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NPT I > NPT I - EXAM I > Flashcards

NPT I - EXAM I Flashcards

1
Q

What is motor control?

A

Using motor memory and current sensory input to coordinate effective and efficient movements and govern posture.

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2
Q

What is the difference between strength and motor control?

A

Strength is a muscle’s capacity to generate power that responds to strengthening exercises.

Motor control is the capacity to contract muscle fibers in the right sequence with appropriate force.

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3
Q

What is the reflex theory?

A

That every action is driven by a stimulus. Stimuli and response work together.

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4
Q

What are the limitations of the reflex theory?

A

Does not explain: movement in absence of stimuli, fast movement, multiple responses to the same stimulus, production of novel movements.

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5
Q

What is the hierarchical theory?

A

Control is top-down (brain controls everything).

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6
Q

What are the limitations of the hierarchical theory?

A

Does not explain: dominance of reflex behavior in adults (balance, swallowing)

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7
Q

What are the motor programming theories?

A

Movement is controlled by a preexisting centralized program that can be activated by an external stimulus or centrally (voluntary/involuntary movement).

Central Pattern Generator

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8
Q

What is a Central Pattern Generator?

A

A neural circuit that is hardwired for a function so it takes limited energy to perform.

Regular rhythmic walking is due to a CPG in the spinal cord.

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9
Q

What are the limitations of the motor programming theory?

A

Does not explain musculoskeletal and environmental variation in motor task performance.

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10
Q

What is the systems theory?

A

Higher and lower level systems work together to achieve movement. Higher levels activate lower levels. Lower levels activate synergies.

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11
Q

What are the limitations of the systems theory?

A

Does not emphasize the interaction of individual and environment.

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12
Q

What is the dynamical action theory?

A

Movement control evolves into preferred patterns of movement (attractor states).

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13
Q

What is an attractor state?

A

The way you ordinarily do things that is different from others. You could do it differently if asked, but prefer your way.

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14
Q

What are the limitations of dynamical action theory?

A

Does not explain the importance of the nervous system in motor control.

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15
Q

What is the ecological theory?

A

Motor control enables us to cope with the environment. Perception is important and it considers environmental factors.

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16
Q

What are the limitations of the ecological theory?

A

Does not emphasize function of the nervous system.

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17
Q

What is the motor learning theory?

A

Combines the ecological model with psychology and education research.

Movement emerges from interaction of individual, task, and environment. Movement is a result of a dynamic interplay of perception, cognition, and action systems.

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18
Q

What is neural plasticity?

A

Capacity of the CNS to adapt to functional demands and therefore to the system’s capacity to reorganize.

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19
Q

What is reactive synaptogenesis?

A

Collateral sprouting of new synapses by axons.

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20
Q

What is regenerative synaptogenesis?

A

Neural regeneration when injured axons sprout new dendrites.

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21
Q

What is diaschisis?

A

Neural shock - temporary abolition of excitability in areas related to the damaged area from: decreased blood flow, reduction in metabolism, and lesion

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22
Q

What is denervation hypersensitivity?

A

When a neuron loses normal input, the post-synaptic membrane becomes hypersensitive to neurotransmitters. This refers to recovering lost function, not necessarily hypertonicity.

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23
Q

What is the ischemic penumbra?

A

Cells bordering an ischemic region where the neurons are viable but not functional due to lost connections or insufficient blood flow.

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24
Q

How can neurons in the ischemic penumbra be treated?

A

Amphetamines and PT

When post-synaptic neurons become hypersensitive, this will allow them to be depolarized when diaschisis resolves.

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25
Q

What is system redundancy? How is it treated?

A

Recruitment of previously silent/unused synapses (structurally intact but functionally weak).

PT and amphetamines can facilitate their activation.

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26
Q

After an ischemic episode, pharmacologic interventions are used to…?

A

Prevent scarring
Prevent swelling
Stimulate growth
Disinhibit inhibited regions

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27
Q

Much of neural recovery in the first 3-4 weeks is a result of…?

A

Spontaneous normalization of edema, circulation, and/or neural shock.

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28
Q

A patient presents no initial deficit, but develops one over time. What kind of damage is this?

A

Damage to an immature brain area.

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29
Q

Why are symptoms slow to present in brain tumors?

A

Grow slowly and the brain adapts around it (plasticity). Eventually the tumor becomes too large for adaptation to occur.

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30
Q

What is learned non-use? What therapy developed to overcome this?

A

An initial loss of function from neural causes leads patients to continue to not use the involved side.

CIMT - Constraint Induced Movement Therapy

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31
Q

Why is specificity important in training?

A

The closer you get to duplicating the task in an activity, in the time, in the muscle groups required, in the positioning required, the better.

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32
Q

What is learning?

A

The memorization of new information or skills (declarative or procedural)

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33
Q

What is declarative learning? What areas of the brain are involved?

A

Knowledge that can be verbally or mentally recalled.

Temporal lobe and hippocampus are involved.

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34
Q

Why is it that an Alzheimer’s patient can’t recall facts but can remember how to do things like eating, walking, etc?

A

Alzheimer’s affects the hippocampus which damages declarative memory. The patient still has procedural memory.

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35
Q

What is procedural memory? What areas of the brain are involved?

A

Tasks that can be performed without attention or conscious though.

Cerebellum and some basal ganglia portions are involved.

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36
Q

How hard should motor learning interventions be?

A

Hard enough to challenge the patient but has to be doable as well.

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37
Q

What is practice?

A

The continuing and repetitive effort to become proficient at a skill.

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38
Q

What are the 3 stages of motor learning?

A
  1. Cognitive
  2. Associative
  3. Autonomous
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39
Q

What is cognitive learning?

A

Patient understands the task and develops strategies to accomplish it. Requires a high degree of attention.

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40
Q

What is associative learning?

A

The best strategy for a task is selected and skills are refined. Not as much conscious thought is required.

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41
Q

What is autonomous learning?

A

Skill becomes automatic and requires a low degree of attention to complete.

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42
Q

What are the brain areas associated with the cognitive stage of learning?

A 
Association motor cortex
Language centers (planning)
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43
Q

What are the brain areas associated with the associative learning stage?

A 
Basal ganglia
Motor cortex (execution)
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44
Q

What are the 4 processes of motor learning?

A

Acquisition
Retention
Generalizability
Application in altered contexts

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45
Q

What is skill acquisition?

A

Initial development of motor skill through practice.

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46
Q

What is skill retention?

A

Remembering a motor skill (in the future)

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47
Q

What is skill generalizability?

A

The positive influence that a previously practiced skill has on the learning of a new skill. Generalizing tasks that have similar attributes.

Ex: transfer from bed, transfer from mat

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48
Q

What is skill in altered contexts?

A

Patient can perform same activity in a different context.

Ex: transfer to toilet and in restaurant

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49
Q

What is feedback?

A

The return to the brain of information regarding the result of action or process.

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50
Q

When is frequent feedback appropriate? What are the negatives?

A

Can help with skill acquisition to get patient started, but can be distracting and interfere with information processing.

Eventually need to back off and let them learn themselves.

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51
Q

What is intrinsic feedback?

A

Feedback generated from patient’s sensory organs

Proprioceptive, tactile, visual, vestibular

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52
Q

What is extrinsic feedback?

A

Provided by external source

PT, biofeedback, balance master

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53
Q

What is KP?

A

Knowledge of performance

Feedback on execution of movement components (part of the activity)

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54
Q

What is KR?

A

Knowledge of results

Feedback on outcome of task completion (entire activity)

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55
Q

What is immediate vs. summary feedback?

A

Immediate - given after each trial

Summary - after a few trials

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56
Q

What is bandwidth feedback?

A

Feedback only given when certain level of accuracy is not achieved.

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57
Q

What type of feedback is most effective for long-term retention?

A

“Faded” feedback - start out immediate but move toward summary

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58
Q

Why should the patient have the opportunity to sense and correct errors in order to improve?

A

Keeping a patient from exploring makes them reliant on you to do the task.

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59
Q

What is the importance of mental practice in conjunction with physical practice?

A

Allows for correction of errors in execution and improved concentration.

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60
Q

When is partial task practice the most useful?

A

For long tasks or difficult aspects of a skill

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61
Q

When is whole task practice the most useful?

A

When learner has the prerequisite skills, task takes < 1 sec, or task requires minimal cognitive processing

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62
Q

A patient doesn’t sit forward when they go from sit to stand. What is a functional activity to use to help this?

A

Have patient practice sitting forward (give them an object to reach forward and grab).

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63
Q

What is blocked practice? What is this used for?

A

Task or sequence of tasks are repeated in a very predictable way.

Used to improve skill acquisition

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64
Q

What is serial practice? What is this used for?

A

Tasks are predictable but the order changes.

Used for skill retention and transfer

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65
Q

What is random practice? What is this used for?

A

Tasks are ordered predictably but are out of sequence.

Used for long-term skill retention and transfer

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66
Q

What is distributed practice? What is it best used for?

A

Rest periods > practice time that results in increased performance (time to think through).

Best for continuous tasks, complex tasks, and learners with decreased motivation.

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67
Q

What is mass practice? What is it best used for?

A

Practice time > rest time resulting in increased retention

Best for discrete tasks and learners with increasing skill levels

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68
Q

Skill acquisition: What kind of feedback, guidance, and practice should be used?

A

Feedback: frequent, concurrent
Guidance: manual guiding, verbal cueing
Practice: blocked, allow problem solving

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69
Q

Skill retention and generalizability: What kind of feedback, guidance, and practice should be used?

A

Feedback: faded, summary
Guidance: no manual, some cueing
Practice: serial/random, promote entire movement, task-oriented, diverse

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70
Q

What kind of manipulation: eyes open/closed, conflicting visual input, confusing environment

A

Perceptual manipulation

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71
Q

What kind of manipulation: ask patient to do Serial 7’s while balancing

A

Cognitive manipulation

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72
Q

What kind of manipulation: modify environment, require additional movements?

A

Motor manipulation

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73
Q

What are the 4 steps of the motor relearning program?

A
  1. Analysis of the task
  2. Practice of the whole task
  3. Practice of missing components if needed
  4. Transference of training (variability)
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74
Q

What are the 3 levels of learning?

A

Neuromotor level
Movement level
Action level

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75
Q

What is the difference between intrarater and interrater reliability?

A

Intrarater is same person gets same result

Interrater is different people get same result

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76
Q

What is weakness? What causes weakness in CNS pathology?

A

Inability for muscle to generate force

Primary: Lack of stimulation of alpha motor neuron
Secondary: disuse atrophy

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77
Q

What are the consequences of CNS weakness?

A

Increase fall risk
Increase energy expenditure during gait
Foster activity intolerance

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78
Q

What is bradykinesia?

A

Very slow movement, common in Parkinson’s disease

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79
Q

What is akinesia?

A

No movement caused by a motor control problem with initiating movement. Common in Parkinson’s disease (freezing)

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80
Q

What is apraxia?

A

Problem with motor planning. Patient has intact motor system and strong muscles but can’t do purposeful movement, particularly on demand (can’t figure out how to start).

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81
Q

When can you use MMT on a CNS pathology patient? How would you test strength otherwise?

A

Only if they can perform the movement. If not, assess strength via observational analysis.

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82
Q

Why would FES not be indicated in a neuro patient?

A

Becomes a compensatory device and generate negative plasticity.

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83
Q

What intervention would be most appropriate to address weakness following CNS pathology?

A

Functional strengthening

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84
Q

If a patient cannot perform active movement (0 or 1 on MMT scale), what are the interventions for weakness?

A

Facilitation techniques - use stretch reflex for autogenic facilitation; tapping, vibration, light touch

Modify functional task/environment (ex: use gravity to reach for object)

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85
Q

If a patient cannot perform active movement against gravity (2-3 on MMT), what are the interventions for weakness?

A

Gravity-eliminated PREs and functional tasks

ex: arm elevation - supine abduction exercises

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86
Q

If a patient lacks full muscle power (4 on MMT), what are the interventions for weakness?

A

PREs against gravity and then resistance, manual resistance in PNF diagonals, endurance training.

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87
Q

What considerations should you take when thinking of strengthening exercises?

A

Action specific
Velocity specific
Angle specific

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88
Q

What does PNF do?

A

Uses specific movement patterns and techniques to improve flexibility and strength (diagonal patterns).

Does not restore normal motor control.

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89
Q

What are the principles of PNF?

A

Mass movement is a characteristic of normal motor activity which requires tissue shortening and lengthening.

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90
Q

What is NDT?

A

Neurodevelopmental Treatment

Use of developmental sequence to challenge trunk muscles and proximal muscle stability

91
Q

What are the roles of the cerebellum?

A

Initiation and control of voluntary movement
Timing of movement/muscle action
Moment to moment correction of errors
Compensation for lesions of cerebral cortex
Motor learning and adaptive adjustments

92
Q

What is ataxia?

A

Disordered movement

93
Q

What is dysmetria?

A

An abnormal condition that prevents the affected individual from properly measuring distances associated with muscular acts and from controlling muscular action.

Crossing the midline is harder.

94
Q

What is dysdiadochokinesia?

A

Inability to perform alternating movement - contracting antagonist/agonist in sequence.

95
Q

What are coordination tests?

A 
Finger to finger, finger to nose tests
Heel to shin test
Rebound test
Rapid alternating movements
Romberg test
96
Q

What are interventions for impaired coordination?

A

Training during functional movements

Constraint to stabilize body during movement
Encourage smooth movement and accuracy
Activities that require sustained force generation
Use open/closed tasks

97
Q

What are some coordination activities that you could use?

A 
Placing activities (targeted movement)
Dart throwing
Throw ball in hoop
Walk on treadmill
Jumping
98
Q

What does PNF stand for?

A

Proprioceptive
Neuromuscular
Facilitation

99
Q

Why use manual contact in PNF?

A

Increase the strength of contraction, indicate desired direction of movement.

100
Q

What is irradiation?

A

Spreading of a muscular response from one muscle group to another by altering the emphasis of resistance.

101
Q

What is successive induction?

A

An increased response of the agonist results after contraction of its antagonist.

102
Q

What is reciprocal inhibition?

A

Facilitation of the agonist results in simultaneous inhibition of the antagonist.

103
Q

What is autogenic inhibition?

A

Internal reduction of force production (stimulation of GTOs result in muscle relaxation).

104
Q

What is approximation? What is it used for?

A

Compression of joint surfaces.

Used to facilitate co-contraction around joints and increase stability.

105
Q

What is traction? What is it used for?

A

Separation of joint surfaces.

Used to decrease pain and facilitate movement.

106
Q

What is rhythmic initiation?

A

Start by doing motion for patient and then work up to them independent and resisted. Good for generalized strengthening.

107
Q

What is a combination of isotonics?

A

Stabilizing contractions from concentric to eccentric. Strengthens the same set of muscles up and down.

108
Q

What is a repeated quick stretch?

A

Quick stretch that produces contraction of the agonist. Good for patients too weak to do the movement.

109
Q

What is an isotonic reversal?

A

Alternating concentric isotonic contractions

110
Q

What are stabilizing reversals?

A

Alternating isometrics and maintained isotonics.

Ex: have pt hold in weak position and then practice resistance

111
Q

What are relaxation/stretching techniques?

A

Contract relax - contraction of agonist followed by PROM

Hold relax - isometric or maintained isotonic followed by PROM

112
Q

What is muscle tone?

A

Resistance to passive movement. Should be uniform resistance at all speeds.

113
Q

What is the difference between hypotonia and flaccidity?

A

Hypotonia - less than normal, barely noticeable muscle tone

Flaccidity - tone completely absent

114
Q

What are the 2 types of hypertonia?

A

Spasticity - velocity-dependent resistance of PROM

Rigidity - non-velocity dependent

115
Q

What is dystonia?

A

Involuntary muscle contractions which force body into abnormal and sometimes painful postures.

116
Q

What is spasm?

A

Sustained involuntary muscle contraction, less intense than dystonia.

117
Q

What causes hypotonia?

A

Loss of normal alpha-gamma coactivation.

Pathologies: Down’s, Cb damage, CVA

118
Q

What are the typical abnormal synergies caused by spastic paralysis in the UE? LE?

A

UE: flexor > extensor

LE: extensor > flexor

119
Q

What are the UE flexor synergies at: scapula, shoulder, elbow, wrist, fingers?

A

Scapula - retraction, downward rot., elev.

Shoulder - abd, ER, ext.

Elbow - flexion w/ pro or sup

Wrist: flexion with radial or ulnar dev.

Fingers: flexion

120
Q

What are the UE extensor synergies at: scapula, shoulder, elbow, wrist, fingers?

A

Scapula - less retraction, downward rot., dep

Shoulder: add, IR, minimal flex

Elbow - extension, pronation

Wrist - flexion, minimal ulnar dev.

Fingers - flexion

121
Q

What are the LE flexor synergies at pelvis, hip, knee, ankle?

A

Pelvis - elev., retract, posterior tilt

Hip - flexion, abd, ER

Knee - flexion

Ankle - DF, inversion

122
Q

What are the LE extensor synergies at pelvis, hip, knee, ankle?

A

Pelvis - elev., retract, anterior tilt

Hip - ext, add, IR

Knee - extension

Ankle - PF, inversion

123
Q

What is the “typical” arm posture of someone with spastic paralysis?

A 
Shoulder adduction (ext)
Elbow flexion (flex)
Forearm pronation (ext)
Wrist flexion (flex)
124
Q

What is the “typical” leg posture of someone with spastic paralysis?

A 
Hip flexion (slight) and adduction
Knee extension
Ankle PF (ext)
125
Q

What are the 2 scales used for stages of recovery from spastic paralysis?

A

Brunnstrom: 7 stages
Bobath: 3 stages

126
Q

What is Brunnstrom’s Stage 1?

A

Flaccidity of limb

No reflex or voluntary movement

127
Q

What is Brunnstrom’s Stage II?

A

Minimal voluntary movement
Associated reactions (involuntary)
Spasticity begins to develop

128
Q

What Brunnstrom stages correlate with Bobath’s Initial Flaccid Stage?

A

I and II

129
Q

What is Brunnstrom’s Stage III?

A

Voluntary control of movement synergies
Movement not through full ROM
Spasticity reaches peak

130
Q

What is Brunnstrom’s Stage IV?

A

Patient can do some movements out of synergy
Spasticity declining but observable

Individual can:

  • Place hand behind body
  • Elevate arm to forward horiz. position
  • Pro/sup with elbow at 90 deg
131
Q

What Brunstromm stages correlate with Bobath’s Stage of Spasticity?

A

III and IV

132
Q

What is Brunnstrom’s Stage V?

A

Declining spasticity
Able to perform more difficult movements out of synergy

Patient above to:

  • Abduct arm
  • Flex and reach overhead
  • Pro/sup with elbow extended
133
Q

What is Brunnstrom’s Stage VI?

A

Individual, isolated joint movements

  • Hand from lap to chin
  • Hand from lap to opposite knee

Nearly normal coordination
No spasticity

134
Q

What Brunnstrom stages correlate with Bobath’s Stage of Relative Recovery?

A

V and VI

135
Q

What is Brunnstrom’s Stage VII?

A

Normal motor function

136
Q

What is decorticate rigidity?

A

UE flexion, trunk and LE extension

Injury at higher level (affects less brain)

137
Q

What is decerebrate rigidity?

A

Extension of trunk and extremities

Injury more central in brain

138
Q

What are the 2 presenting types of rigidity?

A

Lead pipe - slow resistance through ROM (slowly gives way)

Cog wheel - catch and release throughout ROM (ratcheting)

139
Q

What are neural mechanisms of hypertonia?

A

Alpha-motor neurons more sensitive to input (denervation hypersensitivity)

New synapses form and hypertonia develops over time

Pathology - Parkinson’s + brain injury, rigidity + spasticity, non-neural causes

140
Q

What are non-neural mechanisms of hypertonia?

A

Altered visco-elastic properties of connective tissue due to immobilization

Change in muscle fiber structure (fibrosis, atrophy, free Ca in motor fibers)

141
Q

How is it that using intrathecal baclofen can inhibit function?

A

Removing spasticity can sometimes inhibit function because the spasticity was preventing a muscle weakness.

142
Q

What is Ashworth Scale Grade 0?

A

No increase in muscle tone

143
Q

What is Ashworth Scale Grade 1?

A

Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end range of motion when the part is moved.

144
Q

What is Ashworth Scale Grade 2?

A

Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout remainder of ROM

145
Q

What is Ashworth Scale Grade 3?

A

More marked increase in muscle tone through most of the ROM, but the affected part is easily moved

146
Q

What is Ashworth Scale Grade 4?

A

Considerable increase in muscle tone, passive movement is difficult

147
Q

What is Ashworth Scale Grade 5?

A

Affected part is rigid in position.

148
Q

What is an H-reflex?

A

EMG exam that indicates sensitivity to alpha-motor neuron system. Invasive and time-consuming way to measure muscle tone.

149
Q

How is hypertonicity treated?

A 
Pharma (Baclofen, valium, botox)
Surgical (nerve cut, block)
Prolonged stretch (serial casting)
Rhythmical rotation (relaxing)
Weight bearing (normalizing effect)
150
Q

What is the rationale for treating hypertonicity?

A

Effects are temporary but may allow for functional task practice.

151
Q

What is the Brunnstrom method?

A

Neurophysiological treatment based on the use of reflexes to elicit movement; stereotyped whole-limb movement patterns are facilitated.

Uses primitive reflexes

152
Q

How are associated reactions used to treat abnormal muscle tone?

A

Used to facilitate hypotonic muscle or inhibit hypertonic muscle.

153
Q

If you want to get UE flexion of the involved side, what would you do to the uninvolved side?

A

Resisted flexion

154
Q

If you want to get LE extension of the involved side, what would you do to the uninvolved side?

A

Resisted flexion

155
Q

What is Ramiste’s phenomenon?

A

Resisted LE abduction of uninvolved side facilitates abduction of involved side.

156
Q

What is ATNR? What does it facilitate?

A

Asymmetrical Tonic Neck Reflex - hold neck to one side –> Extension on chin side and flexion on skull side.

157
Q

If you have a weak elbow extensor, which way would you have the patient look when using the ATNR to facilitate elbow extension?

A

Patient turns head toward affected side

158
Q

What is STNR? What does it facilitate?

A

Symmetric Tonic Neck Reflex

Extension at neck –> UE extension, LE flexion
Flexion at neck –> UE flexion, LE extension

159
Q

What is a tonic labyrinthine reflex?

A

Lying on back –> UE flex, LE ext

Lying on side –> ceiling side flex, floor side ext

160
Q

What is Bobath’s NDT?

A

Abnormal movement is the result of failure to integrate primitive reflexes.

Must inhibit abnormal movement before facilitating normal movement.

161
Q

What are RIPs?

A

Reflex Inhibiting Patterns - inhibit abnormal tone/movement to facilitate normal movement.

If hypertonia is decreased, “weak” muscles can contract.

162
Q

When is a permanent decrease in spasticity achieved?

A

When patient able to perform selective movements.

163
Q

What is stereognosis?

A

Tactile identification of common objects (recognition of physical properties)

Asterognosis - absence of ability

164
Q

What is 2-point discrimination?

A

Ability to recognize 2 points when simultaneously applied with vision occluded.

165
Q

What areas have the best 2-point discrimination? Worst?

A

Best: Fingers, face
Worst: Thigh, calf

166
Q

Where is proprioceptive impairments most obvious?

A

Distally

167
Q

What should visual field deficits be distinguished from?

A

Neglect syndrome

168
Q

What is homonymous hemianopsia?

A

Loss of vision in same side of each eye. Patient may not compensate for deficit (neglect).

169
Q

What is the interaction between perception and cognition?

A

Perception - ability to process and interpret sensory information

Cognition - ability to process and interpret information

170
Q

Body scheme disorders
Spatial relations disorders
Agnosia
Apraxia

A

Perceptual-cognitive impairments

171
Q

What is agnosia?

A

Inability to recognize familiar objects

172
Q

What is apraxia?

A

Inability to perform purposeful, skilled motion in the presence of adequate strength, sensation, and coordination.

173
Q

What side of hemiplegia has a better chance at improving somatosensory impairments?

A

Left-sided hemiplegia

174
Q

What is posture orientation, stability, and control?

A

Orientation - of body to environment
Stability - static/dynamic equilib (balance)
Control - orientation and stability

175
Q

What are the motor mechanisms of postural orientation?

A

Spontaneous postural sway
Alignment
Postural tone

176
Q

What are the sensory mechanisms of postural orientation?

A

Visual
Vestibular
Somatosensory

177
Q

When does a child exhibit adult-like movement patterns?

A

7-10 years

178
Q

Why does an old person have increased postural sway?

A

Degeneration of muscle strength, ROM, and sensory input.

179
Q

What is pusher syndrome?

A

Patients with CVA actively push their weight away from the nonhemiparetic side which leads to loss of postural balance.

180
Q

Closing eyes would do what to a postural exercise?

A

Make postural stability more difficult

181
Q

What is balance?

A

The ability to control the COG over the BOS in any given sensory environment

182
Q

What is Center of Gravity? Where is it typically?

A

The point where all the weight of the object can be considered to be concentrated.

Typically anterior to L2

183
Q

What is Base of Support?

A

The surface that experiences pressure as the result of weight and gravity, and the area contained within.

184
Q

What is Limit of Stability?

A

The farthest distance in any direction a person can lean (away from midline) without altering the original BOS by stepping, reaching, or falling

185
Q

What are the 4 demands on the system in balance?

A

Location of COG, BOS, LOS
Surface conditions
Visual environment
Intentions and task choices

Above 4 constantly changing

186
Q

What are the 3 peripheral sensory systems used in balance?

A

Somatosensory
Visual
Vestibular

187
Q

What does the central sensory system do in regards to balance?

A

Compares sides of the body and different sensory modalities

Integration of sensory information

Resolution of sensory conflict

188
Q

Where does somatosensation come from throughout the body? What information is provided?

A

Joints, ligaments, muscles, skin

Information about muscle length, stretch, joint position, pressure

189
Q

What is the purpose of central vision?

A

Provides environmental orientation and perception of verticality. Used for obstacle motion and avoidance.

190
Q

What is the purpose of peripheral vision?

A

Detects the motion of self in relation to environment.

191
Q

What does the vestibular system do for balance?

A

Provides information regarding head position in relation to gravity and during linear/rotary movement.

192
Q

What is vestibular dysfunction?

A

Misperceiving the environment

193
Q

What is the result of unresolved sensory conflict by the sensory systems?

A

Impaired balance and/or dizziness, nausea, vomiting.

194
Q

What does motor planning and execution consist of?

A

Reflexes
Automatic postural responses
Anticipatory postural responses
Volitional postural responses

195
Q

What reflexes contribute to the orientation of the eyes, head, and body?

A

Vestibuloocular (VOR)

Vestibulospinal (VSR)

196
Q

What is the vestibuloocular reflex?

A

Keeps eyes focused on object even during motion of the head

197
Q

What is the vestibulospinal reflex?

A

Maintains head, neck, and body orientation

198
Q

What are the 2 automatic postural responses?

A

Righting reactions

Postural/balance strategies

199
Q

What are righting reactions?

A

Orientation of the head to the trunk:

  • Optical/labyrinthine
  • Body-on-head
  • Body-on-body
200
Q

What is the purpose of automatic postural responses? How fast do they occur?

A

Operate to keep COG over BOS - functionally organized to match amplitude and direction of stimulus.

Occur in less than 250 msec

201
Q

What are the 4 postural/balance strategies?

A

Ankle
Hip
Suspensory
Stepping

202
Q

What is the ankle strategy?

A

Body moves as a unit over the feet, with muscles contracting distally to proximally.

Used when sway is small, slow, and near the midline.

203
Q

What is the hip strategy?

A

Control is from the pelvis and the trunk (head and hips move in opposite directions) where muscles contract proximally to distally.

Used when sway is large, fast, and nearing limit of stability

204
Q

What is suspensory strategy?

A

A lowering of the COG toward the BOS via bilateral LE flexion or slight squatting. This shortens the distance between COG and BOS for easier control.

Used when combination of stability and mobility is required (surfing)

205
Q

What is the stepping strategy?

A

An attempt to re-establish a new BOS when COG moves outside of the original BOS.

206
Q

What does the anticipatory postural response before the actual disturbance?

A

Postural set

207
Q

What is an example of volitional postural response?

A

Shifting weight to reach for object

208
Q

What is the Romberg test?

A

Client stands with feet parallel and together, then closes eyes for 20-30 seconds

209
Q

What is the Sharpened Romberg test?

A

Heel-to-toe position with arms crossed for 60 sec - eyes open or closed.

210
Q

How do you test SOLEO/SOLEC?

A

Hip in neutral
Knee flexed to 90 deg
5 trials 30 sec per leg

Eyes open or closed

211
Q

How is postural sway assessed?

A

Force plate or other measuring device.

212
Q

What is the nudge-push test?

A

Backwards perturbations applied at the sternum or pelvis, then forward between shoulder blades or pelvis

Judges automatic responses to unpredictable perturbations.

213
Q

What is the motor control response test?

A

Client stands on movable footplate, whose surface rotates toes up or down, and translates forward or backward.

Perturbs the client through surface displacement

214
Q

What is the postural stress test?

A

A quantifiable, repeatable nudge/push test - waist belt is attached to pulleys with weights. Weight is then dropped from standard heights.

215
Q

What is the Foam and Dome?

A

CTSIB (Clinical Test of Sensory Integration and Balance)

Tests balance under many conditions (can determine which sensory system is responsible for balance dysfunction):

  • Firm vs. soft surface
  • Eyes open vs. closed vs. lantern

5 reps of 30 sec for each condition

216
Q

What does a foam block do to sensory input?

A

As weight shifts on the foam, the foam tips with the weight so there’s no movement of the tibia on the ankle. This limits the proprioceptive input which usually provides subtle shifts in pressure. Postural sway increases as a result.

217
Q

If a patient demonstrates poor balance with eyes closed, what does this indicate they are at risk for?

A

Patient requires heavily on vision for balance so they would be at risk for falls at night or in dark rooms.

218
Q

What is the Sensory Organization Test?

A

Similar to CTSIB - uses computerized movable force plate and movable visual surround to systematically alter surface and visual environment.

Conditions 1-3 are fixed
Conditions 4-6 have sway

219
Q

What are 5 functional balance scales?

A 
Functional reach test
Timed up and go test
Berg balance test
Dynamic gait index
Tinetti
220
Q

What is the functional reach test?

A

Measures LOS where less than 10” indicates high risk for falls

221
Q

What is the Timed Up and Go test (TUG)?

A

PT times how quickly patient can rise from chair, walk 10 feet, turn around, and sit. Test is performed 4x. Greater than 13.5 sec indicates elevated risk of falls.

222
Q

What is the Berg Balance Test?

A

14-item test that has a highest score of 56 (considered “normal”). Less than 42 is considered very high fall risk.

Score of 49/56 or less plus a history of falls is most sensitive measure of falls prediction in community-dwelling older adults.

223
Q

What is the ABC?

A

Activities-specific Balance Confidence Scale - questionnaire that gathers info about pt’s confidence in performing variety of typical activities.

224
Q

What are common treatments for balance dysfunction?

A 
Sitting balance
Sit-stand transfers
Standing
Strategy training
Gait training

NPT I (3 decks)

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