Session 5 Flashcards
directs, regulates, and organizes tactile, vestibular, or proprioceptive input.
manual contacts
parts of the body deemed optimum for directing movement patterns and to facilitate or inhibit postures or movements
key points of control
name the 2 proximal key points of control.
- shoulder
- pelvis
name the 3 distal key points of control.
- head
- upper extremities (hands)
- lower extremities (feet)
describe 4 specific aspects of inhibiting abnormal tone with key points of control.
- head/trunk flexion to decrease shoulder retraction, trunk and limb extensor tone (head/trunk)
- shoulder ER/abduction and elbow extension to decrease UE flexor tone (humerus)
- thumb abduction and extension and forearm supination to decrease wrist/finger flexor tone (thumb)
- hip ER and abduction to decrease LE extensor/adductor tone (hip)
avoid exercises that increase ___ ___ and avoid ___ movement patterns.
muscle tone, abnormal
what is necessary for good alignment and symmetry of the extremities?
alignment and symmetry of the trunk and pelvis
inhibition techniques and postures are used to… (what 3 things)
- decrease abnormal muscle tone during task performance
- restore normal alignment in the trunk
- decrease unwanted movements or associated reactions
- facilitating the opposite pattern of the spastic upper limb to lengthen spastic muscles
- critical for training in proper positioning to decrease potential for pain, muscle imbalance, and deformity
- weight bearing to decrease increased muscle tone
- trunk rotation and scapular mobilization (in sitting or supine)
reflex inhibiting postures (AKA out of pattern)
reflex inhibiting postures should always move in which direction?
start proximal to distal
name the 6 reflex inhibiting postures.
- shoulder protraction
- shoulder abduction (as tolerated)
- external rotation
- elbow and wrist extension
- finger extension and abduction
- thumb abduction
name 5 aspects of positioning the hemiplegic limb.
- support
- alignment
- joint preservation
- prevent muscle tightness
- promote limb awareness through weight bearing
n/a
n/a
used to:
- provide somatosensory input of normal movement
- stimulate muscles to contract
- allow for practice and teach ways to incorporate the involved side into functional tasks.
- weight bearing to increase tone into forearm or extended arm
- activate postural responses through weight bearing or trunk
- facilitate arm movements in supine with “place and hold”
- arm movements in sitting with guided movement practice
facilitation techniques
describe proper base of support
- upper trunk extension
- neutral pelvis
describe proper shoulder stability and mobility.
- co-contraction of shoulder girdle muscles to support distal UE movement
- reaching with distal use in all directions
describe proper wrist stability and mobility.
- maintain the wrist in a neutral or extended position to allow for grasp and prehension patterns.
- approx. 20 to 30 degrees of wrist extension
describe proper elbow stability and mobility.
co-contraction of the elbow musculature to support distal UE movement in space during reaching
- grip that places an object in contact with the palm and palmar surface of the digits.
- needed to grasp and release large objects.
gross grasp
hand position that allows for finger and thumb opposition and manipulation of objects.
prehension patterns
thumb opposes one or more fingers (ex: the index and long fingers)
palmar prehension
thumb and the radial side of the index and long fingers meet
lateral prehension
thumb and the radial side of the index and long fingers meet
lateral prehension
name the 2 types of motions involved in PNF.
- rotation
- diagonals
synergistic movement or performance involves the motions of rotation and diagonals
PNF
synergistic movement or performance involves the motions of rotation and diagonals
PNF
the goal of PNF is to facilitate which 2 things?
- proximal stability of the trunk for adequate distal control of limbs.
- voluntary motor control and coordinated movement
in PNF, movement patterns occur across which planes?
all 3 planes
use of ____ is key when using PNF techniques.
proprioception
___ ___ ___ (such as repetition, feedback, practice) are also used to enhance movement in PNF.
motor learning principles
name 4 goals of PNF.
- acquisition of new motor skills
- retention of new motor skills
- transfer of learning of new motor skills
- increase in strength, control, and endurance
therapist engages pt. in which 5 ways during PNF.
- manual contacts
- verbal commands
- body positioning
- body mechanics
- visual guidance of movement pattern
the therapist is trained in observing which 4 aspects of PNF.
- when to apply these techniques
- when to withdraw techniques as pt. gain more motor control and independence
- contraindications to use of techniques (significant pain, joint instability, fractures, or medically unstable)
- position pt. in optimal or neutral alignment as much as possible
muscle spindle is involved with…
- autogenic excitation
- reciprocal inhibition
GTO is involved with…
- autogenic inhibition
- facilitating contraction of opposing muscle aka antagonist muscle
name the 5 aspects of the D1 Flexion PNF pattern.
- shoulder adduction and external rotation
- supination
- radial deviation
- wrist flexion
- finger flexion/adduction
name 5 aspects of the D1 extension PNF pattern.
- shoulder abduction and internal rotation
- pronation
- ulnar deviation
- wrist extension
- finger extension/abduction
name 5 aspects of the D2 flexion PNF pattern.
- shoulder abduction and external rotation
- supination
- radial deviation
- wrist extension
- finger extension abduction
name 5 aspects of the D2 flexion PNF pattern.
- shoulder abduction and external rotation
- supination
- radial deviation
- wrist extension
- finger extension abduction
name 5 aspects of the D2 extension PNF pattern.
- shoulder adduction and internal rotation
- pronation
- ulnar deviation
- wrist flexion
- finger flexion/adduction
name the 4 phases in which movement training occurs (rhythmic initiation).
- pt. instructed to relax (PROM)
- movements progressed to active assistive (AAROM)
- movements are resisted (resistance to AROM)
- Pt. moves independently (AROM)
(can reverse phase 3 and 4 when indicated)
when would you start with phase 3 rather than phase 4?
if pt. lacks full AROM and needs to facilitate recruitment of more motor units, then follow up with phase 4.
when would you start with phase 4 rather than phase 3?
if pt. has full AROM, followed by phase 3, to work on strengthening of muscle.
rhythmic initiation is used for pts. with which 4 conditions?
- hypertonicity
- difficulty initiating active or voluntary movement
- uncoordinated movement
- difficulty with motor planning or apraxia
