NeuroPT 1 REVIEW #1 Flashcards
1
Q
What is Motor Learning?
A
Acquisition of NEW SKILLS w/ Practice
2
Q
Learning is NOT _____
A
Passive
*experience and active problem-solving are necessary for learning to take place
3
Q
What facilitates a permanent change in behavior?
A
Result of experience and (perfect) practice
4
Q
In terms of Motor Learning…adult pts are not learning new skills, but rather ___________
A
relearning OLD skills w/ a damaged CNS
5
Q
More _______ gen leads to _______
A
GOOD practice leads to better performance
6
Q
Fundamental unit of therapy
A
TASK and all learning is GOAL-ORIENTED
7
Q
practice needs to be accurate
A
Practice makes permanent
8
Q
Most effective interventions are……
A
Functional!
*Practice must have PURPOSE!!!
9
Q
3 Trad. Stages of Motor Learning
A
- Cognitive
- Associative
- Autonomous
*NOTE: Attentional demands DEC from cognitive to autonomous stages
10
Q
Motor Learning:
Cognitive stage
A
Understand task, develop strategies, high deg. of attention*
11
Q
Motor Learning:
Associative Stage
A
Best strategy selected, skill refinement
*associate the skill w/ the task and refine it
12
Q
Motor Learning:
Autonomous Stage
A
Skill is automatic, low deg. of attention
13
Q
Process of motor learning:
Acquisition
*exactly what it sounds like
A
- Skill Acquisition: initial dev. of motor skill, impossible w/out practice!
14
Q
Process of Motor Learning:
Retention
*exactly what it sounds like
A
- Skill Retention: remembering a motor skill
15
Q
Process of Motor Learning:
Generalizability
*incorporating it into your life
A
- Skill Generalizability: positive influence that a prev. practiced skill has on the learning of a new skill
16
Q
Process of Motor Learning:
Application in Altered Contexts
*exactly what it sounds like
A
Will this pt be able to perform the same activity in a diff context?
17
Q
FEEDBACK***
A
return to the brain of info. regarding the result of action or process
Trad. feedback in PT informs pt of how they performed or completed an activity
18
Q
Feedback Timing:
Frequent
A
distracts and interferes w/ info processing, NEGATIVELY impacts learning
19
Q
Feedback Timing:
Concurrent & Continuous
A
MOST EFFECTIVE for performance, maximizes dependency
20
Q
Feedback:
Intrinsic
A
- gen’d from pts sensory organs
- Proprioceptive (jt pos. sense), tactile (pressure sense), visual, vestib.
21
Q
Feedback:
Extrinsic
A
- Provided by some EXT. source
- YOU, device
22
Q
Feedback:
Knowledge of Performance
KP
A
- Feedback on execution→ gives info on mvmt components→ building block
- EX. Goal→ transfer from sit→ stand <5s
- Tell them what happened
- insuff trunk flex
- incorrect sitting pos. @ initiation
- Incorrect pos. of feet
- Tell them what happened
- EX. Goal→ transfer from sit→ stand <5s
23
Q
Feedback:
Knowledge of Results
KR
“How it Went”
A
- Feedback on outcome (info about task completion) whether they did task correctly→ better for long-term learning
- EX. Goal to transfer from sit→ stand <5s
- tell them how it went
- successful completion of transfer
- Time to complete
- tell them how it went
- EX. Goal to transfer from sit→ stand <5s
24
Q
KP vs. KR
EXAMPLE: watching someone don their shirt and they put it on backwards
A
KP: they did not turn shirt around first before they put their head thru neck opening
KR: Their shirt is on backwards
25
Feedback:
## Footnote
**Immediate**
Given **after ea. trial**
26
Feedback:
## Footnote
**Summary**
Given after a **given # of trials**
27
Bandwidth Feedback
“Are you in the range?"
Provided when a certain lvl of **accuracy** is not achieved
Given when the person **exceeds the target range** or when person **fails to meet target range**
Overshot it or Came up short
28
NOTE: Use of **Feedback**
* “Faded” Feedback→ **MOST EFFECTIVE for long-term retention\***
* **Early** feedback→ frequent and concurrent
* **Once performance improves→** feedback should be → LESS FREQ., very brief, focused on precision, **given in summary**
29
Error detection:
we want the pt to have the opportunity to **sense** and **correct errors** in order to make improvements
30
Goals of Practice
**Acquisition:** initial learning
**Retention & Transfer (Generalizability):** long-term learning
31
Practice
What combo is most effective?
Physical AND Mental
32
Partial-Task practice
select portion of the action
33
Whole-Task practice
do the whole task
34
MOST USEFUL for **Part-Task practice**
1. Long task
2. Diff aspects
1. must gradually integrate to minimize transfer problems
35
Most useful for **Whole Practice**
1. Learner has **prereq. skills**
2. Task \<1sec
3. min. cognitive processing
36
Blocked Practice
\***improves skill acquisition (initial learning)**
* task or seq of tasks repeated in a very predictable way
37
Serial Learning
\*improves **skill retention & transfer**
* tasks are predictable, but the **order is changed**
38
Random Practice
\***improves skill retention & transfer (long-term results)**
* tasks are ordered **unpredictably and out of seq.**
39
Distributed Practice vs. Mass Practice
see pics
40
Facilitation of **Skill Acquisition**
**Feedback**: freq and concurrent w/ performance
**Practice:** blocked, correct only sig. errors, allow for prob-solving
**Guidance**: manual guiding, verbal cues
41
Facilitation of **Skill Retention & Generalizability**
**Feedback:** Extrinsic→ Faded and summary feedback
**Practice:** promote ENTIRE mvmt pattern, encourage active prob-solving, tasks oriented practice, random practice, diversify
42
Tx Implications
MINIMIZE block practice, use **early random practice,** change environment, min. inapprop feedback
43
Optimize **Skill Learning**
achievable, functional tasks
change environment
vary cond's
consider spectrum of diff.
44
Optimally structure **Tx:**
Unclear goal is NOT achievable!
instruct pt about goal carefully
promote selective attn
suggest mvmt patterns
45
4 Steps to Motor Relearning Program:
1. Analysis of Task
2. Practice of Task
3. Practice of Missing Components
4. Transference of Training
46
Modifiers to Disablement Model
* Indv factors:
* lifestyle/health
* psychosocial attr's
* ability to **adapt to limits**
47
ENABLEMENT models
from perspective of **what the indv is ABLE TO DO vs. cnt do**
48
EXAM:
3 components
1. Hx
1. hx current cond, PMH, social hx/habits, living environment, activity lvl, functional statue,
2. holistic picture of pt and how affected by patho
3. PIPs and NPIPs
2. Systems review
3. Tests and Measures
1. Reliability→ will it produce same results again
2. Validity→ does it tell me what I want to test?
49
EVAL, Dx, Prognosis
* body structure/function probs
* act. limits
* clinical impression
* prognosis
* EVAL is:
* analysis of all info collected thru exam
* prioritized list of PIPs, NPIPs
* Determine **appropriate**, **measurable**, **achievable** goals
* POC
* anticipated goals
* expected outcomes
50
Hypothesis-oriented clinical practice
Gen. mult. hypotheses
select/perform tests to R/O one or more hypotheses
Continue until cause is understood
51
Neuro Screening
Purpose:
* localizes source of patho
* where to focus in-depth
* tests/measures to use
* determines pts gross capabilities and limits.
* ID
* s/s suggesting deterioration
52
Components of screen:
* mental status
* Pt hx
* vitals
* UQS/LQS
* mm tone
* DTRs
* patho reflexes
* coord
* posture
* CN's
53
Sx Investigation
* Consider
* loc
* pattern of change
* hx of onset
* Interpret pts description of sx's, act/part limits, exam findings
* LINK b/w probs and body structure/function and act/part limits
54
Diff Dx
GOAL:
* recognize s/s
* communicate findings
* **Create PT Dx**
55
Clinical Decision
Treat
Treat & Refer
Refer
56
Asthenia
weakness
57
Bradykinesia
extreme slowness of mvmt
58
Akinesia
Inability to initiate mvmt
59
A**p**raxia
**P** for Planning
inability to perform **purposeful mvmt** even tho there are no sensory or motor impairs
\***prob w/ motor Planning**
60
Interventions for weakness
* PREs
* absence of active mvmt (0 or 1 on MMT)
* facilitation
* stretch reflex for **autogenic facilitation**
* lack anti-gravity power (2 or 3 MMT)
* gravity eliminated pos's
* functional tasks
* lack full mm power (3+ or higher MMT)
* resistance
* man. resistance
* consider body pos.
61
PNF
Proprioceptive Neuromuscular Facilitation
\*dev'd to combat weakness assoc'd w/ polio (LMN)
62
PNF principles
1. mass mvmt is characteristic of normal motor act.
1. brain knows only mvmt
2. Mass mvmt reqs tissue short + lengthening
63
NDT
challenge trunk mm's , prox mm stability
64
Constraint Induced Mvmt
“Forced Use”
GOLD STANDARD FOR CVA
motor learning principles
65
Discoordination
\*prob w/ **timing and amplitude** of mvmt
* manifests several ways
66
Discoordination:
Ataxia
abnormal coordination
\*deficits in speed, amp, directional accuracy, force of mvmt
67
Discoordination:
Dysmetria
inacc amp and timing of mvmt
overshoot→ hypermetria
undershoot→ hypometria
68
Discoordination:
Dysdiadochokinesia
diff performing rapid alt mvmts
clumsy, slow
69
Discoordination:
Tremor
alt contractions of agonists & antagonists
**Intention→** voluntary→ occurs during mvmt of limb→ cerebellum issues
**Resting→** present @ rest→ not assoc'd w/ dyscoord.→ BG probs
70
Intervents for impaired coord:
Encourage reference to **smoooooth mvmts** w/ verbal cues and alter lvl of diff
* Placing activities
* targeted mvmts
* stairs
* darts
* TM walking
71
PNF
Proprioceptive→ sensations of body pos and mvmt
Neuromuscular→ regarding mms and nerves
Facilitation→ make easier, inc ease of performance of action or task
72
Resistance w/ PNF
approp. resistance
“correct” amt
smooth contraction w/out being too easy or too dif
INC mm fibers
INC kinesthetic awareness by INC force of contraction
73
PNF
Irradiation
spreading of nmsk response from one muscle group to another by altering emphasis or resist
*where we provide resistance*\*\*
74
Successive Induction
Incd response of **agonist** results AFTER **contraction of its antagonist**
**\***contract tri's b4 bicep curl
75
Reciprocal Inhibition
Facilitation of **agonist** results in **simultaneous inhibition of the antagonist**
**\***bridge to turn off hip flexors
76
Autogenic Inhibition
Stimulates GTOs and results in **muscle relaxation**
\*bicep curls to relax biceps
77
UE diagonal pattern
Scapula
D1 flex: elevation/protraction
D1 ext: depression/retraction
D2 flex: elevation/retraction
D2 ext: depression/protraction
78
Pelvic PNF patterns
1. Ant elevation/post depression (1-7:00)
2. Ant depression/post elevation (10-4 or 9-3)
79
PNF Activation:
Rhythmic Initiation
Passive→ Active Assistance→ Resistive
80
PNF Activation:
## Footnote
**Combination of Isotonics**
Conc←→ecc, stabilizing contractions
81
PNF activation:
## Footnote
**Reversal of Antagonists**
* Isotonic Reversal
* alternating isometrics or maintained isometrics
* Stabilizing Reversals
* alternating isometrics or maintained isotonics
82
PNF Activation:
## Footnote
**Quick Stretch**
used to facilitate strong mm contraction
83
PNF Stretching:
## Footnote
**Contract Relax**
contraction of agonist followed by PROM
84
PNF Stretching:
## Footnote
**Hold Relax**
Isometric or stabilizing contraction followed by PROM
85
Rigidity
non velocity dependent inc in resist to PROM
86
Decorticate
flexion one
UE→ flexion
trunk & LE→ extension
87
Decerebrate
all the e's!→ EXTENSION one
EXT of trunk & all extremities
