Traditional Motor Control Theory Flashcards
Overview
Central problems with hemiplegia. loss of postural control and selected movement.
Abnormal tone and movement.
Lead to non-functional movement patterns and functional limitations.
Basic principles of NDT
- Normal movement sequences and balance are focus of intervention.
- Emphasis is normalization of sensory and perceptual experiences through tactile and kinesthetic stimulation
- Treatment is individualized,
- Abnormal tone, primitive reflex patterns and mass synergies interfere with normal movement patterns.
- treatment focuses on inhibiting or eliminating patterns, normalizing postural tone, promoting active control of movements.
NDT of persons with CVA
manual techniques,
Goal= prevent or eliminate abnormal tone and coordination, retrain normal movement responses, increase functional use of hemiplegic side.
Handling= provides specific tactile, proprioceptive and kinesthetic messages which help patient to organize quality of movement
-facilitation and inhibition
-key points of muscle control
Inhibition
Abnormal tone and coordination, Decrease spasticity, Block or eliminate abnormal patterns of movement, Reflex inhibiting patterns. Decrease spasticity***
Facilitation
Tone normalized,
Activate automatic postural responses, trunk control,
Re-educate weight bearing and non weight bearing movements in arm and leg. Person is low tone and you are trying to get them to the middle of the spectrum.
Occupational functioning
with NDT you are always incorporating the arm into activity.
Problems of CVA
Posture, Motor, Asymmetry, Non-weight bearing, Fear, Sensory loss, Neglect, Painful shoulder.
Assessment
Observation,
Handling- identify abnormal and normal movement patterns on involved side
Placing response- Pt. holds position if movement control present on hemiplegic side.
Occupation-as-means
Use activities to provide motor learning opportunities,
Cooking while weight bearing
Occupation-as-end
Patient directly engaged in learning task,
Self care tasks
Techniques
Encourage weightbearing over involved side, (most effective for regulating tone, increases client awareness of involved side),
Encourage trunk rotation (visual field opens up, most common for clients to move in “blocklike” pattern, by stimulating trunk rotation become more stable),
Encourage trunk elongation (common posture, gentle stretching),
Encourage scapular protraction.
Slow, controlled movements,
Proper positioning
Rood and PNF
Both use reflex arcs to elicit particular types of motor responses by supplying sensory stimulation in a controlled way,
Both address vital function (respiration, facial motions, tongue motions, swallowing, bowel and bladder control),
Facilitation and inhibition of muscle function along with concepts of stability and mobility are basic to application of controlled sensory stimulation used in both approaches.
Hypertonicity
Can lead to malalignment of trunk and limbs which will lead to contracture with subsequent deformity.
Hypotonicity
Important to counteract joint subluxation, overstretching of muscles, edema, pain and contracture
Proprioceptive Neuromuscular facilitation (PNF)
Mass movement patterns that are spiral and diagonal in nature and that resemble movement seen in functional activities,
Are unilateral, bilateral and total patterns.
PNF- impacts motor learning
Auditory - Verbal commands (brief and clear) - Verbal mediation (say steps aloud) Visual -positioning of self and objects Tactile - Manual contacts
Assessment (proximal to distal)
Vital and related functions, Head and neck region, Upper trunk, UEs, Lower trunk, LEs, ADL's
treatment
works towards the patient goals,
Therapist uses the patterns of movements and procedures to facilitate movement into function.
PNF uses total patterns rather than breaking down the movement. A PNF therapist would not have pt practice wrist extension without doing the entire pattern.
Diagonal patterns
are mass movement patterns observed on most functional activities.
Part of the challenge is recognizing the diagonal patterns in ADL’s
Knowledge of the diagonals is necessary to identify the areas of deficiency.
Each pattern has a flexion and extension component.
Eyes follow the hand of leading arm so the head and hand cross midline
UE D1 F&E
seatbelt (combing hear, opening door)
UE D2 F&E
picking a apple and putting it in basket
Symmetrical
Paired extremities perform similar movements at the same time.
Rood
Principles of treatment
- Humans function in a dynamic fashion
- Muscles have different duties,
- Heavy work muscles should be integrated before light work muscles
Rood- basic treatment assumptions
appropriate sensory stimulation can elicit specific motor responses,
- Thus, muscle action can be activated, facilitated, and inhibited through the sensory system,
- Motor control is regained through a predictable developmental sequence.
Faciliatory techniques
- To increase tone and cause arousal/excitation
-When used
– hypotonic or flaccid, has decreased level of movement or activity, has a depressed or withdrawn affect
-DO NOT
use when patient is anxious, agitated, highly distractible,
or overfacilitate or use on spastic muscles.
Used for Low tone
tactile stimuli
light touch
brushing
Thermal stimuli
A icing
C icing
Proprioceptive stimuli
- Quick stretch (stretch the muscles you are wanting to move/flex)
- Vibration (can use skateboard)
- stretch to finger intrinsics
- Heavy joint compression- on all fours
- Resistance
faciliatory techniques
- Room temp cool- verge of uncomfortable
- Olfactory: harsh odors
- Visual- bright colors, lights
- Auditory: load irregular beat music
- Tastes: sour (lemon)
- Very cold (ice chips): facilitates mouth muscles
- Warm fluids: facilitate swallow
Inhibitory techniques
- Maintained input results in maintained response: slow,rhythmic, repetitive= calming,
- slow stroking
- Neutral warmth
- Prolonged cooling
- Prolonged stretch
- joint approximation
- Tendon pressure
- Gentle rocking
Limitations of Rood
Effect is short lasting,
effect of stimulation is unpredictable,
Passive nature of sensory stimulation
Brunnstrom’s Movement Therapy
In normal development, spinal cord and brainstem reflexes become modified and rearranged into purposeful movement through the influence of higher centers,
Stroke results “development in reverse” reflexes use to facilitate recovery of voluntary movement,
Proprioceptive stimuli can be used to evoke desired motion or to alter tone,
Progresses in a sequence,
Newly produces, correct motions must be practiced to be learned,
Practicing functional activities enhances the learning process.
Brun Typical Eval
Sensation, Assessment of reflexes, associated reactions, Brunnstrom recovery stage, Motor assessment, ADL, Cognition
Tonic Reflexes
Return after CNS damage
Brainstem reflexes
STNR,
ATNR,
TLR,
Tonic lumbar rotation of trunk- trunk rotation in relation to pelvis. Rotation of trunk leads to UE flexion and LE extension. Flex UE and Extend LE in direction turned to.
Synergy
a group of muscles acting together in a stereotyped manner.
Patterns impede patient from performing isolated movement
Associated reactions
Automatic activities which fix or alter the posture of a part or parts when some other part of the body is brought into action by either voluntary effort or reflex stimulation.
UEs (mirror) VS LEs (opposite)
Homolateral limb Synkinesis
Flexion of the right UE results in flexion of the right LE. The stimuli may result in affected (most common) or unaffected side.
Ramiste’s Phenomenon
Abduction: resisted hip abduction on sound side results in abduction on affected side.
Adduction: resisted hip adduction on sound side results in adducted on affected side.
Associated hand reactions
- Proprioceptive traction response (a stretch of the flexor muscles of any joint of the UE facilitates a flexor contraction of all other joints)
- Instinctive Grasp (Occurs with a stationary contact in the palm of the hand. The person can flex and extend; however, as long as the contact remains in the palm of the hand, grasp continues)
- Soque’s phenomenon (automatic extension of the fingers when the shoulder is abducted or flexed beyond 90 degrees).
True grasp reflex
Obtained by distally moving deep pressure over certain areas of the palmar surface (not thenar or hypothenar regions).
Catching phase and holding phase.
Brunstrom Recovery Stages
UE
- Stage 1: no voluntary movement initiated, flaccid
- Stage 2: basic limb synergies emerge as weak associated reactions or no voluntary attempt of the person to move. The extend of the response does not necessarily result in joint motion. Spasticity developing.
- Stage 3: Basic limb synergies performed voluntarily. Spasticity marked. Only one exception to basic limb synergy is the combination of the pectoralis major with the elbow flexors.
- Stage 4: Spasticity begins to decrease and some basic movement combination deviating from synergy occur.
- Hand behind the back
- elevation of the arm to a forward horizontal position
- Pronation and supination with elbows at 90 degrees of flexion.
- Stage 5: Relative independence of limb synergies. Spasticity present, but not nearly as significant. More difficult deviations from synergy can be accomplished.
- arm raising to a side horizontal
- -Pronation and supination elbow extended forward or side
- -arm raising forward and overhead.
- Stage 6: Free movements of isolated joints. Movements are coordinated. Rapid movements may reveal spasticity.
- Stage 7: Normal
Hand, stages of recovery
- Stage 1: flaccidity
- Stage 2: little or no active finger flexion. Increasing spasticity.
- Stage 3: Gross grasp; use of hook grasp but no release; no voluntary finger extension: possibly reflex extension of digits.
- Stage 4: Lateral prehension; some thumb movements; semi-voluntary finger extension, small range.
- Stage 5: Palmar prehension; spherical and cylindrical grasp and release: semi-voluntary finger extension, small range.
- Stage 6: All prehensile types under control; skills improving; full range voluntary extension of digits; individual finger movements present, less accurate than on non-affected side.
- Stage 7: Normal
