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SEMESTER 4 - REHAB > PNF Interventions to Improve Motor Control and Motor Learning part 2 > Flashcards

PNF Interventions to Improve Motor Control and Motor Learning part 2 Flashcards

1
Q

Objectives

  • Compare and contrast theories of motor control, motor learning and common principles of therapeutic interventions.
  • Identify the purposes and components of a motor control assessment
  • Define: spasticity, clonus, decerebrate rigidity, decorticate rigidity and flaccidity (delivered via BB)
  • Identify common causes of motor control impairments (discussed last lecture & throughout course)
A

fyi

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2
Q

What About Practice?

A
  • Make sure that patient practices desired activity
  • Helps to increase the learning
  • Watch for faulty postures and habits- educate families so they can help fix if needed
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3
Q

Massed vs Distributed Practice

A
  • Rest time is much shorter than practice time
  • May see fatigue, decreased performance and risk of injury can occur
  • Distributed Practice: spaced practice intervals  Practice and rest are close to 1:1 ration
  • Use massed practice when motivation and skill level are high
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4
Q

Blocked vs random practice

A
  • Blocked: practice sequence, perform one task repeatedly
  • Random practice: test/practice a variety of tasks that are ordered randomly across trials
  • Random practice has been shown to have better carry over
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5
Q

Mental Practice

A
  • Imagine or visualize the task
  • Creates cognitive rehearsal
  • Mental practice helps facilitate the acquisition of motor skills
  • Mental practice helps relieve anxiety
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6
Q

Part vs Whole practice

A
  • Break movement down into component parts
  • Practice all of the components and then group them together
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7
Q

Closed vs Open environments

A
  • Initial trials of an exercise should be in a controlled environment
  • As learning progresses, take it to a more open, variable environment
  • As performance becomes more consistent then modify the environment
  • Some people with TBI or other serious injury will never be able to perform well in challenging environments
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8
Q

Sequence in which tasks are practiced- name the types

A

Practice order

  1. Blocked order
  2. Serial order
  3. serial random order
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9
Q

What type of practice order

  1. repeated practice of a task or tasks in order
  2. better prediction of improved early acquisition of skills
A

Blocked order

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10
Q

What type of practice order?

non repeating and non-predictable

A

Random order

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11
Q

what type of practice order?

predictable and repeating order

A

Serial order

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12
Q

What type of practice order?

better retention and generalizability of skills

should go to too soon

A

Serial and Random

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13
Q
  • How much did you gain/lose in skill as a result of practicing?
  • Can a patient gain from exercising contralateral extremities? called bilateral transfer
    • With stroke: try activity with stronger side first
    • Does not work if affected arm is flaccid
    • Works best if the task is very similar side to side
A

Transfer of Learning

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14
Q

simple versions of what you want to see as a final complex task

usually Practice in easier positions, with less degrees of freedom

A

Lead up activities

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15
Q
  • Forced use of the involved extremity
  • See improvement in UE function
  • See cortical reorganization
  • Needs repetitive practice (up to 6 hrs a day)
A

Constraint-Induced Movement Therapy or Forced-Use Therapy

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16
Q
  1. 
functional/task oriented training,
  2. neuromotor development training,
  3. compensatory training
A

Framework for Intervention

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17
Q
  • Specific task oriented training with lots of practice- essential to reacquiring a skill
  • There are specific important functional tasks that are emphasized
  • Grasp and release, stand and walk
A

Functional task-oriented training

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18
Q

Reinforce, reward and promote skill development

Guide initial movements

A

Behavioral shaping techniques can be used

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19
Q

why can you not use task-oriented training with everyone

A

Lack voluntary control or cognitive function
Example: early stages of traumatic brain injury

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20
Q
  • Includes developmental activities training, motor training, movement pattern training, and neuromuscular re-education/education.
  • Target affected body segments
  • No compensatory movements
  • Hands on approach for guidance
A

Neuromotor Development Training

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21
Q

WHat is the Treatment philosophy for Neuromotor Development Training?

A
  • Use sensory input to modify CNS, stimulate motor output
    • Emphasis on developmental activities
    • More functional training as time has progressed
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22
Q

Neuromotor Development Training

3 Treatment Approaches

A
  • NDT (Neurodevelopmental Treatment)
  • PNF (Proprioceptive Neuromuscular Facilitation)
  • Neuromuscular/Sensory Stimulation Techniques
    • Facilitation
    • Inhibition
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23
Q
  • Developed in 40’s and 50’s by Dr Karel and Berta Bobath
  • Worked with patients who had a stroke and had abnormal tone and postural reflexes
  • Considers weakness, decreased ROM, impaired tone, impaired communication
  • Use sensory stimulation during treatment
  • Facilitate postural alignment and decrease excessive tone
  • “Postural control is the foundation for all skill learning”
  • Uses key points of control
A

NDT

Neuromotor Development Training

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24
Q
  • Synergistic patterns are part of normal movement
  • Diagonal planes
  • Work to improve functional performance and coordinated patterns
A

Proprioceptive Neuromuscular Facilitation

(PNF)

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25
Q

“Techniques that enhance capability to initiate a movement response through increased neuronal activity and altered synaptic potential” (facilitation)
Focus is also on activation- production of a movement response

A

Neuromuscular/Sensory Stim Techniques

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26
Q

Neuromuscular/Sensory Stim Techniques

decreased capacity to initiate movement response

A

Inhibition

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27
Q

Neuromuscular/Sensory Stim Techniques

what are the treatment guidelines?

A
  • Repeat application of same stimulus
  • Some stimulus is contraindicated (i.e. facilitation for spasticity)
  • Response to treatment varies from pt. to pt.
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28
Q

Resume functional skills early with use of uninvolved or less involved segments

A

Compensatory Training

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29
Q

Patient is aware of deficits and formulates a new way to complete tasks

A

Substitution

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30
Q

Modify the task and the environment

A

Adaptation

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31
Q

what is the best way to Integrate approaches

A
  • Don’t just use one approach
  • Must use what will work with the specific patient
  • Be in tune with changes in patients status
  • Promote adaptability of skills in the real world (the front yard)
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32
Q

Muscle Strength


Independent Review of Information

A
  1. Strength training: increases production of max force
  2. Causes change in neural drive (inc motor unit recruitment, increase rate and synchronization of firing)
  3. Change in muscle: hypertrophy, inc size/number myofibrils, CT tensile strength, inc bone mineral densit
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33
Q

what does an Exercise Prescription involve

A
  1. Mode/type of exercise
  2. Intensity
  3. Frequency
  4. Rest interval
  5. Duration
  6. Correct alignment
  7. stabilization
34
Q

Effective strength Training

loads placed on mm must be greater that those normally incurred

A

Overload principle

35
Q

Effective strength Training

training effects are specific to the mode of exercise stress imposed

A

Specificity principle

36
Q

Effective strength Training

variety of training elements

A

Cross training

37
Q

Effective strength Training

failure to sustain benefits of strength training if mm aren’t regularly used

A

Reversibility Principle

38
Q

Effective Strength Training FYI

  1. Base program on patients needs
  2. isometric: less stress on joint motion, may use early in rehab
  3. Dynamic: use to develop power and strength and endurance
A

fyi

39
Q

Deficits in motor function

A
  • May see deficit in motor activation
  • Focus on isometric and eccentric contractions initially, followed by isotonic contraction (start in lengthened
  • range)
  • Weak muscles: lightly resist
  • Control velocity
40
Q
  • Distal segment moves in space
  • Resistance is applied to distal moving segment, usually in NWB position
A

Open chain exercises

41
Q
  • Distal part is fixed, with proximal segment moving (squats)
  • Performed in WB posture
  • Involve simultaneous action of synergists at multiple joints
A

Closed chain exercise

42
Q

Closed vs open chain

A
  • Closed: can see substitution of agonists for weak muscles
  • Open: can isolate contraction of a muscle
43
Q

Quick powerful movements, start with muscles in prestretched position for improved neuromuscular response

A

Plyometric

44
Q

free weights or fixed

A

Progressive resistive exercise

45
Q

can only lift as much as muscle can do at weakest point of range

A

mechanical resistance

46
Q

accomodating resistance through entire range

A

Isokinetic

47
Q

functionally based, synergistic pattern (PNF), can accommodate weakness in patient
Use strength training +task specific skills

A

Mechanical resistance

48
Q

dynamic contraction of large muscle groups: have cardiovascular and muscular effects

With deficits in motor function- will see fatigue and poor muscle endurance

A

Endurance training

49
Q

Debilitating Fatigue

Will see this in MS, Guillain-Barre syndrome, CFS, post polio syndrome

why should you be careful?

A

Be careful of overwork weakness

50
Q

Flexibility Exercises

  • Joint ROM/muscle flexibility: need to have adequate motion for normal functional excursion of mm and biomechanical alignment
  • Disuse and immobility: atrophy fibrosis, etc
  • Age related changes

Avoid what limitations?

A

ROM exercise, muscle strenghtening, joint mob

51
Q

ROM exercises REVIEW

  • AROM voluntary
  • AAROM: ext assist voluntary
  • PROM no assist from patient
  • Can do ex in anatomic planes or diagonal patterns
A

fyi

52
Q
  • Lengthen structures
  • Static: slow elongation to tolerance: hold 20-30 sec, this decreases activation of muscle spindle and reflex contractions
  • Maintain max end range; firing of GTO, which inhibits muscle being stretched
  • Low load for up to 30 min
  • Decreases chance of damage to muscle
A

Stretching

53
Q

Stretching techniques

use high load short duration
Usually contraindicated for elderly or neuromuscular impairments

A

Ballistic stretching

54
Q

Stretching techniques

  • Use with PNF: uses inhibition techniques to elongate muscles
  • Will discuss more during PNF lecture
A

Facilitated stretch

55
Q
  • Replicates normal movement patterns
  • Teach the pattern from starting position to terminal position
  • Verbal cues used to enhance pt. performance
  • Manual cues with appropriate pressure
  • PT/PTA- appropriate position and body mechanics. With contact, your movement should mimic what you want pt to do
  • Need appropriate amount of resistance which will allow appropriate coordination and timing
A

PNF

56
Q

Patterns are named for proximal joint motions

A
  • UE D1, flex: Flex, add, ext rot of shoulder/supination of forearm/flex, rad dev of wrist/flex, add of fingers
  • UE D1 Ext: ext, abd, int rot of shoulder/ pronation of forearm/ ext, ulnar dev of wrist/ext, abd of fingers
  • UE D2 flex: flex, abd, ex rot of shoulder/supination of forearm/ ext, rad dev of wrist/ ext, abd of fingers
  • UE D2 ext: ext, add, int rot of shoulder/ pron of forearm/ flex, ulnar dev of wrist/ flex, add of fingers
57
Q

PNF LE Patterns

A
  • LE D1 Flex: flex, add, ext rot of hip/ dorsiflex, inv of ankle/ ext of toes
  • LE D1 Ext: ext, abd, int rot of hip/ plantar flex, eversion of ankle/ flex of toes
  • LE D2 Flex: Flex, abd, int rot of hip/ dorsiflex, eversion of ankle/ ext of toes
  • LE D2 Ext: Ext, add, ext rot of hips/ Plantar flex, inv of ankle/ flex of toes
58
Q

Basic Procedures for PNF

Timing

A
  • normal timing is smooth and coordinated
    • Distal to proximal
    • Rotation occurs from beginning to end
59
Q

Basic Procedures for PNF

Timing for emphasis

A
  • Max resistance to strong muscles is used to elicit a strong contraction and overflow to weak components
  • “lock in” strong muscles; allow weak muscle to move
60
Q

Basic Procedures for PNF

Resistance

A
  • Facilitates muscle contraction
  • Tracking- in combo w/ light stretch to weak muscles
  • Max Resistance- see above
61
Q

Basic Procedures for PNF

Overflow or irradiation

A
  • Spreads mm response from stronger mm to weaker mm
  • Happens typically with max resistance
62
Q

Basic Procedures for PNF

  • Manual Contacts
A
  • Precise manual contacts: provides pressure to tactile and pressure receptors: facilitate contraction and guide movements
    • i.e. Provide manual contact to flexors if you want the flexors to contract
63
Q

Basic Procedures for PNF

Positioning

A

Position mm at optimum range (length-tension relationship)

64
Q

Basic Procedures for PNF

Verbal Commands

A
  • Preparatory commands
  • Action commands
  • Corrective commands
65
Q

Basic Procedures for PNF

Visual Commands

A

(demonstration)

66
Q

Basic Procedures for PNF

Stretch

A

Elongated position and stretch reflex: facilitate mm contraction

67
Q

Approximation:

A

facilitates extensor mm contraction/stability

Can use gravity, manually or using weights

Example: approximation through pelvis to promote sitting posture

68
Q

Traction (distraction)

A

facilitates mm contraction and motion esp in flex pattern
force is applied manually

69
Q

PNF Techniques

Isotonic contraction; first agonist then antagonist. Start with strong pattern

A

Dynamic reversal (slow reversals)

70
Q

PNF Techniques

Alternate isotonic contractions agonist and antagonist: very limited ROM

A

Stabilizing reversals

71
Q

PNF Techniques

alternate isometric contractions; agon/antag, no
motion is allowed

A

Rhythmic Stabilization (RS)

72
Q

PNF Techniques

Repeated contractions from lengthened range, induce by quick stretches, perform through range or at weak point

A

Repeated Stretch (Repeat Contractions) (RC)

73
Q

PNF Techniques

Resisted isotonic contraction of agonist through range, stabilizing contraction and then eccentric contraction back to start position.

A

Combination of Isotonics(Agonist Reversals) (AR)

74
Q

PNF Techniques

Start with passive movement and progress to A-A motion then active motion, then resistive

A

Rhythmic Initiation (RI)

75
Q

PNF Techniques

  • Usually use at point of limited range in agonist pattern
  • Do small range isotonic contraction of antagonists, follow with isometric hold for 5-8 sec then relax and move into new range of agonist pattern
    • CR-active- contraction- active contraction of the agonist into the newly gained range
A

Contract Relax (CR)

76
Q

PNF Techniques

  • Start in position of comfort; below level of pain
  • Strong isometric contraction of antagonists is resisted and then have voluntary relaxation, passive motion into new range
    • HR-active-contraction- active contraction of agonist into the newly gained range
A

Hold Relax (HR)

77
Q

Position patient in shortened range, hold position (isometric), follow with voluntary relaxation and passive movement into lengthened range, then followed by active movement back to end point (resistance offered)

A

Replication (HRA)

78
Q

Stretch, approximation and tracking resistance applied to facilitate pelvic motion and progression during locomotion; light resistance

A

Resisted Progression (RP)

79
Q

Slow repeated rotation of a limb where limitation is noticed. As muscles relax, limb is moved slowly

A

Rhythmic Rotation (Rro)

80
Q

What we did in lab so fyi stuff

  • In prep for the lab, and to enhance learning, read and continuously review the following:
    • Boxes 2.10, 2.11 & 2.14
    • Phys Rehab text, Appendix C, I & II of Chapter 13: Neuromuscular/Sensory Stimulation Techniques
A
81
Q
A

SEMESTER 4 - REHAB (16 decks)

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