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NPT I > NPT I - EXAM 2 > Flashcards

NPT I - EXAM 2 Flashcards

1
Q

What is the systems theory?

A

Systems work cooperatively to achieve movement.

Higher levels activate lower levels
Lower levels activate synergies

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2
Q

What is the motor learning theory?

A

Ecological model + psychology + education research.

Movement emerges from interaction of individual, task, and environment.

Movement is a result of dynamic interplay of perception, cognition, and action systems.

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3
Q

What are the 4 parts for rehabilitation of functional limitations?

A
  1. Task analysis
  2. Practice of task
  3. Practice of missing components
  4. Transference
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4
Q

Why is it necessary to know the components of a task?

A

Steers treatment choice - what partial tasks to practice in order to complete whole task.

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5
Q

Essential components of supine –> sidelying?

A

Neck flexion

Neck rotation toward side rolling to

Contralateral shoulder flexion

Scapular protraction

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6
Q

Why should you make the patient do as much as possible before helping or giving verbal cues?

A

Facilitates independence.

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7
Q

Essential components of sidelying –> sitting

A

Ipsilateral lateral cervical flexion

Ipsilateral lateral trunk flexion

Inferior UE abduction

LEs lift and lower over side of bed

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8
Q

What compensations should be avoided during the supine –> sit?

A

Leg hooking

Using intact UE to push/pull

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9
Q

PNF techniques to help with rolling and to initiate hip/knee flexion and shoulder protraction?

A

Mass trunk flexion patterns

Isolated scapular anterior depression and/or pelvic anterior elevation

D1 scapular flexion
D2 scapular extension

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10
Q

How would you modify a rolling technique to make it easier?

A

Prop patient up with pillows to decrease the angle needed to move

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11
Q

Why do you modify the environment to make a task easier rather than allow compensations?

A

Allows patient to still complete the task and allows them to figure out how to do it themselves.

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12
Q

What do upright activities do for patients’ well-being?

A

Stimulates the CNS - increases arousal
Increases B&B function
Decreases hopelessness

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13
Q

What has an inverse correlation with institutionalization risk?

A

Being able to sit –> stand

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14
Q

What are the requirements of sit –> stand

A

Move body mass from large BOS –> small BOS

Extend lower limb joints and trunk (and control them)

Maintain balance

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15
Q

What are the primary movers for sit–>stand?

A

Hip and knee extensors

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16
Q

What functional mobility task does sit–>stand predict?

A

Locomotion (balance and motor patterns)

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17
Q

Patients who could stand up in less than xxx had better gait performance.

A

4.5 sec.

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18
Q

Essential components of sit–>stand

A

Feet slightly behind knees, ankles DF

Extended trunk/neck

Hip flexion

Movement of knees forward (place COG over feet)

Extension of hips and knees

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19
Q

Essential components of stand –> sit?

A

Forward trunk inclination by flexing hips

Neck and trunk in extension

Knees more forward (don’t block)

Knee flexion

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20
Q

Common problems with stand–>sit

A

WB through intact side only

Decreased forward weight shift

Forward weight shift via trunk flexion rather than hip flexion with trunk extension

Poor foot placement

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21
Q

How would you fix these misleading phrases:
“lean forward”
“nose over toes”

A

“Lean forward but keep your chest up”

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22
Q

How would you make sit stand easier?

A

Higher, firmer surface

Sitting down first may make standing up easier due to greater ability to contract extensors eccentrically

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23
Q

How would you make sit stand harder?

A

Stop and start at different points in range

Stand from progressively lower chairs or differing surfaces

Transfer from chair to chair

Combine transfers with different tasks

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24
Q

How is stair climbing mechanically different than walking?

A

Need for more force in raising and lowering of body mass (increased muscle demand)

Need for more range of motion

High demands on balance

Greater foot clearance required

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25
What is the normal stair climbing strategy? What is the compensation?
Normal: reciprocal Compensation: step to, use of rail
26
What are the components of ascending stairs?
Stance: pull up force Swing: foot clearance and placement
27
What is the major problem with ascending stairs?
Conservation of energy
28
What are the components of descending stairs?
Stance: controlled lowering Swing: leg pull-through and foot placement
29
What is the major problem with descending stairs?
Safety
30
Why would you use ramps to help with stair training?
Same demand but without obstacle of step
31
What are the 3 major requirements of gait?
Production of a basic locomotor rhythm Dynamic balance control of the moving body Ability to adapt movement to changing environmental demands
32
Gait is movement of COG through space with...
minimal energy requirement
33
Gait is inherently...?
An unstable process
34
In normal gait, muscle activity is...?
brief, and often eccentric (to counteract momentive forces)
35
What are the 5 key elements of gait?
``` Symmetry Step pattern Speed Trunk posture Arm swing ```
36
Faster, more comfortable walking velocity leads to...?
more efficient walking
37
Why would a patient be reluctant to pick up their speed in gait?
Due to its inherent instability.
38
What is the first thing to happen when we initiate a step?
Lean onto stance leg before propelling forward.
39
What happens in gait when we change speed or stop?
More force is involved - combination of eccentric and isometric contraction.
40
How do we respond to trips and slips?
Reflexive extension of arms Compensatory step(s) to catch COG Lowering COG, widen BOS
41
With age, there is a decrease in:
Aerobic capacity Joint flexibility Muscle strength Bone mass
41
What are the 3 elements of motor control of gait?
Central pattern generator (CPG) - spinal level control center for walking Descending pathways - allow for variation and adaptability Sensory feedback - proprioception and somatosensation of foot position
42
What are 4 gait changes in older adults?
Decreased walking velocity (stride length) Increased duration of double support (stability) Decreased push off power (velocity reduced) Decreased heel initial contact (midfoot or foot flat)
43
Impairments that may cause gait abnormalities following CNS damage
``` Changes in tone Weakness Dyscoordination Sensory impairments Visual deficits Vestibular deficits Perceptual and cognitive impairments Pain ```
44
CVA walking speed:
Decreased
45
CVA stride length:
Decreased
45
CVA ankle dorsiflexion at heel contact
Decreased
46
CVA knee flexion in swing
Decreased
47
CVA hip extension during midstance and pushoff
Decreased
48
CVA stance time of affected limb
Decreased
49
CVA swing time of affected limb
Increased
49
CVA single leg support
Decreased
50
CVA double limb support
Increased
51
CVA coactivation of leg muscles
Abnormal
52
CVA gait energy cost
Increased
53
Improved selective motor control leads to more...
"normal" gait
54
Observable gait deficits following CVA (stance)
``` Inadequate hip extension (TSt) Lateral shift of pelvis (weak abd) Inadequate knee extension beginning of stance Inadequate knee extension in MSt Inadequate plantarflexion at TSt ```
55
CVA: Midstance gait deficits
Excessive knee hyperextension (extensor thrust) Excessive knee flexion Excessive hip flexion
56
CVA: Terminal stance gait deficits
Inadequate hip extension | Inadequate plantarflexion at preswing
57
CVA: Initial contact gait deficits
Flat foot (excessive PF) Foot slap (adequate DF at TSw, rapid movement into PF upon IC) Excessive inversion Excessive eversion
58
CVA: swing gait deficits
Inadequate hip flexion Inadequate knee flexion Inadequate ankle DF Inadequate ankle DF and knee extension approaching/at IC Inadequate foot clearance (toe drag) Excessive hip ER (using hip add) Excessive hip adduction (scissoring) Inadequate knee extension at TSw (decreased step length) Poor foot placement (dyscoordination)
59
Why would CVA patient have excessive pronation of the foot?
Weakness
60
Why would CVA patient have excessive supination of the foot?
Part of synergy with LE extension/PF
62
Why would CVA patient have toe clawing?
Mechanism to seek stability
62
Gait adaptations following CVA
``` Decreased stride length Decreased step length Increased uneven step and stride lengths Decreased stride width Decreased double support Decreased walking velocity Use of arms for support and balance ```
64
Why does an affected limb usually take the bigger step?
Stance time is short on affected limb, so swing limb won't go as far.
65
CVA single leg support
Decreased
66
CVA double limb support
Increased
67
CVA double limb support
Increased
69
CVA coactivation of leg muscles
Abnormal
70
CVA coactivation of leg muscles
Abnormal
71
CVA gait energy cost
Increased
72
CVA gait energy cost
Increased
74
Improved selective motor control leads to more...
"normal" gait
74
Improved selective motor control leads to more...
"normal" gait
76
Observable gait deficits following CVA (stance)
``` Inadequate hip extension (TSt) Lateral shift of pelvis (weak abd) Inadequate knee extension beginning of stance Inadequate knee extension in MSt Inadequate plantarflexion at TSt ```
77
CVA: Midstance gait deficits
Excessive knee hyperextension (extensor thrust) Excessive knee flexion Excessive hip flexion
78
CVA: Terminal stance gait deficits
Inadequate hip extension | Inadequate plantarflexion at preswing
79
CVA: Initial contact gait deficits
Flat foot (excessive PF) Foot slap (adequate DF at TSw, rapid movement into PF upon IC) Excessive inversion Excessive eversion
80
CVA: swing gait deficits
Inadequate hip flexion Inadequate knee flexion Inadequate ankle DF Inadequate ankle DF and knee extension approaching/at IC Inadequate foot clearance (toe drag) Excessive hip ER (using hip add) Excessive hip adduction (scissoring) Inadequate knee extension at TSw (decreased step length) Poor foot placement (dyscoordination)
81
Why would CVA patient have excessive pronation of the foot?
Weakness
82
Why would CVA patient have excessive supination of the foot?
Part of synergy with LE extension/PF
83
Why would CVA patient have toe clawing?
Mechanism to seek stability
84
Gait adaptations following CVA
``` Decreased stride length Decreased step length Increased uneven step and stride lengths Decreased stride width Decreased double support Decreased walking velocity Use of arms for support and balance ```
85
Why does an affected limb usually take the bigger step?
Stance time is short on affected limb, so swing limb won't go as far.
86
Most commonly used assessment tools for gait
Ranchos los Amigos Barthel Index FIM
87
What technology could you use to analyze gait?
GAITrite Nike+ mapmyrun Video
88
What is a great test to measure gait improvement?
Timed walking tests (TUG)
89
What are critical stance phase components?
Extension of the hip with simultaneous ankle DF Lateral horizontal shift of pelvis (to swing opposite leg) Controlled flexion of the knee at heel strike Extension of the knee at heel off Flexion of the knee at toe off
90
What are critical swing phase components?
Flexion of the knee from a position of extension Lateral pelvic tilt downwards Flexion of the hip Forward rotation of the pelvis Knee extension with dorsiflexion at late swing
91
Environmental constraints of gait
``` Surface Direction Grade Velocity Acceleration Footwear Assistive device Weight Task ```
92
Why use backward walking in therapy?
Increases concentric muscle activity Decreases visual cues Decreases step length BOS established prior to weight shift Requires anterior depression and posterior elevation of pelvis Critical for many functional tasks, especially in small enclosed spaces
93
Why use BWSTT (body weight supported treadmill training)?
``` Provides partial body weight support Allows patient to practice "whole" task Safe activity early in recovery following stroke Reduces requirement for stability With improvement, support is reduced ```
94
BWSTT groups demonstrated higher:
Balance scores Motor recovery Overground walking speed Overground walking endurance
95
What does touching a light rail or a cane as you ambulate do to improve gait?
Sensory input to the hand and arm can reduce postural sway and help maintain stability.
96
Advantages of ankle-foot orthoses?
Improved walking speeds Improved balance Improved efficiency Reduced spasticity
97
Disadvantages of ankle-foot orthoses?
May impact recovery of ankle motion May cause kinematic changes at the knee Cosmetic considerations
98
Velocity =
Distance/time (m/sec) or cadence (steps/min) x step length
99
Hip extensor stretch is critical in gait to...?
have good rhythmic walking as it is a trigger in the feedback loop of the CPG. If hip doesn't extend completely, patient loses trigger for rhythmic walking.

NPT I (3 decks)

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