Phys Dys Flashcards
Motor Relearning Theory (MRP)
key components: pt is an active participant in mvnt and problem solving.
spasticity and stereotypical mvnts are not specially addressed.
practice is emphasized for specific motor tasks
assumes brain reorganizes and adapts.
based on incorporating fx tasks and main focus is around teaching required mvnts.
PNF
Increases the ability of the patient to move and maintain stability
uses proper grips and resistance to guide the motion
assist the patient in achieving coordinated mvnt through timing.
increase stamina and avoid fatigue
MRP steps
analysis of task- identify the tasks you would analyze, what are the essential components? what are the missing mvnt components? Identify primary mvnt problems, identify secondary mvnt problems, identify compensatory mvnts.
Practice of missing components: what is the goal? what mvnt components will you address? how will you practice components (fx/exercise). How will pt be positioned? How will act. be positioned or exercise carried out? what are the instructions? how will you manually guide pt?
Practice of task: Identify goal of task, practice fx task using manual guidance, verbal instruction and visual feed-back, re-evaluate pt. success in task compared with success in practice of missing components in step 2, encourage flexibility by varying the environment and context of mvnt.
Transference of learning: Check skill level of pt. (can they perform in various environments with changes in timing, speed and context) encourage practice outside of therapy, encourage pt to self monitor their success, train family.
Basic PNF procedures for facilitation
resistance, irradiation and reinforcement, manual contact, body position and body mechanics, verbal commands, vision, traction and approximation, stretch, timing, patterns.
Typical motor problems for PNF:
SCI, MS, Stroke, Parkinsons problems w initiating mvnt proprioception and praxis problems muscle weakness resulting in instability and decreased strength muscle tightness decreased ROM abnormal tone
NOT used with sternal precautions
can be sued with dif. levels of cognition ( not dementia) need some cognition
Typical motor problems for MRP:
Stroke, paralytic or weak limbs
cognition is a crucial role due to active learning, sensory and proprioceptive are important but many times you are working to improve these.
addresses abnormal tone, teaches to normal mvnt
NOT used with spasticity
What is the basis behind constraint induced therapy ?
Shaping: operant conditioning whereby a behavoral objective is approached (mvnt) in small steps of progressively increasing difficulty.
Participant is awarded with enthusiastic approval for improvement but never punished or blamed for failure.
Massed practice: several hours of therapy at a time
What is the traditional, non-modified protocol behind CIMT?
at least 6 month post-onset in most cases
20 degrees of extension in the wrist
10 degrees of extension in each of the fingers
ability to say at least 3 diff words spontaneously
ability to attend to a single task for at least 2 min with assist.
at least moderately intact receptive language
no more than a moderate verbal apraxia is ideal, however, clients with more servere apraxia are considered on a case by case basis- following full eval.
What are some of the outcome measures involved in CIMT
Disability- Functional independence measure, Barthel index
Arm motor fx- Wolf motor fx test, action research arm test, assessment of motor and process skills
Perceived arm motor fx- motor act. log
Arm motor impairment- Fugl Meyer assess.
Dexterity- 9 hole peg test, grooved pegboard test
Quality of life- stroke impact scale
How does shaping and massed practice play a role in this tx approach ?
Shaping: operant conditioning whereby a behavoral objective is approached (mvnt) in small steps of progressively increasing difficulty.
Participant is awarded with enthusiastic approval for improvement but never punished or blamed for failure.
Massed practice: several hours of therapy at a time
Constraint Induced Therapy
Pt. use the weaker extremity by constraining the dominant one resulting in increased mvnt and functionality.
Teaches the brain to “rewire” itself following a stroke or brain related injury and overcome the phenomenon of learned non-use.
TX= 6 hours a day, 5 days a week for 2-3wks (need physical stamina)
-always address hemiparetic side, even just to stabilize
find fx for it whenever possibl
What kind of patient might benefit from the CIT approach
motivated, 6 months post stroke, endurance to make it through long sessions.
Different kinds of activities patients do?
CIMT: restraint of unaffected UE with > 3 hrs therapy/day (sling or splint in place for 90% of waking hours during usual ADL’s or exercises)
mCIMT (modified)- restraint of unaffected UE with 3 hours or < therapy/day
FU(forced use)- restraint of unaffected UE with no specific tx of affected UE
(sit on hand, mitt, sling)
what kinds of activities might patients do?
Gross Motor- ball catching, twisting lid of jars, lift and place large objects in shopping bag, stack cans, open doors
Fine motor tasks- Sort and stack change, pick up paper clips, manipulate buttons/zippers, play piano, board games, use can opener, use key to open door.
FX tasks- cooking, household tasks (cleaning, wiping, loading dishwasher, ironing, folding clothes), maintenance tasks w tools, vacuuming, mopping, sweeping, dusting.
Perception
The integration of sensory impressions into meaningful information
-hear sounds and recognizing, recognizing visual info, feeling object and knowing what it is.
Apraxia
absence of motor planning ability
lack of purposeful, skilled mvnt that cant be attributed to weakness, tremor, spasticity, loss of position sense.
(have the ROM but cant do things on command/imitate)
Ideational apraxia
inappropriate tool use, sequences activity incorrectly, overall loss of concept of task, uses familiar objects incorrectly, cant relate object together (cant put toothpaste on tooth brush)
cant imitate or stop task (hand over hand)
Ideomotor Apraxia
disorder of the production praxis system. A loss of kinesthetic memory patterns so that purposeful mvnt cant be produced or achieved due to defective planning and sequencing of mvnts even though the idea/purpose of task is understood. (dif. executing task in smooth pattern).
Assessments for Apraxia
Content- what the pt. needs to do (handle basic tools to get job done)
Temporal- time factor, efficiency, finish task while using task efficiently
Spatial- over shooting, under shooting, bad deph perception
Initiation (intervention)
developing necessary plan of action and selecting objects (hand over hand assist, help start task)
Execution (intervention)
performing the plan (guiding, talking through)
Control (intervention)
detect and correcting errors to ensure desired end result (spatial problems)
Error-less Learning
(for more dif. tasks)
preventing mistakes through verbal and physical support versus trial and error.
Used for apraxia and memory impairments.
(modeling how you do routine through entire task)
hand over hand, repetition, tell pt. correct way.
Hemianopsia
Blindness in 1/2 of visual field , sensory loss within visual field (most improvement in 1st month).
Visual Discrimination Deficits
Depth perception (sereopsis) 3-D understanding of object
Figure ground- foreground from background (being able to find objects when their on top of each other).
Spatial relations- relationship of objects to each other and self (reaching, how close are objects )
Agnosia
Inability to recognize incoming sensory information
relatively rare
*loss of ability to recognize objects, people, sound, and shapes.
Visual Agnosias
Object agnosia- cant recognize objects in the environment
Prosopagnosia- poor face recognition -not recognizing family/maybe by voice but NOT face
Simultanagnosia- inability to recognize whole visual scenes (home, beach, ect)
Alexia: inability to recognize letters or words
