Neuro approaches (ch 12) Flashcards
Stages of motor learning (3)
- Skill acquisition stage (cognitive stage): occurs during initial instruction and practice of a skill.
- Skill retention stage (associated stage): “carry-over” as person is asked to demonstrate their newly acquired skill after initial practice.
3 Skill transfer stage (autonomous stage): the person demonstrates the skill in a new context.
Factors/conditions that promote generalization of motor learning:
- capacity to generate intrinsic feedback
- high feedback regarding knowledge of performance
- low extrinsic feedback regarding knowledge of results
- practice conditions that are variable, random
- whole task performance as opposed to breaking activities into parts
- high contextual interference utilizes enviro that increases the difficulty of learning (noise, crowded enviro, random practice)
- practice in naturalistic settings.
Neurodevelopmental Treatment (NDT) (The Bobath Technique)
- normalization of postural and limb tone is prerequisite to normal movement.
- inhibition of primitive reflexes and abnormal postural and limb movements
- postural reactions are considered the basis for control of movement (righting, equilibrium, and protective responses)
- focus is on improving quality of movement
- handling is the primary intervention to promote normal movement
Proprioceptive Neuromuscular Facilitation (PNF)
- assumption: the response of the neuromuscular mechanisms can be hastened through stim of the proprioceptors
- techniques are superimposed on patterns of movement (diagonals) and posture, focusing on sensory stim from manual contacts, visual cues, and verbal commands.
- normal motor dev proceeds in a cervicocaudal and proixmodistal direction
- frequency of stim and repetitive activity are used to promote and retain motor learning, and to develop strength and endurance.
Brunnstrom’s Movement Therapy
-focuses on facilitating recovery through a specific sequence; tx focused on promotion of movement from reflexive to volitional
Margaret Rood’s Approach
- sensorimotor control is developmentally based; tx must begin at person’s current level and progress sequentially.
- 4 sequential phases of motor control:
1. reciprocal inhibition/innervation (an early mobility pattern that is primarily a reflex governed by spinal and supraspinal center)
2. co-contraction (a simultaneous contraction of agonist and antagonist that provides stability in static pattern.)
3. heavy work (“mobility superimposed on stability”… proximal muscle contract and move and distal segments are fixed.)
4. skill (the highest level of control- combines stability and mobility. Stabilized proximal segment while distal segments move in space.)
What is the Ashworth Scale?
a measure of spasticity (1= normal tone; 5= severe hypertonus/rigidity)
Reflex testing
- utilized to evaluate involuntary stereotyped responses to a particular stimulus
- responses develop during fetal life and persist through early infancy
- reflexes may be released after brain injury or not integrated during early development secondary to CNS pathology
what is dysmetria?
the undershooting (hypometria) or overshooting (hypermetria) of a target.
what is dyssynergia?
a breakdown in movement resulting in joints being moved separately to reach a desired target as opposed to moving in a smooth trajectory; decomposition of movement.
what is dysdiadochokinesia?
impaired ability to perform rapid alternating movements
what is ataxia?
loss of motor control including tremors, dysdiadochokinesia, dyssynergia, and visual nystagmus
what is rigidity?
increased resistance to passive movement throughout the range; may be “cogwheel” (alternative contraction/relaxation of muscles being stretched), or “lead pipe” (consistent contraction throughout range)
what is bradykinesia?
overall slowing of movement patterns
what is kinesia?
inability to initiate movements
what is athetosis?
dyskinetic condition that includes inadequate timing, force, and accuracy of movements in the trunk/limbs; movements are writhing and worm-like.
what is dystonia?
an involuntary sustained distorted movement or posture involving contraction of groups of muscles.
what is chorea?
involuntary movements of the face and extremities which are spasmodic and short duration.
what is hemiballismus?
unilateral chorea characterized by violent, forceful movements of the proximal muscles.
How to assess for glenohumeral joint subluxation?
- allow person’s arm to dangle into gravity
- palpate the space underneath the acromion process with your index finger
- compare to the intact side and document the width of the space in terms of finger breadths.
cock-up splint
- supports wrist in 10-20 deg extension to prevent contracture
- allows digits to function (example: to support flaccid wrist)