Motor screen & PNF interventions Flashcards
when performing a gross screen of strength and ROM, what are you really looking for?
are they able to perform other aspects of examination activites
in a pt who demonstrates weakness, what is the primary impairment and what is the secondary impairment?
primary: paresis (partial weakness) / plegia (absence of muscle strength)
secondary: muscle atrophy due to neurologic injury
stroke patients demonstrate significant changes in ______ _______ due to altered _______ ______ and decreased motor unit firing rates
muscle performance
recruitment patterns
what is the protocol/flow for the motor screen?
- stabilize trunk w/ body supported in supine or sitting w/ assist
- AROM
- AAROM - pt w/ paresis may require gravity eliminated position or facilitation
- perform at all joints UE and LE
what is active restraint (insufficiency)?
presence of abnormal co-activation, spasticity, and abnormal posturing may alter the patient’s ability to perform isolated joint movements
what is passive restraint (insufficiency)?
muscle and soft tissue changes due to contracture
what are PT considerations when performing a motor screen?
consider movement capabilities
muscle substitutions/compensations
use functional activities
make sure to include these 5 things when documenting that you performed a motor screen on your patient:
- laterality & objective MMT grade
- position
- quality of movement or need for facilitation
- any observed synergy or muscle substitution
- functional movements tested
qualitative documentation will also include: (6)
- type and degree of changes present
- symmetrical or asymmetrical
- distal or proximal
- description of effects of muscle weakness on active movements, posture, and function
- UMN or LMN
- presence of atrophy
PNF technique has an emphasis on patterns of movement to promote _________ vs. __________
recovery of function (restoration) vs. compensation
which element of PNF matches the following descriptions:
- enhances contraction and motor control, increases strength, and aids motor learning
- response to stimulation spreads to adjacent muscles working in synergistic patterns
- increases responses and guides movements
- important for control of motion
- promote normal timing and activation of muscles to assist in the facilitation of synergistic movement
- resistance
- irradiation and reinforcement
- manual contact
- body position and body mechanics
- timing
which element of PNF matches the following descriptions:
- provide direction for movements and play a role in motor learning
- use of ____ guides movement and plays a role in motor learning
- compression force applied to joints stimulates nerves and facilitates extensor muscles and stabilizing patterns
- distraction force applied to joints stimulates nerves and facilitates flexor muscle mobilizing patterns
- verbal cues
- vision
- approximation
- traction
what is the optimal patient position for PNF?
neutral alignment
maximal postural stability
enhance muscle contraction
what is the optimal therapist position for PNF?
directly in line with desired motion
use body to resist - enhance therapist control, reduces fatigue, protects against injury
what are manual contacts used for with PNF?
guiding movement
provide resistance
use lumbrical grip
enhance kinesthetic awareness and muscle contraction
how should you use verbal cueing with PNF?
clear, concise, well timed
preparatory, action, corrective cueing
improves motor learnin
what is a D2 pattern?
UE
flex/abd/ER
ext/add/IR
what is a D1 pattern?
UE
flexion/add/ER
ext/abd/IR
what is normal timing for:
- trunk?
- extremities?
proximal to distal
distal to proximal
optimal resistance with PNF facilitates _____
muscle contraction
what approximation?
what does it ensure?
compression of joints
ensure all joints are properly aligned
what is traction?
what does it facilitate?
elongation of joint
facilitate muscle response
what is irradiation?
- facilitation?
- inhibition?
spread of response to stimulation
- contraction
- relaxation
what is reinforcement?
to strengthen
irradiation and reinforcement is a result of ______
response increases as the stimuli increase ______ and ______
properly applied resistance
duration and intensity
what is a quick stretch associated with PNF?
facilitate existing contractions through increased motor unit recruitment –> lengthened position of muscles
what is a contraindication for using quick stretch technique?
complete flaccidity
what is rhythmic initiation?
voluntary relaxation followed by passive movements through increasing ROM followed by AAROM, progressing to resisted movements
what are indications to use rhythmic initiation?
inability to initiate movement
uncoordinated motion
general tension or muscle tone
motor learning deficits due to comprehension
what is the 4 part technique used for rhythmic initiation?
PROM - “relax, let me move you”
AAROM - “now, help me move you”
AROM - “now, move on your own”
resisted - “now, push up”
what is combination of isotonics aka agonist reversals?
combines concentric and eccentric contractions of one muscle group
what are indications to use combination of isotonics technique?
weak postural muscles
inability to eccentrically control body weight during movement transitions
decreased active ROM
poor control and weakness
what is the 3 part technique for combination of isotonics?
concentric
isometric
eccentric
what is stabilizing reversals aka alternating isometrics?
isometric holding is facilitated first on one side of the joint, followed by alternate holding of the antagonist muscle groups
- applied in multiple directions
what are indications of using stabilizing reversals?
decreased stability
poor control
weakness
what is rhythmic stabilization?
- emphasis on?
simultaneous isometric contractions of both agonist and antagonist muscles (co-contraction) performed without relaxation using careful grading of resistance
emphasis on rotational stability control
what are indications to use rhythmic stabilization?
decreased stability in WB and holding
poor antigravity control
weakness
ataxia
what are dynamic (slow) reversals?
slow concentric contractions of first agonist, then antagonist patterns using careful grading of resistance and optimal facilitation
what are indications to perform dynamic reversals?
improve intra- and intermuscular coordination, strength, AROM, endurance, decrease muscle tone
what is repeated stretch (repeated contractions) technique?
repeated stretch linked to voluntary effort to contract stretched muscles, may be repeated without stopping, as soon as the contraction weakens or stops
what is the goal of repeated stretch technique?
enhance initiation of motion and motor learning, increase strength, endurance, improve intra and intermuscular coordination, ROM, reduce fatigue, guide desired motion
what are indications to perform repeated stretch technique?
weakness
fatigue
decreased ability to perform desired pattern
what is contraindication of repeated stretch technique?
do not apply in presence of joint instability, pain or injured muscle
describe how you would perform contract-relax/hold relax?
actively move limb into end range (agonist contraction)
apply strong resisted isometric/isotonic contraction of the antagonists 5-8 sec (autogenic inhibition)
voluntary relaxation and passive movement into new range of agonist pattern
what are indications to perform CR/HR?
limitations in ROM caused by muscle tightness or pain
spasticity
what is the autogenic inhibition reflex?
sudden relaxation of muscle upon development of high tension to prevent injury of tissue
–> turn off
what is myotatic reflex (stretch reflex)?
muscle contraction in response to stretching within the muscle tissue secondary to muscle spindle reaction
–> fire on
process of muscles on one side of a joint relaxing to accommodate the “reciprocal” contraction of the muscles on the other side of the joint to improve synchrony and smoothness of the movement
reciprocal inhibition
