Part IV: Approaches to Intervention Flashcards
What is the Task-Oriented Approach?
*Intervention is the manipulation of tasks
*Outcome = skill development
(SKILL-CONTROL, not task-control)
Requires extensive content-specific practice (active!)
Incorporates motor learning principles and examination
Involves careful analysis and management of underlying impairments
*Patient-therapist collaborative goal setting is the most important part of clinical decision making
Normal movement emerges from the interaction of individual, task & environment
Movement organized around behavioral goals
Sensation important for reflexive, predictive, and adaptive control
Abnormal movement results from impairments in underlying systems
(we are meant to build control of a skill, not capacity)
More effective than immobilization, resistance training, usual PT/OT, and Bobath apporach
What is the Neurofacilitation Approrach?
Assumptions:
- Top-down control
- Sensory information drives movement
- Lesions disrupt cortical control
- Abnormal reflexes constrain normal movement
Recovery:
- Higher centers must regain control
- Recovery recapitulates normal development
- Facilitate “normal” movement patterns
- Inhibit “abnormal” movement patterns
- Repetition of normal transfers to function
What are the characteristics of Neurodevelopmental Treatment (Bobath)?
Neurodevelopmental Treatment (Bobath)
- Therapeutic handling
- Key points of control
- Control sensory input
- Developmental activity `
(evidence shows Bobath is better than the orthopedic approach, but not as effective as the task-oriented approach)
What are the characteristics of PNF?
- Patterns of motion
- Timing for emphasis
- Overflow
- Manual contact
- Vision, stretch, resistance, approximation, traction
Facilitatory and Inhbitory Effects of Neuromuscular Facilitation techiques?
Facilitory Effect:
- Resistance
- Quick Stretch
- Tapping (tendon or muscle belly)
- Joint approximation
- Joint traction
Inhibitory Effect
-Prolonged stretch
What are some concepts for developing a motor plan?
Start early, set goals, build programs for early success
Utilize behavioral shaping
Promote patient problem solving skills
Focus on ACTIVE learning (patients are students; foster active problem solving - they must self-manage)
Consider learning impairments, stages of learning (skill acquisition and transfer training), and characteristics of motor learning stages and training strategies (O’Sullivan pg 397-8 has more)
Minimize explicit (declarative) instructions Consider practice type and schedule (part, whole, constant, blocked, massed, etc) Feedback type and schedule
Develop stability and work towards mobility
Overlap stages
Minimize equipment (use as a tool)
When questioning if a goal was achieved, assess:
- Consistency
- Efficiency
- Flexibility
What are facilitatory and inhibitory sensory stimulation techniques?
Facilitatory:
- Light touch
- Rapid vestibular stim
Inhibitory Effect
- Maintained pressure
- Slow, repetitive stroking
- Neutral warmth
- Prolonged cooling
- Slow vestibular stim
What are basic principles of rehab for the UE and Trunk?
- Encourage weight shift on to hemiplegic side
- Encourage trunk rotation (dissociated movement)
- Elongate (spastic) muscles without over-stretching
- Encourage forward flexion
- Encourage scapular protraction
Remember head-hips relationship and to unweight body parts before moving
How would you manage Excessive Neurogenic Tone?
- Medication
- Positioning
- -Seating / positioning (e.g. flexion to eliminate extensor tone)
- -Prolonged stretch
- -Weight bearing
- -Splinting (for positioning, not just support)
- -Serial / inhibitory casting
- Rhythmic Rotation (used a lot; pt on back as you do windshield wipers)
- Prolonged icing
- Inhibitory Pressure (e.g. put pressure on biceps tendon, then slowly extend arm to stretch biceps without activating spasticity)
- Neutral warmth
How should you manage Hypotonia?
- Quick stretch
- Tapping
- Resistance
- Joint approximation
- Positioning
- Supportive / Protective Devices
- Neuromuscular Electrical Stimulation
What is Activity-Based Restorative Therapies?
-Based on the idea that highly repetitive task-specific training stimulates the nervous system
-Activity is a tool for neurological recovery
Physical activity => Neural activity
Examples:
- CIMT - unpatterned
- Locomotor Training - patterned
