problems with Language & Communication: Troubles comprehending and communicating effectively and clearly. Be patient with these clients as they are trying their best to communicate and talk with significant others to help mediate communication.
Identify and describe three (3) possible social/behavioural sequelae of acquired brain injury and describe three (3) strategies and solutions that could be used by exercise physiologists who work people with those behaviours.
Social/Behavioural Sequelae
1. Egocentrism: Refers to a difficulty in accurately perceiving and understanding the perspectives other than one’s own. An egocentric person may have difficulties empathising or recognising how their behaviours affects those around them.
2. Disinhibition: Refers to a lack of inhibitory control to withhold inappropriate or unwanted behaviours. This might manifest in impulsivity and difficulty regulating emotions in addition to inappropriate social behaviour.
3. Lack of Motivation/Drive: Decrease in the ability to initiate and persist in self-directed purposeful activities. May present as not wanting to follow through with plans and activities, and not being as cooperative to compliant as would be expected.
Strategies
1. Facilitate entry into a community group situation done personally in at least the first instance to evaluate the likelihood of success and the appropriateness for the client.
2. Maintain standards to personal interactions that they have for any other person. Can compromise, but compromises should not be so big such that practitioners/others feel uncomfortable or unstable.
3. If the client oversteps, your response should be proportional and firm to enforce appropriate interaction standards.
Describe four (4) different types of problems that people with brain injury may have with language and communication. Describe one (1) strategy and/or solution you might use to manage each problem.
- Dysnomia: Troubles finding the right word to express what is meant. Be patient when the client is trying to communicate, try and help them fill in missing words in sentence.
- Dysarthia: Difficulties coordinating the muscles of the mouth to talk. Familiarise yourself with the persons speech pattern as quickly as possible, use closed questions that require short responses to help the patient communicate.
- Speak in sentences which are disorganised and difficult to follow, containing ideas tangential to the flow of conversation. Ask questions that help keep them on track and addressing the topic.
Speak too rapidly to be easily understood. Ask the person to slow their speech down.
Define spastic hypertonia (or high muscle tone).
Spastic hypertonia is a condition where there is an increase in resting muscle tone, and the resistance to muscle stretch increases with faster movements. The muscle often displays a “clasp-knife” response, where it feels very stiff initially but then suddenly loosens as the joint continues to move. This pattern occurs because damage to the upper motor neurons disrupts signals, preventing proper muscle relaxation and leading to increased muscle tone. Spastic hypertonia may also cause cogwheel rigidity, where the joint moves in a ratchet-like way, with brief moments of resistance followed by easier movement.
What are three (3) of the main motor disorders that affect people with cerebral palsy?
Describe the key features of each.
Spastic Hypertonia:
- Increased resting muscle tone.
- Velocity dependent, so resistance to movement increases with an increase in passive stretch.
- Clasp-knife pattern of resistance, where increased resistance to movement is seen initially then sharply decreases.
- Cogwheel rigidity - areas of ROM with high resistance to movement, followed by areas of low resistance, and this sequence repeats.
Dyskinetic Movement:
- Involuntary, irregular movements.
- Chorea and athetosis.
- Often affects more distal regions.
- Can affect muscles of face and speech.
- Muscle tone fluctuates in affected areas on irregular basis.
Dystonic Movement:
- Sustained muscle contractions occur involuntarily.
- Result in abnormal postures or repetitive movements.
- No single dominant activation patter, and patterns can fluctuate.
- Different ways of presenting.
Ataxic Movement:
- Lack of coordination or precision in voluntary movements due to poor muscle control.
Can present as intention tremor, poor balance, poor depth perception, difficulties walking, fine motor problems.
Based on what you know about the neuroanatomy of the brain, how would the effects of a frontal lobe injury differ from the effects of occipital lobe injury.
Occipital: Visual processing area of the brain and responsible for functions like distance and depth perception, colour determination and object recognition.
Frontal Lobe: Responsible for executive functions like planning, decision making, and problem-solving, emotional regulation, control of voluntary movement, and speech production in the Broca’s area.
A frontal lobe injury could result in cognitive impairments, voluntary movement difficulties, speech and language difficulties and emotional dysregulation, whereas an injury to the occipital lobe would disrupt one’s ability for visual perception and recognition.
If a referring practitioner described a client as being “physically unimpaired but exhibiting behaviour consistent with impaired frontal lobe function”, what sort of behaviours might you expect? Outline four (4) of these behaviours.
- Cognitive Impairments: Difficulties with planning, organising, problem-solving and decision making.
- Speech and Language Difficulties: Aphasia, trouble producing and expressing language.
- Emotional and Behavioural Dysregulation: Changes in mood, personality, impulsivity, and difficulty regulating emotions.
Attentional Deficits: Lack of motivation.
Summarise the main reasons that resistance training was previously not recommended for people with cerebral palsy (CP).
Previous studies indicate that resistance training only resulted in modest, statistically insignificant improvements in muscle strength in children with CP.
Previous studies’ findings were inconsistent, with some studies showing limited or no improvement in strength or functional activity despite training.
There were concerns that resistance training might exacerbate spasticity although most studies did not observe this increase, the potential risk was a significant concern for practitioners.
High effort thought to reinforce poor posturing and stereotypical movement.
When strength gains were observed in previous studies, they did not always translate into meaningful improvements in functional activities like walking.
Based on current evidence, would you include strength training as part of exercise prescription for a person with CP?
Yes. New evidence from Taylor et al, indicates that this mode of exercise could help this clinical population.
The study showed that progressive resistance training significantly increased muscle strength in targeted muscles and in exercises participants training in.
Taylor et al (2013) conducted a randomised controlled trial of a progressive resistance training program in young people with cerebral palsy. Results showed that, compared to the control group, there was a statistically significant increase in strength of the resistance training group. However there were no between-group differences in any objective measure of mobility at 12 weeks or 24 weeks.
According to the authors, what is a possible explanation for the lack of objective change in mobility-related function in the resistance training group?
Resistance training did not provide a sufficient stimulus to change walking or mobility-related function.
Other impairments can affect walking function (impaired balance, and postural control, limited range, spasticity, impaired motor planning).
Addressing the single impairment of muscle weakness for a relatively short duration may not have provided the task-specific practice necessary to improve mobility.
Brad is 15 years old and has spastic diplegic cerebral palsy. He walks with a typical diplegic gait (hips and knees flexed, internally rotated at the hip, no heel strike, short stride length). He walks most places but sometimes uses a wheelchair for long distances. He can run but only for short distances. You are to design him a gym-based lower limb resistance training program.
Using examples, describe the strategies you would use to take account of his spasticity and ensure the program was safe, appropriate and effective.
- Positioning his joints under load in best possible load-bearing positions, such that the line of force through optimally aligned load bearing joints. E.g. leg press, sitting on machine allows for easy repositioning and naturally lends itself to stacking joints effectively.
- Strengthen muscles least affected by high tone in antagonistic pairs, and stretch muscles most affected. E.g seated hamstring stretches to increase mobility in hamstring in wheelchair and leg extension to strengthen quadriceps.
- Full ROM training to build general strength of joint in all positions, using stretch-load-stretch pattern, and incorporating a warm-up and stretching initially to allow muscle to move more freely in exercises.
You are an exercise physiologist and you receive a referral for a client who has had an acquired brain injury. The referral indicates that the client is disinhibited and egocentric.
Explain what these terms mean and describe the sorts of challenges this might create for you.
Egocentrism refers to a difficulty in accurately perceiving and understanding the perspectives other than one’s own. An egocentric person may have difficulties empathising or recognising how their behaviours affects those around the,
Disinhibition refers to a lack of inhibitory control to withhold inappropriate or unwanted behaviours.
A disinhibited client may engage in unsafe practices/not adhere to safety protocols, and this would require close monitoring and potentially modifying the exercises to reduce the risk to the client.
Client might demonstrate socially hurtful and inappropriate behaviour that could hurt yourself, other professionals and their peers in a group setting. This may present itself as disclosing personal and inappropriate information, coming off as self-absorbed and disregarding of others.
