test 1 pages 1-46 Flashcards
Elements of patient/client management
- Examination- history, systems review, test measure
- Evaluation
- Diagnosis
- Prognosis
- Evaluation
Nagi model
does not consider societal/ environmental factors
- disability- quality of life measures
- functional measures
- impairment measures
ICF Model
- Human functioning- not disability
- Integrative model- integrates medical and social
- Interactive- not linear like nagi
- context- inclusive,not person alone
- Cultural applicability- not western concepts
- life span coverage- not adult driven
Components of ICF model
- Impairments- problems in the body
- activity limitations- difficulty executing actions
- participation restrictions- unable to be involved in a life situation
Reliability
the extent to which a measurement is consistent and free from error
Internal consistency
degree to which items measure various aspects of the same characteristic
Intrarater reliability
consistency of data recorded by one individuals across two or more trials
Interrater reliability
consistency of two or more raters measure of the same statistic
Test-retest reliability
degree to which something can be measured the same value repeatedly
Validity
extent to which an instrument measured what it is designed to measure
ICC intraclass correlation coefficient
computed to measure reliability- above .75 is ok above .90 is good
Content validity
not a statistic test
a group of experts say if they think it is valid or not
Construct validity
ability of an instrument to measure an abstract concept
Face validity
does the tool appear to measure what it is supposed to measure
Criterion validity
degree a test score is related to some recognized gold standard
Concurrent validity
when a new test and target test are administered at the same time
ex. leg length with xray vs tape measure
Predictive validity
when a test is a predictor of some future criterion score.
ex. timed up and go predicts level of dependence
Sensitivity
tests ability to obtain a positive test when condition is truly present.
true positives
Specificity
tests ability to obtain a negative test when condition is truly absent
True negatives
SpIN
Specificity is high
true negs is high so you can rule condition in
SnOUT
Sensitivity is high
true pos is high so you can rule condition out
Responsiveness
ability of measurement to detect change overtime ex, paired t tests, effect size, 0.5-.7 moderate .8-1.0 good >1.0 excellent
Hedman Model
- Initial conditions- individual and environment
- Preparation- CNS organization of movement
- Initiation- segment displacement begins
- Execution- period of segment movement
- Termination-
- Outcome- was the goal achieved successfully
Primary motor (M1)
movement preparation and initiation
Premotor cortex
input from cerebellum
learning and control is visually guided movements
pathways for reaching and grasping
supplementary motor cortex
input from basal ganglia
helps with internally generated movements- active during complex tasks- important for preparation and initiation
Sign of damage: Primary motor
muscle paralysis- contralateral to lesion
spasticity- increased tone
loss of movement fractionation
loss of control of complex, multijoint movements
Sign of damage: premotor
difficulty performing complex, particularly visual guided movements
Sign of damage: supplementary motor
difficulty with sequential movements- increased latency, multiple joint involvement and increased motor response choices
disruption in movement preparation- postural muscle timing
Sign of damage: Prefrontal cortex
input from limbic and frontal. deficit of short term memory increased distractibility lack of motivation difficulty remembering spatial cues
Secondary somatosensory (SII)
active during exploratory movements
important to ability to discriminate object texture and shape
Sign of damage: posterior parietal cortex
loss of stereognosis
inability to associate function with an object
neglect of one side of body
misreading or poorly timed limb movements
corollary discharge
copy of info from primary motor cortex that is also sent to the cerebellum
Sign of damage: cerebellum
balance disturbance- feedforward/back hypotonia dysmetria- over/under shooting target inability to sequence movement dysdiadochokinesia difficulty with eye movements
Sign of damage: basal ganglia
tremors and involuntary movements difficulty initiating movements using internal cues increased reaction times rigidity- increased tone slowness and poverty of movement freezing impairment in smooth motion postural instability
Reflex theory
by Sherrington said nervous system is black box, specific sensory inputs yielded distinct motor outputs or REFLEX
sensory input will yield a motor output
limitations to reflex theory
desensed monkeys could still learn and function
cannot explain open-loop/ feedforward/ or anticipatory movements
cant explain the ability to produce various responses to the same stimuli
Hierarchical theory
by Jackson and Magnus-
topdown control- cortex- brainstem-spinal cord
higher centers control more, low centers control primitive and automatic reactions
primitive reactions are unleashed after injury to upper level.
limitations to hierarchical theory
bottom up control possible- ex pulling hand from fire
central pattern generators
doent explain more complex movements that require sensory feedback
cant explain motor learning
motor control
area of study to understand neural, physical and behavioral aspects of movement
motor program theory
centralist view that CNS can handle most details of action, but is sensitive to movement produced by feedback
fixed vs variant characteristics
limitations to motor program
not generalizable, novel movements not explained, how programs are stored not explained.
Ecological theory
by Gibson- perception and action are inseparable
constraints are called AFFORDANCES
perception is direct- ex slamming on brakes
emphasizes the imprtance of environment, task and individual. - must allow individual to be an active problem solver
Limitations to ecological theory
role of nervous system not defined
discovery of mechanisms for perceiving affordances necessary for theory survival
Dynamic action theory
by engineers Kelso, Scholz, Thelen
movement comes from subsystems that selforganize with respect to task and environment
deep attractor wells are stable and performed with little variability
period of greatest variability is early, important to intervene before bad habits are formed
Limitations to dynamic actions theory
assumes nervous system is unimportant
Systems theory
by bernstein- movement are not peripherally or centrally driven but are from a complex interaction of many systems- output is the nervous systems most efficient and effective way of accomplishing a goal
Limitations to systems theory
abstract model
difficult to relate individual component systems to neuroanatomy
Task oriented model
by Horak- similar to Bernsteins systems theory
targets both peripheral and central systems- assumes that movement control is organized around goal oriented functional behaviors rather than muscles or movement patterns
the way individual accomplishes the task depends on individual and environment, and contraints
only give necessary support by therapist
Arousal
extent to which a patient can respond to stimuli
Types of attention
- Attention- limitation in the capacity to handle information in the environment
- Focused- ability to respond to specific stimuli
- Sustained- ability to maintain attention
- Selective- ability to focus with distractions
- Alternating- ability to shift attention from one task to another
- Divided- respond simultaneously to different tasks
Stages of problem solving
- Preparation- understanding the problem
- Production- generating a solution
- Judgement- evaluating the solution
Explicit learning
specific instructions given to promote task performance
Implicit learning
learning through performance of the task
muscle tone
resistance to passive stretch
Hypotonia
usually cerebellar lesions
Hypertonia
- Spasticity
2. Rigidity
Spasticity
velocity dependent increase in tone.
not soley due to neural factors
Rigidity
velocity independent passive stretch resistance
1. Lead pipe- constant thru ROM
2. Cog wheel- alternating tone thru Rom
Seen in basal ganglia disorders
Tremor
involuntary oscillations resulting from alternate contractions of opposing muscle groups
resting tremor
not voluntarily activated but increases during mental stressor during movement of another part of the body- ex parkinsons disease
intention/action tremor
by voluntary contraction of the muscle. increases as approach goal. ex cerebellar lesion
postural tremor
oscillations that occur in standing posture ex cerebellar lesions
choreiform
involuntary rapid, jerky movements resulting from basal ganglia lesion
athetosis
slow involuntary twisting wormlike movements usually in upper extremities, neck or face. in cerebral palsy
