Neuro Intervention - Body Structure and Function Flashcards by Austin Wright

Define: Flaccidity

Absence of tone; complete loss

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Define: Hypotonia

Low muscle tone.

Think… ‘Floppiness’ or ‘Weakness’

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List some of the safety considerations for someone with hypotonia

Head/Neck
* Swallowing difficulties leading to choking and aspiration
* Excessive flexion/extension

Shoulder Girdle
* Joint/Ligamentous Laxity
* Careful handling to prevent damage to joint
* Subluxation
* Range of motion limitations secondary to lack of voluntary movement.
* Pain

Trunk
* Balance and equilibrium reactions absent or decreased
* Poor Breathing
* Poor Posture Control

Hip & Knee
* Instability during transfers and gait
* Joint laxityleading to pain
* Hip subluxation or dislocation

Ankle/Foot
* Instability during transfers and gait
* Joint laxity leading to pain and/or contractures

Overall
* If sensation is compromised: inability to move a limb in reaction for noxious stimuli
* Risk for falls
* Joint Integrity
* Skiin breakdown due to immobility
* Contractures due to immobility

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What is the prognosis for motor recovery post-stroke with a primary symptom of hypotonia?

POOR OUTCOME;

If there is a lack of voluntary motor control of the…

Leg - within 1 week
AND
Arm - No noticable movement within 4 weeks.

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What supportive or protective devices can be used for patients with shoulder subluxation issues?

Traditional Single-Strap Hemisling
Humeral Cuff Sling
GivMohr Sling

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When using a LE AFO or KAFO, what knee motion/movement is being prevented

Knee Hyperextension is being PREVENTED

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What are the different therapeutic techniques used to treat hypotonia?

Positioning & Handling
ROM - Joint Integrity
Weight-Bearing
Facilitation
Strengthening
Shoulder Strapping/Taping
Neuromuscular Electrical Stimulation (NMES)

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True or False:

Contractures are 100% preventable?

True

Contractures are 100% preventable.

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Movement type: Facilitation or Inhibition :

Joint Approximation

Joint Approximation =

Facilitation technique as a result of weight bearinf or loading the joint.

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What are the goals of using the weight-bearing when treating a patient with hypotonia?

(1) Muscle Activation (i.e. - f/ a patient who is flaccid UE post-stroke)

(2) Osteoporosis Prevention & Circulatory Stimulation (i.e. - LE weight bearing post chronic SCI

(3) Postural Alignment

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In regard to “weight-bearing” , what are some progressions that can be made?

Weight shifting
Unilateral Reaching
Manipulation of objects with a fixed component.
Limb movement from a target
Holding & sustaining graded movements.

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What is the goal of a facilitation technique?

Increase Muscle Tone
Increase Muscle Activity

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What methods fall under Facilitation techniques?

Quick Tapping
Quick Stretch
Vibration
Manual Contacts
Resistance
Approximation
Fast brushing/icing

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What is cocontraction used for?

Increases joint stability due to activation of muscles around the joint.

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Define: Irradation/Overflow

Applying maximal resistance to a stronger muscle or muscle group may result in facilitation of a muscle contraction in weaker muscles within the same synergistic movement or in the contralateral extremity.

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What occurs to the human body when applying the fast brushing or icing technique?

Activating tactile and thermoreceptors through bried quick strokes of the skin over a muscle with ice or with the fingertips may promote a muscle contraction.
Contraction is SHORT LIVED
CAUTION – when working with autonomic instability and/or patients with heightened state of arousal

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Strengthening is a _ _ _ _ technique.

Facilitation technique

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When focusing on strengthening as a facilitation technique, what is the overal goal?

Goal = Improve motor unit recruitment if able to facilitate muscle activity.

Perform facilitation techniques then follow up with resistance to IMPROVE MUSCLE CONTRACTION

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Define: Light Tracking Resistance

The maximal allowable resistance while maintaining smooth coordinated movement against gravity.

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Shoulder Strapping/Taping is a _ _ _ _ technique.

Facilitation Technique

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What is the goal when utlizing the shoulder strapping/taping technique?

Goal = Reduce shoulder subluxation or prevent shoulder pain in inividuals poststroke, either as a stand-alone intervention or in combination with electrical stimulation.

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What is the Function/Goal when utilizing Neuromuscular Electrical Stimulation (NMES)?

Function/Goal: Deliver electrical current to specific muscles or peripheral nerves to (in the case of hypotonia or flaccidity) facilitate active muscle contraction & prevent disuse atrophy.

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What is FES and what is the goal/purpose

FES = Functional Electrical Stimulation

Goal/Purpose = Apply NMES in an organized manner to promote goal-oriented movement. which enhances functional motor relearning.

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What type of lesion is typically associated with hypertonia?

Upper Motor Neuron Lesion

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Define: **Dystonia**

A movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both.

What is the effect on muscle tone with a lesion (associted with *hypertonicity*) occurs in the **BRAINSTEM**

- Cortical motor center loss -- INCREASED spastic tone - Supraspinal motor center loss -- SEVERE SPASTICITY (often extensor distribution affected).

What is the effect on muscle tone with a lesion (associted with *hypertonicity*) occurs in the **Subcortical White Matter**

Cortical motor center white matter loss -- INCREASED SPASTIC TONE

What is the effect on muscle tone with a lesion (associted with *hypertonicity*) occurs in the **Primary Motor Cortex**

Corticospinal tract leasion allows motor neurons to fire without modification -- INCREASED SPASTIC TONE

What is the effect on muscle tone with a lesion (associted with *hypertonicity*) occurs in the **BASAL GANGLIA**

Rigidity

What is the effect on muscle tone with a lesion (associted with *hypertonicity*) occurs in the **CEREBELLUM**

Hypotonia

What COMMON drug can be used for both SCI and someone with extreme tone with MS?

Baclofen

Tendon lengthening (or tenotomies) most commonly occur where?

Achille's Tendon

What intervention involves severing sensory nerve fibers and has been said to have the best results when treating pediatric patients with high tone? This is used in "EXTREME CASES"

Selective Dorsal Rhizotomy

What intervention is said to show positive results with parkinsons patients?

Deep Brain Stimulation (DBS)

Deep Brain Stimulation has been proven to work best for which patient population?

Parkinson's

What are the *common adverse events* when using **serial casting**

- Skin irritation and breakdown - Pain - Swelling - Numbness - Nerve Impingement

What are the ***contraindications*** when using **serial casting**

- Medical Instability - Open Wounds - Skin Infection - Cellulitis

What are the ***precautions*** when using **serial casting**

- Impaired sensation - Impaired cognition - Altered communication

What are some **inhibition** techniques?

- Deep Pressure - Joint Traction - Rhythmic Rotation - Sustained Stretch - Warm/Cold - Taping - Biofeedback - Vibration & sonic pulses - E-stim NMES -- Apply to innervated *antagonist* muscle - Acupuncture

What are some **inhibitory techniques** use when treating **rigidity?**

- Passive Stretch - Physical Activity & Physical Exercise - Aquatic exercise in warm water - stretch exercise - Traeger Therapy -- gentle rocking motion, 3-4Hz, 1-4 amplitude 20 min - Whole body vibration - Botox - E-stim & magnetic pulse stimulation

What body postion is said to "break up extensor tone"

Quadruped

Damage to which area of the CNS will typically lead to rigidity?

Basal Ganglia

# Movement Disorders Define: **Dyskinesia**

* Involuntary, erratice, writhing movements of the face, arms, legs or trunk. * Typically a basal ganglia deficit * Abnormal involuntary movement

# Movement Disorders Define: **Tremor**

MOST COMMON involuntary, rhythmic oscillations of reciprocally innervated muscles -- resting, action, postural, essential

# Movement Disorders Define: **Dystonia**

Persitent contraction

# Movement Disorders Define: **Athetosis**

Slow, Writhing movements

# Movement Disorders Define: **Chorea**

abrupt, involuntary, variable, jerky type movmements. Rehab is typically NOT EFFECTIVE for these types or patients.

# Movement Disorders Define: **Ballismus**

Uncontrollable, violent, and/or flailing movements

# Movement Disorders Define: **Tics**

Stereotypical movement or vocalization, habit spasms, sudden, **nonrhythmic** movements

Define: **Myoclonus**

Brief, Sudden, Rapid, and asymmetrical movements.

What *interventions* are used to treat **dystonia?**

* Sensorimotor training * Mirror therapy or mirror box * CIMT * TENS * Transcranial magnetic stimulation (TMS) * Biofeedback * Orthoses * AROM cervical spine/whole body relaxation * KinesioTape Application

What *intervenetions* are use to treat **chorea?**

* Medications * General exercise, customized * Relaxation techniques * Hydrotherapy * Rhythmic Auditory Stimulation

What is the *difference* between **dystonia** and **chorea?**

The two are both *involuntary movement* disorders. However, **Dystonia** = Twisted or repetitive motions, possible abnormal posture. **Chorea** = Ongoing random-appearing sequence of one or more discrete involuntary movements or movement fragments.

If someone has a *tremor*, what is something we can do for the extremity to help with functional practice and ADL continuance?

Adding weight to the extremity with the tremor. (i.e. weighted untencil, cuff weight, etc.)

Which of the following dyskinesias would a patient present with uncontrollable, violent and flailing movements? (a) Tremor (b) Dystonia (c) Myoclonus (d) Ballismus

(d) Ballismus

Define: **Ataxia**

Neurological disorder causing a lack of coordination which often results in difficulty with balance, movement, and speech.

True or False: Ataxia is due to muscle weakness?

FALSE; Ataxia is NOT due to muscle weakness.

If someone has **ataxia**, what are they **unable** to perform?

**Smooth, skilled, adequatley ranged movements** "Leads to walking, valance, and safety issues" - King The individuals have a lack of cooperation between agonist/antagonist muscles.

True or false: **Ataxia** is a *Cerebellar* issue.

TRUE; Cerebellar issue, NOT a strength issue.

What *deficits* are commonly seen in someone with **ataxia/incoordination** issues?

* **Dysmetria** - Inability to judge distance, speed, and force required for movements. * **Dysdiadochokinesia** - inability to perform quick alternating movements (open/close hand, wrist up/wrist down, etc.) * **Tremors** - Involuntary rhytmic shaking movements of limbs. This is uncontrolled. * **Hypometria** - Voluntary movement, but doesn't reach the end of the movement. Falls short

**Ataxia/Incoordination** can occur as a result of what different situations/causes? (Pathology)

Lack/Absence of sensory (proprioceptive) input from the peiphery to the... * Cerebellum ***"OR"*** * Higher sensory centers ***"OR"*** * Lesion/disruption in the interaction of upper and lower motor neurons

What is our number one **goal/focus** when treating someone with **ataxia?**

We want to focus on things that will help with **balance**

True or false: **Peripheral Neuromuscular Facilitation (PNF) **is something that should be included when treating **ataxia**

TRUE "PNF is very important for ataxic individuals" - King

We should always focus on establishing ____ control before promoting proximal or distal control?

Trunk Control BEFORE proximal or distal segments

Which area of the CNS is primarily responsible for **planning** movement?

Motor Cortex