Neuromuscular Unit 1 Readings Ch. 1,3,5,6 Flashcards
In Element 2 (Models of Disablement/Enablement), based on Schenkman, what are Direct Impairments, Indirect Impairments, and Composite Impairments?
- Direct impairments: Impairment that affects the patients body function and body structure
- Indirect impairments: Secondary impairments resulting from the primary injury or disease
- Composite impairments: Having multiple underlying causes that can result from both direct and indirect impairments or from multiple systems
What is Task Oriented Approach to Examination? What is the order
With this approach we must first examine function:
- To determine how the diagnosis has impacted that patients functional performance (we do this in systems review and task analysis)
Then we look at the strategies used to accomplish dysfunction:
- So we look at how is this function being performed
Finally impairments:
- What is constraining or limiting the function that we’re examining
What are the Themes of IV Step?
- Explore PT’s roles in preventing disabling conditions
- Evaluate ways to classify individuals movement disorder
- Summarize critical periods for emergence of neuroplasticity and strategies for maximizing experience-dependent plasticity
- Analyze and apply emerging measures and interventions to optimize participation
What are the 4 P’s?
- Participation
- Prediction
- Plasticity
- Prevention
In the 4 P’s, what is the definition of Participation?
“Involvement of people in all areas of life or the functioning of a person as a member of society.
Participation restrictions are problems an individual may experience in involvement in life situations”
In the 4 P’s, what is the definition of Prediction?
Prediction of optimal response to intervention choice is fundamental to effective practice; begins with meaningful movement systems diagnosis and measurement
- Prediction is also essential as it relates to primary prevention
In the 4 P’s, what is the definition of Plasticity?
- The capacity of cerebral neurons and neural circuits to change, structurally and functionally in response to experience
- Brain and Spinal Cord plasticity is critical not only for sensory function maturation during development and behavioral adaptation to the environment but also for CNS repair resulting from injury or disease
In the 4 P’s, what is the definition of Prevention? What is Primary, Secondary and Tertiary Prevention?
Actions taken to prevent the onset of disease (or disability), to stop its progress and to minimize its consequence
- Primary Prevention: Before it happens
- Secondary Prevention: Screening, using procedures to detect and treat pre-clinical pathological changes for control of progression to a disability
- Tertiary Prevention: Main focus of PT practice: We act to minimize the impact of movement disorders on individuals activity and participation and impact their quality of life.
What are the 3 main groups of Direct Intervention?
- Recovery
- Compensatory
- Preventive
With Direct Interventions, what are Recovery Interventions?
They are directed towards restoring the patient’s premorbid status across the ICF
- This approach is based on knowledge and evidence for existing potential for change
With Direct Interventions, what are Compensatory Interventions?
They promote optimal function across the ICF without full recovery
- These can result from the adaptation of remaining motor elements or substitution (different body segments are used/replaced)
With Direct Interventions, what are Preventive Interventions?
They are directed toward minimizing potential problems and maintaining health.
What is shared decision-making? Where in the patient/client management would you use it? What is the 3 phase model of shared decision making?
- This is when the PT and the patient work together to make clinical decisions
- Patient participation through shared decision-making throughout the episode of care is essential in ensuring successful outcomes
3 phase model:
1. Preparing for collaboration
2. Exchanging information on options
3. Affirming and implementing a decisions
What are Goals and Goal Statements?
- Goals are the interim steps necessary to achieve expected outcomes.
- Goal Statements should be measurable, functionally driven, and time limited. They also involve a negotiated process of reconciling goals related to Patient-identified Problems (PIP) and Non-patient Problems (NPIP).
What are the 4 essential elements to each goal?
- Individual: Goals and outcomes are focused on the patient/client
- Behavior/Activity: This includes changes in activity limitations, ADL changes in participation restrictions, and changes in body functions and structures. Changes should be measurable, attainable, and relevant.
- Condition: The statement specifies the specific conditions or measures required for successful achievement
- Time: Goals should be short-term (generally to be 2-3 weeks) and long term (longer than 3 weeks)
What is the FITT equation?
Frequency: This is typically defined in terms of the number of times per week exercise or activity training is performed or the number of visits before a specific date.
Intensity: How hard the person will work.
(Ex. 3 x 5). Intensity is usually monitored by HR, perceived exertion, talk test, and fatigue levels
Time (duration): Defined in terms of days or weeks (3 times per week for 6 weeks). The duration (how long the person exercises during an anticipated sessions) should also be defined (30 or 60 minute sessions)
Type: What is the specific exercise intervention being performed? Cardiovascular, strength, neuromuscular, etc.
Define Sensory Integration, and describe the relationship to motor performance.
Ch. 3 pg. 68 (O’Sullivan)
Sensory Integration is the ability of the brain to organize, interpret, and use sensory information
- This integration provides an internal representation of the environment that informs and guides motor responses
- These sensory representations provide the foundation of which motor programs for purposeful movements are planned, coordinated, and implemented.
How does the CNS use Feedback and Feedforward control?
Ch. 3 pg. 68 (O’Sullivan)
- Feedback control uses sensory information received during the movement to monitor and adjust output.
- Feedforward control is a proactive strategy that uses sensory information obtained from experience.
When the CNS uses Feedback and Feedforward control, when are these signals sent?
What is the primary role of sensation in movement?
Ch. 3 pg. 68 (O’Sullivan)
Signals are sent in advanced of movement, allowing for anticipatory adjustments in postural control or movement
Primary role of sensation in movement is to:
- Guide selection of motor response for effective interaction with the environment
- Through feedback, adapt movements and shape motor programs for corrective action
Sensation also provides the important function of protecting the organism from injury
What is Somatosensation (Somatosensory)?
Ch. 3 pg. 68 (O’Sullivan)
This refers to sensation received from the skin and musculoskeletal system, as opposed to that from specialized senses such as sight or hearing.
What does the examination of sensory function involve?
Ch. 3 pg. 68 (O’Sullivan)
Involves testing Sensory integrity by determining the patients ability to interpret and discriminate among sensory information.
How does the Guide to Physical Therapist Practice define sensory integrity?
Ch. 3 pg. 68 (O’Sullivan)
The soundness of cortical sensory processing, including proprioception, vibration sense, stereognosis, and cutaneous sensation
(Sensory integrity is included in the list of 26 categories of test and measures that may be used by PTs during a patients initial exam or during subsequent visits as part of re-examination.)
What are clinical indications for examination of sensory function based on?
Ch. 3 pg. 69 (O’Sullivan)
Based on the patients history and systems review. These data may indicate the existence of pathology of a health condition resulting in sensory function changes
Define a dermatome, and describe a precaution with using published dermatome maps.
Ch. 3 pg. 71 (O’Sullivan)
Dermatome refers to the skin area supplied by one dorsal root.
- With dermatome maps there are many discrepancies and inconsistencies
