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OT Process > Neurological Approaches > Flashcards

Neurological Approaches Flashcards

1
Q

Sensorimotor Approaches

A

NDT, Proprioceptive Neuromuscular Facilitation (PNF), Brunnstrom’s Approach & Rood’s Approach - used for pts w CNS dysfun

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2
Q

Sensorimotor Approaches

A

NDT, Proprioceptive Neuromuscular Facilitation (PNF), Brunnstrom’s Approach & Rood’s Approach

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3
Q

General Assumptions of Sensorimotor Approaches

A

Controlled mvmt is preceded by stereotypic reflexes. Sensory input regulates motor output (sensation necessary for mvmt). Norm mvmts are governed by hierarchical centralized motor programs that determine muscle activation patterns. Damage to higher control centers release primitive reflexes/mvmt patterns form inhibition. When basic mvmts/postures are normalized skilled mvmt will occur automatically. Integration of lower level reflexes occurs by eliciting higher level righting/equilibrium responses. Controlled sensory input provided by OT can influ motor responses. Use of facilitation/inhibition techs can improve motor performance

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4
Q

NDT/Bobath Tech Principles

A

Normalization of postural/limb tone is a prereq to normal mvmt. Inhib of prim reflexes/abnorm mvmts. Focus: Improve OVERALL qual of mvmt (&of involved side). Avoidance of acts that increase tone/associated reactions. *Postural reactions are considered basis for control of mvmt (righting, equilibrium & protective). Loss of postural control results in overuse of sound side.

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5
Q

NDT/Bobath Tech Focus

A

Improve qual of mvmt: norm of mvmt pattersn, integ of both sides, est ability to weight bear/shift & est of norm righting/equilibrium patterns. * Handling is prim intervention to promo norm mvmt

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6
Q

PNF Principles

A

Response of neuromus mechanisms can be hastened thru stim of proprioceptors . Utilized for neurolog/orthopedic pops t/o lifespan. Techs are superimposed patterns of mvmt/posture. Norm motor dev = cervico-caudal & proximodistal. Early motor behavior is dom by reflexes & characterized by spontaneous flex/ex mvmt. Shifts between flex/ex dom in development. Goal-directed acts coupled w techs of facilitation are used to hasten learning of total patterns of walking/selfcare. Goal directed acts are made up of reversing mvmts.

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7
Q

PNF Diagonal Patterns

A

All patterns cross midline & encourage rotary components of mvmt. UE are ID-ed as D1/D2, Flex/Ex. *Fist width from head

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8
Q

PNF: D1 Flex

A

Scapula: abduct & upward rot. Shoulder: flex, adducted & ex rot. Elbow: slight flex. Forearm: Supinated. Wrist: flex to radial side. Fingers/thumb: Flexed & adducted
*Start down by side and come up to opp ear-lead w pinky

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9
Q

PNF: D1 Exten

A

Scap: adducted & downward rot. Shoulder: exten, abducted & in rot. Elbow: Exten. Forearm: Pronated. Wrist: extended to ulnar side. Fingers/thumb: exten/abducted
*Come back down from opp to ear to right side

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10
Q

PNF: D2 Flex

A

Scapula: adduct & upward rot. Shoulder: flex, abducted & ex rot. Elbow: exten. Forearm: supinated. Wrist: ex to radial side. Fingers/thumb: exten/abducted
*Start down at opp hip and come up to same ear

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11
Q

PNF: D2 Exten

A

Scap: abducted & downward rot. Shoulder: exten, adducted & in rot. Elbow: toward flex. Forearm: Pronated. Wrist: flexed to ulnar side. Fingers/thumb: flex/abducted/opposed
*Come back down from same ear to opp him

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12
Q

Brunstromms Mvmt Therapy

A

Focused on recover thru specific sequence. Tx focused on promo of mvmt from reflexive to volitional - 7 stages of motor recovery - includes ID of developing synergies

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13
Q

Rood’s Approach Principles

A

Sensorimotor control is dev based - tx must begin at pt current level and progress sequentially. 4 phases of motor controls. Muscle responses of agonist/antagonist & synergists are believed to be reflexively programmed. Ontogenic motor patterns. *Proposed that the motor response achieved is dependent on type of sensory stim

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14
Q

Rood’s 4 sequential motor phases

A
  1. Reciprocal inhibition/innervation - early mob pattern that is prim a reflex governed by spinal/supraspinal centers. 2. Co-contraction: Defined as a simultaneous contraction of agonist/antagonist that provides stability in static pattern. Used to hold position for long period of time. 3. Heavy work: Aka mobility superimposed on stability. prox mus contract/move & distal segs are fixed. 4. Skill - consist of stabilized prox seg while distal segs move in space
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15
Q

Spasticity Eval

A

Evaled by elicitation of velocity dependent stretch reflexes. Limb is quickly stretched in a direction opp the pull of the mus group being tested. Objectively measured by 5pt Ashworth (1=norm & 5=sever hypertonus/rigidity) or Mod Ashworth (0=no increase & 4=rigid in flex or exten)

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16
Q

Reflex Testing

A

Used to eval invol stereotyped responses to particular stim - reflexes may be released after TBI or not integrated during dev 2/to CNS pathology. A response = positive and no response = neg. Therapist must be aware of dev reflex age range

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17
Q

Eval of Motor Control

A

Should include observation of quality of mvmt during performance of fx’al tasks

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18
Q

Dyssynergia

A

Breakdown in mvmt resulting in joints being moved separately to reach desired object. Decomposition of mvmt

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19
Q

Athetosis

A

Dyskinetic condition that includes inadequate timing, force and accuracy of mvmts in trunk/limbs -writhing and worm-like mvmts

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20
Q

Chorea

A

Invol mvmts of the face and extremities which are spasmodic and of short duration

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21
Q

Hemiballismus

A

Unilat chorea characterized by violent, forceful mvmts of prox muscles

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22
Q

Static Splint

A

No moving parts. Utilized for ex support, prevention of motion, stretching for contractures, aligning joints for healing, resting joints & reducing pain

23
Q

Dynamic Splint

A

Moving parts included. Resilient component (elastic bands/springs) and are utilized to increase passive motion, assist weak motions or substitute for lost motion

24
Q

Cock-up Splints - may be volar or dorsal

A

Supports wrist in 10-20 of exten to prevent contratures & allows digits to fx

25
Q

Resting Hand Splint -may be volar or dorsal

A

Used for pts who need to have wrist, digits and thumb supported in fx’al position for a prolonged period

26
Q

Opponens Splint - may be volar or dorsal

A

May be short or long. Designed to support the thumb in a position of abduction and opposition. Utilized during fx’al acts to compensate for weakness patterns

27
Q

Bobath Finger Spreader (Abduction Splint)

A

Soft, positions digits/thumb in abduction in effort to reduce tone

28
Q

Rood Cone

A

Based on Roods inhib principles of sustained deep pressure. Cone-shaped splint is used to reduce flexor spasticity in hand

29
Q

Orthokinetic Splint

A

Utilizes tactile input (via elastic bandages) to facilitate or inhib appropriate mus group.

30
Q

Spasticity Reduction Splint

A

Places spastic distal extrem on submax stretch to reduce spasticity

31
Q

Overhead Suspension Sling

A

Incorps arm support that is supported by a sling and suspended over head by a rod. Persons rep prox weakness w mus grades 3/5 and less are appropriate candidates

32
Q

Balanced Forearm Orthoses

A

Mobile arm supports or ball-bearing forearm orthoses. Consists of an arm trough, prox/dist arms and support bracket. Allows pt w weak prox musculature to utilize available control of trunk/shoulder to engage in fx’al tasks

33
Q

Shoulder slings

A

Utilized to support a flaccid arm after neurolog insult for short/controlled periods of time. LT use may be detrimental

34
Q

Splinting Considerations

A

Wearing schedules must be prescribed to enhance splint fx. Must be monitored for pressure over bony prominences. Donning/doffing procedures should be reviewed w pt/caregivers.

35
Q

Overall Eval for Oral Motor Dysfun

A

ROM/Strength/Tone of lips, cheeks & tongue. Extra- & intra- oral sensation. Dentition (integrity of teeth). Oral control of bolus: containing, forming & propelling. Presence of swallow reflex. Airway protection. Relaxation of esophageal sphincter. Primitive reflexes: Rooting, Jaw jerk, Bite & ATNR/STNR. CN testing. Objective testing

36
Q

Swallow Reflex

A

Laryngeal elevation-protects airway. Soft palate elevation-rises to close off naso-pharynx. Pharyngeal peristalsis to propel food thru pharynx

37
Q

Oral Motor Dysfun Tx: Direct

A

Direct therapy involves use of bolus: modifications of consistency, amount and pacing; postural interventions for chin tuck, forward head tilt & head turn & specific swallowing adaptations

38
Q

Oral Motor Dysfun Tx: Indirect

A

Cold stim. Reflex facilitation. Strengthening, facilitating and coordinating oral mvmts. Airway adduction procedures. Positioning to maintain trunk/head/neck in ocrrect postures.

39
Q

Supraglottic Swallow Tech

A

Vol close/protect airway during food intake

40
Q

Mendlesohn’s Maneuver

A

Vol prolong rise of larynx by prolonging tongue contraction

41
Q

Constraint Induces Mvmt Therapy (CIMT)

A

Task oriented approach for pts who present w control of the wrist/digits. 20 of wrist ex & 10 of fing ex or 10 of wrist ex, 10 of thumb abduction and 10 of fing ex of ant other 2 digits. Able to lift rag off table using any type of prehension and release

42
Q

CIMT Guidelines

A

Massed practice/shaping of affected limb during repetitive fx’al acts. Less affected UE is constrained in splint/sling/glove to remind pt to use affected side. Designed to “force use” of affected side. An environment that utilizes the common everyday challenges of life is created by OT. Opps for practice outside of therapy are provided. Adaptations utilized. Use contemp motor learning principles

43
Q

Ayers SI Overview

A

SI approach to view the neural org of SI for an adaptive response. Plasticity of CNS allows for modification of CNS. Occurs in dev/sequential manner. Sensory stim can be facilitatory/inhib. Adaptive responses facilitate integration of sensory stim.

44
Q

Sensory Integration Praxis Test (SIPT)

A

Standardized test for 4-8.11yrs. 17 tests primarily address relations among tactile, vest-proprio, vis processing and practic ability. Scoring is computerized. Categorized into 4 overlap groups: Measures of tactile/vest-prop; Tests of form/space percep & visual percep; Tests of practic ability & Measures of bilat integ/sequencing * must have cert

45
Q

DeGangi-Berk Test of SI (TSI)

A

Standardized test for 3-5yrs. Measures SI fx w focus on vestibular system. Categorized into 3 areas: bilat motor coord, postural control & reflex integration

46
Q

Test of Sensor Fx in Infants

A

Standardized test for 1-18mo. Assess level of infant sensory responsiveness to a variety of sensory stim

47
Q

Sensory Processing Measure (SPM)

A

Test for elementary kids. Measures sensory processing, praxis & soc participation across diff environments. Assess vis, aud, tact, olfact, gust, proprio, and vestib behaviors. Home form completed by caregiver and main school form by teacher and school environments by other school personnel

48
Q

Gen application principles for Ayer’s SI Approach

A

OT controls input that is child-driven and play-based to improve sensory processing, facilitate SI and elicit adapive responses. “Just right challenge.” Balances structure & freedom. Ensures registration of meaningful sensory input. Gradually grading up. Promo org adaptive behaviors

49
Q

Grading for Proprio Resistance Guidelines

A

Firm pressure and resistance is less threatening than light touch. Linear mvmt is less threatening than angular. Slow mvmt is less threatening than rapid.

50
Q

Gen Sensory Process Dysfun Tx

A

Combo of stim must be used to elicit adaptive response. OT closely observes childs response and adheres to all precautions.

51
Q

Tx for tactile defensiveness

A

Self applied stim are more tolerable. Firm pressure where child can see source of stim. Provide controlled sensory acts that also provide tactile & vest-prop feedback. Begin w slow linear mvmts and deep pressure. Tact stim in direction of hair growth is more tolerable. Follow tactile stim w joint compression

52
Q

Tx for tactile discrimination

A

Provide deep touch pressure to hands/body. Rarely seen in isolation. Provide graded acts req tactile discrim acts using a mix of textures/items.

53
Q

Tx for proprioceptive deficits

A

Firm touch, pressure, joint compression or traction. Provide resistance to active mvmt to help child learn appropriate amount of force. Provide acts w various body positions combo vest-prop info (yoga), provide slow, linear mvmt, resistance and deep pressure. Adaptive techs like weighted vests.

54
Q

Tx fir vestibular deficits

A

Grade for type/rate of mvmt and amt of resistance - noting precautions. Slowly intro linear mvmt w touch pressure in prone and provide resistance against active mvmts. Use linear stim to increase awareness of spatial orientation. Provide rapid rotary/angular mvmts w freq starts/stop and accel/decel to increase ability to distinguish pace of mvmt.

OT Process (16 decks)

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