Neuro Rehab

Question 1

Adam’s closed loop theory

Answer 1

Sensory feedback is an ongoing process for the nervous system to compare current movement with stored information or memory of past movement

Question 2

Schmidt’s schema theory

Answer 2

Open loop processes and a motor program concept. Promotes clinical feedback and importance of variation with practice

Question 3

Cognitive stage of motor learning

Answer 3

1st stage of motor learning. Requires high concentration of conscious processing. Acquire information regarding goal and problem solving. Required controlled environment.

Question 4

Associative stage of motor learning

Answer 4

2nd stage of motor learning. More independently distinguishing correct from incorrect performance. Can use less structured environment and less external feedback.

Question 5

Autonomous stage of motor learning.

Answer 5

3rd stage of motor learning. Improves efficiency of activity without need for cognitive control. Can perform the task with interference from a variable environment.

Question 6

Massed practice

Answer 6

Practice time greater than rest between trials

Question 7

Distributed practice

Answer 7

Rest time between trials equal or greater than amount of practice time for each trial

Question 8

Constant practice

Answer 8

Practice under a uniform condition

Question 9

Variable practice

Answer 9

Practice under differing conditions

Question 10

Random practice

Answer 10

Varying practice amongst different tasks

Question 11

Blocked practice

Answer 11

Consistent practice of a single task

Question 12

Whole training

Answer 12

Practice of an entire task

Question 13

Part training

Answer 13

Practice of component of a task

Question 14

Closed system model

Answer 14

Incorporates multiple feedback loops and larger distribution of control. Nervous system is active participant with ability to initiate movement, as opposed to solely reacting to stimuli.

Question 15

Open system model

Answer 15

Characterized by single transfer of information without any feedback loop (reflexive hierarchical theory). Nervous system is seen as awaiting stimuli in order to react.

Question 16

Carr and Shepherd: Motor Relearning Approach

Answer 16

Based on the idea that factors involved with learning are also involved with relearning and should include:
 Identification of a goal
 Inhibition of unnecessary activity that does not relate to normal movement
 Ability to adjust during activity to effects of gravity and balance
 Proper body alignment
 Proper motivation
 Incorporate internal/mental practice in addition to external/physical practice
 Feedback
 Knowledge of results

Question 17

Bobath: Neuro-Developmental Treatment (NDT)

Answer 17

Based on hierarchical model of neurophysiologic function. Abnormal postural reflexes and abnormal muscle tone caused by loss of CNS control at brainstem and spinal cord. Uses key points of control for facilitation and inhibition.

 Postural control can be learned and modified through experience
 Postural control uses both feedback and feed-forward mechanisms for execution of tasks
 Postural control is initiated from BOS
 Postural control is required for skill development
 Postural control develops by assuming progressive positions where there is an increase in distance between COG and BOS. BOS should also decrease.

Question 18

Brunnstrom: Movement Therapy in Hemiplegia

Answer 18

Uses hierarchical model

Seven Stages of Recovery used to evaluate and document patient progress

Question 19

Seven Stages of Hemiplegia Recovery: Stage 1

Answer 19

No volitional movement

Question 20

Seven Stages of Hemiplegia Recovery: Stage 2

Answer 20

Basic limb synergies. The beginning of spasticity.

Question 21

Seven Stages of Hemiplegia Recovery: Stage 3

Answer 21

Synergies performed voluntary, spasticity increases.

Question 22

Seven Stages of Hemiplegia Recovery: Stage 4

Answer 22

Spasticity begins to decrease. Movement patterns are not solely dictated by limb synergy patterns

Question 23

Seven Stages of Hemiplegia Recovery: Stage 5

Answer 23

Further decrease in spasticity with independence from limb synergy patterns

Question 24

Seven Stages of Hemiplegia Recovery: Stage 6

Answer 24

Isolated joint movements are performed with coordination

Question 25

Seven Stages of Hemiplegia Recovery: Stage 7

Answer 25

Normal motor function is restored

Question 26

Associated reaction

Answer 26

An involuntary movement as the result of an intentional movement of another body part

Question 27

Homolateral synkinesis

Answer 27

Flexion pattern of the UE facilitates flexion of the LE.

Question 28

Kabat, Knott, and Voss: Proprioceptive Neuromuscular Facilitation (PNF)

Answer 28

Uses hierarchical model
Normal movement based on balance between control of antagonist and agonist muscles
Emphasis on manual contacts and handling, short/concise verbal commands, and resistance throughout full movement pattern
Uses methods that promote the response of neuromuscular mechanism through stimulation of proprioceptors

Question 29

Overflow

Answer 29

Muscle activation of an involved extremity due to intense action of an uninvolved muscle or group of muscles

Question 30

Developmental sequence: a progression of motor skill acquisition

Answer 30

Mobility: Ability to initiate movement through a functional ROM
Stability: Ability to maintain position or posture through co-contraction and tonic holding around a joint.
Controlled mobility: Ability to move within a weight bearing position or rotate around a long axis.
Skill: Ability to consistently perform functional tasks and manipulate the environment with normal postural reflex mechanisms and balance reactions.

Question 31

Agonistic Reversals

Answer 31

Controlled mobility, skill
Concentric contraction against resistance followed by alternating concentric or eccentric contraction with resistance. May be used in increments throughout the range to maximize control.

Question 32

Alternating Isometrics

Answer 32

Stability
Isometric contractions are performed alternating from one side of a joint to the other without rest.
Emphasizes endurance or strengthening.

Question 33

Contract-Relax

Answer 33

Mobility (Increase ROM)
Pt performs max contraction of antagonist muscle group as joint reaching limit of ROM. Therapist resists movement for 8-10 seconds followed by relaxation. Repeated until no further gains in range are made during the session.

Question 34

Hold-Relax

Answer 34

Mobility (Increase ROM)
Isometric contraction of all muscle groups at the limited point in ROM. Followed by relaxation and taking up new range.
Often used with patients that present with pain.

Question 35

Hold-Relax Active Movement

Answer 35

Mobility (Increase ROM)
Used to improve initiation of movement for muscle groups tested at 1/5 or less.
Isometric contraction performed with extremity passively placed into a shortened range within the pattern. Upon relaxation, extremity is moved into a lengthened position of the pattern with a quick stretch. Pt asked to return extremity to shortened position through isotonic contraction.

Question 36

Joint Distraction

Answer 36

Mobility (Initiate movement)
Proprioceptive component used to increase ROM around a joint. Can be used in combination with mobilization or quick stretch to initiate movement.

Question 37

Normal Timing

Answer 37

Skill (Distal functional mobility)
Used to improve coordination of a task.
Performed in distal to proximal sequence. Proximal components are restricted until the distal components are activated and initiate movement.

Question 38

Repeated Contractions

Answer 38

Mobility
Used to initiate a movement pattern throughout a weak movement pattern. Therapist provides quick stretch followed by isometric or isotonic contraction.

Question 39

Resisted Progression

Answer 39

Skill (Proximal dynamic stability)
Used to emphasize coordination of proximal components during gait.
Resistance provided to pelvis, hips, or extremity during the gait cycle to enhance coordination, strength, or endurance.

Question 40

Rhythmic Initiation

Answer 40

Mobility
Used to initiate movement when hypertonia exists.
Progresses from passive to active assisted to slightly resisted
Movement must be slow and rhythmical to reduce hypertonia and allow for full ROM

Question 41

Rhythmic Stabilization

Answer 41

Mobility, stability
Used to increase ROM and coordinate isometric contractions.
Isometric contraction of all muscles around a joint against progressive resistance. Pt should relax and move into the newly acquired range.

Question 42

Rhythmical Rotation

Answer 42

Mobility

Used to decrease hypertonia by slowly rotating an extremity passively.

Question 43

Slow Reversal

Answer 43

Stability, controlled mobility, skill
Slow and resisted concentric contractions of agonists and antagonists around a joint without rest between reversals
Used to improve control of movement and posture

Question 44

Slow Reversal Hold

Answer 44

Stability, controlled mobility, skill

Slow reversal with an isometric contraction at the end of each movement to gain stability

Question 45

Timing for Emphasis

Answer 45

Skill
Used to strengthen the weak component of a motor pattern
Isotonic and isometric contractions produce overflow to weak muscles.

Question 46

Rood

Answer 46

Based on reflex stimulus model. Believed that all motor output is the result of both past and present sensory input. Movement is considered non-cognitive and autonomic.
Used sensory stimulation to facilitate or inhibit responses or elicit reflex motor responses
Once response is obtained during treatment via sensory feedback, the stimulus should be withdrawn.

Question 47

Facilitative techniques

Answer 47

Approximation, joint compression, icing, light touch, quick stretch, resistance, tapping, traction

Question 48

Inhibitory techniques

Answer 48

Deep pressure, prolonged stretch, warm, prolonged cold