Neurodevelopmental Treatment Flashcards
Central problems with hemiplegia
- Loss of postural control and selected movement
- Abnormal tone and movement
- Spasticity develops in selected muscles
- Often accompanied by “associated reactions”
Above problems lead to non-functional movement patterns and functional limitations
Basic Principles
- Normal movement sequences and balance are focus of intervention
- Emphasis is normalization of sensory and perceptual experiences through tactile and kinesthetic stimulation
- Treatment is individualized
- Abnormal tone, primitive reflex patterns and mass synergies interfere with normal movement patterns
- Treatment focuses on inhibiting or eliminating patterns, normalizing postural tone, promoting active control of movements
What are key points of NDT when working with persons with stroke?
- Manual techniques
- Goals = prevent or eliminate abnormal tone and coordination, retrain normal movement responses, increase functional use of hemiplegic side
- Handling = provides specific tactile, proprioceptive and kinesthetic messages which help patient to organize quality of movement (key points of control - where therapist strategically places hands and facilitation and inhibition)
NDT Inhibition
Used when there is abnormal tone and coordination
- Decrease spasticity
- Block or eliminate abnormal patterns of movement
- Use of reflex inhibiting patterns (RIPs)
Facilitation
Used when trying to normalize tone
- Activate automatic postural responses and trunk control
- Re-educate weight-bearing and non-weight bearing movements in arm and leg
- Functional activities are incorporated
Occupational Functioning
- Lower level functional prerequisites may not result in improvements
- Occupation-as-means: use activities to provide motor learning opportunities (ex: cooking while weight-bearing)
- Occupation-as-end: patient directly engaged in learning task (ex: self-care tasks while engaging in symmetry)
Common Problems of CVA
- Posture
- Motor
- Asymmetry
- Non-weight bearing
- Fear
- Sensory loss
- Neglect
- Painful shoulder
Assessment
1) Observation
2) Handling - identify abnormal and normal movement patterns on involved side
3) Placing response - pt holds position if movement control is present on hemiplegic side
Functional Outcomes
- Functional goals set through occupation-as-means and occupation-as-end
- Basically goals depend on patient problems, level of independence, movement control, patient’s needs
- Goals are ongoing as patient status improves
Techniques
- Encourage weight-bearing over involved side: most effective for regulating tone and increases client awareness of involved side
- Encourage trunk rotation: most common for clients to move in “block-like” pattern and by stimulating trunk rotation the individual becomes more stable and trunk rotation increases the visual field
- Encourage trunk elongation: common posture - scapular retraction with downward rotation and posterior pelvic tilt/retraction and gentle stretching
- Encourage scapular protraction
What are other techniques to normalize tone:
1) Proper positioning
2) Slow, controlled movements
Bed positioning
If laying on affected side: put affected forearm under pillow and extend affected leg, place bent unaffected leg on pillow
If laying on unaffected side: put affected arm over a pillow laying horizontally across from shoulder and put affected leg bent on pillow
If laying on back place a pillow along the affected side so that shoulder, arm, and affected hip are supported by pillow
Rood and Proprioceptive Neuromuscular Facilitation
- Both of these theories use reflex arcs to elicit particular types of motor responses by supplying sensory stimulation in a controlled way
- Both address vital functions (respiration, facial motions, swallowing, bowel and bladder control)
- Facilitation and inhibition of muscle function along with concepts of stability and mobility are basic to application of controlled sensory stimulation used in both approaches
Stability and Mobility
- Determine if limitation is due to instability or due to a mobility problem
- If both are problems, then start with stability first
- Mobility: adequate functional ROM and ability to initiate and sustain AROM
Rood and PNF: Abnormal Tone
- Goal is to normalize tone
- Hypertonicity: can lead to malalignment of trunk and limbs which can lead to contractures with subsequent deformity
- Hypotonicity: important to counteract joint subluxation, over stretching of muscles, edema, pain, and contracture
What is Proprioceptive Neuromuscular Facilitation known for?
- Mass movement patterns that are spiral and diagonal in nature and resemble movement seen in functional activities
- Patterns are unilateral, bilateral, and total patterns
- Originated in the 40’s and developed through the 50’s and key therapists were Margaret Knott and Dorothy Voss who are both PTs
What does PNF believe impacts motor learning?
Auditory
- Verbal commands (brief and clear)
- Verbal mediation (say steps aloud)
Visual
- Positioning of self and objects
Tactile
- Manual contacts
Assess proximal to distal to evaluate internal control
PNF Assessment (Proximal to Distal)
1) Vital and related functions: breathing, swallowing, voice quality, visual-motor control
2) Head and neck region: note dominance in tone, alignment, stability, and mobility
3) Upper trunk
4) Upper extremities
5) Lower trunk
6) Lower extremities
7) ADL’s
What does PNF treatment look like?
- Works toward the pt’s goals
- Therapist uses the patterns of movements and procedures to facilitate movement into function
- PNF uses total patterns rather than breaking down the movement. A PNF therapist would not have pt practice wrist extension without doing the entire pattern
PNF Diagonals
1) The diagonal patterns are mass movement patterns observed on most functional activities
2) Part of the challenge is recognizing the diagonal patterns in ADL’s
3) Knowledge of the diagonals is necessary to identify the areas of deficiency
4) Each diagonal pattern has a flexion and extension component - shoulder and hip only
5) The reference points for flexion and extension are the shoulder and hip joints of the UE and LE
6) The movements associated with each diagonal are seen in self-care and other ADL’s
7) Eyes follow the hand of the leading arm so that head and hand cross midline
How are PNF Diagonals named?
- Extremity: U and L patterns are named by using the motion components of the proximal pivot (UE = shoulder, LE = hip)
- D - diagonal
- 1 or 2
- F or E (flexion or extension)
Example: UE D1 F or UE D2 E
PNF Diagonal One
- D1 extension begins in the shortened range of D1 flexion with hand closed toward radial side
- D1 extension leads with hand opening toward the ulnar side
- Eyes follow hand of leading arm so that head and hand cross midline
- Elbows may remain straight, may flex or extend
What are functional examples of UE D1 F and E
Examples of D1 Diagonal:
Brushing hair across body (UE D1 flexion) and opening car door (UE D1 extension)
PNF Diagonal Two
- D2 flexion begins in shortened range of D2 extension with hand closed toward the ulnar side
- D2 flexion leads with hand opening toward radial side
- All diagonal patterns, head to foot, cross midline when performed through full range
- Elbows may remain straight, may flex or extend
What are functional examples of UE D2 F and E
Examples of D2 Diagonal:
Brushing hair and twisting to put belt into back belt loop
PNF Symmetrical
Paired extremities perform similar movements at the same time
