Neuromuscular Theories of Rehabilitation Flashcards
Bobath: Neuromusclular Developmental Treatment (NDT)
based on hierarchical model of disfunction
abnormal postural reflex activity/ muscle tone caused by loss of CNS control @ brainstem/spinal cord
recognizes abnormal function of CNS = slowing/cessation of motor development, inhibited righting/equilibrium reactions, automatic movements
**pts should learn to control movement via normal movement patterns that integrate functionality
NDT Postural Control Assupmptions
Can be learned/modified w/ experience
Uses both feedback & feed-forward mechanisms to perform tasks
Initiated from pt’s base of support
Required for skill development
Develops by assuming progressive positions that increase distance b/w CoG and BoS (BoS should also decrease)
NDT Intervention Constructs
Inhibit abnormal patterns w/ simultaneous facilitation of normal patterns
Alter abnormal tone & influence isolated active movement
Use manual contact/handing through key points of control for facilitation/inhibition
Achieve balance b/w muscle groups during interventions
Use developmental sequence, dynamic reflex inhibiting patterns, functional activities w/ varying difficulties
Emphasize rotation
Provide sensation of normal movement by inhibiting abnormal postural reflexes
Tx should be active/dynamic w/emphasis on function
Orient pt to midline control by moving in/out of midline w/dynamic activity
Belief that compensation techniques are unnecessary/should be avoided
Brunnstrom Movement Therapy in Hemiplegia
created/defined “synergy,” encouraged use of synergistic patterns during rehab immediately, then develop combos of patterns outside of syngery
synergies = primitive patterns occurring @ spinal level as result of hierarchical organization of CNS
**research now says synergies are very hard to change, use discouraged in therapy
Brunnstrom’s 7 Stages of Recovery
1: no lateral movement
2: appearance of basic limb synergies, beginning of spasticity
3: synergies performed voluntarily, spasticity increases
4: spasticity begins to decrease, movement patterns not dictated solely by limb synergies
5: further decrease in spasticity w/ independence from synergistic patterns
6: isolated joint movement performed w/ coordination
7: normal motor function restored
Homolateral Synkinesis
flexion pattern of involved UE facilitates flexion in involved LE
Limb Synergies
group of muscles that produce predictable pattern of movement in flex/ext patterns
Raimiste’s Phenomenon
involved LE AB/ADDucts w/applied resistance to uninvolved LE in same direction
Souque’s Phenomenon
raising involved UE above 100˚ w/ elbow ext produces ext and ABduction of fingers
Proprioceptive Neuromuscular Facilitation (PNF)
based on idea that stronger body parts are used to stimulate/strengthen weaker ones
Normal posture= balancing agonist and antagonist muscle groups, development follow normal sequence
places great emphasis on correct manual contacts/handling w/ short verbal commands+resistance through full movement of pattern
should promote response of neuro mechanism through stimulation of proprioceptors
movement follows diagonal/spirals (flex/ext/rotation) directed towards/away from midline
PNF Constructs
pt learns diagonal patterns of movement
must have accurate timing/ specific commands/ correct hand placement
verbal cues must be concise
repetition is important for motor learning
resistance given is greater to develop stability, less to develop mobility
techniques should use isometric/isotonic contractions
Tx objective dictate use of techniques through either full movement/ @points w/in range
used in conjunction w/ developmental sequence to increase balance between agonists/antagonists
implemented to progress pt through stages of motor control
functional patterns used to increase control
should increase strength/relaxation by enhancing overflow from stronger muscles to weaker ones
PNF Pattern: Scapula
D1 Flex: elevation, ABduction, Upward rotation
D1 Ext: ext, ADDuction, downward rotation
D2Flex: elevation, ADduction, upward rotation
D2 Ext: depression, ABduction, down rotation
PNF Pattern: Shoulder
D1 Flex: flex, ADduction, LAT rotation
D1 Ext: ext, ABduction, MED rotation
D2Flex: flex, ABduct, LAT rotation
D2Ext: ext, Adduct, MED rotation
PNF Pattern: Elbow
D1 Flex: flex/ext
D1 Ext: flex/ext
D2 Flex: flex/ext
D2 Ext: flex/ext
PNF Pattern: RadioUlnar
D1 Flex: supination
D1 Ext: pronation
D2 Flex: supination
D2 Ext: pronation
PNF Pattern: Wrist
D1 Flex: flex, RAD deviation
D1 Ext: ext, ULN deviation
D2 Flex: ext, RAD deviation
D2 Ext: flex, ULN deviation
PNF Pattern: Thumb
D1 Flex: ADduct
D1 Ext: ABduct
D2 Flex: extension
D2 Ext: opposition
PNF Pattern: Pelvis
D1 Flex: protraction
D1 Ext: retraction
D2 Flex: elevation
D2 Ext: depression
PNF Pattern: Hip
D1 Flex: flex, ADduct, LAT rotation
D1 Ext: ext, ABduct, MED rotation
D2 Flex: flex, ABduct, MED rotation
D2 Ext: ext, ADduct, LAT rotation
PNF Pattern: Knee
D1 Flex: flex/ext
D1 Ext: flex/ext
D2 Flex: flex/ext
D2 Ext: flex/ext
PNF Pattern: Ankle and Toes
D1 Flex: dorsiflex, inversion
D1 Ext: plantarflex, eversion
D2 Flex: dorsiflex, eversion
D2 Ext: plantarflex, inversion
Rood
introduced use of sensorimotor stim to facilitate/inhibit responses
all motor output is result of both past and present sensory input. Tx based on sensorimotor learning. uses developmental sequence of “key patterns” to enhance motor control. Goal = obtain homeostasis in motor output & activate muscles to perform tasks independent of stimuli
Once response is obtained curing Tx, stimulus should be widthdrawn
Sensory Stimulation Techniques: Facilitation
Approximation Joint compression Icing Light Touch Quick Stretch Resistance Tapping Traction
Sensory Stimulation Techniques: Inhibition
Deep Pressure
Prologued Stretch
Warmth
Prologued Cold
Rood Constructs
use sensorimotor stim to achieve motor output during Tx
movement considered autonomic, not cognitive
homeostasis is essential
use neutral warmth, maintained pressure, slow rhythmic stroking to calm patient
tactile stim/ environment can influence effects of Tx
exercise must provide proper sensory feedback in order to be therapeutic
belief in stimulation of proprioceptive/ exteroceptive/ vestibular channels of CNS
