Neuro peds UE training and strengthening Flashcards
what is the difference btwn learned non-use and developmental disregard?
learned non-use we see a lot in the adult population after stroke
Developmental disregard: peds patients because they haven’t even had the chance to develop it yet
throughout development connections are pruned off, what happens when you have a lesion?
your brain has to rewire the existing synapses, this wont happen if you wont use it!
what is the difference btwn forced use and CIT (constraint induced therapy)?
forced is is they just go home with a cast and they go throughout their day, its not therapeutic in nature.
CIT: intense therapy
true or false: all models of CIT have shown improvement in UE function
true!
what is the big pro of HABIT?
younger kids being able to learn to use both hands together, its the PRACTICE that matters
did CIT or HABIT have improved grasp?
CIT
what are the four key components to neuromotor recovery?
repetition
shaping
functional practice
behavior change
what is shaping
individualized tasks to work on specific movements
signature CIT how much % of waking hours is it worn
intense training for how many hours a day for 2 weeks
90%
intense training for 3 hours EVERYDAY for at least 2 weeks
how many hours a day and days a week is the restraint worn for modified CIT?
5 hours a day
5 days a week
intense training 2 hours a day 3x a week
brushing teeth and opening baggies vs. stacking blocks or placing push pins
functional practice
vs.
shaping
critical piece of UE training she said
behavior change!! can make a behavior contract
what creates gains 2.4 x higher than if you don’t use it
behavior contracts/going through life everyday as practice
Saeboflex would be used for what population
someone who has a lot of spasticity impeding function
reoGO is what kind of device
robotic: can give different things depending on what they need
what does physiological flexion allow infants
mechanically stable base; they constantly practice active movement which builds trunk and proximal limb strength which you need before distal mobility
in atypical development what does an infants posturing normally look like
hips, knees, elbows extended
in atypical development when children are extended what does this do to the proximal muscles?
they are at a mechanical disadvantage to initiate movement.
which is normal development: repetitive movement or no movement?
repetitive: leads to increased strength and better control
which is normal development: more movement patterns or less?
more! atypically developing kids have.a limited number of movement patterns they can use
large arcs of motion vs. ballistic patterns, which is normal development?
large arcs of motion: allows strengthening with more degrees of freedom
which is normal development: practice of components or no practice?
practice of components: they go through smaller trials of movements
reciprocal inhibition is normal or not?
it is normal, you need to be able to shut off muscles to do certain movements
atypically developing children have decreased reciprocal inhibition therefore increased co-contraction
what 2 things are normally weak in the trunk area and what are the issues with these things
spinal extensors: can’t move against gravity and creates hypermobility at joint junctions
abdominals; impacts breathing!
what are the three common problem muscles in the hip and what is the impact of this
extensors: not enough strength to gain full range
flexors: shortened
hip ABD; moment arm disadvantage due to muscle size
Match the following
distal
proximal
elongation
shortening
talking about the patella and rectus
distal elongation of patella tendon
proximal shortening of the rectus
match the following
distal
proximal
elongation
shortening
talking bout the hamstrings
distal shortening: med
no foot to mouth play due to extended posturing and no supported bouncing lead to what weaknesss?
DF and PF
true or false: strength training was previously thought to be contraindicated for children with neurologic conditions
true! especially those with hypertonicity
they believed that poor motor control precluded performance of strength training exercises
true or false: isolated motor control is a prerequisite for participation in strength training programs
false! we now kids with CP we can strengthen
is strength training a new idea in neurologic population!
nope we know its going to work for a long time now
how do you chose which muscles to target?
base it on your examination, interview the patient and family and find out what is the most important for them!
Name the four muscles typically strengthened for CP
quads
glutes
abdominals
extensors
whats the deal with strengthening gastroc hamstrings hip ABD DF
theyre difficult to isolate for desired motion
may require NMES or FES intervention
what is the ideal % for OC exercise
what about CC exercise
65%
50 to 100% more
how do you progress the training load?
retest MVIC every 2 weeks
whats the rule if you don’t have a HHD for OC exercises
how do you check if you’re right
double or triple what you’re thinking
with this weight strapped on see if they can ACTIVELY move through 50% of their ROM
what are some things to think about when doing CC exersises
maximize technique and alignment first, move through shorter ROM if needed
what is the dosage for these kids.
reps
sets
rest
5-8 reps
5-6 sets
90-120 sec rest:
THINK FIVE SETS OF FIVE they need a lot more rest! can be just the other side working
what is the deal with frequency for these kids
3-5days a week
2 days rest between is optimal!
Back to back days is seen to be just as effective as training once a week
open chain non functional exercises use distal or proximal load placement?
distal!
open chain functional exercises use distal or proximal load?
proximal! their bodies are already heavy enough, put it on their proximal muscles
what does the theraband provide that cuff weight does not
graded resistance
any closed chain exercise where do you want the load, distal or proximal?
Proximal
for closed chain exercise you are trying to maintain sagittal plane alignment, who is this super important for?
super important for skeletally immature population
what is super important for these kids HEP
one exercises a week, work up to 6-8
