Neurological and Cognitive-Perceptual Approaches Flashcards
Contemporary Task-Oriented Approaches to Motor Control
Reject assumptions of reflex-hierarchical model of motor control and traditional neuro theories
Movement is controlled by the integration and interaction of multiple systems (enviroment, sensorimotor, musculoskeletal, behavioral/emotional goals)
Includes motor learning principles
Believes continued practice of compensatory methods limits functional recovery
Stages of Motor Learning
- Skill Acquisition/Cognitive stage
- Skill Retention/Associated stage
- Skill Transfer/Autonomous stage
Cognitive Stage
of Motor Learning
Develops an understanding of task.
Strategies
Highlight purpose of task
Demo ideal performance of task
Have pt verbalize task components/requirements
Select appropriate feedback- (high dependence on vision; focus on errors as they become consistent; focus on success of movement outcome)
Learner self-eval (id problems/solutions)
Organize initial practice
Assess, modify arousal lvls
Structure environment
Associated Stage
of Motor Learning
Learner practices movements, refines motor program
Dependence on visual feedback decreases; proprioceptive feedback increases
Strategies
Select appropriate feedback- continue to focus on consistent errors and success of outcome; assist learner with self-eval and decision-making
Organize feedback schedule
Organize practice- encourage consistency of performance
Structure environment
Autonomous Stage
of Motor Learning
Learner practices movements; continues to refine motor responses; movements are largely error-free
Strategies
Assesses need for conscious attention, automaticity of movements
Select appropriated feedback- occasional feedback when errors are evident
Organize practice- high lvls of practice are appropriate
Structure enviroment
Focus on competitive aspects of skills as appropriate
Motor Learning Practice
Random practice- practice of several tasks that are presented in a random order, encouraging reformulation of the solution to the presented motor problem
Blocked practice- repeated performance of the same motor skill
Variable conditions- practice of skills in various contexts to improve transfer of learning and retention
Mental practice- cognitive rehearsal of a skill w/o actually moving
NDT Treatment
Inhibit abnormal patterns of movement and posture via handling, positioning, use of key points of control
Goal is to replace the abnormal movement patterns with normal patterns of movement. Secondary result will be more normal sensory input to reinforce the normal movement patterns
PNF Approach
Stimulation of the proprioceptors (in the joints)
Use of reflexes to stimulate normal movement
Focus is on correcting imbalances between the antagonists
Facilitate stronger muscles to stimulate the weaker ones
Use of sensory cues to facilitate normal motor movement (touch, vision, auditory)
Use of diagonal and circular patterns of movement to reinforce normal patterns of movement
Brunnstorm Approach
there is belief to use whatever the patient may have.
Sees the use of synergies as being ok and if used over and over then ultimately they get integrated into more normal patterns of movement
Rood Approach
Felt sensory stimulation assisted with the development of normal muscle tone and motor responses
Treatment uses a lot of vibration, stroking, slow rolling from side to side, brushing, rubbing, followed by a functional motor movement
Assessment of Glenohumeral Joint Subluxation
Allow pt’s arm to dangle into gravity
Palpate the space underneath the acromion process w/index finger
Compare to intact side and document width of space in terms of finger breadths
Direct Intervention (Bolus) Oral Motor Dysfunction
Mod if consistency, amount, and pacing of solids and liquids
Postural interventions to increase swallowing efficiency during meals (chin tuck, head tilt, head turn)
Specific swallowing adaptions
Indirect Intervention (No Bolus) Oral Motor Dysfunction
Thermal (cold) stimulation via chilled dental examination mirror to elicit a swallow reflex
Reflex facilitation
Strengthening, facilitation, and coordination of oral movements
Airway adduction procedures
Positioning
Goals of Orthotic/Splinting Interventions for Neuromotor Dysfunction
Prevent/correct deformity
Control spasticity by aligning joints and providing stretch
Position hand in functional posture
Compensate for weakness
Support painful joint
Promote distal joint mobility
Immobilize to promote healing
Prevent/reduce scarring
Types of Inhibitory/Tone Normalizing Orthoses
Bobath finger spreader- soft splint positions digits/thumb in abd to reduce tone
Rood cone- reduce flexor spasticity in hand
Orthokinetic splints- utilizes tactile input to facilitate and/or inhibit muscle groups
Spasticity reduction splint- places the spastic distal extremity on submaximal stretch to reduce spasticity
Cock-up Splint
Supports the wrist in 10-20* of ext to prevent contracture
Allows digits to function
Ayres Sensory Integration Approach
Assumes:
Neuroplasticity of the CNS allows for its modifications
Sensory integration occurs in a developmental sequential manner
Tactile Modulation for Tactile Defensiveness; Hypo/Hypersensitivity; Sensory Seeking
Self-applied more tolerable than passive application
Apply controlled sensory activities that simultaneously provide tactile and vestibular-proprioceptive info
Begin w/slow linear movements and deep touch-pressure (visible)
Apply tactile stimuli in the direction of hair growth
Follow tactile stimuli w/joint compression
Monitor and adjust stimuli
Assess the child’s behavioral responses
Tactile Discrimination Intervention
Provide deep-touch pressure to the hands/body
Tx for tactile discrimination is usually performed simultaneously when providing tx for deficits in motor planning
Provide graded activities req tactile discrimination activities using a mix of textures/items (rice,sand)
Proprioception Intervention
Deficits in modulation demonstrated by hypersensitivity and sensory seeking
Provide firm touch, pressure, joint compression, or traction
Provide resistance to active movement to help child learn approp amount of force to perform tasks
Provide actv in various positions combining vestibular proprioceptive info (yoga)
Provide slow linear movement, resistance, deep pressure
Use adaptive techniques (weighted vest)
Vestibular Interventions
Deficits in modulation include hyposensitivity, hypersensitivity, sensory seeking, and gravitational insecurity
Grade for type and rate of movement, and for amount of resistance
Slowly intro linear movement w/touch pressure in prone and provide resistance to active movements
Use linear vestibular stimuli to increase awareness of spatial orientation
Provide rapid rotary and angular movements w/freq starts/stops and acceleration/deceleration to increase ability to distinguish the pace of movement (semicircular canals)
Astereognosis
Also know as tactile agnosia
inability to recognize objects, forms, shapes, and sizes by touch alone
Types of Apraxia
Ideomotor: unable to complete activity at will
Ideational: inability to comprehend the concept of movement or execute the act automatically or in response to a command
Constructional: deficit in the ability to copy, draw, or construct a design.
Brocca’s Aphasia
Frontal Lobe
expressive aphasia
Can range from the mildest type with intact comprehension and the ability to communicate through writing to a complete loss of speaking out loud.
Wernicke’s Aphasia
Temporal
receptive aphasia
Somatoagnosia
diminished awareness of body structure and a failure to recognize one’s body parts
Anosognosia
an unawareness of motor deficit
Perserveration
continuation/repetition of motor act or task
Acalculia
inability to perform calculations
Alexia
inability to read
Agraphia
inability to write
Anomia
loss of ability to name objects or retrieve names of ppl
Dysmetria
udershooting (hypometria) or overshooting (hyepermetria) of a target
Dyssynergia
a breakdown in movement resulting in joints being moved separately as opposed to smooth movement
Dysdiadochokinesia
impaired ability to perform rapid alternating movements
Ataxia
loss of motor control or coordination of voluntary movement
Akinesia
inability to initiate movement
Athetosis
writhing movement
Dystonia
involuntary muscle group contractions that cause repetitive or twisting movements
Chorea
involuntary movements of face and extermities
Choreoathetosis
involuntary movements in a combination of chorea (irregular migrating contractions) and athetosis (twisting and writhing).
Hemiballismus
thrashing movements of extremities
Impaired Alertness Intervention
Increase environmental stimuli
Use gross motor activities
Increase sensory stimuli
Motor/Ideomotor Apraxia Intervention
Utilize general verbal cues as opposes to specific
Decrease manipulation demands
Provide hand/hand input
Utilize visual cues
Ideational Apraxia Intervention
Provide step-by-step instructions
Use hand/hand input
Provide opportunities for motor planning/execution
Perseveration Intervention
Bring perserveration to a conscious level and train the pt to inhibit the behavior
Redirect attention
Engage pt in tasks that req repetitive action
Spatial Neglect Intervention
Provide graded scanning actv
Grade actv from simple to complex
Use anchoring techniques
Utilize manipulative tasks in conjunction with scanning actv
Use external cues (colored markers, written directions)
Body Neglect Intervention
Provide bilateral actv
Guide the affected side thru the actv
Increase sensory stimulation to the affected side
Aphasia Intervention
Decrease external auditory stimuli
Give increased response time
Use visual cues and gestures
Use concise sentences
Investigate the use of augmentative communication devices
Sequencing/Organizing Deficit Intervention
Use external cues (written directions, daily planners)
Grade tasks that are increasingly complex in terms of # of steps req
Spatial Relations Dysfunction Intervention
Utilize actv that challenge underlying spatial skills (orienting clothing to body during dressing, wrapping a gift, making a bed)
Utilize tasks that req discrimination of right/left (dress right arm first, plates in left cabinet)
Memory Loss Intervention
Use rehearsal strategies
Chunk info
Utilize memory aids
Utilize temporary tags focusing on when the event to be remembered occurred
Increased LE edema and pain CVA pt
may indicate a cardiovascular complication, such as deep vein thrombosis, which requires immediate attention from the nurse.
Any intervention should be discontinued.
