Positioning and handling in neuro

Question 1

Positioning

Answer 1

Child’s ability to maintain postural control while participating in daily activities

Question 2

Therapeutic handling

Answer 2

 Dynamic techniques that guide child’s movements to:
* Influence muscle tone
* Promote postural stability
* Trigger new automatic movement responses

Question 3

Transitional movements:

Answer 3

moving in and out of different
positions
 Numerous movements while engaging in daily occupations

Question 4

General Considerations

Answer 4

● Progression of motor development is necessary for engagement in activities.
● Skeletal alignment and symmetry
● Postural control for balance and functional activity

Question 5

Postural Mechanism

Answer 5

● Muscle tone
● Postural control and stability
● Righting responses
● Equilibrium reactions
● Protective extension reactions

Question 6

Positioning as a
Therapeutic Tool: Principles

Answer 6

● Provide variety of options.
● Use positions that enhance function.
● Avoid restricting movements.
● Provide comfortable positions.
● Consider safety.
● Promote skeletal alignment and symmetry.
● Provide proximal stability to promote distal mobility.

Question 7

Prone on Elbows and Extended Arms

Answer 7

● Infant begins to stretch hip flexors and develop head control, shift center of gravity
● Use:
 Wedges: firm and adjustable
 Rolls
 Bolsters
 Inverted labyrinthine board

Question 8

Side-Lying

Answer 8

● Promotes coactivation of flexors and extensors
● Promotes eye–hand regard
● Promotes hands to midline
● Use:
 Side-lyers
 Padded benches, rolled towels, or pillows

Question 9

Sitting

Answer 9

● Motor control important requisite
● W-sitting: not recommended for children older than 1 year
● Facilitate using:
 Corner chairs
 Bolster chairs
 Tires covered with a blanket
 Firm inner tubes

Question 10

Sitting Positions

Answer 10

● Long-sitting
● Ring-sitting
● Tailor-sitting

Question 11

Basic Sitting Position in a Regular
Chair

Answer 11

-Hips and knees in flexion at 90 degrees or ^
-truck support and alignment
● Natural curves of the spine maintained and
supported
● Feet supported
● Tabletop or lap-tray at proper height

Question 12

Quadruped

Answer 12

● Arms extended, on knees
● Requires head and trunk control coupled with shoulder and pelvic stability
● Assume and maintain position

Question 13

Tall Kneel and Half Kneel

Answer 13

● Typically a prerequisite to standing
● Tall kneeling is easier.
 Larger base of support
 Half kneeling requires more dissociation of the legs
and balance.
● Vulnerability of the knee joint

Question 14

Standing

Answer 14

● Full weightbearing through hips and lower extremities
● Promotes bone growth, joint alignment, muscle development and circulation
● Adapted standers (prone, supine or free standing)

Question 15

Neurodevelopmental
Treatment (NDT)

Answer 15

● Developed by Karel and Berta Bobath
 To help children with functional limitations

Question 16

NDT General Principles

Answer 16

-Brain plasticity
● Key points of control
 Proximal: shoulders, hips, trunk, pelvis
 Distal: hands, feet, head
● Inhibition for hypertonicity
● Facilitation for hypotonicity
● Entrainment

Question 17

Therapeutic Handling

Answer 17

● Dynamic interaction among the child, OT practitioner, and significant others involved in the intervention process

Question 18

Handling Technique

Answer 18

● Gentle physical cueing using the palm of the hand or pads of fingertips
● Directional cueing to encourage weight shifts
● Stimulation of muscle groups to contract or relax
● Less cueing used as child gains control

Question 19

Inhibition

Answer 19

● Sustained pressure on tendon
● Slow rocking, rolling, or
● Rotation
● Weight bearing and weight shifting
● Heavy joint compression
● Wrapping or swaddling
● Hand vibration
● Calming environment

Question 20

Facilitation

Answer 20

● Light moving touch
● Tapping, sweep tapping,
brush tapping, and/or alternate tapping
● Fast vestibular input
● Heavy joint compression
● Weight bearing and weight shifting
● Quick and variable movement
● Stimulating environment

Question 21

Neutral Warmth

Answer 21

Wraps the child’s body in a soft cotton or
thermal blanket for 15 to 20 minutes to
reduce hypertonicity

Question 22

Slow Stroking

Answer 22

Use open palm and the pads of the
fingertips only
 Apply stroking motion with firm but light pressure down child’s back, moving from head down (cephalocaudal)
 Use hands alternately so there is no break in pressure
 Done with child prone, side lying, or
seated between therapist’s legs

Question 23

Gentle Shaking or Rocking

Answer 23

 Shaking helps to reduce tone in an
extremity
 Extremity/body part is shaken
rhythmically and gently with pads of
therapist’s fingers
 Rocking is also rhythmical, and can be
alternated with rotational input as well

Question 24

Trunk & Hip Rotation

Answer 24

 Key point of control is the hips
 Your hand on the hips can help control
the trunk

Question 25

Slow Rolling

Answer 25

 Handling the trunk and pelvis
 Supine position and slowly rolls them
from a supine position to side-lying
and back to supine
 Alternate sides
 Muscles relax