Movement Science 2 (Exam 1-Midterm) Flashcards
What is Motor Control?
Necessary input, sufficiently processed, with an acceptable output
What is Motor Learning?
- Study of and acquisition (and reacquisition) and/or modification of skilled action
- Set of processes associated with the steps leading to relatively permanent changes in the capacity for producing a specific movement task
What are the 3 stages of Motor Learning?
- Cognitive
- Associative
- Automous
What is the difference between Intrinsic and Augmented (Extrinsic) feedback?
Intrinsic feedback includes: Visual, Auditory, Proprioceptive, Vestibular, and Tactile
Augmented feedback includes: Knowledge of performance and knowledge of results
With Augmented Feedback, what does Knowledge of results (KR) mean?
- Terminal feedback about the movement outcome
- This is provided by an instructor or clinician
–Usually verbal
–Can be visual or auditory
With Augmented Feedback, what does Knowledge of Performance (KP) mean?
- This is information about the pattern of a movement
–Kinematic feedback: speed, velocity, displacement
–Kinetic or EMG feedback if equipment: force and muscle activity
–Quality of movement: no reference to goal or outcome
What is Concurrent Feedback?
Feedback given during task performance
What is Constant Feedback?
Feedback given after every trial
What is Delayed Feedback?
Feedback with a brief time delay
What is Summary Feedback?
Feedback after a set number of trials
What is Faded Feedback?
Feedback given less frequent with ongoing practice
What is Terminal Feedback?
Feedback given at the end of task performance
What is Bandwidth Feedback?
Feedback given if performance falls outside a predetermined error range
How may feedback affect performance? How do you consider their stage of learning?
- Frequent extrinsic feedback may improve performance but slow learning
- Less extrinsic feedback may slow performance initially but may lead to improved learning (retention test)
- If the patient is in the cognitive stage of learning. they should get feedback more frequent to develop reference of correctness
- If the patient is in the associative and/of autonomous stage of learning they should get feedback less frequent
What are General Practice Principles?
Practice attempts should be maximized to promote motor learning
With practice, what should be the therapist role?
Therapist should ensure the patient practices correct movements to prevent negative learning
In Practice Progression, What is Massed vs. Distributed progression?
Masses: has more practice time vs rest time
Distributed: has more rest time vs practice time
This depends on the patient, either can be chosen, however usually progressed TO massed in the autonomous stage
In Practice Progression, What is the difference between Constant vs. Variable practice?
Constant: Task is practiced in the same way with no variety; This is better for performance
Variable: Task is practiced in variable conditions and parameters; This is better for learning
In Practice Progression, What is the difference between Blocked vs. Random practice?
Blocked: 1 task repeated throughout whole practice time; This promotes performance
Random: A variety of task are practiced during practice time in random order; This promotes learning
What is the difference between Discrete and Continuous, in terms of task constraints on movement control?
Discrete: Recognizable beginning and end
Continuous: Performer decides end
What is the difference between Closed and Open, in terms of task constraints on movement control?
Closed: Fixed or predictable environment (Little variation of movement)
Open: Unpredictable; must adopt movement strategy (Constant changing of positions)
What is the difference between Stability and Mobility, in terms of task constraints on movement control?
Stability: Nonmoving BOS
Mobility: Moving BOS
What is the difference between Manipulation and Non-Manipulation?
Manipulation: Use of your hands to accomplish a goal
Non-Manipulation: No use of hands
What is the Temporal Sequence of Movement?
Initial Condition
Preparation
Initiation
Execution
Termination
Outcome
What is included in the Initial condition in the Temporal Sequence of Movement?
-State of the individual and environment
-Posture
-Ability to interact with environment
-Environment context
What is included in the Preparation in the Temporal Sequence of Movement?
Period of time when the movement is being organized within the CNS
-Stimulus identification
-Response selection
-Response programming
What is included in the Initiation portion in the Temporal Sequence of Movement?
Initiation of movement is the instance when the displacement begins
-5 body segments: Head/Neck, Upper truck, Lower trunk, UE, LE
-Important parameters:
Timing, Direction, and Smoothness
What is included in the Execution portion in the Temporal Sequence of Movement?
Period of actual segment movement
-Important parameters:
Amplitude, Direction, Speed, Smoothness
What is included in the Termination portion in the Temporal Sequence of Movement?
Refers to the instant when movement stops
Important parameters:
Timing, Stability, Accuracy
What is included in the Outcome portion in the Temporal Sequence of Movement?
Refers to whether the movement was reached successfully
With Functional Movement System (FMS) what are the different stages from the Fundamental Level to the Functional Level?
Fundamental Lvl:
1. Supine
2. Prone
3. Rolling
4. Quadruped
5. Crawling
Transitional Lvl:
6. Sitting
7. Kneeling
8. Squatting
Functional Lvl:
9. Vertical Stance
10. Gait
What is the 1st Principle for FMS?
We should move well, then move often.
- This is the “Natural Principle”
- Moving well enables us to adapt and gives us opportunities to develop and allows us to respond to environmental signals, it sets up the feedback that is vital for progressive movement; Moving often provides us with the ability to explore and expose ourselves to movement opportunities, this add volume across time and allows patterns and tissues to adapt
What is the 2nd Principle for FMS?
Direct us to protect, correct, and develop the movement of those in our care
- This is the “Ethical Principle”
- This can refer to the PT to address pain or avoiding patterns and exercises where pain and dysfunctions are present.
- Protection always precedes correction, which in turn precedes development
– We must protect our clients from themselves and us by removing negatives that are reinforcing poor movement quality
What is the 3rd Principle for FMS?
Create systems that enforce the philosophy
- This is the “Practical Principle”
- Implementation of standard operating procedures, the practice of intelligent selection, always matching the risk to challenge ration to the growth and development desired
- If movement is below an acceptable standard for a movement vital sign or ability, thats dysfunction
- If some is unable to express physical capacity with a minimum standard of load, energy system response, frequency or volume, that deficiency
What is the Optimum Performance Pyramid?
This represents a type of athlete whose movement patterns, movement efficiency and sport skill are balanced and adequate
What is Over Powered Performance Pyramid?
This represents an athlete that generates power that exceeds their ability to move freely.
- This pyramid represents the individual who scores poorly on mobility and stability test but very high on power production
What is the Performance Pyramid? What do the rectangles represent?
This is a visual representation and understanding of human movement and movement patterns.
- The first rectangle lvl is the base platform or foundation. It represents that ability to move through fundamental patterns
- The second rectangle represents performance. This is general, measurable power or gross athleticism
- The third rectangle represents sport specific skill
What is the Under Powered Performance Pyramid?
This represents those athletes that have excellent freedom of movement but whose efficiency is poor and could stand improvement
What is the Under Skilled Performance Pyramid?
This represents those athletes who have overall weakness or below-average performance.
A training program designed around sports skill fundaments and technique would be best investment of time for this person
What are the 7 FMS exercises?
- Deep Squat
- Hurdle Step
- Inline Lunge
- Shoulder Mobility
- Active Straight-Leg Raise
- Trunk Stability Push-Up
- Rotary Stability
Why should your patient/client do a Deep Squat Screen? What is the scoring for this screen?
This shows whether the person can move symmetrically into a full ROM of the ankles, knee, and hips. Maintaining the overhead position of the arms tells us if the individual can full access lower body mobility without robbing movement from the torso and UE.
- The scoring is a scale of 1-3, 3 being normal, and 1 being asymmetrical/not proper squat
Pain = 0
What does a 3 look like for the Deep Squat?
- The torso is parallel with Tibia or toward vertical
- Femur is below horizontal
- Knees do not track inside of feet
- Dowel aligned over feet
What does a 2 look like for the Deep Squat?
- Torso is parallel with Tibia or toward vertical
- Femur is below horizontal
- Knee do not track inside of feet
- Dowel aligned over feet
- Heels are elevated
What does a 1 look like for a deep squat?
- Tibia and Torso are not parallel
- Femur is not below horizontal
- Knees track inside of feet
- Dowel is not aligned over feet
A score of 0 is given when pain is present
With the Deep Squat Movement Pattern, why the symmetrical stance pattern?
The ability to squat is a fundamental movement ability. The deep squat is both a posture and pattern.
With the Hurdle Step Screen, why should the patient/client do the Double to Single Leg Pattern?
This is fundamental to our ability to walk and is the base of our locomotive mechanisms. Its a display of control of our center of mass with a changing BOS. Rolling, Crawling and other developmental milestones set the stage for this pattern
Why the Hurdle Step Screen?
This looks at single leg stance challenged by a dynamic stepping motion. The pattern demands a higher step then normal to express mobility and ROM with the stepping leg, while requiring stability of the stance leg
What is a 3 in the Hurdle Step?
- Hips, knees and ankle remain aligned in the sagittal plane
- Minimal to no movement in lumbar spine
- Dowel and hurdle remain parallel
What is a 2 in the Hurdle Step?
- Alignment is lost between hips, knees, and ankles
- Movement in lumbar spine
- Dowel and hurdle do no remain parallel
What is a 1 in the Hurdle Step?
- Inability to clear the cord during the hurdle step
- Loss of balance
A score of 0 is given when pain is present
With the Inline Lunge Movement Pattern, why the Spit Squat Stance?
This pattern requires us to lower our center of mass like we do with a squat but in a more dynamic way.
Why the Inline Lunge Screen?
This replicates the natural counterbalance the UE and LE use to complement each other, as it uniquely demands spine stabilization. This test challenges hip, knee, ankle, and foot mobility and stability, while at the same time challenging the flexibility of the Latissimus dorsi and Rectus femoris.
What is a 3 in the Inline Lunge?
- Dowel contact maintained
- Dowel remains vertical
- Minimal to no torso movement
- Dowel and feet remain in sagittal plane
- Knee touches the center of the board
- Front foot remains in start position
What is a 2 in the Inline Lunge?
- Dowel contact not maintained
- Dowel does not remain vertical
- Movement in torso
- Dowel and feet do not remain in sagittal plane
- Knee does not touch center of the board
- Flat front foot does not remain in start position
What is a 1 in the Inline Lunge?
- Loss of balance by stepping off the board
- Inability to complete movement pattern
- Inability to get into set up position
A score of 0 is given when pain is present
What is the purpose of the Ankle Clearing Screen? How is this documented?
To identify pain and to ensure ankle mobility is not a barrier to movement pattern competency and capacity
This screen is documented by using Green, Yellow, Red.
What is considered “Green” in the Ankle Clearing Screen?
- Knee moves beyond the medial malleolus of the front leg while the heel stays down
- This indicated the ankle has cleared mobility requirements
What is considered “Yellow” in the Ankle Clearing Screen?
- The knee resides within the width of the medial malleolus of the front leg while the heel stays down
- This indicates a potential ankle mobility limitation
- Failure on the ankle clearing screen implies that ankle mobility should be addressed and cleared
What is considered “Red” in the Ankle Clearing Screen?
- The individual’s knee does reach the medial malleolus of the front leg while the heel stays down
- This indicates a potential ankle mobility limitation
- Failure on the ankle clearing screen implies that ankle mobility should be addressed and cleared
What is a 3 with the Shoulder Mobility Screen?
- Fist are within one hand length
What is a 2 with the Shoulder Mobility Screen?
- Fist are within one and a half hand lengths
What is a 1 with the Shoulder Mobility Screen?
- Fist are not within one and a half hand length
After the Shoulder Mobility Screen, what other test should you do, what is it for?
The shoulder clearing test is at the end of the Shoulder mobility test. If there is pain if this clearing test a 0 is given to the entire test.
- This clearing test is done bilaterally and it is necessary because shoulder impingement will sometimes go undetected by shoulder mobility test alone
Why the Active Straight-Leg Raise Screen?
Lumbo-Pelvic control, extension of the down leg and flexion of the raising leg are the components of this screen.
What is a 3 in the Active-Straight Leg Raise?
- Vertical line of the malleolus resides between mid-thigh and ASIS
- The non-moving limb remains in neutral position
What is a 2 in the Active-Straight Leg Raise?
- Vertical line of the malleolus resides between mid-thigh and joint line
- The non-moving limb remains in neutral position
What is a 1 in the Active-Straight Leg Raise?
- Vertical line of the malleolus resides below the joint line
- The non-moving limb remains in neutral position
A score of 0 is given when pain is present
Why the Trunk Stability Push-Up Screen?
This is not meant to test upper body strength in isolation. The goal is to use the upper body movement in this position to challenge the trunk stability pattern
What is a 3 in the Trunk Stability Push-Up Screen?
- Men perform a repetition with thumbs aligned with the top of the forehead
- Women perform a repetition with thumbs aligned with the chin
- The body lifts as a unit with no lag in the spine
What is a 2 in the Trunk Stability Push-up Screen?
- Men perform a repetition with thumbs aligned with the chin
- Women perform a repetition with thumbs aligned with the clavicle
- The body lifts as a unit with no lag in the spine
What is a 1 in the Trunk Stability Push-Up Screen?
- Men are unable to perform a repetition with thumbs aligned with the chin
- Women are unable to perform a repetition with thumbs aligned with the clavicle
A score of 0 is given when pain is present
What test is done after the Trunk Stability Push-Up Screen?
- Extension Clearing Test, if there is pain give a (+) score with a final 0 score and perform a more thorough evaluation or refer out
What is a 3 in the Rotary Stability Screen?
- Hand and knee leave ground at the same time
- Ability to perform this pattern while keeping the arm and leg moving in-line and parallel with the board
- Fingers touch the lateral malleolus
- Knee and elbow achieve full extension
What is a 2 in the Rotary Stability Screen?
- Hand and knee did not leave ground at same time
- Inability to keep the arm and leg moving in-line and parallel with the board
- Fingers touch the lateral malleolus
- Knee and elbow achieve full extension
What is a 1 in the Rotary Stability Screen?
- Loss of balance
- Hand does not touch the lateral malleolus
- Knee and elbow do not fully extend
- Inability to get into set-up position
A score of 0 is given when pain is present
What test is done after the Rotary Stability Screen?
- The Flexion Clearing Test, Flexion can be cleared by first assuming quadruped position, then rocking back and touching the buttocks to the heels and chest to thighs. If (+) a final score of 0 is given
What is Functional Capacity Assessment/Evaluation?
A detailed examination and evaluation that objectively measures the patients current level of function, primarily within the context of the demands of competitive employment.
Basically looking at the patients ability to do their job and the jobs impact on the patient
What is Industrial Medicine (aka Occupational Medicine)?
The branch of medicine concerned with the maintenance of health and the prevention and treatment of diseases and accidental injuries in the workplace
Where did Industrial Medicine come from?
- Workers Compensation (WC) becomes a key issue:
–Early on, workers comp. was growing at same rate as medical cost
–Later on, workers comp. cost and claims increased
Why was Functional Capacity Evaluations introduced to Workers Comp.?
To help objectively measure a patients level of function within the text of the individuals work environment
With Industrial medicine, what are the steps an injured worker goes through to get back to work?
- After the work injury or work-related illness they are sent for treatment, either:
–Acute care (hospital; clinic)
–Rehabilitation (in/out patient) - Then they go through a course of industrial medicine here they’ll do:
–Evaluation (Job analysis {site/task} and functional assessment {Whole body})
–Treatment (Work hardening {rehab specific to work}, this resulted in formation of pain centers)
–Evaluation (Exit assessment (are they ready for RTW, then the do Special Programs)
Special Programs (Made for prevention): Evaluation- pre-employment screenings and job analysis (site/task) and Education- Body mechanics and prevention of overuse syndrome
Through the eyes of the employee, what are 2 perspectives that should be taken to account with their injury?
1) They want to be back to normal ASAP
2) Issue of secondary gain
- With workers comp. a person only receives a % of previous salary; “checks rarely come on time”
Through the eyes of the employee, what are some of the Financial considerations that should be taken into account with their injury?
- Firstly the patient is injured
- They are receiving less money
- Checks are not on time
- Their bills are still due
- Finances can cause increased stress in the household
Through the eyes of the employee, what are some of Household/Family considerations that should be taken into account with their injury?
- The person’s identity changes due to changes in injury status:
–Staying at home
–No longer primary bread winner
–Can’t pay bills - There is pressure to get better; get a job
Through the eyes of the employer, what are some considerations that should be taken to account with the injured patient?
- 2nd most affected person
- Must pay the employee
- Must (re)train a replacement
- Must pay for (re)training…more cost
- Increased paperwork (claims)
- Concern ie. permanent disability
- Must make “reasonable accommodations”
Through the eyes of the employer, what are some Problems that should be taken to account pertaining to the injured patient? If a lawyer is involved what is there job in the situation?
- People will begin to point fingers at each other on how and why the worker got injured (Often employee blames unsafe work environment)
- No ground work for communication
- Increased likelihood for retaining a lawyer
The lawyers agenda is to win for their side
- PT/OT has good chance of being deposed
With a workers injury what is the role of the Physician?
- Utilizes the “medical model”
- Prescribe med, then ask them to return is a couple weeks
- Problem: MD communicates with employee/employer with medical terminology…not on their level…confusion
What is the role of the Rehabilitation Consultant? What should they consider?
- They are the interpreter from the medical community …to work place, for the insurance company
- They are the patient advocates
- Determines # of visits, what MD to go to, and whether insurance will pay for a 2nd opinion
They should consider:
- Employee’s perspective of rehab consultant
- Insurance companies dont make money, if they spend money
What is the role of the Government?
- They set the standards in the workplace
- They limit the amount an employee can sue medical professionals
- Implications for PTs, you need to carry malpractice insurance
What is the role of the Physical Therapist?
- Being good communicators and being professional towards the worker (employee), the employer, the lawyer, the rehab consultant and the doctor
- Being hands on with patients…establish rapport/trust
What does it mean to look at someone’s Functional Capacity?
We must look at the persons ability to perform a job or the jobs impact on or requirement of the person
What are the results of the FCE used for?
- Information for rating disability
- Identify ways to modify the workplace
- Identify levels of “Return to Work”
- Identify symptom magnifiers
- Develop a rehabilitation plan
–Modify the worker - Work hardening
Specifically the Role of the FCE is to?
- Determine the presence/degree of disability
- Improve job role performance by identification of functional decrements
- Improve the likelihood of safe return to job/task performance
When doing a FCA, what are you supposed to look at?
- The abilities vs disabilities…what can a person do functionally
- At the whole body, not just parts
- Considers what is safe level of performance
- Must determine SAFE functional maximum
How do you determine a Safe Functional Maximum?
- They are not dictated by pain
- They may be safe and still have discomfort
- Do not stop test due to pain, if patient maintains proper body mechanics
- Test may be “self limited” due to pain
- SFM = @ least 100% max effort
- FCA : each station = max effort
What are the Physiological reasons to stop a test?
- HR, angina
- Skin color
- Sweating
- Muscle shaking
- SOB
- unsafe substitutions/compensations
What are potential outcomes of FCA?
- RTW
- Go to work hardening
- Disability
- Job modification
In order to complete a FCA, what is required?
- A large area
- Lots of time (4-6hrs, usually over 2 days), second day allows check for reliability…repeat test
- Trained PT/OT for consistency
–Follows a script (no encouragement/coaching)
–Professional judgement = Key…will patient be hurt
After the FCA/E, do you do a normal PT eval.?
Yes so you know physical limitations
What do FCA test look at?
- Strength
- May use 5 RM (For endurance and to reveal compensations with fatigue)
- May look at positions held for a given time
- Lifts may timed (At a particular pace)
- Coordination/balance
- Body mechanics
- Behavior during the test - pain is not a reason to stop test (if they stop, its a self limited test due to pain)
How does the FCA/E get further insight into consistency for the patient?
It uses test to “Simulate” the symptoms reconstruction (To test for faking)
What is the def. of Malingering?
Psychological diagnosis, therefore do not use
What is the def. of Symptom Magnification?
Describes objective inconsistency in the test
What is Symptom Magnification Syndrome (SMS)?
This stratifies symptom magnifying patients into personality types:
- Refugee
- Game Player
- Perpetual/Identified Patient
With Symptom Magnification Syndrome, what is the Refugee personality?
- Tends to be female with no future orientation
- If symptoms are maintained, they get out of resolved conflict
- Patients feel they are indispensible
- No career, rather job hop
- Martyr
- When asked, Can you do this…Patient response “yes but”
With Symptom Magnification Syndrome, what is the Game Player personality?
- Symptoms provide opportunity for a game
- Tend to be male, opportunistic
- They see symptoms as a way out of the slums
- Extravagant goal setting (beyond possible)
- Impulsive (they dont care about re-injury
- Tend to be irresponsible (But pretend to be responsible)
- Symptoms may be appropriate but rare
With Symptom Magnification Syndrome, what is the Perpetual/Identified Patient personality?
- Not gender specific
- They present with increased assistive device
- Likes patient role because it diminishes all other roles
- No real goal, rather survival
- Life is to be survived not enjoyed
- Tend to fall in the middle of the test for unknown reason
- Symptoms will/may be fictitious
How do we identify symptom magnifiers?
- Their symptoms are not controlled or effected by anything
- Their symptoms control activities; Activities no not control symptoms
- Things dont add up…Objective findings dont match the symptoms
The treatment of symptom magnifiers occurs with?
Work hardening
-Work hardening must have a psychological component to it…Behavior modification
- Work hardening is also used post FCA/E to address the impairments, functional limitations associated with that employees ability to do their job
What will work Hardening address?
It will address issues found in the FCA/E:
- Muscular Endurance
- Strength
- Attendance (Punch in/out)
- Increased ROM
- Cardiovascular Endurance
All in the context of work and job related requirements
- Clients becomes in control of documentation and progress
For industrial Medicine what would be the flow
FCE/A -> Work Hardening -> FCE/A (post, to determine if work hardening achieved our goals)
With the Guiding Principles of PNF, what are the components of Patient Position?
- Pt. should be in optimal alignment - Neutral
- Muscle position should be considered:
–Midrange: Greatest muscle tension
–Shortened Range: Weak contractile force
–Lengthened Range: Optimal stretch for muscle spindle - Changes in body position can either increase of decrease the demands of a task
- Indications: Enhance muscle contraction and maximize postural stability
With the Guiding Principles of PNF, what are the components of Therapist Position?
Directly in line with the desired motion
- Use body to resist; this enhances therapist control of the patient, reduces fatigue, and protects against injury
With the Guiding Principles of PNF, what are the components of Manual Contacts?
- PT is guiding movement and providing resistance, and uses a lumbrical grip
- This enhances kinesthetic awareness (movement or position)
- It enhances muscle contraction and synergistic patterns
With the Guiding Principles of PNF, what are the components of Verbal Cues?
- Verbal cues should be clear, concise and well timed
- There should be Preparatory, Action, and Corrective verbal cues
- Verbal cues enhances the Pts. muscle contraction and synergistic movements
- Verbal cues improve motor learning
With the Guiding Principles of PNF, what are the components of Patterns of Movement?
- There are normal functional movements
& - There are synergistic patterns
With the Guiding Principles of PNF, what are the components of Timing?
- Timing involves sequencing of muscle activity for smooth movement
- Proximal stability for distal mobility
- Normal timing in trunk is proximal to distal
- Normal timing in extremities is distal to proximal
With the Guiding Principles of PNF, what are the components of Appropriate Resistance?
- Optimal resistance facilitates muscle contraction
- Resistance applied is manually and functionally
- Types of contraction:
–Isotonic: Concentric/Eccentric
–Isometric - PT should promote relaxation of antagonist muscle (Reciprocal inhibition)
With the Guiding Principles of PNF, what are the components of Approximation and Traction?
Approximation:
- Compression of joints
- Applied manually or functionally
- Ensure all joints are properly aligned
Traction:
- Elongation of joint
- Traction force is applied through arc of motion
- Facilitate muscle response
With the Guiding Principles of PNF, what are the components of Visual Input?
- Visual feedback
- This enhances and guides movement
(For example: using a mirror)
With the Guiding Principles of PNF, what are the components of Irradiation and Reinforcement?
- Irradiation: The spread of the response to stimulation, can either be:
–Facilitation (contraction)
–Inhibition (relaxation) - Reinforcement: To strengthen; to make stronger
- The response will increase as the stimuli increases in either intensity or duration, this can occur in any direction and across any segment in the body
With the Guiding Principles of PNF, what are the components of Quick Stretch?
- This is used to facilitate muscle contractions and contractions of associated synergistic muscles
- The stretch reflex is elicited for muscles that are under tension from either elongation or contraction. To optimize the effects of the stretch reflex, all synergistic muscles in the pattern should be elongated
- Should only be used when your trying to facilitate a dynamic muscle activity
- Verbal cues must be synchronized with the stretch, for maximal benefit
- Can be contraindicated with injuries.
What is the overall goal for PNF techniques?
To promote functional movement through facilitation, inhibition, strengthening, and relaxation of muscle groups
What are different types of PNF techniques?
- Rhythmic initiation
- Reversal of Antagonists
(Dynamic reversal, and stabilizing reversals, Rhythmic stabilization) - Repeated quick stretch
- Combination of isotonics (COI)
- Timing for emphasis
- Contract-relax
- Hold-relax
With PNF techniques, what is Rhythmic Initiation? Describe the different parts of the technique?
- This involved a rhythmic motion of the limb or body through the desired ROM, firstly start with PROM and progress to Active resistive movement.
Technique: - PROM: “Relax, let me move you”
- AAROM: “Now, help me move you”
- AROM: “Now, move on your own”
- Resisted: “Now, push up”
What are the goals for Rhythmic Initiation (RI)?
- Promote learning of new movement and initiation
- Improve intra- and intermuscular coordination
- Promote relaxation, independent movement
With PNF Techniques, What is Reversal of Antagonists?
- This involves contraction of antagonist and is followed by an intensified excitation of the agonist
This includes 3 techniques: - Dynamic Reversals
- Stabilizing Reversals
- Rhythmic Stabilizations
With Reversal of Antagonist, what is Dynamic Reversals Technique? What are verbal cues you can use? How can this benefit the patient?
- This involves the resistance of an agonist and then antagonist without pause or relaxation, during this the patient is actively moving the limb or body part through active ROM
- Cues such as “Push up” “Push down”
(Ex. if we are working with Bicep and triceps, I will actively resist you moving into flexion and then I will assist you moving into extension without pause or break)
Benefits:
- Helps improve intra- and Intermuscular coordination, strength, AROM, endurance, and to decrease muscle tone
With Reversals of Antagonist, what is Stabilizing Reversals? What is the muscle activity? What are the benefits?
- Alternating isometric contractions with stabilizing hold to agonist and then to antagonist opposed by enough resistance to prevent motion. The intension is to move
- The muscle activity from agonist to antagonist
Benefits:
- Improve stability, strength, balance, and coordination
With Reversals of Antagonist, what is Rhythmic Stabilization? What is the muscle activity? What are the benefits?
- Alternating isometric contractions of antagonist patterns against resistance focusing on co-contraction. No intension to move
- The muscle activity is agonist and antagonist together (co-contraction)
Benefits:
- Improve ROM, strength, stability, balance and pain
With PNF Techniques, What is Reversal of Antagonists? What is the goal/benefit?
- This is a stretch reflex elicited from muscles under tension of contraction
- Can be performed at the beginning of ROM or throughout the range at point of weakness
Goal/Benefit:
- Enhance initiation of motion and motor learning, increase strength, endurance, improve intra- and intermuscular coordination, ROM, reduce fatigue, guide desired motion
Does not apply in presence of joint instability, pain, or injured muscle
With PNF Techniques, What is Combination of Isotonics (COI)? What is the goal/benefit?
- Combined concentric, eccentric, and isometric (stabilizing) contraction of 1 group of muscles (agonist) without relaxation.
- For treatment begin where pt has most strength or best coordination
- “Push up.” “Hold.” “Slowly let me win.”
- Often used in antigravity activities and assumption of
postures (bridging and sit to stand) - Goals/Benefits: improve active motor control/motor learning, coordination, AROM, strength, eccentric control of
movement, improve function
With PNF Techniques, What is Timing For Emphasis? What is the goal/benefit?
- Emphasize 1 component of the pattern
- Use resistance to enhance a more localized contraction
- Emphasize a particular component within the pattern
- Strengthen weaker component through
irradiation and reinforcement. - Strong muscles resisted isometrically (“locking in”) while motion is allowed in weaker muscles
- Improve strength and coordination
With PNF Techniques, What is Contract-Relax? What is the goal/benefit?
Resisted isotonic contraction of the resisting muscle (antagonist) followed by relaxation and active movement into new ranges.
1. PT actively moves limb in pattern to end range (agonist contraction)
2. Followed by strong resisted contraction of the antagonist 5-8 seconds (autogenic inhibition), “hold, dont let me move you”
3. Voluntary relaxation and active movement into the new range of agonist pattern
Goal/Benefit:
- Improve ROM
With PNF Techniques, What is Hold-Relax? What is the goal/benefit?
Resisted isometric contractions of the
antagonistic muscles (shortened muscles)
followed by relaxation.
1. PT actively moves limb in pattern to end range (agonist contraction).
2. Followed by strong resisted isometric contraction of the antagonists 5‐8 sec (autogenic inhibition).
3. Voluntary relaxation and passive movement into the new range of agonist pattern.
Goal/Benefit: Improve ROM especially in pts with pain
What kinds of patterns of movements was PNF made for?
- They were made to mimic patterns in normal activities and sports
- They combine all 3 planes:
–Sagittal
–Frontal
–Transverse
What do Scapular Patterns influence?
What are 2 motions with scapular patterns?
What positions do we normally put patients in?
Scapular Patterns influence function of C-Spine, T-Spine, and bilateral UE
Motion occurs in 2 diagonals:
- Anterior elevation - Posterior Depression
- Posterior Elevation - Anterior Depression
These patterns are usually performed in side-lying, although they can be performed in other positions, like sitting or standing
In reference of a clock, when performing Anterior Elevation-Posterior Depression of the right scapula/pelvis what should be the direction of this movement?
What are the verbal cues used for these movements?
Towards 1 O’clock (Anterior Elevation)
Towards 7 O’clock (Posterior Depression)
(AE)
“Bring your shoulder and scapula up towards your nose or ear w/o rotating the scapula forward”
(PD)
“Think about tucking your scapula into your back pocket”
In reference of a clock, when performing Posterior Elevation-Anterior Depression of the right scapula/pelvis what should be the direction of this movement?
What are the verbal cues used for these movements?
Towards 11 O’clock (Posterior Elevation)
Towards 5 O’clock (Anterior Depression)
(AD)
“Think about tucking your shoulder/scapula towards your front pockets”
(PE)
“Your scapula is going to come up towards the back part of your ear”
When performing Anterior Elevation-Posterior Depression, what do you do to set up the scapula?
The scapula needs to be in neutral position to move freely and efficiently
- If scapular is noted, elevate the should complex
- Use lateral border of hand to downwardly rotate and retract the scapula back into neutral
When performing Posterior Elevation-Anterior Depression, what do you do to set up the scapula?
- If scapular deviation is noted, move shoulder into posterior elevated position using lateral border of your hand
- Compress and upwardly rotate the scapula to allow superior angle to move the spinous process of cervical vertebrae
When performing Scapular Anterior Elevation (AE) what is the patient position, PT position, starting position of scap. , the manual contacts and movement with this technique?
- Pt. is sidelying; head and spine in neutral
- PT is behind pt. facing head in line with diagonal
- The starting position of the scapula is in Posterior Depression
- The PT will be in contact with the superior/anterior aspect of the pt. shoulder
- Movement, The scapula moves up and forward towards nose, and inferior angle rotates away from spine. Resistance is down and back
With Scapular Anterior Elevation, what are the principle muscles involved?
- Levator Scapulae
- Rhomboids
- Serratus Anterior
What are functional activities involved with Scapular Anterior Elevation?
- Reaching up in front of the body
- Rolling forward
- Gait Related: Terminal stance on the ipsilateral side and swing phase on the contralateral side
When performing Scapular Posterior Depression (PD) what is the patient position, PT position, starting position of scap. , the manual contacts and movement with this technique?
- Pt. is sidelying; head and spine in neutral
- PT is behind pt. facing head in line with diagonal
- The starting position of the scapula is in Anterior Elevation
- The PT will be in contact with the inferior angle/medial border of the scapula and posterior humerus
- Movement, The scapula moves down and back; Inferior angle rotates towards spine. Resistance is up and forward
What are the Principle muscles involved with Scapular Posterior Depression (PD)?
- Latissimus Dorsi
- Rhomboids
- Serratus Anterior
What are the functional activities involved with Scapular Posterior Depression (PD)?
- Trunk extension
- Rolling backwards
- Using crutches while walking
- Pushing up with a straight crutch
When performing Scapular Posterior Elevation (PE) what is the patient position, PT position, starting position of scap. , the manual contacts and movement with this technique?
- Pt. is sidelying; head and spine in neutral
- PT is behind pt. near head, facing pelvis in line with diagonal
- The starting position of the scapula is in Anterior Depression
- The PTs heel of hand will be on the superior/posterior aspect of acromion and spine of scapula
- Movement, The scapula moves up and back; Resistance is down and forward
When performing Scapular Anterior Depression (AD) what is the patient position, PT position, starting position of scap. , the manual contacts and movement with this technique?
- Pt. is sidelying; head and spine in neutral
- PT is behind pt. near head, facing pelvis in line with diagonal
- The starting position of the scapula is in Posterior Elevation
- There are 2 points of manual contact:
–1. Axillary border of scapula and lateral border of pec major/inferior border of coracoid process
–2. Axillary border and distal humerus - Movement, The scapula moves down and forward towards opposite hip. Resistance is up and back
With scapular Posterior Elevation, what are the principle muscles involved?
- Trapezius
- Levator Scapulae
What are the functional activities involved with Scapular Posterior Elevation?
- Moving backwards
- Reaching out before throw
- Donning (Putting on) a shirt
What are the Principle muscles involved with Scapular Anterior Depression?
- Rhomboids
- Serratus Anterior
- Pec. Major
- Pec Minor
What are the Functional Activities involved with Scapular Anterior Depression?
- Rolling forward
- Reaching forward
- Throwing a ball in sporting activities
- Reaching down (i.e. don/doff shoes and socks)
What do Pelvic Patterns influence?
What are 2 motions with Pelvic patterns?
Pelvic Patterns influence function of the spine and bilateral LE
Motion occurs in 2 diagonals:
- Anterior elevation - Posterior Depression
- Posterior Elevation - Anterior Depression
When performing Pelvic Anterior Elevation (AE) what is the patient position, PT position, starting position of Pelvis , the manual contacts and movement with this technique?
- Pt. is sidelying; hips flexed 80-90° head and spine in neutral
- PT is behind pt., facing head in line with diagonal
- The starting position of the Pelvis is in Posterior Depression
- There are 2 points of manual contact:
–1. Fingers on anterior iliac crest
–2. Lateral border of hands on the iliac crest - Movement, The pelvis moves up and forward; inferior angle angle rotates away from spinel Resistance is down and back
“Pull your pelvis up and forward”
What are the Principle muscles involved with Pelvic Anterior Elevation?
- Internal Obliques
- External Obliques
What are the functional activities with Pelvic Anterior Elevation?
- Rolling forward
- Swing phase of gait
When performing Pelvic Posterior Depression (PD) what is the patient position, PT position, starting position of Pelvis , the manual contacts and movement with this technique?
- Pt. is sidelying; hips flexed 80-90° head and spine in neutral
- PT is behind pt., facing head in line with diagonal
- The starting position of the Pelvis is in Anterior Elevation
- Manual contact is at the base of hands on ischial tuberosity using lumbrical grip
- Movement, The pelvis moves down and back; Resistance is up and forward
“Sit on my hand. Push down and back”
What are the Principle muscles involved with Pelvic Posterior Depression?
- Contralateral Internal Oblique
- Contralateral External Oblique
What are the functional activities with Pelvic Posterior Depression?
- Terminal stance activities
- Jumping
- Walking stairs
- Making high steps
When performing Pelvic Posterior Elevation (PE) what is the patient position, PT position, starting position of Pelvis , the manual contacts and movement with this technique?
- Pt. is sidelying; hips flexed 70° head and spine in neutral
- PT is behind pt., near head, facing pelvis and in line with diagonal
- The starting position of the Pelvis is in Anterior Depression
- Manual contact is at the heel of hand on posterior superior ilium. Other hand overlaps. No finger contact
- Movement, The pelvis moves up and back; Resistance is down and forward
“Push up and back”
What are the Principle muscles involved with Pelvic Posterior Elevation?
- Ipsilateral quadratus lumborum (QL)
- Ipsilateral latissimus dorsi
- Iliocostalis lumborum
- Longissimus thoracis
What are the functional activities with Pelvic Posterior Elevation?
- Walking backwards
- Preparing to kick a ball
When performing Pelvic Anterior Depression (AD) what is the patient position, PT position, starting position of Pelvis , the manual contacts and movement with this technique?
- Pt. is sidelying; hips flexed 70° head and spine in neutral
- PT is behind pt., near head, facing pelvis and in line with diagonal
- The starting position of the Pelvis is in Posterior Elevation
- Manual contact is at the lateral border of hand on greater trochanter, other hand may reinforce first hand
- Movement, The pelvis moves down and forward; Resistance is up and back
“Push down and forward”
What are the Principle muscles involved with Pelvic Anterior Depression?
- Contralateral quadratus lumborum
- Iliocostalis lumborum
- longissimus thoracis
What are the functional activities with Pelvic Anterior Depression?
- Going down stairs
Gait: - Initial contact
- Loading response
With Scapular and Pelvic PNF, what are Symmetrical Reciprocal?
What is Pt. position, PT position?
Same diagonal, opposite pattern
- Scapular Anterior Elevation (AE) - Pelvic Posterior Depression (PD): Trunk elongation with rotation
- Scapular Posterior Depression (PD) - Pelvic Anterior Elevation (AE): Trunk shortening with rotation
- Pt. in sidelying, hips flexed 70-80°
- PT’s body is parallel to the lines of the diagonal, facing pt. head
With Scapular and Pelvic PNF Symmetrical Reciprocal, what are the functional activities involved?
- Walking
- Rolling
- Pushing something away
- Reaching overhead
- Dissociation of upper and lower trunk
With Scapular and Pelvic PNF, what are Asymmetrical Reciprocal?
What is Pt. position, PT position?
Opposite Angles
- Scapular Anterior Depression (AD) - Pelvic Anterior Elevation: Massed Flexion
- Scapular Posterior Elevation (PE) - Pelvic Posterior Depression: Massed Extension
- Pt. in sidelying, hips flexed at 70-80°
- PT is behind pt., forearms in line of diagonals
(1 hand scapula, 1 hand pelvis)
With Scapular and Pelvic PNF Asymmetrical Reciprocal, what are the functional activities involved?
- Supine to prone
- Backward
With UE PNF pattens, what are the 2 Diagonals?
Where does movement begin?
D1: Flex-ADD-ER and Ext-ABD-IR
D2: Flex-ABD-ER and Ext-ADD-IR
Distal Component begins the pattern
- Hand/wrist->Elbow->Shoulder
With D1 Flexion (Flex/Add/ER), what is the position of the Scapula, Shoulder, Forearm, Wrist, Fingers, and Thumb?
Scap: Anterior Elevation
Shoulder: Flex/Add/ER
Forearm: Supination
Wrist: Flexion, Radial Deviation
Fingers: Flexion
Thumb: Flex, Add, Opposition
With D1 Extension (Ext/Abd/IR), what is the position of the Scapula, Shoulder, Forearm, Wrist, Fingers, and Thumb?
Scap: Posterior Depression
Shoulder: Ext/Abd/IR
Forearm: Pronation
Wrist: Extension, Ulnar Deviation
Fingers: Extension
Thumb: Palmar Abduction, Extension
With D2 Flexion (Flex/Abd/ER), what is the position of the Scapula, Shoulder, Forearm, Wrist, Fingers, and Thumb?
Scap: Posterior Elevation
Shoulder: Flex/Abd/ER
Forearm: Supination
Wrist: Ext, Radial Deviation
Fingers: Extension
Thumb: Extension, Abduction
With D2 Extension (Ext/Add/IR), what is the position of the Scapula, Shoulder, Forearm, Wrist, Fingers, and Thumb?
Scap: Anterior Depression
Shoulder: Ext/Add/IR
Forearm: Pronation
Wrist: Flexion, Ulnar Deviation
Fingers: Flexion
Thumb: Flexion, Adduction, Opposition
With UE D1 Flexion (Flex/Add/ER), what is the Pt. and PT position, Movement, and verbal cues?
- Pt. Position: Supine with arm in Ext/Abd/IR
- PT position: Start facing feet and swivel to and end pattern facing pt’s head. Hips in line with diagonal
- Movement: Shoulder Flex, Add; wrist flexion; Radial deviation; Thumb adduction
- Verbal Cues: “Squeeze my hand, pull up and across”
What are Functional Activities with UE D1 Flexion?
- Feeding
- Dressing
- Brushing Teeth
With UE D1 Extension (Ext/Abd/IR), what is the Pt. and PT position, Movement, and verbal cues?
- Pt. Position: Supine with arm Flex/Add/ER
- PT position: Start facing the pt’s head and swivel to end pattern facing pt’s feet. Hips in line with diagonal
- Movement: Shoulder Ext, Abd, IR; Elbow ext, Forearm pronation, Wrist ext; Ulnar Deviation;Thumb abd
- Verbal Cues: “Open your hand, Push down and out”
What are Functional Activities with UE D1 Extension?
- Sit to Stand
- Scooting Forward
- Sit to Sidelying
With UE D2 Flexion (Flex/Abd/ER), what is the Pt. and PT position, Movement, and verbal cues?
- Pt. Position: Supine with arm Ext/Add/IR
- PT Position: Stand facing pt feet. Hips in line with diagonal
- Movement: Shoulder Flex, Abd, ER; Wrist Extension; Radial Deviation; Thumb Extension, Abduction
- Verbal Cues: “Open your hand, push up and out”
What are Functional Activities with UE D2 Flexion?
- Reaching for seatbelt
- Reaching for overhead light
- Reaching into Cabinet
With UE D2 Extension (Ext/Add/IR), what is the Pt. and PT position, Movement, and verbal cues?
- Pt Position: Supine with arm in Flx/Add/IR
- PT Position: Stand at shoulder, facing pt’s feet. Hips in line with diagonal
- Movement: Shoulder Ext, Add, IR; Forearm pronation; Wrist flexion; Ulnar Deviation; Thumb flex, Abd, Opposition
- Verbal Cues: “ Squeeze my hand, pull Down and across”
What are Functional Activities with UE D2 Extension?
- Putting on seatbelt
- Tucking in shirt
With Bilateral UE Patterns, what is the difference Symmetrical and Asymmetrical patterns?
Symmetrical: This is the same pattern
- For example, L/R arm do D2 Flexion
Asymmetrical: This is the opposite pattern
- For example, one does D1 Flexion the other does D2 Flexion
With Bilateral UE Patterns, what is the difference Symmetrical Reciprocal and Asymmetrical Reciprocal patterns?
Symmetrical Reciprocal: Same Diagonal/Opposite Direction
- For example, One does D2 Flexion and the other does D2 Extension
Asymmetrical Reciprocal: Opposite Diagonal/Opposite Direction
- For example, One does D1 Flexion the other does D2 Extension
Why are Bilateral UE patterns useful?
- This allows use of irradiation from the patient’s strong UE to facilitate weaker muscles
- Also places greater demand on trunk
What is the Bilateral UE Pattern: Chop? What is the movement for this pattern and what are the functional activities with this?
This is a Bilateral Asymmetrical UE Extension with Neck Flexion
Movement: Trunk Rotation with Flexion
- Lead UE: D1 Extension (Ext. Abd/IR)
- Assisting UE: D2 Extension (Ext/Add/IR)
- Neck: Flexion
Functional Activities:
- Rolling - Supine to sidelying/prone
- Supine to sit
What is the Bilateral UE Pattern: Lift? What is the movement for this pattern and what are the functional activities with this?
This is a Bilateral Asymmetrical UE Flexion with neck Extension
Movement: Trunk Extension with Rotation
- Lead UE: D2 Flexion (Flex/Abd/ER)
- Assisting UE: D1 Flexion (Flex/Add/ER)
- Neck: Extension
Functional Activities:
- Rolling - Sidelying to supine
With LE PNF pattens, what are the 2 Diagonals?
Where does movement begin?
D1: Flex-ADD-ER and Ext-ABD-IR
D2: Flex-ABD-IR and Ext-ADD-ER
Distal component begins the pattern
- Toes/foot/ankle ->Knee->Hip
With D1 Flexion (Flex/Add/ER), what is the position of the Hip, Foot/Ankle, Toes?
Hip: Flex, Add, ER
Foot/Ankle: DF, Inversion
Toes: Extension, Medial Deviation
With D1 Extension (Ext/Abd/IR), what is the position of the Hip, Foot/Ankle, Toes?
Hip: Ext, Abd, IR
Foot/Ankle: PF, Everson
Toes: Flexion, Lateral Deviation
With D2 Flexion (Flex/Abd/IR), what is the position of the Hip, Foot/Ankle, Toes?
Hip: Flex, Abd, IR
Foot/Ankle: DF, Eversion
Toes: Extension, Lateral Deviation
What D2 Extension (Ext/Add/ER), what is the position of the Hip, Foot/Ankle, Toes?
Hip: Ext, Add, ER
Foot/Ankle: PF, Inversion
Toes: Flexion, Medial Deviation
With LE D1 Flexion (Flex/Add/ER), what is the Pt. and PT position, Movement, and verbal cues?
- Pt. Position: Supine with LE in D1 Extension (Ext/Abd/IR)
- PT Position: Standing at ankle facing head. Hips in line with diagonal
- Movement: Hip flex, add, ER; Knee flexion; Ankle DF, inversion, Toe extension and medial deviation \
- Verbal Cues: “Pull up and across”
What are the Functional Activities with LE D1 Flexion?
- Swing phase of gait
- Ascending stair
With LE D1 Extension (Ext/Abd/IR), what is the Pt. and PT position, Movement, and verbal cues?
- Pt. Position: Supine with LE in D1 Flexion (Flex/Add/IR)
- PT Position: Stand at ankle facing head. Hips in line with diagonal
- Movement: Hip ext, abd, IR; Knee ext; Ankle PF, eversion; Toe flex and lateral deviation
- Verbal Cues: “Push down and out”
What are the Functional Activities with LE D1 Extension?
- Stance phase of gait
- Descending stairs
With LE D2 Flexion (Flex/Abd/IR), what is the Pt. and PT position, Movement, and verbal cues?
- Pt. Position: Supine with Le in D2 Extension (Ext, Add, ER), contralateral LE slightly abducted
- PT Position: Stand at hip facing foot. Hips in line with diagonal
- Movement: Hip flex, abd, IR; Knee flexion; Ankle DF, Eversion; Toe extension, lateral deviation
- Verbal Cues: “Toes up, push out”
What are the Functional Activities with LE D2 Flexion?
- Stepping into shower
- Sitting to side lying
With LE D2 Extension (Ext/Add/ER), what is the Pt. and PT position, Movement, and verbal cues?
- Pt. Position: Supine with LE in D2 Flexion (Flex, Abd, IR)
- PT Position: Stand at hip facing foot. Hips in line with diagonal
- Movement: Hip ext, add, er; Knee ext; Ankle PF, inversion; Toe flexion, medial deviation
- Verbal Cues: “Toes down, Pull in”
What are the Functional Activities with LE D2 Extension?
Rolling supine to sidelying
What is Equilibrium?
A state of zero acceleration where there is no change in speed or direction of the body
What is Balance?
The ability to control equilibrium (Either static or dynamic)
What is Stability?
The resistance to a change in the body’s acceleration or the resistance to a disturbance of the body’s equilibrium
What are the 3 most important factors for achieving balance?
- A person has balance when the COG falls within the BOS (The upright posture is only stable when the line of gravity lies within the foot base)
- A person has balance in direct proportion to the size of the BOS (The larger the BOS, the more balance)
- A person has balance depending on mass (The greater the mass, the more balance)
What is Base of Support?
The supporting area underneath the body, it includes the points of contact with the supporting surface and the area between them
With BOS, what is High Stability (Low Mobility)?
This is characterized by a large BOS, a low COG, a centralized COG projection within the BOS, a large body mass, and a high friction at the ground surface
With BOS, what is Low Stability (High Mobility)?
This is characterized by a small BOS, a high COG, a COG projection near the edge of the BOS, a small body mass, and low friction
What is Center of Mass?
The unique point where the body’s mass is equally distributed in all directions, may also be referred to as the center of gravity.
What are the 3 Balance Components?
- Vestibular
- Proprioceptive (Somatosensory)
- Visual
With balance what is Vestibular Input?
The ear has a labyrinthine structure that has balance receptors that detect movements of different types. There are receptors for head rotation, horizontal acceleration and vertical acceleration.
With balance what is Proprioceptive Input?
This is the sense through which we perceive the position or movement of our body.
- In order to perform balance skills a person must know their position in space, which is called Kinesthetic awareness, as well a possess quick reactions, coordination, agility, and flexibility
What is the Vestibulo-Ocular Reflex?
This is one of the fastest and most active reflexes in the human body. It uses head movements detected by the inner ear to generate compensatory eye movements that are equal - but in opposite direction - to head motions
- This ongoing adjustment of eye position results in a stable visual field, despite significant movement of the head
What type of balance is BOS?
Static: Fixed
Semi-Dynamic: Fixed
Dynamic: Moving
What type of balance is Surface?
Static: Stable
Semi-Dynamic: Unstable
Dynamic: Stable
What is Ankle Strategy? When is this used?
- Used when perturbation is:
–Slow
–Low Amplitude - Contact surface is firm, wide and longer than foot
- Muscles recruited are distal to proximal
- Head movements in-phase with hips
What is Hip Strategy? When is this used?
- Used when perturbation is fast or large amplitude
- Surface is unstable or shorter than feet
- Muscles recruited are proximal to distal
- Head movement out-of-phase with hips
What is Stepping Strategy?
- This is used to prevent a fall
- Used when perturbations are fast or large amplitudes or when other strategies fail
- BOS moves to “catch up with” BOS
What factors affect balance?
- Posture
- Disease
- Meds
- De-conditioned state
- Disuse, injury, or surgery
- Fatigue
How does Posture affect balance?
- Posture affects balance, strength, and coordination
- Postural equilibrium is crucial to balance
How can injury/surgery affect balance?
- If there is a ligament injury, it may affect the joint proprioceptors and this will result in joint deafferentation (decreased input to afferent pathways), and this has a chance of reinjury
Ankle is the most frequently injured
How does deconditioning affect balance?
Neuroplasticity
- Use it or lose it
If not actively practiced it will slowly go away
How do you restore balance?
Balance is functional and is a skill
- To restore you have to work on integrated, coordinated, efficient, multidirectional movement and proprioception
How does Disease affect balance?
- May cause vision, sensation or neurological changes
How can fatigue affect balance?
- Muscular fatigue worsens or impairs joint position sense
- May also affect neuromuscular control of joint
How can CKC exercises help with balance?
What would happen if there is damage to the Mechanoreceptors?
LEs function primarily in CKC
Closed Kinetic Chain activities increase load to the joints stimulates mechanoreceptors and encourages functional muscle co-contraction
- Damage to mechanoreceptors will affect proprioception
Why is Proprioception and Balance Rehab. important?
- Proprioception is the center of performance and function
- Quick and coordinated muscle response helps to protect joint form injuries
- This works on static and dynamic (Kinesthesia) position sense
How do patients get balance back?
- Posture (Visual, Vestibular, and proprioceptive inputs)
- Core strength and stability (base strength before extremity strength, proximal stability before distal mobility)
- Stimulation of mechanoreceptors (weight bearing, oscillations, isometrics)
- Kinesthesia (Pertinent in orthopedic patients, pertinent in neurological patients)
- Strength and endurance (Isolate, functional, SAID, overload)
- Muscle balance (Length-tension relationship, force coupled)
- Neuromuscular system exercise (reflex, reaction time)
If a patient is doing a balance exercise, his balance will depend on…?
- Configuration of BOS
- COG alignment over the BOS
- Speed of postural movement
- Ability to maintain a position
- Ability to voluntary move
- Ability to react to perturbation
How do we progress the type of balance training with a patient?
We go from Static to Semi-Dynamic to Dynamic
How do we progress the body weight with balance training?
We start Sitting then to Standing then to Weight shifts
How do we progress the BOS with balance training?
First we start with the patient in Bilateral BOS then Unilateral BOS
With balance training, how do we progress vision?
Firstly the patient will have their eyes Open, then progress to eyes close
With balance training, how do we progress the surface that the patient is training on?
Firstly we’ll start on a stable and firm surface then to an unstable and soft surface (Airex Pad)
With balance training, how do we progress counterbalance?
At first the patient will have a counterbalance then progress to no counterbalance
With balance training, how do we progress when the patient will wear shoes?
At first the patient will have shoes on, then progress to shoes off
With balance training, how do we progress External Stimuli?
At first we would not add perturbations then progress to add perturbations
With balance training, how do we progress Dual Task?
At first we will isolate an exercise/movement then progress to add a cognitive challenge
With balance training, how do we progress speed?
At first we will start with slow speed movement then progress to fast speed
With balance training, how do we progress force?
At first we start with low force then progress to hight force
With balance training, how do we progress control?
At first we start with controlled movement/exercise then progress to uncontrolled
Does the patient need to be in full weight bearing in order to begin Proprioceptive training?
No they do not need to be in full weight bearing, but they should have adequate strength, flexibility, and ROM
What is required for Dual Task Activity for Balance? What is this type of training specific for?
- This requires attention
- Specific to activity or sport
Why is Spine Stabilization important?
- The spine is vulnerable
- To protect articular surfaces
- Prevent injury or reinjury
- To facilitate healing
- To decrease pain
- To improve performance
Which muscles are crucial in providing lumbar spine stabilization?
Which muscles are affected as a result of LBP?
- Lumbar Multifidus
- Transverse Abdominis
- Internal and External Obliques
What is the difference between Global and Local muscles?
Global muscles only provide indirect stability to the spine
Local muscles provide segmental stability and must be addressed first
What are the characteristics of the Lumbar Multifidus?
70% of stabilization comes from this muscle
The lumbar multifidus is the deepest posterior spinal muscle
- Unilaterally it would do trunk flexion, side bending and rotation of the opposite side
- Bilaterally it would extend the trunk and stabilize the vertebral column
More of a tonic muscle
How is the lumbar multifidus affected by LBP?
If you’ve had a hx of LBP, first time unilateral P!, these pt. had atrophy of the multifidus on the same side and the same segment as their acute unilateral LBP
What are the characteristics of the Transverse Abdominus?
This is the deepest abdominal muscle
- This muscle is in charge of compression, support and protection for the abdomen
- This muscle is recruited prior to any other muscle when there is expected and unexpected loading of the spine
How is the Transverse Abdominus affected by LBP?
- When it is no longer recruited first prior to loading of the spine
(Global muscle were activated first) - This is going to result in a loss of stability to the spine and effect of the muscle itself
What are the characteristics of the Internal Oblique?
- The 2nd intermediate layer of the abdominals (Layer above transverse abdominus)
- If pelvis is fixed, the IO would flex and rotate to the same side, if the trunk is fixed then IO would side bend and rotate to the opposite side. Also compress, supports and protects abdomen
What is the definition of Neutral Spine?
The position in which an individual is most asymptomatic and the position in which an individual can produce the greatest amount of force through the extremities and the position in which an individual can best maintain balance and agility
When observing a pts. Neutral spine, how do we look at their alignment?
- Using a plumb line
- Palpation, of boney landmarks
- Vertical Compression
When assessing Neutral spine, how do you assess strength and balance?
- Force generation through the extremities
- The ability to maintain balance
When assessing Neutral spine, how do you assess Agility and Protective Mechanisms?
- This is the ability to receive proprioceptive feedback and response with change in direction
Once we have neural spine, how do we train the stabilization of muscles?
With co-contractions
When training the stabilization of muscles, what positions can you place the patient in? What are the 4 Ss?
- Prone
- Quadruped
A good place to start because there is no external load, and they inhibit the Rectus abdominus - Supine/hook lying
Progression to functional positions/postures; such as standing, squatting and sitting
The 4 Ss:
- Supported Posture
- Suspended Posture
- Stacked Posture
- Standing Posture
When training for stabilization of muscles, how do you avoid substitutions?
- Isolate the muscle
- Avoid global muscle activation
- Inspect the pt.
- Palpate the muscle
- Use pressure biofeedback unit
- Use verbal and tactile cues
What are signs of dysfunction with the intrinsic stabilization subsystem?
- Abdominal Distension (abdomen expands)
- Change in LPHC alignment
–Excessive lordosis (APT)
–Excessive Forward Lean
–Asymmetrical Weight Shift
What muscles are part of the Intrinsic Stabilization subsystems?
- Multifidus
- Transverse Abdominus
- Diaphragm
- Muscles of pelvic floor
Also:
- Internal Oblique
- Transversospinalis (Semispinalis, multifidus, and rotatores)
What Muscles are part of the Anterior Oblique Subsystem?
- Adductors
- External Oblique
What are the signs of dysfunction with the Anterior Oblique subsystem?
- Change in LPHC or femoral alignment
–Excessive Lordosis (APT)
–Excessive Forward Lean
–Genu Valgum
–Asymmetrical weight shift
What muscles are part of the Posterior Oblique Subsystem?
- Glute Max
- Latissimus Dorsi
What are the signs of dysfunction with the Posterior Oblique subsystem?
- Change in LPHC or Femoral Alignment
–Excessive Forward Lean
–Excessive Lordosis (APT)
–Genu Valgum
–Genu Varum
–Asymmetrical Weight Shift
What muscles are part of the Lateral Subsystem?
- QL
- Glute Med
- TFL
- Adductors
What are the signs of dysfunction with the Lateral Subsystem?
- Frontal Plane Changes in Pelvis or Hip Alignment
–Genu Valgum
–Genu Varum
–Asymmetrical Weight Shift
What muscles are part of the Deep Longitudinal Subsystem?
- Bicep Femoris
- Tibialis Anterior
- Peroneus Longus
Also:
- Sacrotuberous Ligament
What type of muscle type are the muscles of stabilization?
Type 1 fibers, Slow twitch
How should you train the muscles of stabilization?
Endurance exercises
- Low load:Long durations
- Repeated bouts
When training the muscles of stabilizations, how should the patient progress going from NWB to Proprioception?
- NWB > WE
- Nonfunctional > Functional positions
- Simple movements > Complex
- No external Loads > External Loads
- Low Speed > High Speed
- Local Muscle > Global Muscles
- Proprioception
