PT Interventions - Augmented Approaches Flashcards
what is an augmented approach
hands on approach to neuro rehab in which the therapist guides and supports normal movements and/or prevents abnormal movement patterns
what is an augmented approach based on
outdated theories of motor development and motor control
- prior to knowledge of neuroplasticity
what does the literature say about an augmented approach
varied findings
when would you use an augmented approach
“jump start” functional recovery
- degree of CNS impairment prevents starting w functional task training
- early stage of motor learning
- early stages of recovery
how do PTs guide patient’s learning in augmented therapeutic interventions
via hands on techniques and/or environmentally controlled techniques
how can an augmented approach be transitioned to a task-oriented one
augmented approach to allow pt to achieve success w task -> learn task and successful
motivated to continue w therapy -> inc ability -> need less help -> use functional task-oriented approach
what are examples of neuromotor/augmented training strategies (5)
PNF
NDT
guided movements
facilitated movement
somatosensory training
what are examples of activity-based, task-oriented training strategies (3)
task training
- whole task
- part to whole
environmental structure
behavioral shaping
what are examples of motor learning training strategies (5)
feedback: KP, KR, schedule
practice: order, schedule
transfer training
environmental context
problem solving
what are examples of compensatory training strategies (3)
substitution
adaptation
assistive/supportive devices
what pt population was NDT originally developed for
treat motor deficits in:
- children w CP
- adults post-stroke
what is the theoretical basis behind NDT
hierarchal level of reflex integration-model of motor control
- which has been disproved
NDT was based on the theory that ______ controlled the nervous system
sensory feedback
what was the focus of NDT
sensory input and muscle re-ed
- what the pt experiences results in action they will perform
what impairments does NDT address (4)
normalize tone
address postural deficits
improve postural control
improve motor performance
what is NDT
neurodevelopmental technique
therapeutic handling to promote learning or aid in re-learning adaptive motor patterns and prevent abnormal, primitive or maladaptive patterns
what are the key points of control that NDT highlights
scapula
iliac crests
prox or distal limbs
what are NDT activity level interventions (6)
postural control
trunk control
rolling & bed mobility
transitional movements
ambulation
reaching, grasping and releasing, manip objects
what are specific BSF impairments that NDT can address (7)
abnormal tone
abnormal posture
impaired sensation & sensory integration
impaired motor control
weakness
impaired ROM
reduced activity tolerance
what population is NDT used heavily in
pediatric
what are 4 variables of NDT
- body position/posture & support surface
- manual contacts/key points of control
- type/mode of facilitation
- prevent extraneous, maladaptive, primitive movement patterns
what other interventions is NDT often combined with? why?
other augmented approaches
task-oriented retraining
helps person be more functional
what is the theory PNF is based on
ability, strength, and endurance are developed by active participation
- applying PNF recognizes hidden potential exists and developed by response to a demand; frequency or repetition is important to learning process
where can PNF patterns be applied (4)
extremity
scapula
trunk
pelvis
what is the technique to PNF
use resistance, quick stretch, proprioceptive input to improve flexibility, stability, motor control, initiation of movement, strength, function
what does the literature say about PNF
poorly supported
does improve ms length (per low quality studies, and no more than other approaches would)
what is an important consideration in the real-world application of PNF
clinically often performed in less pure manner than in class
how can you vary components of PNF
surface
position
use of resistance bands
cuff weights
what is the biggest problem w PNF exercises
not functional
what was Rood one of the first to propose
link b/w motor response & sensory input
- used multi-modal sensory inputs to improve motor funciton
what was Rood’s primary contribution
described stages of motor control
- mobility-stability concepts
what is the relevance of Rood’s stages of motor control now
based on outdated neurophys and models of motor control (ie reflex, hierarchal models)
still used clinically
how does Rood describe mobility? what is a synonymous term used today?
moving into position or posture
involves change in COG and/or BOS
- aka transitional mobility
how does Rood describe stability? what is a synonymous term used today?
ability to maintain posture or position
- aka static postural control
how does Rood describe controlled mobility? what is a synonymous term used today?
closed chain WTS or other movement
- aka dynamic postural control
how does Rood describe skill? what are examples of this?
open chain, distal segment moving on stable proximal base
ex: amb, reaching, grasping, manipulating
what are Rood’s stages of motor control
mobility -> stability -> controlled mobility -> skill
what are examples of mobility per Rood’s definition
ex: rolling, sup to sit, sit to stand
what impairments might contribute to impaired mobility (6)
altered tone
reduced ms length
lack of isolated ms activation/ACOM
lack of coordination
dec strength
impaired sensation
what are interventions to improve mobility (7)
hold relax
rhythmic rotation
rhythmic initiation
NDT inhibitory handling
NDT facilitaiton
soft tissue/joint mob
task-oriented re-training
how is stability achieved
tonic holding involving active postural ms, co-contraction in limbs (agonist + antagonist)
what biomechanical factors should be considered when it comes to mobility
BOS
COM
gravitational forces
postural alignment
what are contributing impairments to stability (5)
weakness
low ms tone
poor recruitment of tonic motor units
lack of sensation
poor WB tolerance
what are interventions to treat stability
stabilizing reversals
rhythmic stabilization
facilitation via:
- quick swiping
- maintained touch
- resistance
- joint approx
- external supports
what are examples of controlled mobility per Rood’s definition
wt shifiting in WB position
- moving w/i posture or position
closed chain movement involving concentric and eccentric control
what are impairments contributing to poor controlled mobility (8)
pain
weakness
abnormal alignment
impaired postural control
impaired motor control
poor motor planning
lack of coordination
impaired sensation
what are interventions to promote controlled mobility (4)
NDT facilitation
dynamic reversals
combo of isotonics
task oriented re-training
what is required for skilled movements/actions
normal timing and sequencing
prox holding/dynamic stability
what are characteristics of skill per Rood’s definition
distal parts move freely in space; open-chain
rotational components
what are contributing impairments to poor skill (4)
prox weakness
impaired ACOM/abnormal synergies
impaired sensation
impaired coordination
what are interventions for skill (4)
task oriented re-training
PNF extremity patterns
resisted progression
NDT facilitation
