traditional approaches

Question 1

What is the Brunnstrom approach?

Answer 1

patients progress through sequences of recovery and may plateau

treatment aimed at progressing patient through stages

Question 2

Group of muscles that work together as a bound unit in a primitive/automatic way
Present at spinal cord level

Answer 2

movement synergies

Question 3

postural/attitudinal reflexes are…

Answer 3

present in adults with and without brain damage

*the position of the patient may influence movement ability

Question 4

example of postural/attitudinal reflex

Answer 4

Tonic neck reflexes (STNR, ATNR)
Tonic labyrinthian reflexes
Tonic lumbar reflexes

Question 5

Raimiste’s phenomenon is…

Answer 5

an associated reaction!
Resistance to Hip abduction or adduction of noninvolved extremity causes same motion in involved leg)

Question 5

Automatic movements that change the position of a body part when
-another body part moves
-more effort is used
-sneezing/coughing
-artificially stimulated

Answer 5

associated reactions

Question 6

What are Brunnstrom’s stages of recovery?

Answer 6

Motor recovery reflects CNS recovery
*may still see aspects of more primitive stages when patient is under stress

recovery can stop at any stage and stages are never skipped.

Question 7

Brunnstrom Stage 1

Answer 7

-nothing
-flaccidity (no reflexes, no voluntary activity, no associated reactions, nothing)

Question 8

Brunnstrom stage 2

Answer 8

-DTRs!

-minimum voluntary movement within synergy
spasticity developing!

Question 9

When are partial limb synergies elicited reflexively?

Answer 9

-stage 2 Brunnstrom (DTRs and developing spasticity)

Question 10

Brunnstrom stage 3

Answer 10

-SPASTIC SYNERGIES
-Perform basic synergies voluntarily (maybe not full ROM)
-*spasticity at PEAK MAX LEVELS

Question 11

Brunnstrom stage 4

Answer 11

-DECREASE AND OUT
-spasticity starts to decrease
can perform MINIMUM movement out of synergy (1 joint)

-*knee extension with hip abduction

Question 12

Brunnstrom stage 5

Answer 12

-decrease in spasticity continues
-basic synergies lose dominance over movement
-can perform some movement combos outside of synergies

Question 13

Brunnstrom stage 6

Answer 13

SLIGHTLY SLOW SIX
Slight remnants of spasticity
Isolated mm action with variety of mvmt patterns
Slow speed/coordination

Question 14

Brunnstrom stage 7

Answer 14

NORMAL no spasticity, restoration of normal movement and function

Question 15

The activation of the neuromuscular system through stimulation of the proprioceptors

Answer 15

PNF

Question 16

Therapists can enhance a patient’s voluntary control by stimulating a deficient neuromuscular system.
Which technique does this premise belong to?

Answer 16

PNF

Question 17

Why do patients need input through PNF?

Answer 17

input given to know:
1. where limbs are in space
2. what speed of movement is required
3. what force is needed
4. what mm are needed

Question 18

A patient’s efferent motor response will be specific to the afferent sensory input applied.
What philosophy is this?

Answer 18

PNF

Question 19

Patients have physical potential, the amount of which may be unknown.
Patients need repetitions for motor learning.
What philosophy is this?

Answer 19

PNF

Question 20

For maximal learning, keep activities as functionally relevant as possible.
What philosophy is this?

Answer 20

PNF

Question 21

What are the main purposes of PNF?

Answer 21

1. strengthen mm
2. develop increased PROM/AROM mobility
3. promote motor learning
4. improve functional movement

Question 22

Contraction of _____ will allow immediate relaxation of same muscle

Answer 22

antagonist *autogenic inhibition

Question 23

Maximum effort of antagonists will overflow into agonists if reversal of direction is quick

Answer 23

successive induction

Question 24

Maximum effort of stronger muscles within a pattern facilitate or overflow into weaker muscles.

Answer 24

irradiation

Question 25

What are the 7 commandments of PNF?

Answer 25

1. manual contacts 2. commands/communication 3. stretch 4. traction/approximation 5. max resistance 6. normal timing 7. reinforcement

Question 26

manual contacts, PNF

Answer 26

hands are used to stimulate specific groups of mms and to direct the line of movement

Question 27

commands/communication of PNF

Answer 27

tone, prep instructions ACTION COMMANDS that are short, directive, timed with movement

Question 28

stretch, PNF commandment

Answer 28

1. activation of muscle spindles stimulates agonist 2. body positioned in lengthened range at first 3. quick stretch to elongated mm adds reflexive component to movement initiation

Question 29

Traction/approximation (PNF)

Answer 29

Traction facilitates movement Approximation facilitates stability

Question 30

maximum resistance, PNF

Answer 30

Max resistance is what the patient can take (not what you can deliver) without “breaking” the mvmt pattern or the hold *Resistance can be graded to maximize pt’s response

Question 31

Normal timing, PNF

Answer 31

1. Distal to proximal movement 2. Allow rotation to occur earliest in pattern 3. Excessive therapist resistance can interfere with normal timing

Question 32

Reinforcement, PNF

Answer 32

Can use “timing for emphasis” or combinations of patterns to increase the strength of a response

Question 33

stages of motor control (PNF)

Answer 33

1. mobility (isotonic) 2. stability (isometrics) 3. controlled mobility/dynamic postural control (ability to change position while maintaining postural stability) 4. skilled mobility

Question 34

PNF stage of motor control: 1. mobility

Answer 34

ISOTONICS, need enough ROM and motor unit activation 1. strengthening 2. lengthen shortened muscles 3. get the full motion going

Question 35

PNF strengthening techniques to enhance mobility

Answer 35

1. Repeated contractions 2. Hold-relax-active-motion 3. Reversal of antagonists/slow reversals 4. Timing for emphasis

Question 36

PNF technique to lengthen shortened muscles

Answer 36

1. Hold/contract-relax (with passive repositioning) 2. Hold/contract-relax active contraction

Question 37

What do you use for "getting the full motion going" in PNF technique to enhance mobility?

Answer 37

rhythmic initiation

Question 38

Isometric contractions Ability to hold a body position in an anti-gravity posture

Answer 38

stability/static postural control

Question 39

2 PNF techniques to enhance stability

Answer 39

1. Reversals of isometrics/alternating isometrics 2. Rhythmic stabilization

Question 40

Ability to change position while maintaining postural stability

Answer 40

controlled mobility/dynamic postural control

Question 41

what are techniques for controlled mobility/dynamic postural control?

Answer 41

slow reversals/reversals of isotonics

Question 42

1. Coordinated movements that allow interaction with environment 2. Movements are task specific, precisely timed and directed, can continue for extended periods, and can be combined with other movements. Example: proximal stability with distal mobility

Answer 42

skilled mobility

Question 43

2 PNF techniques for skilled mobility

Answer 43

1. normal timing 2. agonist reversals

Question 44

Sequence of movements that progressively challenges the patient to control more body segments/weight against gravity *these are functional training exercises, like rolling, prone progression, sitting, kneeling, standing

Answer 44

developmental activities

Question 45

What is NDT?

Answer 45

Is a neuromuscular and functional reeducation treatment approach that now also includes neuroplasticity as a basis of how the brain can change and reorganize itself and its processes based on practice and experiences during recovery and rehabilitation.

Question 46

You cannot superimpose efficient movement on

Answer 46

abnormal postural alignment *NDT philosophy consider alignment at beginning during end