Test 1 Flashcards
6 steps to OT process
Theory, evaluation, problem definition, intervention plan, intervention implementation, re-evaluation
What is a FOR?
Vehicle for putting abstract ideas into practice, pieces theories together
Restorative approach
remediate, BOTTOM UP, restore brain pathway, specific foundational skills- CIMT, RESTORE SPECIFIC PROCESSES
Adaptive approach
adapt task or environment - TOP DOWN, increase time to complete, practice, LESSEN FXNAL DEFICITS
WHICH MODELS APPLY TO ADAPTIVE APPROACH>
MOHO, OA, EHP, PEO
WHEN A PERSON IS LETHARGIC, HOW DO THEY PRESENT?
OPENS EYES TO VERBAL STIM
SLOW BUT APPROPRIATE RESP
SHORT ATTN SPAN
OBTUNDED
WHEN A PERSON IS AT AN ALERTNESS LEVEL OF STUPOR, HOW DO THEY PRESENT?
RESPOND TO PHYSICAL STIM WITH GROANS, NEVER FULLY AWAKE, UNCLEAR, CONFUSED
SEMICOMATOSE
PAINFUL STIMULI, NO VERBAL RESP, PROTEXTIVE REFLEXES PRESENT
COMATOSE
ONLY RESPONDS TO PAINFUL STIM, NO PROTECTIVE REFLEXES, PUPILS FIXATED, NO VOLUNTARY MOVEMENT
UNCONCIOUS
STUPOR - COMATOSE
PERSISTENT VEGETATIVE STATE
NO COGNITIVE BRAIN FUNCTION, NO SLEEP-WAKE CYCLES
BRAIN DEAD
ONLY REFLEXIVE MOVEMENTS
NO COG FX
WHAT ARE THE FIVE DIFFERENT TYPES OF STIMULI
VOICE, TOUCH, SHAKE, SHAKE AND VOICE, NOXIOUS
GLASGLOW - EYE OPENING
SPONTANEOUS - 4, TO SPEECH-3, PAIN-2, NIL-1
GLASGLOW - BEST MOTOR RESPONSE
6- OBEYS 5- LOCALIZE 4 - WITHDRAWS 3-ABNORMAL FLEXION 2- EXTENSOR RESPONSE 1 - NIL
Glasglow - verbal
5 - oriented 4 - confused conversation 3 - inappropriate words 2 - incomprehensible sounds 1 - Nil
Glasglow predictors
13 - mild
9-12 - moderate
<8 - severe (coma)
What appearance aspects should you asses when first seeing a pt?
grooming, aids, dress, eye deviation, skin composure
What is Battle’s sign?
bruising over mastoid - skull fx
Raccoon’s eyes
peri- orbital bruising and swell - frontal-basal fx
rhinorrhea
CSF draining from nose, fx of cribriform with torn meninges
ottorhea
drainage of CSF from ears, fx temporal bone with torn meninges
Decorticate posturing
fl, fl, fl, add, internal rotation, pf
critic-spinal tract
Which posturing is more preferable?
decorticate because decelerate means brain stem
Decerebrate posturing
ext, fl, add, pronation w/pf
brainstem
what is opisthotonus?
severe m spasm of neck and back
Orientation x 4
person, place, time, why?
bottom up
component skills
top down
performance in task
Where would an injury be if a pt showed these primitive reflexes; MORO, GRASP, FLEXOR WITHDRAWAL?
SPINE
Where would an injury be if a pt showed these primitive reflexes; ATNR, STNR, Tonic lab, positive supporting, associated reactions?
brainstem
Which reflex would occur if injury was at the mid-brain
righting-reaction
Which reflex would occur if injury was at the basal ganglia?
protective extension
UMN
motor cortex to brainstem / interneurons in ventral horn
spasticity
hyperactive reflex
LMN
vetral horn to skeletal muscles, link btw UMN and muscles
flaccidity, hypotonia
hypoactive reflex
tone
resistance of a muscle to passive elongation or stretching
Muscle tone continuum
rigidity > spasticity > normal > hypotonia > flaccid
High tone
rigidity
low tone
flaccidity (complete loss of muscle tone)
Ashworth scale 0
no increase
Ashworth scale 1
slight increase in tone with catch at end of ROM
Ashworth scale 1 +
slight increase in tone with catch at end of ROM, minimal resistance throughout motion
Ashworth scale 2
more marked tone, resistance throughout movement but easily moved
Ashworth scale 3
considerable tone, PROM difficult
Ashworth scale 4
rigid in flexion and extension
Ashworth scale 9
unable to test
clonus
uncontrolled oscillations
cogwheel rigidity
jerky resistance
clasp knife
prolonged stretch will stretch muscle
coordination
ability to produce accurate, controlled movement
Problem with synergy?
abnormal or disordered motor control
Co-activation problems?
Agonist & antagonist muscles both fire, preventing functional movement
What are the stages of motor learning?
Cognitive - Associative - autonomous
cognitive - slow, errors, demonstrations valuable
associative - correct and error distinction, finer details
autonomous - automatic, stable
NDT
Tactile stim
normal sequences and balance
Treatment focuses on inhibiting or eliminating patterns, normalizing postural tone, promoting active control of movements
NDT Facilitation
when tone has normalized
autonomic postural control
wt bearing
NDT Inhibition
abnormal tone and coordination
decrease spasticity
reflex inhibiting patterns
NDT techniques
weight-bearing
trunk rotation
trunk elongation
encourage scapular protraction
PNF
auditory, visual, tactile
proximal to distal
entire movement patterns
UE D1 Flex and ext
PNF
midline cross pick apple
midline cross
throw away
UE D2 flex and ext
PNF
midline cross unbuckle seatbelt
midline cross
put it away
Rood
tactile: light touch and brushing, thermal
Proprioceptive: quick stretch, vibration, heavy jt comp, resistance
What are inhibitory techniques?
Slow stroking Neutral warmth Prolonged cooling Prolonged stretch Joint approximation Tendon pressure Gentle rocking
Brunnstrom’s Movement Therapy
development in reverse - reflexes
STNR
flex head - flex UE, Ext LE
TLabR
supine - extend
prone - flex
Tonic Lumbar
R trunk rot, R UE flex, R LE ext, L UE ext, L LE flex
synergy
group of muscles acting together in a stereotyped manner
UE Flexion synergy - Brunnstrom’s
scapulas - add and elev shoulder - external rotation, 90 abduction xx elbow flex **** forearm sup wrist flex fingers flex
UE Extension synergy - Brunnstrom’s
scapulas - dep and abd shoulder - internal and add **** elbow ext XXX forearm pron wrist flex/ext fingers flex/ext
Associated Reactions - Brunnstrom’s
UE - direct
LE - inverse
Homolateral limb synkinesis
UE flexion evokes LE flexion
Ramiste’s Phenomenon
resisted abd evokes contralateral abd
Soque’s Phenomenon
Automatic extension of the fingers when the shoulder is abducted or flexed beyond 90 degrees.
Brunnstrom’s Recovery Stages UE
Stage 1 Flaccid
Stage 2 basic limb synergies weak, spasticity starts
Stage 3 basic limb synergies voluntary, spas marked
stage 4 spastic
stage 5 relative synergy independence
stage 6 coordination
Stage 7 normal
What are the two stages of the True Grasp Reflex?
catching phase - weak contractions of flexors & adductors of the digits
holding phase - occurs only if traction is made on the tendons activated during the catching phase, as long as traction is maintained, it will continue
What are the fxs of the sensory systems?
Vision Hearing Smell and taste Touch Pain Proprioception – where your body is in space Vestibular Functioning
Special senses?
Olfaction
Vision
Gustation - taste
Audition, balance and equilibrium
Sensory modalities?
light, sound, taste, temperature, pressure, and smell.
What are the two types of sensory systems?
Special and somatosensory (sensory)
If there is no pain or temperature, will fine touch be resent?
no
Graphesthesia
ability to recognize writing on the skin purely by the sensation of touch.
fovea
takes signals from light and send neural signals to the brain to stimulate visual recognition
Greatest ability to process detail
macula
Where vision is most highly developed within retina
What are the four primary spatial components for visual acuity?
frequency?
Orientation?
Contrast?
Intensity?
WBC
5-10
Hemoglobin
M 14-17.4
F 12-16
hematocrit
M 42-52
F 37-47
Na
134-142
K
3.7-5.1
CA
8.6-10.3
Glucose
70-100
fasting 90-130
diabetes >126
>200
A1C
norm<5.7
pre 5.7-6.4
DM >6.4
HDL
M >40
F >50
LDL
<100
Triglycerides
<150
Chol
<200
