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DPT 830 Neuromuscular Rehab > Neuromuscular Unit 2 Exam > Flashcards

Neuromuscular Unit 2 Exam Flashcards

1
Q

the integration of information that is psychologically meaningful + the ability to select stimuli that requires attention and action

A

perception

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2
Q

the perceptual motor process is a change of events through which the individual _____, _______, and ______ stimuli from the body and the surrounding environment

A

selects, interprets, integrates

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3
Q

why is discussing perception important?

A

perceptual and cognitive deficits can lead to poor rehabilitation progress for patients + important for learning

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4
Q

screen that often co-occurs with other system screens

A

perceptual screen

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5
Q

a perceptual screen observes for:

A

-inattention to therapist during subjective
-inattention to half the body (neglect)
-decreased response to verbal cues

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6
Q

what finding would lead you to perform formal testing for perceptual deficits?

A

when there is functional loss unexplained by motor or sensory impairments in comprehension

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7
Q

what is the purpose of examining perceptual deficits?

A

to determine which perceptual abilities are intact vs impaired, therefore guiding to appropriate intervention

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8
Q

factors that influence the perceptual exam

A

-psychological and emotional status
-ability to detect relevant cues from the environment
-anxiety, depression, fatigue
-aphasia

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9
Q

how do you sequence the perceptual exam?

A

-sensory exam first (includes visual screen)
-cognitive screen
-hearing screen
-consult with family about usual vs unusual behaviors

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10
Q

true or false: perception cannot be viewed as independent of sensation

A

true

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11
Q

true or false: deficits do not lie with sensory ability itself, but rather the interpretation of sensation and the follow up response

A

true

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12
Q

awareness of stimuli through organs of special sense, peripheral cutaneous sensory system, or internal receptors

A

sensation

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13
Q

inattention or neglect of visual stimuli presented on the involved side (patient is NOT aware of the deficit)

A

perceptual deficit/visual neglect

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14
Q

example: hemianopsia
the patient IS aware of the deficit and the patient may compensate spontaneously (true field cut)

A

visual field impairment

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15
Q

one of the most common forms of sensory loss in those with hemiplegia

A

visual field impairment

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16
Q

a visual screen should include:

A

visual acuity
oculomotor control
visual field testing

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17
Q

perceptual deficits may include disorders of what 3 categories?

A

-body scheme/image/awareness
-spatial relations
-agnosias

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18
Q

the relationship of the body parts to each other and the relationship of the body to the environment

A

body scheme

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19
Q

visual and mental image of one’s body that includes feeling about one’s body

A

body image/awareness

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20
Q

impairments that have in common a difficulty in perceiving the relationship between self and two or more objects in the environment

A

spatial relations

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21
Q

inability to recognize incoming information despite intact sensory capacities

A

agnosias

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22
Q

lesions of what lobe typically produce perceptual deficits?

A

right parietal lobe

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23
Q

body scheme/body image impairments (5)

A

-unilateral neglect
-anosognosia
-somatagnosia
-right-left discrimination
-finger agnosia

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24
Q

lack of awareness of part of the body or external enviorment NOT due to sensory loss

A

unilateral neglect/hemineglect

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25
Q

patients with unilateral neglect should be observed for what?

A

limited use of the more involved extremity or inability to attend to an object or the environment as a whole

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26
Q

patient with unilateral neglect will have limited reaction to?

A

sensory stimuli
-visual
-auditory
-somatosensory

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27
Q

3 spaces of neglect

A

personal
peripersonal
extrapersonal

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28
Q

neglect of space that pertains to the body

A

personal space

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29
Q

neglect of space within arm distance from the body

A

peripersonal space

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30
Q

neglect of space beyond arm length

A

extrapersonal space

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31
Q

what does neglect look like clinically?

A

not dressing, eating, shaving, putting on makeup, bumping into objects on the left side

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32
Q

why would a patient with L hemineglect veer to the right when propelling a wheel chair?

A

stronger on the right side

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33
Q

despite no sensory loss, patients with this condition lack ability to register and integrate stimuli from one side of the body and the environment

A

neglect

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34
Q

lesion area of neglect

A

right parietal lobe
(inferior-posterior regions)

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35
Q

example for neglect of personal space

A

not putting makeup on the left side of the body

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36
Q

example of neglect of peripersonal space

A

failing to use objects on the contralesional/contralateral side of their plate

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37
Q

example for neglect of extrapersonal space

A

failing to negotiate obstacles, doorways, etc.

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38
Q

what test can be performed to determine if neglect is present?

A

behavioral inattention test (BIT) + ADL observation

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39
Q

treatment strategy for neglect?

A

remedial or compensatory approach (want neuroplasticity + education)

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40
Q

what is the overall goal of hemineglect/hemianopsia interventions?

A

encourage awareness and use of the environment on the hemiparetic side and use of the hemiparetic extremities

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41
Q

the lack of awareness, denial, of a paretic extremity as belonging to the person OR lack of insight concerning, or denial of, paralysis or disability

A

anosognosia

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42
Q

anosognosia limits the patients ability to recognize the need for what?

A

compensatory strategies

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43
Q

patients with this condition may say things such as “nothing is wrong” or “my mind has an arm of its own”

A

anosognosia

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44
Q

lesion area for anosognosia

A

unclear, proposal of supramarginal gyrus

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45
Q

testing for anosognosia

A

subjective interviewing and asking questions such as “what happened to your arm or leg?”

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46
Q

main treatment strategy of anosognosia

A

prioritize safety

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47
Q

body scheme impairment where there is a lack of awareness of the body structure and the relationship of body parts to oneself or others

A

somatognosia

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48
Q

another name for somatoagnosia

A

body agnosia

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49
Q

patients with somatagnosia often have difficulty following _______

A

instructions

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50
Q

patient with somatagnosia often report extremities as feeling _____

A

heavy

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51
Q

lesion area for somatagnosia

A

dominant parietal lobe (often seen with right hemiplegia)

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52
Q

how do you test to see if a patient has somatagnosia?

A

ask the patient to point to certain body parts or ask them to imitate movements

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53
Q

what is the treatment strategy for somatoagnosia?

A

remedial approach to facilitate body awareness

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54
Q

an inability to identify the right and left sides of one’s own body or that of the examiner

A

right left discrimination

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55
Q

patient with right-left discrimination will have a difficult time verbally responding to commands that include what 2 terms?

A

right and left

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56
Q

lesion area of right left discrimination

A

parietal lobe of either hemisphere

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57
Q

how do you test to see if a patient has right left discrimination?

A

ask the patient to point to body parts on command

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58
Q

how can right left discrimination be ruled out when performing testing?

A

test first without using the terms right and left

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59
Q

what treatment approach is used for patients with right left discrimination?

A

compensatory approach
-avoid left and right
-point or provide other cues

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60
Q

an inability to identify the fingers of the hand or that of the examiners

A

finger agnosia

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61
Q

lesion area for finger agnosia

A

parietal lobe at the region of the angular gyrus of the left hemisphere

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62
Q

testing for finger agnosia includes a portion from what test?

A

Sauguet’s test
-touching hands
-recognition on a picture
-imitation

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63
Q

what treatment approach is used for patients with finger agnosia?

A

limited evidence but a remedial approach can be attempted to bring attention/awareness back

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64
Q

spatial relations syndrome impairments (6)

A

-figure ground discrimination
-form discrimination
-spatial relations
-position in space
-topographical disorientation
-depth and distance perception

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65
Q

inability to distinguish a figure from the background in which it is embedded

A

figure ground discrimination

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66
Q

difficulty ignoring irrelevant visual stimuli, increased distractibility, shortened attention span, frustration, and reduced safety

A

functional relevance for figure ground discrimination

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67
Q

lesion area for figure ground discrimination

A

parieto-occiptal lesion of the right hemisphere

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68
Q

what test can be done for figure-ground discrimination?

A

ayres figure ground test

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69
Q

treatment strategy for figure ground discrimination?

A

remedial + compensatory approaches

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70
Q

impairment of discrimination in the ability to perceive or attend to subtle differences in form and shape

A

form discrimination

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71
Q

lesion area in form discrimination

A

parieto-temporoccipital region of non dominant lobe

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72
Q

confusing pen/toothbrush, vase/water pitcher, and cane/crutch is common with what condition?

A

form discrimination

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73
Q

how do you test for form discrimination?

A

ask the patient to identify several items similar in shape and different in size

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74
Q

treatment strategies for form discrimination?

A

remedial + compensatory approaches

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75
Q

inability to perceive the relation of one object in space to another object

A

spatial relations disorder

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76
Q

what is another name for spatial relations disorder?

A

spatial disorientation

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77
Q

what type of skills are required to manage most ADLs?

A

spatial relation skills

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78
Q

what are clinical examples of spatial relation disorders?

A

difficulty with:
-setting the table
-reading a clock
-preparing for a transfer

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79
Q

lesion area for spatial relation disorders

A

inferior parietal lobe or parieto-occipital junction on the right

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80
Q

2 tests used for spatial relation disorders

A

-riverbed perceptual assessment battery (RPAB)
-arnadottir OT -ADL neurobehavioral evaluation (A -ONE)

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81
Q

what would a remedial approach treatment strategy look like for a patient with spatial relations disorder?

A

-provide instructions to the patient to position themselves in relation to the therapist or another object
-set up a maze
-midline crossing activities

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82
Q

inability to perceive and interpret spatial concepts such as up, down, over, or under

A

position in space impairment

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83
Q

lesion area for position in space impairment

A

non-dominant parietal lobe

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84
Q

what is an example for testing to see if a patient has a position in space impairment?

A

utilize a shoe and shoebox and ask the patient to place in the shoe in different positions in relation to the shoe box

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85
Q

what 3 things should be ruled out with a position in space impairment?

A

-figure ground difficulty
-apraxia + incoordination
-lack of comprehension

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86
Q

what does the retraining approach treatment strategy look like for a position in space impairment?

A

3 or 4 identical objects are placed in the same orientation with an additional object placed in different orientation and the patient is asked to identify the off one and place it in the same orientation

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87
Q

difficulty understanding + remembering the relationship of one location to another

A

topographical disorientation

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88
Q

lesion area of topographic disorientation

A

-right retrosplenial cortex
-bilateral parietal regions
-L parietal regions

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89
Q

how can a therapist test to see if a patient has topographical disorientation?

A

ask the patient to draw or describe a familiar route

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90
Q

what does the remedial approach treatment strategy look like for a patient with topographic disorientation?

A

practice going from one place to another
-simple to more complex
-use verbal instructions

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91
Q

what does the compensatory approach treatment strategy look like for a patient with topographic disorientation?

A

marking frequent routes with colored dots

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92
Q

inaccurate judgement of direction, distance, and depth

A

depth and distance perception disorder

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93
Q

lesion area of depth and distance perception disorder

A

posterior right hemisphere in the superior visual association cortices

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94
Q

how do you test to see if a patient has depth and distance perception disorder?

A

ask a patient to gasp an object on a table or in the air or fill a glass of water

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95
Q

what are some clinical examples of depth and distance perception disorder?

A

-missing the chair when returning to sit
-continue pouring water despite a full glass

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96
Q

what are some treatment strategies for depth and distance perception disorder?

A

-assist the patient in becoming aware of the deficit
-provide education on uneven terrain and stair negotiation
-remedial or compensatory approach

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97
Q

what does the remedial approach treatment strategy look like for a patient with topographic disorientation?

A

-ask the patient to place their feet on a designed spot during gait training
-ask the patient to touch foot to a pile to reestablish sense of depth and distance

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98
Q

what does the compensatory approach treatment strategy look like for a patient with a depth and distance perception impairment?

A

utilize UE support to sit squarely within a chair

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99
Q

disordered perception of what is vertical

A

vertical disorientation

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100
Q

lesion area of vertical disorientation

A

non dominant parietal lobe

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101
Q

how would a therapist test for vertical disorientation?

A

therapist holds a cane sideways in a horizontal position and the patient is asked to return the cane back to the original vertical position

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102
Q

what is the treatment strategy for vertical disorientation?

A

enhance awareness and cue tactile input to assist in orienting back to normal

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103
Q

motor behavior characterized by active pushing with the strongest extremities toward the hemiparetic side with a lateral postural imbalance

A

pusher’s syndrome

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104
Q

pusher’s syndrome results in a loss of balance towards the ________ side

A

hemiparetic side

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105
Q

what misperception is involved in pusher’s syndrome?

A

subjective postural vertical

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106
Q

what area is affected with pusher’s syndrome that results in altered perception of the body’s orientation in relation to gravity?

A

posterolateral thalamus

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107
Q

individuals with pusher’s syndrome will actively + strongly resist any attempt at passive correction to _______

A

midline

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108
Q

true or false: the brain can compensate with therapeutic training with pusher’s syndrome

A

true

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109
Q

what are the 2 therapeutic management goals for patients with pusher’s syndrome?

A

-reorienting patients to true vertical
-manage environment to optimize visual cues

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110
Q

with pusher’s syndrome, what side pushes?

A

strong side pushes to weak side = imbalance on weak side

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111
Q

the inability to recognize or make sense of incoming information despite intact sensory capacities

A

agnosia

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112
Q

3 agnosia impairments

A

-visual object agnosia
-auditory agnosia
-tactile agnosia

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113
Q

an inability to recognize familiar objects despite normal function of the eyes + optic tracts

A

visual object agnosia

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114
Q

lesion area of visual object agnosia

A

occipito-temporo-parietal association areas of either hemisphere

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115
Q

3 types of visual object agnosia (difficulty recognizing people, progressions, and common objects)

A

-simultanagnosia
-prosopagnosia
-coloragnosia

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116
Q

how can a therapist test for visual object agnosia?

A

place several common objects in front of a patient with instruction to name, point to, or demonstrate the use of each object

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117
Q

______ and ______ can make it difficult to recognize visual object agnosia

A

aphasia and apraxia

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118
Q

what does the remedial approach treatment strategy look like for visual object agnosia?

A

practice drills to discriminate between colors and common objects

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119
Q

what does the compensatory approach treatment strategy look like for visual object agnosia?

A

encourage the use of intact sensory modalities to distinguish people and objects

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120
Q

an inability to recognize non-speech sounds or to discriminate between them

A

auditory agnosia

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121
Q

what are some clinical examples of auditory agnosia?

A

inability to distinguish ring of doorbell/telephone or the dog bark/thunder

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122
Q

lesion area of auditory agnosia

A

dominant temporal lobe

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123
Q

which profession tests for auditory agnosia?

A

SLP

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124
Q

what treatment strategy can be used for patients with auditory agnosia?

A

drill the patient on sounds, but reduced effectiveness overall

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125
Q

the inability to recognize forms by handling them although tactile, proprioceptive, and thermal sensations may be intact

A

tactile agnosia

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126
Q

what is a clinical example of tactile agnosia?

A

patient inability to recognize a familiar object when it is handed to them

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127
Q

lesion area of tactile agnosia

A

parieto-temporo-occipital lobe of either hemisphere (posterior association areas)

128
Q

how would a therapist test for tactile agnosia?

A

have the patient identify objects when placed in their hand WITHOUT visual cues

129
Q

what would the remedial approach treatment strategy look like for tactile agnosia?

A

instruct the patient to feel objects placed in their hand followed by immediate visual feedback

130
Q

what would the compensatory approach treatment strategy look like for tactile agnosia?

A

visual compensation

131
Q

perceptual and planning problem

A

apraxia

132
Q

what are ways the therapist can mitigate these impairments?

A

-use verbal cues
-closed environment
-limited distractions
-adequate lighting
-collaboration with OT + speech

133
Q

4 CVA time periods

A

hyper acute
acute
subacute
chronic

134
Q

CVA time period for hyper acute phase

A

0-24 hours

135
Q

CVA time period for acute phase

A

1-7 days

136
Q

CVA time period for subacute phase

A

early: 7 days-3 months post
late: 3-6 months post

137
Q

CVA time period for chronic phase

A

> 6 months post

138
Q

setting of acute phase post stroke

A

ICU or specialized stroke care unit

139
Q

goals of the acute phase post stroke

A

-early mobilization
-functional reorganization of hemiparetic side
-encourage positive outlook
-instruction, education, and training

140
Q

interventions of acute phase post stroke

A

-bed mobility
-sitting
-transfers
-locomotion
-ADL training
-ROM
-splinting
-positioning

141
Q

frequency of subacute phase sessions

A

2 professions 3 hrs/day 6x/week

142
Q

setting of subacute phase post stroke

A

inpatient rehab or transitional care unit (TCU) within skilled nursing facility

143
Q

setting of chronic phase post stroke

A

outpatient, community setting, or home

144
Q

true or false: the fastest recovery takes place in the first few weeks and months after onset, however improvements can continue thereafter

A

true

145
Q

recovery variability occurs due to what 3 things

A

-level of language/visuospatial function
-impairment involvement
-stroke severity

146
Q

5 parts of the patient-client management model

A

-examination
-evaluation
-diagnosis
-prognosis
-intervention

147
Q

factor that allows for the ability of the brain to modify in function + repair itself

A

neural plasticity

148
Q

3 mechanisms of neural plasticity

A

-neuroanatomical
-neurochemical
-neuroreceptive

149
Q

sprouting of the injured axons to innervate previously innervated synapses

A

regenerative synaptogenesis

150
Q

collateral sprouting/reclaiming of synaptic sites of the injured axon by dendritic fibers from neighboring axons

A

reactive synaptogenesis

151
Q

synaptic plasticity occurs through the release + receptive sensitivity of what?

A

neurotransmitters

152
Q

10 principles of neuroplasticity

A

-use it or lose it
-use it and improve it
-salience
-repetition
-intensity
-specificity
-age
-time
-transference
-interference

153
Q

promote ______ first

A

neural plasticity

154
Q

the ability of the nervous system to modify itself in response to changes in activity and new experiences by use-dependent reorganization

A

function induced recovery

155
Q

the brain is most responsive to improvements from motor training during what period?

A

critical/sensitive period

156
Q

type of training that uses repetitive task practice

A

task-oriented training

157
Q

3 interventions to promote neuroplasticity

A

-restorative
-compensatory
-preventative

158
Q

interventions directed towards remediating or improving the patient’s status in terms of impairments, activity limitations, participation restrictions, and recovery of function

A

restorative interventions

159
Q

target areas of restorative interventions

A

involved extremities or trunk

160
Q

interventions direct toward promoting optimal function using new motor patterns

A

compensatory interventions

161
Q

2 considerations for compensatory interventions

A

adaptation and substitution

162
Q

using involved segments and adapting with remaining motor elements

A

adaptation

163
Q

functions are replaced or taken over by different body segments using different motor patterns

A

substitution

164
Q

target of compensatory interventions

A

less involved or uninvolved extremities

165
Q

interventions directed towards minimizing potential problems and maintaining health

A

preventative interventions

166
Q

the reappearance of motor patterns that were present before CNS injury

A

restoration

167
Q

the reappearance of new motor patterns resulting from the adaptation of remaining motor elements or substitutions of alternative motto strategies and body segments

A

compensation

168
Q

type of training where the patient is made aware of movement deficiencies and the changes required to complete the functional task

A

substitution training

169
Q

focusing on the less involved segments with substitution training may suppress recovery and contribute to learned ______ of impaired segments

A

nonuse

170
Q

skills acquired in a manner inconsistent with skills the individual already possesses

A

splinter skills

171
Q

learned nonuse can lead to ____ skills

A

splinter skills

172
Q

what type of training is recommended for a patient who presents with significant comorbidities, impairments, and functional limitations with little or no expectation for additional recovery

A

substitution training

173
Q

_____ and _______ deficits have the greatest impact on functional performance

A

motor and perceptual deficits

174
Q

understanding of the neural, physical, and behavioral aspects of biological movement

A

motor control

175
Q

coordinated movement strategies with a goal or attaining and action + require voluntary control

A

motor skill

176
Q

2 categories of motor skill

A

mobility and stability

177
Q

requires the individual to move the body from one posture to another in a controlled manner (BOS and COG are moving)

A

mobility

178
Q

static postural control and dynamic postural control

A

stability

179
Q

maintaining posture with unchanging COM and BOS

A

static postural control

180
Q

posture adjusted and maintained while extremities are moving

A

dynamic postural control

181
Q

motor skills requiring large muscle groups and body parts acquired in early childhood (examples: rolling, crawling, standing)

A

gross motor skills

182
Q

motor skills requiring control of small muscle groups, smaller movements with precision (examples: ADLs, eating, buttoning, writing)

A

fine motor skills

183
Q

motor skills that have a recognized beginning and end (examples: STS, lying down, throwing a ball)

A

discrete motor skills

184
Q

series of discrete motor skills with specific order
(example: bed to wheelchair transfer)

A

serial motor skills

185
Q

motor skills with no recognizable beginning or end (examples: swimming or running)

A

continuous motor skills

186
Q

motor skills in a stable and predictable environment

A

closed motor skills

187
Q

motor skills in a constantly changing and unpredictable environment

A

open motor skills

188
Q

motor skills that are simple and produce an individual movement response

A

simple motor skills

189
Q

motor skills that involve multiple actions and motor programs combined to create coordinated movement

A

complex motor skills

190
Q

motor skills that also involve a cognitive or physical task

A

dual task skills

191
Q

3 stages of motor learning

A

-cognitive
-associative
-autonomous

192
Q

stage of motor learning of understanding the task

A

cognitive stage

193
Q

stage of motor learning of practice movements + refining motor PROGRAMS

A

associative stage

194
Q

stage of motor learning of practice movement + refining motor PROCESSES

A

autonomous stage

195
Q

_______ is more effective in slower positional tasks and less effective in ballistic tasks

A

guidance

196
Q

which 2 stages can dual tasks be initiated?

A

associated and autonomous

197
Q

as the patient progresses to associative and autonomous stages, the patient should now be focusing on more ___________ feedback rather than verbal or guided movements

A

proprioceptive

198
Q

increased practice = increased ______ _________

A

motor learning

199
Q

information given by the body

A

intrinsic feedback

200
Q

information given by external sources

A

extrinsic feedback

201
Q

information about the movement outcome

A

knowledge of results

202
Q

information about the nature or quality of the movement

A

knowledge of performance

203
Q

frequent _______ feedback can slow retention and foster dependence on an external source

A

extrinsic

204
Q

new learners need more ______ feedback, but as the learner improves they need less frequent feedback

A

immediate

205
Q

interventions for motor control/motor skills

A

-flexibility
-strengthening
-neuromuscular endurance/fatigue
-coordination
-balance + postural control
-task specific training
-task specific environment structure
-dosage

206
Q

type of feedback used with severe weakness and used to assist in recruitment of muscles and re-education

A

electromyographic feedback

207
Q

patients may be able to generate muscle function but do not have the ability to _______ the contraction over time

A

sustain

208
Q

inability to coordinate muscles, joints, and limbs for smooth and accurate movement (usually due to cerebellar lesion)

A

ataxia

209
Q

training treatment for neurological patients that is meaningful, effortful, and task specific

A

task specific training

210
Q

4 task specific structuring of the environment

A

-stationary person in stationary environment
-moving person in stationary environment
-stationary person in moving environment
-moving person in moving environment

211
Q

what is the proper intensity dosage to achieve neuroplastic changes?

A

high intensity (FITT principle)

212
Q

intervention that uses the facilitation of total patterns of movement to promote motor learning

A

proprioceptive neuromuscular facilitation (PNF)

213
Q

PNF places emphasis on _____ of function rather than compensation

A

recovery

214
Q

PNF is based on the idea that normal movements are _____ and ________

A

spiral and diagonal

215
Q

typically impaired following CVA due to weakness, sensory loss, impaired balance, and loss of confidence

A

gait

216
Q

part of the body that is often overlooked during gait but very important

A

upper extremity

217
Q

used in predicting patient’s ability to ambulate in different environments

A

gait speed

218
Q

what 4 aspects of gait should be measured and recorded?

A

-time
-distance
-cadence
-velocity

219
Q

what are some common gait deviations post stroke?

A

-slow speed
-asymmetrical or uneven step + stride lengths
-reduced stance time on affected limb
-decreased push off force on affected limb
-use of synergy patterns to advance limb
-impaired balance with UE + LE posturing
-reliance on adaptive equipment
-spasticity requiring compensatory advancement

220
Q

3 classifications of walking handicap after stroke

A

physiological walker
limited household walker
community walker

221
Q

walking classification: walks for exercise only either at home or in therapy

A

physiological walker

222
Q

walking classification: relies on walking for home activities but requires assist for other walking activities

A

limited household walker

223
Q

walking classification: can walk for an unlimited distance outside

A

community walker

224
Q

primary contributor to disordered gait affecting the number, type, and frequency of motor neuron activation necessary for gait progression

A

paresis

225
Q

primary impairment after corticospinal pathology

A

paresis

226
Q

muscles act concentrically to generate ______ and eccentrically to ______

A

concentric: force
eccentric: control

227
Q

spasticity is _______ dependent

A

velocity

228
Q

what 2 ways can spasticity impact gait?

A

-inappropriate activation of muscle when rapidly stretched (beating)
-increased stiffness

229
Q

_______ patterns are associated with reduced stability and poor locomotion

A

synergistic

230
Q

post stroke, patients have a decreased ability to modify gait characteristics in response to terrain and slope changes such as?

A

-gait speed
-step length

231
Q

_________ of muscles unrelated to spasticity can affect progression in gait and postural control

A

overactivity

232
Q

overactivity is common in what muscle group?

A

hamstrings

233
Q

inability to time and scale muscle activity during gait can lead to ______ gait

A

ataxic

234
Q

_______ is critical to balance strategies during gait

A

vision

235
Q

______ can have an impact on the person’s ability to perceive potential threats to stability during gait

A

hemianopsia

236
Q

loss of ______ input in adulthood can produce gait ataxia and difficulty stabilizing the head in space

A

vestibular

237
Q

in patients who have lost vestibular input, will they show shorter or longer double stance support?

A

longer

238
Q

a vision problem that makes it seem like your surroundings are moving when they’re actually still because they eyes cannot stabilize (bounce with head)
+ impaired VOR

A

oscillopsia

239
Q

what compensations occur if there is no eccentric plantarflexion control?

A

knee hyperextension during stance
lack of knee flexion for swing

240
Q

what muscle produces more propelling force than any other muscle during the gait cycle?

A

gastrocs

241
Q

plantarflexor spasticity primarily occurs in the early part of the _____ phase of walking secondary to stretching of the gastrocs

A

stance

242
Q

spasticity in the plantarflexors causes inability of the _____ to generate enough force for push off

A

gastrocs

243
Q

what 2 ways does spasticity in the plantarflexors impact foot position?

A

-limit dorsiflexion
-prevent heel strike at initial contact

244
Q

if initial contact is made with foot flat, what will happen to the knee?

A

knee hyperextension

245
Q

if the patient has reduced forward foot clearance, what will happen to the toe?

A

toe drag

246
Q

weak ______ lead to difficulty controlling knee flexion during loading and midstance

A

quads

247
Q

weak quad compensation is knee _______ during mid stance or forward trunk lean to bring ground reaction forces ________ to the knee

A

knee hyperextension
anterior

248
Q

true or false: weak quads can also contribute to excessive knee extension

A

true

249
Q

during initial contact, there is brief knee ______ to absorb shock, which can trigger spasticity in the quads = knee hyperextension

A

flexion

250
Q

excessive gastroc and posterior tibialis activation can produce _______ and ________ foot positions

A

inversion and equinovarus

251
Q

common compensatory strategies during gait

A

-reduced WB time on involved LE
-avoiding impact loads
-limiting joint excursions to maintain stability

252
Q

hip flexor weakness primarily affects the _____ phase of gait

A

swing phase

253
Q

if inadequate hip flexion and knee flexion for swing is lost, toe ______ is reduced

A

clearance (toe drag)

254
Q

compensatory strategies used to achieve foot clearance without adequate hip flexion

A

-posterior pelvic tilt
-activation of abdominals
-circumductioon (hip hike)
-contralateral vaulting to toe
-lateral trunk lean

255
Q

weakness in these muscles can result in a forward trunk learn

A

hip extensors

256
Q

what compensation is made for hip extensor weakness to bring the center of mass behind the hips?

A

backward lean

257
Q

what muscle is active to prevent from falling backwards?

A

TA

258
Q

weakness in this muscle group can result in a contralateral pelvic drop (Trendelenburg), resulting in instability in the frontal plane

A

hip abductors (glute med)

259
Q

what is the common compensation for a trendelenburg gait?

A

lateral trunk lean over stance leg

260
Q

Trendelenberg gait is named according to the strong or the weak side?

A

weak side

261
Q

spasticity in the hamstrings produces excessive knee flexion, which leads to a _____ gait pattern

A

crouched

262
Q

in terminal swing, excessive activation of _________ prevents the knee from fully extending

A

hamstrings

263
Q

spasticity in this muscle group can result in a scissoring gait pattern

A

hip adductors

264
Q

knee hyperextension during initial contact = ______ weakness

A

quad

265
Q

knee hyperextension during mid stance = ________ weakness

A

plantarflexors

266
Q

outcome measures for gait (4-5)

A

-TUG
-10 meter walk
-6 minute walk
-FGA/DGI

267
Q

how far does the patient walk during the TUG?

A

10 feet or 3 meters x2

268
Q

> ___ second = fall risk for stroke population on the TUG

A

> 14 seconds

269
Q

normal TUG time for healthy adult

A

< 10-12 seconds

270
Q

total time to ambulate 10 meter walk test is recorded in what units?

A

meters/second

271
Q

what gait speed in m/s is the goal to be independent in ADLs, decrease hospitalization, and be a community ambulator?

A

1.0 m/s

272
Q

how many meters of the 10m walk test are actually timed?

A

6m

273
Q

score < ___ on the DGI is indicative of fall risk

A

< 19

273
Q

outcome measure that measures the patient’s ability to perform steady state walking and variations on common, strong fall risk predictor

A

DGI

274
Q

outcome measure used to assess postural stability during walking and assesses an individual’s ability to perform multiple motor tasks while walking, strong fall risk predictor

A

FGA

275
Q

score < ___ on FGA is indicative of fall risk

A

< 22

276
Q

outcome measure that assesses distance walked over 6 minutes as a sub maximal test of aerobic capacity/endurance

A

6 minute walk test

277
Q

impairment-based standardized way to test for motor recovery, organized by sequential recovery stages, and takes 30-45 minutes to administer

A

fugl-meyer assessment

278
Q

outcome measure for finger dexterity, time is measured

A

9 hole peg test

279
Q

outcome measure comprised of 19 UE functional tasks/movements with 4 sub scales and ordinal scoring

A

action research arm test

280
Q

what are the 4 sub scales of the action research arm test?

A

grasping
gripping
pinching
gross movement

281
Q

a total score of ____ indicates normal UE use on the action research arm test

A

57

282
Q

outcome measure that evaluates disability in UE function of 13 ADLs using a quantitative and qualitative measure, reading an article is required

A

arm motor ability test

283
Q

outcome measure that assesses unilateral gross manual dexterity and is performed in sitting, 2 square compartments with 150 wood cubes

A

box and blocks test

284
Q

make or break test where the patient is asked to maintain an isometric contraction for 2-3 seconds, scored using force production

A

dynamometry

285
Q

clinical syndrome that needs the most attention to the UE

A

MCA stroke

286
Q

attention should be paid to external rotation and humeral distraction with mobilizations, especially in ranges of 90 degrees flexion or more, to avoid _________

A

impingement

287
Q

what scapular motion should be prioritized with mobilizations to prevent impingement with overhead movements?

A

upward rotation

288
Q

contraindicated secondary to impairments in scapulohumeral movement

A

pulleys

289
Q

prioritize elbow extension to avoid ________

A

contractures

290
Q

what mobilization grades for the carpal bones should be considered before stretching?

A

grades I and II

291
Q

additional priority should be placed on maintaining the length of wrist and finger _________

A

extensors

292
Q

once full ROM is achieved, the limbs should be placed in the lengthened position and maintained. this is called?

A

sustained stretching

293
Q

modality that slows nerve conduction and decreases muscle spindle activity to reduce spasticity

A

cold modalities

294
Q

modality used to target the antagonist muscles for the goal of reciprocal inhibition

A

functional electrical stimulation (FES)

295
Q

encourage utilization of the ______ side to promote increased awareness and sensory function

A

affected

296
Q

most common shoulder subluxation

A

inferior

297
Q

occurs secondary to muscular and biomechanics factors of glenohumeral joint stability, often FOOSH mechanism

A

shoulder subluxation

298
Q

when the shoulder is _______ post stroke, there is reduced support and action of the rotator cuff
-proprioceptive loss
-lack of muscle tone
-muscle paralysis

A

flaccid

299
Q

when the shoulder is _______ post stroke, there is abnormal muscle tone that can contribute to poor scapular motion
-subluxation and restricted movement could occur (adhesive capsulitis)

A

spastic

300
Q

application of imagery techniques for improving motor performance and learning, practice can be visual or kinesthetic

A

mental imagery (MI)

301
Q

assesses a patient’s ability to imagine

A

quick mental chronometry screen

302
Q

type of therapeutic intervention that focuses on moving the less impaired limb while watching its mirror reflection

A

mirror therapy (MT)

303
Q

what type of feedback does mirror therapy use to improve motor function?

A

visual feedback

304
Q

inability to activate which muscle is a common cause of impaired heel strike?

A

tibialis anterior

305
Q

corrects supination to improve ankle stability, common impairments in neurologic gait

A

aircast

306
Q

gait intervention that has proper intensity, repetition, and specificity?

A

high intensity gait training (HIGT)

307
Q

score < ____ on the BERG is indicative of a fall risk for older adults and people with a stroke

A

< 45

308
Q

14 item scale for measuring balance in sitting and standing in adults

A

BERG balance scale

309
Q

test for reactive balance, pull backwards and observe response

A

retropulsive test

310
Q

12 items performance based scape used for assessing and monitoring postural control following a stroke, max score is 36

A

postural assessment scale for stroke patients (PASS)

311
Q

36 item test that assesses balance across 6 domains of postural control, total score of 108 and scored as a percentage

A

balance evaluations systems test (BEST)

312
Q

< __% on the BEST Is indicative of a fall risk

A

< 82%

313
Q

16 item self reported measure of balance confidence in performing various activities, rating is 0-100% with 0 being no confidence and 100 being the most confident

A

activities specific balance confidence scale

314
Q

test that assesses how well an older adult is using sensory inputs when one of more sensory systems are compromised, 4 conditions for testing

A

modified clinical test for sensory interaction in balance (mCTSIB)

DPT 830 Neuromuscular Rehab (3 decks)

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