S1_L4: Neurodevelopmental Technique Using Brunnstrom, Bobath, and Proprioceptive Neuromscular Facilitation Flashcards by MindMed Official

Determine the traditional PT strategy.

uses RIMP to perform isolated movements

A. Brunnstrom Movement Therapy
B. Bobath Technique
C. Proprioceptive Neuromuscular Facilitation

B. Bobath Technique

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Determine the traditional PT strategy.

Facilitation and normalization of motor function through primitive reflexes and abnormal patterns, pathological responses to facilitate movement

A. Brunnstrom Movement Therapy
B. Bobath Technique
C. Proprioceptive Neuromuscular Facilitation

A. Brunnstrom Movement

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Determine the traditional PT strategy.

Believed that diagonal and spiral (twisting) movements of limbs, head, neck, and trunk enhance function and mimic the movement

A. Brunnstrom Movement Therapy
B. Bobath Technique
C. Proprioceptive Neuromuscular Facilitation

C. Proprioceptive Neuromuscular Facilitation

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Determine the traditional PT strategy.

Inhibits abnormal patterns to facilitate motor function

A. Brunnstrom Movement Therapy
B. Bobath Technique
C. Proprioceptive Neuromuscular Facilitation

B. Bobath Technique

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Who are the proponents of the Bobath Approach?

Berta and Karl Bobath

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TRUE OR FALSE: Brunnstrom emphasizes hands-on facilitation of movement and positioning to “normalize” tone and reduce the influence of abnormal postures (including primitive reflexes).

False.

This is Bobath’s Principle

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Enumerate the problems of patients with neurological dysfunction.

abnormal tone
loss of automatic postural control
abnormal coordination
abnormal functional performance

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This is a condition where limbs are stiff and assume abnormal positions such as synergists.

Spasticity

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This is a state where limbs feel heavy or floppy and relaxed. It provides no resistance or assistance to passive
motion or range of motion exercises.

Flaccidity

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These are known as non-functional and involuntary changes in limb
position and muscle tone

Associated reactions

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Enumerate 3 NORMAL postural reactions.

Righting Reactions
Equilibrium Reactions
Protective Extension Reaction

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TRUE OR FALSE: Before performing functional skills, there should be a stable posture. If there’s none, it will be difficult for the patient to do normal ADLs

A. Both statements are correct
B. Both statements are incorrect
C. Only the 1st statement is correct
D. Only the 2nd statement is correct

A. Both statements are correct

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TRUE OR FALSE: Abnormal function performance shows of an inability to integrate the 1 side of the body to perform activities. In this state, hemineglect is present.

A. Both statements are correct
B. Both statements are incorrect
C. Only the 1st statement is correct
D. Only the 2nd statement is correct

D. Only the 2nd statement is correct

NOTE: Pt has the inability to integrate both sides of the body; thus, they do not mind the affected side.

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Enumerate the 3 stages of recovery according to Bobath.

Initial Flaccid Stage
Stage of Spasticity
Stage of Relative Recovery

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Match the stages of recovery with its corresponding description.

Increase in tone may be observed
No interplay whatsoever between the sound & affected side
Goal of treatment: improve quality of gait & use of affected hand
Pt cannot move his affected side & often does not appreciate that he has an arm or a leg on that side
Stage that most pts with residual hemiplegia comes out for out-patient tx

A. Initial Flaccid Stage
B. Stage of Spasticity
C. Stage of Relative Recovery

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What will be the PTs goal when his pt is in the stage of spasticity?

dissociate the synergy pattern by developing control of intermediate joints

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What will be the PTs goal when his pt is in the initial flaccid stage?

promote proper positioning & bed mobility

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What is the first prerequisite in neurodevelopmental treatments?

correct posture

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TRUE OR FALSE: Normal movement is learned by experiencing what a
normal movement feels like

True

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TRUE OR FALSE: Based on the principles of motor learning, spasticity is a hindrance to normal movement pattern. It inhibits even when as low as grade 1 or 2.

A. Both statements are correct
B. Both statements are incorrect
C. Only the 1st statement is correct
D. Only the 2nd statement is correct

B. Both statements are incorrect

NOTE: We do not think
about the spasticity as being a hindrance to normal
movement pattern, because in theory, spasticity can only be elicited by fast passive ROM. Spasticity should also not inhibit any movement as
long as spasticity is not grade 3 or 4

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TRUE OR FALSE: In Bobath, the tone of the muscle dictates the treatment, so spasticity must first be decreased.

True

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Based on the developmental sequence of the principles of treatment, what must be the progression of the pt’s position during tx?

supine
sitting
standing

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What is the usual synergy of the UE?

Flexor synergy

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What is the usual synergy of the LE?

Extensor synergy

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_________ are partial patterns opposite to the typical abnormal patterns and postural tone that dominate the patient

Reflex Inhibitory Movement Patterns (RIMPs)

This approach uses motor patterns available to the patient at any point in the recovery process

Brunnstrom Approach

In Brunnstrom's Approach, synergies, reflexes and other abnormal movement patterns are _______ parts of the recovery process that the patient must go through before normal voluntary movement can occur.

normal

The following are commonly observed in a pt with LE flexor synergy, EXCEPT: A. Toes DF B. Ankle Eversion C. Knee flexion D. Hip ER E. Hip Abduction

B. Ankle Eversion

The following are commonly observed in a pt with UE extensor synergy, EXCEPT: A. Forearm pronation B. Shoulder retraction C. Shoulder adduction D. Shoulder IR E. Elbow extension

B. Shoulder retraction

The following are commonly observed in a pt with UE flexor synergy, EXCEPT: A. Elbow flexion B. Shoulder depression C. Shoulder abduction D. Shoulder ER E. Forearm supination

B. Shoulder depression

The following are commonly observed in a pt with LE extensor synergy, EXCEPT: A. Toe PF B. Ankle PF C. Knee extension D. Hip Extension E. Hip Abduction

E. Hip Abduction

What is the strongest component in the UE extensor synergy?

1. Forearm pronation 2. Shoulder IR & Adduction

What is the strongest component in the LE flexor synergy?

Hip flexion

What is the strongest component in the LE extensor synergy?

Knee extension

What is the strongest component in the UE flexor synergy?

Elbow flexion

The following are Attitudinal or Postural Reflexes, EXCEPT: A. Labyrinthine Reflex B. Tonic Neck Reflex C. Tonic Lumbar Reflex D. All E. None

E. None

Tonic Neck and Labyrinthine Reflex is also known as?

Magnus' and De Kleijin's Reflexes

Determine the Tonic Neck and Labyrinthine Reflex. With neck extension, there will be elbow extension A. Symmetric Tonic Neck Reflexes (STNR) B. Asymmetric Tonic Neck Reflexes (ATNR) C. Tonic Labyrinthine Reflexes

A. Symmetric Tonic Neck Reflexes (STNR)

Determine the Tonic Neck and Labyrinthine Reflex. If you put the patient in prone, the flexor tone would dominate. A. Symmetric Tonic Neck Reflexes (STNR) B. Asymmetric Tonic Neck Reflexes (ATNR) C. Tonic Labyrinthine Reflexes

C. Tonic Labyrinthine Reflexes

Determine the Tonic Neck and Labyrinthine Reflex. These reflexes can be seen in infants and obvious in stroke patients. A. Symmetric Tonic Neck Reflexes (STNR) B. Asymmetric Tonic Neck Reflexes (ATNR) C. Tonic Labyrinthine Reflexes

C. Tonic Labyrinthine Reflexes

Determine the Tonic Neck and Labyrinthine Reflex. If you turn your head to the right the upper extremity on the face side ® will extend while (L) elbow will flex. A. Symmetric Tonic Neck Reflexes (STNR) B. Asymmetric Tonic Neck Reflexes (ATNR) C. Tonic Labyrinthine Reflexes

B. Asymmetric Tonic Neck Reflexes (ATNR)

Determine the Tonic Neck and Labyrinthine Reflex. Stimulus: rotation of the head to one side A. Symmetric Tonic Neck Reflexes (STNR) B. Asymmetric Tonic Neck Reflexes (ATNR) C. Tonic Labyrinthine Reflexes

B. Asymmetric Tonic Neck Reflexes (ATNR)

In Tonic Lumbar Reflexes, if you do rotation to one side, the face side would have an increase in (1)______ tone, while the side on the direction of the occipital part of the patient would have a (2)_____ tone domination.

1. extensor 2. flexor

Determine the Associated Reaction. Movement seen on the affected side in response to voluntary forceful movements in other parts of the body

Mirror Synkinesis

Determine the Associated Reaction. Mutual dependency between the synergies of the UE and LE

Homolateral Synkinesis

Determine the Associated Reaction. Presents with an abduction and adduction phenomenon in the LE.

Raimiste’s Phenomenon

Determine the Associated Reaction. Passive flexion of the shoulder will cause extension of fingers

Soque’s Phenomenon

Determine the Associated Reaction. Passive PF of the toes of a patient in supine with hip and knee in slight flexion elicits mass flexor response including ankle DF

Marie-foix Phenomenon/ Bechterev’s reflex

TRUE OR FALSE: Weakness has a direct relationship with spasticty.

False NOTE: Strength is different from tone. Pt can have a normal tone but be weak or he can be weak but spastic.

Determine the motor center group. 1. Re-representing the muscles of the body in the most numerous and most voluntary combinations 2. Do not need volitional control 3. Re-representing the muscles of the body in numerous combinations 4. More voluntary, less automatic 5. Represents all the muscles of the body in a few movement combinations that are mostly automatic activities of the body A. Lowest motor center B. Middle motor center C. Highest motor center

1. C 2. A 3. B 4. B 5. A

Determine the motor center group. 1. walking 2. breathing 3. eye movement 4. blinking 5. urination A. Lowest motor center B. Middle motor center C. Highest motor center

1. C 2. A 3. A 4. B 5. B

When the nervous system is injured, an individual goes through "___________"?

Evolution in reverse

TRUE OR FALSE: Associated Reactions/ Movements can be elicit reflexively or due to resistance

True

This is a technique of promoting or hastening the response of the neuromuscular system by stimulating its proprioceptors

Proprioceptive Neuromuscular Facilitation

TRUE OR FALSE: Early motor behavior is dominated by reflex activity. Mature motor behavior is reinforced or supported by a postural reflex mechanism. A. Both statements are correct B. Both statements are incorrect C. Only the 1st statement is correct D. Only the 2nd statement is correct

A. Both statements are correct

Developing motor behaviour is expressed in a/an _______ sequence of total patterns of movement and posture

orderly

Normal motor development has an orderly sequence but lacks ______ quality

step-by-step

Determine the neurodevelopmental technique. Based on concept that damaged CNS regressed to older or less mature patterns of movements (limb synergies and primitive reflexes) A. Brunnstrom B. Bobath

A. Brunnstrom

Determine the neurodevelopmental technique. “Avoidance of abnormal, introduction of normal” A. Brunnstrom B. Bobath

B. Bobath

Determine the neurodevelopmental technique. Patients are taught to use and voluntarily control the motor patterns available to them at a particular point during their rehabilitation A. Brunnstrom B. Bobath

A. Brunnstrom

Determine the neurodevelopmental technique. Presence of associated reactions, pathologic reflexes to facilitate movement and to train them to perform a certain task A. Brunnstrom B. Bobath

A. Brunnstrom

These are stereotyped, primitive movement patterns associated with the presence of spasticity

Basic Limb Synergies

These are abnormal automatic response of the involved limb to either voluntary effort or reflex stimulation

Associated Reactions/ Movements

What is the stimulus to the reflex response of the UE flexor synergy?

Resist elbow flexion

What is the stimulus to the reflex response of the UE extensor synergy?

Resistance to push on the (N)

What is the stimulus to the reflex response of the LE flexor synergy?

Resist PF on (N)

What is the stimulus to the reflex response of the LE extensor synergy?

Resist Dorsiflexion on the (N)

What is the stimulus to the voluntary movement of the UE flexor synergy?

Rot of head to (N)

What is the stimulus to the voluntary movement of the UE extensor synergy?

Rot of head to the affected

What is the stimulus to the voluntary movement of the LE flexor synergy?

Rot of head to (N)

What is the stimulus to the voluntary movement of the LE extensor synergy?

Rot of head to the affected

(1)______ synergy is more common in UE. (2)_______ synergy is more common in LE.

1. Flexor 2. Extensor

The following muscles are usually NOT involved in either synergies, EXCEPT: A. latissimus dorsi B. ankle evertors C. teres major D. teres minor E. none

D. teres minor

Which 3 muscle or muscle groups are part of the mixed synergy?

1. pectoralis major 2. FA pronators 3. elbow flexors

TRUE OR FALSE: Weight bearing on unaffected LE reinforces the extensor synergy

False WB should be on AFFECTED LE.

This is an associated reactions wherein the response of one extremity to stimulus will elicit the same responses in its ipsilateral extremity.

Homolateral Limb Synkinesis

Enumerate the stimulus and response of the instinctive grasp reaction

Stimulus: stationary contact over the palm of the hand Response: “Closure of the hand”

Motor developments usually occurs (1)_____ and (2)______

1. CEPHALOCAUDALLY 2. PROXIMODISTALLY

Motor development proceeds from stability to mobility. Gross motor control precedes fine motor control. A. Both statements are correct B. Both statements are incorrect C. Only the 1st statement is correct D. Only the 2nd statement is correct

D. Only the 2nd statement is correct Motor development proceeds from mobility to stability

Vertical movements are learned before horizontal movements are learned. Rotary movements are the last to develop. A. Both statements are correct B. Both statements are incorrect C. Only the 1st statement is correct D. Only the 2nd statement is correct

A. Both statements are correct

In motor development, isometric control precedes isotonic control. Concentric movement precedes eccentric movement. A. Both statements are correct B. Both statements are incorrect C. Only the 1st statement is correct D. Only the 2nd statement is correct

C. Only the 1st statement is correct

TRUE OR FALSE: The use of external resisatnce is advocated for stroke pts.

False

Enumerate the RIMP for the UE.

1. Extension of neck and spine 2. External rotation of the shoulder 3. Elbow extension 4. Wrist extension 5. Supination and abduction of thumb

Enumerate the RIMP for the LE.

1. Hip abduction and external rotation 2. Hip and knee extension 3. Dorsiflexion of toes and ankle 4. Abduction of the big toe 5. Rotation of shoulder girdle against pelvis and vice - versa

Proximal stability promotes? A. stability B. guided movement C. coordination D. facilitation of movements

A. stability

Distal stability promotes? A. stability B. guided movement C. coordination D. facilitation of movements

C. coordination

Digital stability promotes? A. stability B. guided movement C. coordination D. facilitation of movements

D. facilitation of movements

Intermediate stability promotes? A. stability B. guided movement C. coordination D. facilitation of movements

B. guided movement

Which approach states that there should always be a stimulus to get a certain response

Margaret Rood Approach Note: She advocated for the use of warmth and pressure

TRUE OR FALSE: Bobath agrees with the developmental sequence of treating a pt in supine to standing.

False Bobath states that a PT can immediately teach the movement patterns of a certain function