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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
Q

What is the normal stair climbing strategy? What is the compensation?

A

Normal: reciprocal
Compensation: step to, use of rail

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26
Q

What are the components of ascending stairs?

A

Stance: pull up force
Swing: foot clearance and placement

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27
Q

What is the major problem with ascending stairs?

A

Conservation of energy

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28
Q

What are the components of descending stairs?

A

Stance: controlled lowering
Swing: leg pull-through and foot placement

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29
Q

What is the major problem with descending stairs?

A

Safety

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30
Q

Why would you use ramps to help with stair training?

A

Same demand but without obstacle of step

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31
Q

What are the 3 major requirements of gait?

A

Production of a basic locomotor rhythm

Dynamic balance control of the moving body

Ability to adapt movement to changing environmental demands

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32
Q

Gait is movement of COG through space with…

A

minimal energy requirement

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33
Q

Gait is inherently…?

A

An unstable process

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34
Q

In normal gait, muscle activity is…?

A

brief, and often eccentric (to counteract momentive forces)

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35
Q

What are the 5 key elements of gait?

A 
Symmetry
Step pattern
Speed
Trunk posture
Arm swing
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36
Q

Faster, more comfortable walking velocity leads to…?

A

more efficient walking

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37
Q

Why would a patient be reluctant to pick up their speed in gait?

A

Due to its inherent instability.

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38
Q

What is the first thing to happen when we initiate a step?

A

Lean onto stance leg before propelling forward.

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39
Q

What happens in gait when we change speed or stop?

A

More force is involved - combination of eccentric and isometric contraction.

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40
Q

How do we respond to trips and slips?

A

Reflexive extension of arms
Compensatory step(s) to catch COG
Lowering COG, widen BOS

41
Q

With age, there is a decrease in:

A

Aerobic capacity
Joint flexibility
Muscle strength
Bone mass

41
Q

What are the 3 elements of motor control of gait?

A

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
Q

What are 4 gait changes in older adults?

A

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
Q

Impairments that may cause gait abnormalities following CNS damage

A 
Changes in tone
Weakness
Dyscoordination
Sensory impairments
Visual deficits
Vestibular deficits
Perceptual and cognitive impairments
Pain
44
Q

CVA walking speed:

A

Decreased

45
Q

CVA stride length:

A

Decreased

45
Q

CVA ankle dorsiflexion at heel contact

A

Decreased

46
Q

CVA knee flexion in swing

A

Decreased

47
Q

CVA hip extension during midstance and pushoff

A

Decreased

48
Q

CVA stance time of affected limb

A

Decreased

49
Q

CVA swing time of affected limb

A

Increased

49
Q

CVA single leg support

A

Decreased

50
Q

CVA double limb support

A

Increased

51
Q

CVA coactivation of leg muscles

A

Abnormal

52
Q

CVA gait energy cost

A

Increased

53
Q

Improved selective motor control leads to more…

A

“normal” gait

54
Q

Observable gait deficits following CVA (stance)

A 
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
Q

CVA: Midstance gait deficits

A

Excessive knee hyperextension (extensor thrust)

Excessive knee flexion

Excessive hip flexion

56
Q

CVA: Terminal stance gait deficits

A

Inadequate hip extension

Inadequate plantarflexion at preswing

57
Q

CVA: Initial contact gait deficits

A

Flat foot (excessive PF)

Foot slap (adequate DF at TSw, rapid movement into PF upon IC)

Excessive inversion

Excessive eversion

58
Q

CVA: swing gait deficits

A

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
Q

Why would CVA patient have excessive pronation of the foot?

A

Weakness

60
Q

Why would CVA patient have excessive supination of the foot?

A

Part of synergy with LE extension/PF

62
Q

Why would CVA patient have toe clawing?

A

Mechanism to seek stability

62
Q

Gait adaptations following CVA

A 
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
Q

Why does an affected limb usually take the bigger step?

A

Stance time is short on affected limb, so swing limb won’t go as far.

65
Q

CVA single leg support

A

Decreased

66
Q

CVA double limb support

A

Increased

67
Q

CVA double limb support

A

Increased

69
Q

CVA coactivation of leg muscles

A

Abnormal

70
Q

CVA coactivation of leg muscles

A

Abnormal

71
Q

CVA gait energy cost

A

Increased

72
Q

CVA gait energy cost

A

Increased

74
Q

Improved selective motor control leads to more…

A

“normal” gait

74
Q

Improved selective motor control leads to more…

A

“normal” gait

76
Q

Observable gait deficits following CVA (stance)

A 
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
Q

CVA: Midstance gait deficits

A

Excessive knee hyperextension (extensor thrust)

Excessive knee flexion

Excessive hip flexion

78
Q

CVA: Terminal stance gait deficits

A

Inadequate hip extension

Inadequate plantarflexion at preswing

79
Q

CVA: Initial contact gait deficits

A

Flat foot (excessive PF)

Foot slap (adequate DF at TSw, rapid movement into PF upon IC)

Excessive inversion

Excessive eversion

80
Q

CVA: swing gait deficits

A

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
Q

Why would CVA patient have excessive pronation of the foot?

A

Weakness

82
Q

Why would CVA patient have excessive supination of the foot?

A

Part of synergy with LE extension/PF

83
Q

Why would CVA patient have toe clawing?

A

Mechanism to seek stability

84
Q

Gait adaptations following CVA

A 
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
Q

Why does an affected limb usually take the bigger step?

A

Stance time is short on affected limb, so swing limb won’t go as far.

86
Q

Most commonly used assessment tools for gait

A

Ranchos los Amigos
Barthel Index
FIM

87
Q

What technology could you use to analyze gait?

A

GAITrite
Nike+
mapmyrun
Video

88
Q

What is a great test to measure gait improvement?

A

Timed walking tests (TUG)

89
Q

What are critical stance phase components?

A

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
Q

What are critical swing phase components?

A

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
Q

Environmental constraints of gait

A 
Surface
Direction
Grade
Velocity
Acceleration
Footwear
Assistive device
Weight
Task
92
Q

Why use backward walking in therapy?

A

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
Q

Why use BWSTT (body weight supported treadmill training)?

A 
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
Q

BWSTT groups demonstrated higher:

A

Balance scores
Motor recovery
Overground walking speed
Overground walking endurance

95
Q

What does touching a light rail or a cane as you ambulate do to improve gait?

A

Sensory input to the hand and arm can reduce postural sway and help maintain stability.

96
Q

Advantages of ankle-foot orthoses?

A

Improved walking speeds
Improved balance
Improved efficiency
Reduced spasticity

97
Q

Disadvantages of ankle-foot orthoses?

A

May impact recovery of ankle motion
May cause kinematic changes at the knee
Cosmetic considerations

98
Q

Velocity =

A

Distance/time (m/sec)

or cadence (steps/min) x step length

99
Q

Hip extensor stretch is critical in gait to…?

A

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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