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.
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.
3
Q
What is the reflex theory?
A
That every action is driven by a stimulus. Stimuli and response work together.
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.
5
Q
What is the hierarchical theory?
A
Control is top-down (brain controls everything).
6
Q
What are the limitations of the hierarchical theory?
A
Does not explain: dominance of reflex behavior in adults (balance, swallowing)
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
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.
9
Q
What are the limitations of the motor programming theory?
A
Does not explain musculoskeletal and environmental variation in motor task performance.
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.
11
Q
What are the limitations of the systems theory?
A
Does not emphasize the interaction of individual and environment.
12
Q
What is the dynamical action theory?
A
Movement control evolves into preferred patterns of movement (attractor states).
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.
14
Q
What are the limitations of dynamical action theory?
A
Does not explain the importance of the nervous system in motor control.
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.
16
Q
What are the limitations of the ecological theory?
A
Does not emphasize function of the nervous system.
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.
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.
19
Q
What is reactive synaptogenesis?
A
Collateral sprouting of new synapses by axons.
20
Q
What is regenerative synaptogenesis?
A
Neural regeneration when injured axons sprout new dendrites.
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
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.
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.
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.
25
What is system redundancy? How is it treated?
Recruitment of previously silent/unused synapses (structurally intact but functionally weak).
PT and amphetamines can facilitate their activation.
26
After an ischemic episode, pharmacologic interventions are used to...?
Prevent scarring
Prevent swelling
Stimulate growth
Disinhibit inhibited regions
27
Much of neural recovery in the first 3-4 weeks is a result of...?
Spontaneous normalization of edema, circulation, and/or neural shock.
28
A patient presents no initial deficit, but develops one over time. What kind of damage is this?
Damage to an immature brain area.
29
Why are symptoms slow to present in brain tumors?
Grow slowly and the brain adapts around it (plasticity). Eventually the tumor becomes too large for adaptation to occur.
30
What is learned non-use? What therapy developed to overcome this?
An initial loss of function from neural causes leads patients to continue to not use the involved side.
CIMT - Constraint Induced Movement Therapy
31
Why is specificity important in training?
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.
32
What is learning?
The memorization of new information or skills (declarative or procedural)
33
What is declarative learning? What areas of the brain are involved?
Knowledge that can be verbally or mentally recalled.
Temporal lobe and hippocampus are involved.
34
Why is it that an Alzheimer's patient can't recall facts but can remember how to do things like eating, walking, etc?
Alzheimer's affects the hippocampus which damages declarative memory. The patient still has procedural memory.
35
What is procedural memory? What areas of the brain are involved?
Tasks that can be performed without attention or conscious though.
Cerebellum and some basal ganglia portions are involved.
36
How hard should motor learning interventions be?
Hard enough to challenge the patient but has to be doable as well.
37
What is practice?
The continuing and repetitive effort to become proficient at a skill.
38
What are the 3 stages of motor learning?
1. Cognitive
2. Associative
3. Autonomous
39
What is cognitive learning?
Patient understands the task and develops strategies to accomplish it. Requires a high degree of attention.
40
What is associative learning?
The best strategy for a task is selected and skills are refined. Not as much conscious thought is required.
41
What is autonomous learning?
Skill becomes automatic and requires a low degree of attention to complete.
42
What are the brain areas associated with the cognitive stage of learning?
```
Association motor cortex
Language centers (planning)
```
43
What are the brain areas associated with the associative learning stage?
```
Basal ganglia
Motor cortex (execution)
```
44
What are the 4 processes of motor learning?
Acquisition
Retention
Generalizability
Application in altered contexts
45
What is skill acquisition?
Initial development of motor skill through practice.
46
What is skill retention?
Remembering a motor skill (in the future)
47
What is skill generalizability?
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
48
What is skill in altered contexts?
Patient can perform same activity in a different context.
Ex: transfer to toilet and in restaurant
49
What is feedback?
The return to the brain of information regarding the result of action or process.
50
When is frequent feedback appropriate? What are the negatives?
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.
51
What is intrinsic feedback?
Feedback generated from patient's sensory organs
Proprioceptive, tactile, visual, vestibular
52
What is extrinsic feedback?
Provided by external source
PT, biofeedback, balance master
53
What is KP?
Knowledge of performance
Feedback on execution of movement components (part of the activity)
54
What is KR?
Knowledge of results
Feedback on outcome of task completion (entire activity)
55
What is immediate vs. summary feedback?
Immediate - given after each trial
| Summary - after a few trials
56
What is bandwidth feedback?
Feedback only given when certain level of accuracy is not achieved.
57
What type of feedback is most effective for long-term retention?
"Faded" feedback - start out immediate but move toward summary
58
Why should the patient have the opportunity to sense and correct errors in order to improve?
Keeping a patient from exploring makes them reliant on you to do the task.
59
What is the importance of mental practice in conjunction with physical practice?
Allows for correction of errors in execution and improved concentration.
60
When is partial task practice the most useful?
For long tasks or difficult aspects of a skill
61
When is whole task practice the most useful?
When learner has the prerequisite skills, task takes < 1 sec, or task requires minimal cognitive processing
62
A patient doesn't sit forward when they go from sit to stand. What is a functional activity to use to help this?
Have patient practice sitting forward (give them an object to reach forward and grab).
63
What is blocked practice? What is this used for?
Task or sequence of tasks are repeated in a very predictable way.
Used to improve skill acquisition
64
What is serial practice? What is this used for?
Tasks are predictable but the order changes.
Used for skill retention and transfer
65
What is random practice? What is this used for?
Tasks are ordered predictably but are out of sequence.
Used for long-term skill retention and transfer
66
What is distributed practice? What is it best used for?
Rest periods > practice time that results in increased performance (time to think through).
Best for continuous tasks, complex tasks, and learners with decreased motivation.
67
What is mass practice? What is it best used for?
Practice time > rest time resulting in increased retention
Best for discrete tasks and learners with increasing skill levels
68
Skill acquisition: What kind of feedback, guidance, and practice should be used?
Feedback: frequent, concurrent
Guidance: manual guiding, verbal cueing
Practice: blocked, allow problem solving
69
Skill retention and generalizability: What kind of feedback, guidance, and practice should be used?
Feedback: faded, summary
Guidance: no manual, some cueing
Practice: serial/random, promote entire movement, task-oriented, diverse
70
What kind of manipulation: eyes open/closed, conflicting visual input, confusing environment
Perceptual manipulation
71
What kind of manipulation: ask patient to do Serial 7's while balancing
Cognitive manipulation
72
What kind of manipulation: modify environment, require additional movements?
Motor manipulation
73
What are the 4 steps of the motor relearning program?
1. Analysis of the task
2. Practice of the whole task
3. Practice of missing components if needed
4. Transference of training (variability)
74
What are the 3 levels of learning?
Neuromotor level
Movement level
Action level
75
What is the difference between intrarater and interrater reliability?
Intrarater is same person gets same result
Interrater is different people get same result
76
What is weakness? What causes weakness in CNS pathology?
Inability for muscle to generate force
Primary: Lack of stimulation of alpha motor neuron
Secondary: disuse atrophy
77
What are the consequences of CNS weakness?
Increase fall risk
Increase energy expenditure during gait
Foster activity intolerance
78
What is bradykinesia?
Very slow movement, common in Parkinson's disease
79
What is akinesia?
No movement caused by a motor control problem with initiating movement. Common in Parkinson's disease (freezing)
80
What is apraxia?
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).
81
When can you use MMT on a CNS pathology patient? How would you test strength otherwise?
Only if they can perform the movement. If not, assess strength via observational analysis.
82
Why would FES not be indicated in a neuro patient?
Becomes a compensatory device and generate negative plasticity.
83
What intervention would be most appropriate to address weakness following CNS pathology?
Functional strengthening
84
If a patient cannot perform active movement (0 or 1 on MMT scale), what are the interventions for weakness?
Facilitation techniques - use stretch reflex for autogenic facilitation; tapping, vibration, light touch
Modify functional task/environment (ex: use gravity to reach for object)
85
If a patient cannot perform active movement against gravity (2-3 on MMT), what are the interventions for weakness?
Gravity-eliminated PREs and functional tasks
| ex: arm elevation - supine abduction exercises
86
If a patient lacks full muscle power (4 on MMT), what are the interventions for weakness?
PREs against gravity and then resistance, manual resistance in PNF diagonals, endurance training.
87
What considerations should you take when thinking of strengthening exercises?
Action specific
Velocity specific
Angle specific
88
What does PNF do?
Uses specific movement patterns and techniques to improve flexibility and strength (diagonal patterns).
Does not restore normal motor control.
89
What are the principles of PNF?
Mass movement is a characteristic of normal motor activity which requires tissue shortening and lengthening.
90
What is NDT?
Neurodevelopmental Treatment
Use of developmental sequence to challenge trunk muscles and proximal muscle stability
91
What are the roles of the cerebellum?
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
What is ataxia?
Disordered movement
93
What is dysmetria?
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
What is dysdiadochokinesia?
Inability to perform alternating movement - contracting antagonist/agonist in sequence.
95
What are coordination tests?
```
Finger to finger, finger to nose tests
Heel to shin test
Rebound test
Rapid alternating movements
Romberg test
```
96
What are interventions for impaired coordination?
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
What are some coordination activities that you could use?
```
Placing activities (targeted movement)
Dart throwing
Throw ball in hoop
Walk on treadmill
Jumping
```
98
What does PNF stand for?
Proprioceptive
Neuromuscular
Facilitation
99
Why use manual contact in PNF?
Increase the strength of contraction, indicate desired direction of movement.
100
What is irradiation?
Spreading of a muscular response from one muscle group to another by altering the emphasis of resistance.
101
What is successive induction?
An increased response of the agonist results after contraction of its antagonist.
102
What is reciprocal inhibition?
Facilitation of the agonist results in simultaneous inhibition of the antagonist.
103
What is autogenic inhibition?
Internal reduction of force production (stimulation of GTOs result in muscle relaxation).
104
What is approximation? What is it used for?
Compression of joint surfaces.
Used to facilitate co-contraction around joints and increase stability.
105
What is traction? What is it used for?
Separation of joint surfaces.
Used to decrease pain and facilitate movement.
106
What is rhythmic initiation?
Start by doing motion for patient and then work up to them independent and resisted. Good for generalized strengthening.
107
What is a combination of isotonics?
Stabilizing contractions from concentric to eccentric. Strengthens the same set of muscles up and down.
108
What is a repeated quick stretch?
Quick stretch that produces contraction of the agonist. Good for patients too weak to do the movement.
109
What is an isotonic reversal?
Alternating concentric isotonic contractions
110
What are stabilizing reversals?
Alternating isometrics and maintained isotonics.
| Ex: have pt hold in weak position and then practice resistance
111
What are relaxation/stretching techniques?
Contract relax - contraction of agonist followed by PROM
Hold relax - isometric or maintained isotonic followed by PROM
112
What is muscle tone?
Resistance to passive movement. Should be uniform resistance at all speeds.
113
What is the difference between hypotonia and flaccidity?
Hypotonia - less than normal, barely noticeable muscle tone
Flaccidity - tone completely absent
114
What are the 2 types of hypertonia?
Spasticity - velocity-dependent resistance of PROM
Rigidity - non-velocity dependent
115
What is dystonia?
Involuntary muscle contractions which force body into abnormal and sometimes painful postures.
116
What is spasm?
Sustained involuntary muscle contraction, less intense than dystonia.
117
What causes hypotonia?
Loss of normal alpha-gamma coactivation.
Pathologies: Down's, Cb damage, CVA
118
What are the typical abnormal synergies caused by spastic paralysis in the UE? LE?
UE: flexor > extensor
LE: extensor > flexor
119
What are the UE flexor synergies at: scapula, shoulder, elbow, wrist, fingers?
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
What are the UE extensor synergies at: scapula, shoulder, elbow, wrist, fingers?
Scapula - less retraction, downward rot., dep
Shoulder: add, IR, minimal flex
Elbow - extension, pronation
Wrist - flexion, minimal ulnar dev.
Fingers - flexion
121
What are the LE flexor synergies at pelvis, hip, knee, ankle?
Pelvis - elev., retract, posterior tilt
Hip - flexion, abd, ER
Knee - flexion
Ankle - DF, inversion
122
What are the LE extensor synergies at pelvis, hip, knee, ankle?
Pelvis - elev., retract, anterior tilt
Hip - ext, add, IR
Knee - extension
Ankle - PF, inversion
123
What is the "typical" arm posture of someone with spastic paralysis?
```
Shoulder adduction (ext)
Elbow flexion (flex)
Forearm pronation (ext)
Wrist flexion (flex)
```
124
What is the "typical" leg posture of someone with spastic paralysis?
```
Hip flexion (slight) and adduction
Knee extension
Ankle PF (ext)
```
125
What are the 2 scales used for stages of recovery from spastic paralysis?
Brunnstrom: 7 stages
Bobath: 3 stages
126
What is Brunnstrom's Stage 1?
Flaccidity of limb
| No reflex or voluntary movement
127
What is Brunnstrom's Stage II?
Minimal voluntary movement
Associated reactions (involuntary)
Spasticity begins to develop
128
What Brunnstrom stages correlate with Bobath's Initial Flaccid Stage?
I and II
129
What is Brunnstrom's Stage III?
Voluntary control of movement synergies
Movement not through full ROM
Spasticity reaches peak
130
What is Brunnstrom's Stage IV?
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
What Brunstromm stages correlate with Bobath's Stage of Spasticity?
III and IV
132
What is Brunnstrom's Stage V?
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
What is Brunnstrom's Stage VI?
Individual, isolated joint movements
- Hand from lap to chin
- Hand from lap to opposite knee
Nearly normal coordination
No spasticity
134
What Brunnstrom stages correlate with Bobath's Stage of Relative Recovery?
V and VI
135
What is Brunnstrom's Stage VII?
Normal motor function
136
What is decorticate rigidity?
UE flexion, trunk and LE extension
Injury at higher level (affects less brain)
137
What is decerebrate rigidity?
Extension of trunk and extremities
Injury more central in brain
138
What are the 2 presenting types of rigidity?
Lead pipe - slow resistance through ROM (slowly gives way)
Cog wheel - catch and release throughout ROM (ratcheting)
139
What are neural mechanisms of hypertonia?
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
What are non-neural mechanisms of hypertonia?
Altered visco-elastic properties of connective tissue due to immobilization
Change in muscle fiber structure (fibrosis, atrophy, free Ca in motor fibers)
141
How is it that using intrathecal baclofen can inhibit function?
Removing spasticity can sometimes inhibit function because the spasticity was preventing a muscle weakness.
142
What is Ashworth Scale Grade 0?
No increase in muscle tone
143
What is Ashworth Scale Grade 1?
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
What is Ashworth Scale Grade 2?
Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout remainder of ROM
145
What is Ashworth Scale Grade 3?
More marked increase in muscle tone through most of the ROM, but the affected part is easily moved
146
What is Ashworth Scale Grade 4?
Considerable increase in muscle tone, passive movement is difficult
147
What is Ashworth Scale Grade 5?
Affected part is rigid in position.
148
What is an H-reflex?
EMG exam that indicates sensitivity to alpha-motor neuron system. Invasive and time-consuming way to measure muscle tone.
149
How is hypertonicity treated?
```
Pharma (Baclofen, valium, botox)
Surgical (nerve cut, block)
Prolonged stretch (serial casting)
Rhythmical rotation (relaxing)
Weight bearing (normalizing effect)
```
150
What is the rationale for treating hypertonicity?
Effects are temporary but may allow for functional task practice.
151
What is the Brunnstrom method?
Neurophysiological treatment based on the use of reflexes to elicit movement; stereotyped whole-limb movement patterns are facilitated.
Uses primitive reflexes
152
How are associated reactions used to treat abnormal muscle tone?
Used to facilitate hypotonic muscle or inhibit hypertonic muscle.
153
If you want to get UE flexion of the involved side, what would you do to the uninvolved side?
Resisted flexion
154
If you want to get LE extension of the involved side, what would you do to the uninvolved side?
Resisted flexion
155
What is Ramiste's phenomenon?
Resisted LE abduction of uninvolved side facilitates abduction of involved side.
156
What is ATNR? What does it facilitate?
Asymmetrical Tonic Neck Reflex - hold neck to one side --> Extension on chin side and flexion on skull side.
157
If you have a weak elbow extensor, which way would you have the patient look when using the ATNR to facilitate elbow extension?
Patient turns head toward affected side
158
What is STNR? What does it facilitate?
Symmetric Tonic Neck Reflex
Extension at neck --> UE extension, LE flexion
Flexion at neck --> UE flexion, LE extension
159
What is a tonic labyrinthine reflex?
Lying on back --> UE flex, LE ext
Lying on side --> ceiling side flex, floor side ext
160
What is Bobath's NDT?
Abnormal movement is the result of failure to integrate primitive reflexes.
Must inhibit abnormal movement before facilitating normal movement.
161
What are RIPs?
Reflex Inhibiting Patterns - inhibit abnormal tone/movement to facilitate normal movement.
If hypertonia is decreased, "weak" muscles can contract.
162
When is a permanent decrease in spasticity achieved?
When patient able to perform selective movements.
163
What is stereognosis?
Tactile identification of common objects (recognition of physical properties)
Asterognosis - absence of ability
164
What is 2-point discrimination?
Ability to recognize 2 points when simultaneously applied with vision occluded.
165
What areas have the best 2-point discrimination? Worst?
Best: Fingers, face
Worst: Thigh, calf
166
Where is proprioceptive impairments most obvious?
Distally
167
What should visual field deficits be distinguished from?
Neglect syndrome
168
What is homonymous hemianopsia?
Loss of vision in same side of each eye. Patient may not compensate for deficit (neglect).
169
What is the interaction between perception and cognition?
Perception - ability to process and interpret sensory information
Cognition - ability to process and interpret information
170
Body scheme disorders
Spatial relations disorders
Agnosia
Apraxia
Perceptual-cognitive impairments
171
What is agnosia?
Inability to recognize familiar objects
172
What is apraxia?
Inability to perform purposeful, skilled motion in the presence of adequate strength, sensation, and coordination.
173
What side of hemiplegia has a better chance at improving somatosensory impairments?
Left-sided hemiplegia
174
What is posture orientation, stability, and control?
Orientation - of body to environment
Stability - static/dynamic equilib (balance)
Control - orientation and stability
175
What are the motor mechanisms of postural orientation?
Spontaneous postural sway
Alignment
Postural tone
176
What are the sensory mechanisms of postural orientation?
Visual
Vestibular
Somatosensory
177
When does a child exhibit adult-like movement patterns?
7-10 years
178
Why does an old person have increased postural sway?
Degeneration of muscle strength, ROM, and sensory input.
179
What is pusher syndrome?
Patients with CVA actively push their weight away from the nonhemiparetic side which leads to loss of postural balance.
180
Closing eyes would do what to a postural exercise?
Make postural stability more difficult
181
What is balance?
The ability to control the COG over the BOS in any given sensory environment
182
What is Center of Gravity? Where is it typically?
The point where all the weight of the object can be considered to be concentrated.
Typically anterior to L2
183
What is Base of Support?
The surface that experiences pressure as the result of weight and gravity, and the area contained within.
184
What is Limit of Stability?
The farthest distance in any direction a person can lean (away from midline) without altering the original BOS by stepping, reaching, or falling
185
What are the 4 demands on the system in balance?
Location of COG, BOS, LOS
Surface conditions
Visual environment
Intentions and task choices
Above 4 constantly changing
186
What are the 3 peripheral sensory systems used in balance?
Somatosensory
Visual
Vestibular
187
What does the central sensory system do in regards to balance?
Compares sides of the body and different sensory modalities
Integration of sensory information
Resolution of sensory conflict
188
Where does somatosensation come from throughout the body? What information is provided?
Joints, ligaments, muscles, skin
Information about muscle length, stretch, joint position, pressure
189
What is the purpose of central vision?
Provides environmental orientation and perception of verticality. Used for obstacle motion and avoidance.
190
What is the purpose of peripheral vision?
Detects the motion of self in relation to environment.
191
What does the vestibular system do for balance?
Provides information regarding head position in relation to gravity and during linear/rotary movement.
192
What is vestibular dysfunction?
Misperceiving the environment
193
What is the result of unresolved sensory conflict by the sensory systems?
Impaired balance and/or dizziness, nausea, vomiting.
194
What does motor planning and execution consist of?
Reflexes
Automatic postural responses
Anticipatory postural responses
Volitional postural responses
195
What reflexes contribute to the orientation of the eyes, head, and body?
Vestibuloocular (VOR)
| Vestibulospinal (VSR)
196
What is the vestibuloocular reflex?
Keeps eyes focused on object even during motion of the head
197
What is the vestibulospinal reflex?
Maintains head, neck, and body orientation
198
What are the 2 automatic postural responses?
Righting reactions
| Postural/balance strategies
199
What are righting reactions?
Orientation of the head to the trunk:
- Optical/labyrinthine
- Body-on-head
- Body-on-body
200
What is the purpose of automatic postural responses? How fast do they occur?
Operate to keep COG over BOS - functionally organized to match amplitude and direction of stimulus.
Occur in less than 250 msec
201
What are the 4 postural/balance strategies?
Ankle
Hip
Suspensory
Stepping
202
What is the ankle strategy?
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
What is the hip strategy?
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
What is suspensory strategy?
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
What is the stepping strategy?
An attempt to re-establish a new BOS when COG moves outside of the original BOS.
206
What does the anticipatory postural response before the actual disturbance?
Postural set
207
What is an example of volitional postural response?
Shifting weight to reach for object
208
What is the Romberg test?
Client stands with feet parallel and together, then closes eyes for 20-30 seconds
209
What is the Sharpened Romberg test?
Heel-to-toe position with arms crossed for 60 sec - eyes open or closed.
210
How do you test SOLEO/SOLEC?
Hip in neutral
Knee flexed to 90 deg
5 trials 30 sec per leg
Eyes open or closed
211
How is postural sway assessed?
Force plate or other measuring device.
212
What is the nudge-push test?
Backwards perturbations applied at the sternum or pelvis, then forward between shoulder blades or pelvis
Judges automatic responses to unpredictable perturbations.
213
What is the motor control response test?
Client stands on movable footplate, whose surface rotates toes up or down, and translates forward or backward.
Perturbs the client through surface displacement
214
What is the postural stress test?
A quantifiable, repeatable nudge/push test - waist belt is attached to pulleys with weights. Weight is then dropped from standard heights.
215
What is the Foam and Dome?
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
What does a foam block do to sensory input?
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
If a patient demonstrates poor balance with eyes closed, what does this indicate they are at risk for?
Patient requires heavily on vision for balance so they would be at risk for falls at night or in dark rooms.
218
What is the Sensory Organization Test?
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
What are 5 functional balance scales?
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Functional reach test
Timed up and go test
Berg balance test
Dynamic gait index
Tinetti
```
220
What is the functional reach test?
Measures LOS where less than 10" indicates high risk for falls
221
What is the Timed Up and Go test (TUG)?
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
What is the Berg Balance Test?
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
What is the ABC?
Activities-specific Balance Confidence Scale - questionnaire that gathers info about pt's confidence in performing variety of typical activities.
224
What are common treatments for balance dysfunction?
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Sitting balance
Sit-stand transfers
Standing
Strategy training
Gait training
```
