neuro interv 1/15 Flashcards
brunnstrom stages of recovery?
• Stage 1: Flaccidity. • Stage 2: Dealing with Spasticity Appearance. • Stage 3: Increased Spasticity. • Stage 4: Decreased Spasticity. • Stage 5: Complex Movement Combinations. • Stage 6: Spasticity Disappears. • Stage 7: Normal Function Returns (see flashcards)
rancho levels of recovery
I. No Response- Appears to be in a deep sleep, unresponsive
II. Generalized Response- Inconsistent, nonpurposeful responses to stimuli. Response is often the same regardless of stimulus.
III. Localized Response Specific but inconsistent response to stimuli. May follow simple localized commands (close eyes, squeeze hand).
IV. Confused-Agitated - Heightened state of activity. Bizarre behavior and nonpurposeful to immediate environment. Unable to cooperate. Lacks memory recall.
V. Confused-Inappropriate- Responds to simple commands. Fragmented response to instruction. Memory severely impaired. Easily distractible.
VI. Confused-Appropriate- Dependent on external instructions. Follows simple directions consistently. Carryover for relearned tasks.
VII. Automatic-Appropriate- appropriate and oriented. Automatic ADL’s (robot-like). Shallow recall.
VIII. Purposeful-Appropriate -Recall and integrate. No supervision required once tasks are learned. Slow increase in cognitive function.
what brunstromm stage?
pt Flaccidity
stage 1
what brunstromm stage?
Dealing with Spasticity Appearance.
Stage 2
what brunstromm stage?
Increased Spasticity.
Stage 3
what brunstromm stage?
Decreased Spasticity.
Stage 4
what brunstromm stage?
Complex Movement Combinations.
Stage 5
what brunstromm stage?
Spasticity Disappears.
Stage 6
what brunstromm stage?
Normal Function Returns
Stage 7
what rancho levels of recovery?
Appears to be in a deep sleep, unresponsive
I. No Response
what rancho levels of recovery?
Inconsistent, nonpurposeful responses to stimuli. Response is often the same regardless of stimulus.
II. Generalized Response
what rancho levels of recovery?
Specific but inconsistent response to stimuli. May follow simple localized commands (close eyes, squeeze hand).
III. Localized Response
what rancho levels of recovery? Heightened state of activity. Bizarre behavior and nonpurposeful to immediate environment. Unable to cooperate. Lacks memory recall.
IV. Confused-Agitated
what rancho levels of recovery? Responds to simple commands. Fragmented response to instruction. Memory severely impaired. Easily distractible.
V. Confused-Inappropriate
what rancho levels of recovery?
Dependent on external instructions.
Follows simple directions consistently.
Carryover for relearned tasks.
VI. Confused-Appropriate
what rancho levels of recovery?
Appropriate- appropriate and oriented.
Automatic ADL’s (robot-like).
Shallow recall.
VII. Automatic
what rancho levels of recovery?
Recall and integrate.
No supervision required once tasks are learned.
Slow increase in cognitive function.
VIII. Purposeful-Appropriate
how many levels rancho los amigos levels of recovery?
8 (1-8)
how many brunnstrom recovery stages?
7 (1-7)
what kind of AFO stop should you use?
patient has knee hyperextension in midstance
articulating AFO with PF stop
what kind of AFO stop should you use?
patient has knee flexion in midstance, weak quad buckles
articulating AFO with DF stop
what functional activity requires increased DF?
going downstairs
what compensations may you see in patient with weak quads during gait?
knee extension, hip flexion to prevent knee buckling
clinical disorder following left or right brain damage in which patients actively push with intact strong side, toward weak side,
- Spontaneous body posture immediately after transitions
- leading to a loss of postural balance- w/wo falling
pusher syndrome
pusher syndrome patient -
what position are UE and LE?
abducted, extended
- hand will be abducted away from the body, the elbow held in extension
- knee and hip held in extension
can you push pusher syndrome patient back to midline?
no
patient will actively resist against therapist’s manual interventions to correct their body posture
how to treat pusher syndrome?
- Enable patient realize actual midline
• visually explore their surroundings and the body’s relationship to their environment and see whether he or she is oriented upright. (eg. mirrors, use reference points- vertical structures, such as door frames, windows or pillars)
• Practicing movements necessary to reach a vertical body position.
• Performing functional activities in vertical body position.
• move out of abduct/ext position > flex elbow, put hand on therapist knee (prevent getting in position to push)
• bobath, NDT
what side should you stand on
side they are pushing towards, weak side
to prevent loss of balance
what are these? • Contract relax • Hold relax • Rhythmic initiation • Slow reversals • Joint distraction
PNF techniques
which PNF technique?
• technique increase increase mobility
• As the extremity reaches the point of limitation, the patient performs a maximal CONCENTRIC contraction of the antagonist muscle group.
• therapist resists or resistance band movement 8-10 seconds with the relaxation to follow.
• This is repeated until no further gains are made
Contract relax
which PNF technique?
• technique increase mobility
• utilized when the agonist is too weak to activate properly or patient has a lot of pain
• restricted muscle is put in a position of stretch followed by an ISOMETRIC contraction of the ALL-muscle groups at the limiting point in the ROM.
• After the allotted time the restricted muscle is passively moved to a position of greater stretch.
Hold relax
which PNF technique?
• technique increase mobility
• Begins with the therapist moving the patient through the desired movement using passive range of motion
• Followed by active-assistive, active- resisted range of motion, and finally active range of motion.
• Used for initiation of movement with hypotonia is present
• Progression – ”Let me move you” – “Help me move you” – “Move against resistance”
• Movements must be slow and rhythmical
Rhythmic initiation
which PNF technique?
• technique increase Stability, controlled mobility and skill
• A technique if slow and resisted concentric contractions of agonists and antagonists around a joint without rest in-between intervals.
• used to strengthen and buildup endurance of weaker muscles and develop co-ordination and establish the normal reversal of antagonistic muscles in the performance of movement.
Slow reversals
which PNF technique?
• technique increase mobility
• increase range of motion around a joint via proprioception
• Consistent manual traction is provided slowly and usually in combination with mobilization techniques
• can also be used in combination with quick stretch to initiate movement
Joint distraction
what month of development?
• can hold head up and begins to push up when lying on tummy
• Makes smoother movements with arms and legs
2 Month
what month of development?
• Holds head steady, unsupported
• Pushes down on legs when feet are on a hard surface
• May be able to roll over from tummy to back, supine to back
4 months
what month of development?
• Can hold a toy and shake it and swing at dangling toys
• Brings hands to mouth
• When lying on stomach, pushes up to elbows
4 months
what month of development?
• Rolls over in both directions (front to back, back to front)
6 Months
what month of development?
• When standing, supports weight on legs and might bounce
• Rocks back and forth, sometimes crawling backward before moving forward
6 Months
what month of development?
• Begins to sit without support
6 Months
what month of development?
• Stands, holding on
• Pulls to stand
9 Months
what month of development?
• Can get into sitting position
• Sits without support
• Crawls
9 Months
what month of development?
• Gets to a sitting position without help
• May take a few steps without holding on
• May stand alone
1Year
what month of development?
• Pulls up to stand, walks holding on to furniture (“cruising”)
1Year
what month of development?
• Walks alone
• May walk up steps and run
18 month
what month of development?
• Pulls toys while walking
• Can help undress herself
18 month
what month of development?
• Drinks from a cup
• Eats with a spoon
18 month
what month of development?
• Stands on tiptoe
2Years
what month of development?
• Kicks a ball
• Begins to run
2Years
what month of development?
• Walks up and down stairs holding on
2Years
what month of development?
• Climbs onto and down from furniture without help
2Years
what primitive reflex?
- protective mechanism
- response to perceived threat, freezes
when appears? integrates? what happens if does not integrate?
fear paralysis reflex
appears - 5-8th wk utero
integrate - birth
retention - anxiety, poor self esteem, sleep/eating disorders, aggression, fear of failure, embarrassment, phobias
what primitive reflex?
- instant arousal of survival systems
-automatic reaction to sudden change, startle response, primitive fight/flight
when appears? integrates? what happens if does not integrate?
moro
appears - birth
integrates - 2-4 month
retention - hyper sensitivity, hyper reactivity, poor impulse control, sensory overload, social and emotional immaturity
what primitive reflex?
- helps baby find food/breastfeed
- turns head toward cheek stimulus
when appears? integrates? what happens if does not integrate?
rooting
appears - birth
integrates - 3-4 months
retention - picky eater, thumb sucking, dribbling, speech and articulation problems
what primitive reflex?
- assist baby grasp development
- hand closes on object in palm
when appears? integrates? what happens if does not integrate?
palmar
appears - birth
integrates - 5-6 months
retention - poor fine motor skills, poor manual dexterity, poor handwriting
what primitive reflex?
- assist baby to get through birth canal
- develop cross pattern movements
- activate by turning head to L/R, ipsi UE/LE extend, contra flex
when appears? integrates? what happens if does not integrate?
ATNR, fencing reflex
appears - birth
integrates - 6 months
retention - difficulty with eye-hand coordination, handwriting, crossing vertical midline, visual tracking
what primitive reflex?
- prepare to crawl
- head down/flex arm bend and legs extend
- head extend/back arms extend legs flex
when appears? integrates? what happens if does not integrate?
STNR symmetrical tonic neck reflex
appears - 6-9 month
integrates - 9-11 month
retention - tendency slump while sitting, poor muscle tone, W-sit, poor eye hand coordination, unable sit still and concentrate
what primitive reflex?
- head management
- postural stability
- forward - head flex forward, body and limbs flexion
- backward- head extend, body and limb extension
when appears? integrates? what happens if does not integrate?
TLD tonic labyrinthine reflex
appears -in utero
integrates - 3.5 yrs
retention - poor muscle tone, W sit, toe walk, poor balance, motion sickness, spatial orientation, gravitational insecurity
what primitive reflex?
- assist birth process, crawl, creep
- hip rotation when back touched on either side of spine
when appears? integrates? what happens if does not integrate?
spinal galant
appears - birth
integrates - 3-9 months
retention - unilateral or bilateral posture issues, fidgeting, bedwetting, clothing issues, poor concentration, poor short term memory
what outcome measure? - able to balance during 14 item list - 5 points, low 0-4 high - 20 minutes to complete - does NOT include gait Is it static or dynamic?
berg balance
- both dynamic and static
berg balance max score? cutoff?
56 max
<45 fall risk
what outcome measure?
- assess postural stability during walking
- perform multiple motor tasks while walking
FGA functional gait analysis
top score FGA outcome measure? cut off score?
30 max
<22 fall risk for community dwelling older adult
what outcome measure? - similar to FGA but less items includes: - stepping in and out of cones - stairs
DGI dynamic gait index
what outcome measure?
- submax exercise test for aerobic and endurance
- distance covered in 6 min
- good for neuro and cardio patients
6 minute walk test
what can patient and therapist NOT do during 6 minute walk test?
- no seated rest break (can stand and rest)
- cannot stop clock
- cannot lead the patient
household ambulation distance?
150ft in 6mwt
