Neuro approaches (ch 12) COPY 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)
resting hand splint
-utilized for people who need to have their wrist, digits, and thumb supported in a functional position for prolonged periods (such as when developing contracture of the long flexors)
opponens splints
- may be short or long
- designed to support the thumb in a position of abduction and opposition
- utilized during functional activities to compensate for weakness patterns.
Bobath finger spreaders (abduction splint)
soft splint that positions the digits and thumb in abduction in an effort to reduce tone
Rood cone
- cone-shaped splint that is utilized to reduce flexor spasticity in the hand.
- based on Rood’s inhibitory principles of sustained deep pressure.
orthokinetic splints
-utilizes tactile input (via elastic bands usually) to facilitate and/or inhibit appropriate muscle groups.
spasticity reduction splint
-places the spastic distal extremity on submaximal stretch to reduce spasticity
overhead suspension sling
- this orthotic device incorporates an arm support that is supported by a sling and suspended by an overhead rod.
- people with proximal weakness (ALS, Guillian-Barre, muscular dystrophy) with muscle grades in 1/5 to 3/5 range are appropriate candidates
balanced forearm orthoses (mobile arm supports or ball-bearing forearm orthoses)
- consists of an arm trough, proximal and distal arms, and a support bracket
- allow a patient with weak proximal musculature to utilize available control of the trunk and shoulder to engage in functional tasks
shoulder slings
- utilized to support a flaccid arm after neurologic insult for short and controlled periods of time.
- long-term use may be detrimental in term of soft tissue contracture, edema, and development of pain syndromes.
Splinting considerations…
- wearing schedules must be prescribed to enhance function of the splint. (splints for decrease in spasticity or reverse contractures require longer wearing times.)
- splints must be monitored for pressure over bony prominences
- donning/doffing procedures should be reviewed with patient and caregiver and be documented.
- appropriate material must be chosen based on resistance to stretch, memory, conformability/drape, rigidity/flexibility, and self-adherence
Eval of oral motor dysfunction
- ROM, stretch, and tone of lips, cheeks, and tongue
- etra- and intra-oral senstion
- dentition
- oral control of bolus (contain bolus, form bolus, and propel posteriorly)
- presence of swallow reflex
- airway protection via: gag reflex, volitional and spontaneous cough, vocal fold adduction (to close off airway), reflexive inhibition of respiration
- relaxation of esophageal sphincter
- primitive reflexes (rooting, jaw jerk, bite, ATNR/STNR)
- CN testing
- objective testing (barium swallow, videoflouroscopy)
Cranial Nerves! (name, function, testing procedure)
CN I
Olfactory- sensory
Sense of smell
Testing: person sniffs various aromatic substances.
Cranial Nerves! (name, function, testing procedure)
CN II
Optic- sensory
Vision
Testing: Eye-chart testing, visual field testing
Cranial Nerves! (name, function, testing procedure)
CN III
Oculomotor- motor AND sensory!
(motor) Fibers to the superior, inferior, and medial rectus muscles of the eye and to the smooth muscle controlling lens shape. Medial and vertical eye movements.
(sensory) proprioception of the eye
Testing: pupil sizes are compared for shape and equality, pupillary reflex is tested; visual tracking is tested.
Cranial Nerves! (name, function, testing procedure)
CN IV
Trochlear- motor AND sensory!
Proprioceptor and motor fibers for superior oblique muscle of the eye. Downward and inward eye movements.
Testing: tested with CN III relative to following moving objects.
Cranial Nerves! (name, function, testing procedure)
CN V
Trigeminal- motor AND sensory!
Motor and sensory for face, conducts sensory impulses from mouth, nose, eyes; motor fibers for muscles of mastication. Control of jaw movements.
Testing: pain, touch, and temperature are tested with proper stimulus; corneal reflex tested with a wisp of cotton; person is asked to move jaw through full ROM.
Cranial Nerves! (name, function, testing procedure)
CN VI
Abducens- motor AND sensory!
Motor and proprioceptor fibers to/from lateral rectus muscle. Lateral eye movements.
Testing: tested in conjunction with cranial nerve III relative to moving eye laterally.
Cranial Nerves! (name, function, testing procedure)
CN VII
Facial- motor AND sensory!
(sensory) fibers to taste buds and anterior 2/3 of tongue;
(motor) fibers to muscles of facial expression and to salivary glands.
Testing: check symmetry of face, ask person to attempt various facial expressions; sweet, salty, sour, and bitter substances are applied to tongue to test tasting ability.
Cranial Nerves! (name, function, testing procedure)
CN VIII
Vestibulocochlear- sensory
Transmits impulses for senses of equilibrium and hearing.
Testing: hearing is checked with a tuning fork
Cranial Nerves! (name, function, testing procedure)
CN IX
Glossopharyngeal- motor AND sensory!
(motor) fibers for pharynx and salivary glands;
(sensory) fibers for pharynx and posterior tongue. Taste sensation for sweet, bitter, and sour.
Testing: gag and swallow reflexes are checked; posterior one third of tongue is tested for taste.
Cranial Nerves! (name, function, testing procedure)
CN X
Vagus- motor AND sensory!
(sensory/motor) impulses for larynx and pharynx;
(motor) parasympathetic motor fibers supply smooth muscles of abdominal organs;
(sensory) impulses from viscera
Testing: tested in conjunction with cranial nerve IX
Cranial Nerves! (name, function, testing procedure)
CN XI
Spinal Accessory- motor AND sensory!
(sensory/motor) fibers for sternocleidomastoid, trapezius muscles, muscles of soft palate, pharynx, and larynx. Movement of neck and shoulders.
Testing: sternocleidomastoid and trapezius muscle testing.
Cranial Nerves! (name, function, testing procedure)
CN XII
Hypoglossal- motor AND sensory!
(motor/sensory) fibers to/from tongue; Movement of tongue.
Testing: ask person to stick out tongue, positional abnormalities are noted.
Postural interventions to increase swallowing efficiency during meals…
- chin tuck
- forward head tilt/chin tuck
- head turn
Sensory Integration and Praxis Tests (SIPT) (population, what does it measure?)
Population: 4-8.11 years of age
Measures: the relationship among tactile processing, vestibular-proprioceptive processing, visual perception, and practic ability, bilateral integration.
*Admin and scoring requires certification.
DeGangi-Berk Test of Sensory Integration (TSI) (population, measures what?)
Population: 3-5 y/o
Measures: sensory integrative function with focus on the vestibular system. 3 areas: bilateral motor coordination, postural control, and reflex integration.
Test of Sensory Function in Infants (population, what does it assess?)
Population: 1-18 months
Assesses the level of an infant’s sensory responsiveness to a variety of sensory stimuli.
Sensory Processing Measure (SPM) (population, what does it measure?)
Population: elementary school age children
Measures sensory processing, praxis, and social participation across different environments. Assesses visual, auditory, tactile, olfactory-gustatory, proprioceptive, and vestibular behaviors.
Intervention for tactile deficits: tactile modulation
- self-applied stimuli is more tolerable
- provide firm pressure making sure that child can see the source of stimuli.
- begin with slow linear movements and deep touch pressure.
- apply tactile stimuli in direction of hair growth
- follow tactile stim with joint compression
Intervention for tactile deficits: tactile discrimination
- provide deep touch pressure to hands and body
- deficits are rarely in isolation- usually treating motor planning deficits too.
- provide graded activities requiring tactile discrim using a mixture of textures and items.
Intervention for proprioception deficits
- provide firm touch, pressure, joint compression, or traction;
- provide resistance to active movement to help child learn appropriate amount of force to perform tasks
- provide activities sin various body positions (like yoga)
- provide slow linear movement, resistance, and deep pressure.
- use adaptive techniques (like weighted vests)
- for proprioceptive discrimination deficits: provide tx as above, as well as activities requiring child to demonstrate ability to grade the force/efforts of movement.
Intervention for vestibular deficits
- grade for type and rate of movement and amount of resistance (careful with precautions)
- slowly introduce linear movement with touch pressure in prone and provide resistance to active mvmnts, esp for gravitational insecurity.
- use linear vestibular stimuli to increase awareness of spatial orientation (otolith organ!)
- provide rapid rotary and angular movements with frequent starts/stops and acceleration/deceleration to increase ability to distinguish the pace of mvmnts (semicircular canals)
