Traditional Sensorimotor Approaches Flashcards
What are the 4 traditional sensorimotor approaches to intervention for a client with a CVA?
Brunnstrom (movement therapy) Approach
Rood Approach
Proprioceptive Neuromuscular Facilitation Approach (PNF)
Neuro-Developmental (NDT) Approach
How is motor control described in the traditional sensorimotor approaches
Motor Control= coordination/ body’s ability to sequence and coordinated a motor task- mms needed. Brain doesn’t have ability to isolate individual joints
Synergy Pattern ie gross motor/ mass pattern movement / you will see the entire movement- abnormal mass movement
What are some of the main concepts of the traditional sensorimotor approaches?
CNS grouped into higher, middle, lower- TSA intervention only targets middle and lower and not higher where motivation, limbic and association areas are found. They do not target volitional intent to do a task.
- Goal: Reintegrate a complete motor control hierarchy
- Limitation: Does not actively engage the client’s volitional intent or motivation to perform a motor act
Focus is on:
- Middle sensorimotor level- basal ganglia and cerebellum
- Motor planning- strategy formulation process
- Lower- Brainstem and spinal cord, level execution process
- Clients are taught motor strategies or compensatory methods
- Use of sensory inputs and sensory stimulation to elicit movement patterns (a lot of doing to the pt)
- Begin with external sensory stimuli
- Then reinforce and strengthen correct motor response with intrinsic sensory information
- Result is voluntary motor control
- Brunnstrom (movement therapy) Approach, Rood Approach, Proprioceptive Neuromuscular Facilitation Approach (PNF), Neuro-Developmental (NDT) Approach
Reflex and Hierarchical Models of Motor Control- TSA rely on these assumptions–>
- Motor strategies are viewed along a developmental continuum
- The basic units of motor control are reflexes
- Motor control is hierarchically arranged
- Application of sensory stimulation to muscles and joints to evoke specific motor responses
- Handling and positioning techniques to effect changes in muscle tone
- Use of developmental postures to enhance the ability to initiate and carry out movements
Give examples of Rood’s inhibitory techniques.
Give examples of Rood’s proprioceptive facilitatory techniques.
Rood’s inhibitory techniques.
- Neutral Warmth- if enough sensation, hot packs
- Slow Stroking
- Light Joint Compression ( Approximation)
- Rocking in Developmental Patterns
- Prolonged Stretch- VERY common- 30 secs stretch
Rood’s proprioceptive facilitatory techniques.
- Heavy Joint Compression
- Resistance
- Vestibular Stimulation
- Inversion
- Tapping- tap on mm belly to illicit movement
Describe Brunnstrom’s 6 stages of recovery for the hemiparetic upper extremity.
Brunnstrom: 6 Stages of Recovery- this can stop at any stage. How much is therapy helping? Don’t know- but for sure avoid contracture. Window of recovery 6months motor. Speech/cognitive 2yrs
Arm
- Flaccidity-nothing is responding
- Beginning development of spasticity; Limb synergies appear as associated reactions (yawn and arm might come up or sneeze or cough and arm- purely reflexes)
- Increasing spasticity; Synergy patterns performed voluntarily
- Spasticity declining; Movement combinations beginning to deviate from synergies (ie deviating from synergies at shoulder flexion)
- Synergies are not dominant; Movement combinations deviating from synergies (typically proximal to distal)
- Spasticity absent; Isolated joint movements
What are the underlying basics of PNF?
Identify the PNF D1 Flexion and Extension Patterns.
Identify the PNF D2 Flexion and Extension Patterns.
Proprioceptive Neuromuscular Facilitation Approach (looking more at agonist/antagonist)
- Developmental sequencing of movement
- Balanced interplay between agonist and antagonist in producing volitional movement
- Mass movement patterns
- Sensory Stimulation
Identify the PNF D1 Flexion and Extension Patterns.
- D1 flexion: scapula elevation, abduction & rotation, shoulder flexion, adduction & external rotation, elbow in flexion or extension, wrist flexion to radial side, finger flexion & adduction; thumb adduction
- D1 extension: scapula depression, adduction & rotation, shoulder extension, abduction & internal rotation, elbow in flexion or extension, wrist extension to ulnar side, finger extension & abduction; thumb in palmar abduction
Identify the PNF D2 Flexion and Extension Patterns.
- D2 flexion: scapula elevation, adduction & rotation, shoulder flexion, abduction & external rotation, elbow in flexion or extension, forearm supination, wrist extension to radial side, finger extension & abduction; thumb extension
- D2 extension: scapula depression, abduction & rotation, shoulder extension, adduction & internal rotation, elbow in flexion or extension, wrist flexion to ulnar side, finger flexion & adduction; thumb opposition
In an NDT approach, what are some of the key concepts?
Neuro-Developmental Treatment
- Based on normal development and movement
- Normalize muscle tone
- Inhibit primitive reflexes
- Facilitate normal postural reactions
- Improving quality of movement
- Relearn normal movement patterns
What are the differences between the past assumptions and current assumptions of NDT?
Past assumptions, Bobath’s original theory was not based off the reflex and hierarchic models of the nervous system. They were merely based off her experiences and understanding of proper alignment and posture. They did not take into account concepts such as higher levels of our CNS control lower levels.
Today with the advancement in the theories like Dynamic Systems Theory and the Heterarchial Model, which argue multiple systems need to work together to do task, NDT is very different and is used in combination with other approaches and is always task oriented in nature.
What are common intervention concepts used in an NDT approach?
What movements of the pelvis and the scapula can be facilitated using an NDT approach?
What are common intervention concepts used in an NDT approach?
- Handling techniques
- Weight bearing over the affected limb
- Use of positions that encourage the use of both sides of the body
- Current Practice: Used within context of purposeful activities
- Can be prep activity then incorporate into ADL
What movements of the pelvis and the scapula can be facilitated using an NDT approach?
Pelvis:
- Neutral
- Posterior Pelvic Tilt
- Anterior Pelvic Tilt
- Lateral Pelvic Tilt
Scapula:
- Elevated
- Depressed
- Protraction
- Retraction
- Upward Rotation
- Downward Rotation
How can you facilitate a client in sitting, weight-shifting, and standing using an NDT approach?
Use arm to weight-bear to get arm involved as soon as possible post accident. Weight shift using arm, use arm to support while standing, use arm as prop when teeth brushing- even if not using, it will be used to bear weight and gain mm.
Define motor learning and motor control.
Motor Learning- not hierarchical vs Rood/brunnstron/ NDT/ PNF
- Motor Learning - Acquisition and modification of learned movement patterns over time. Learn and then get better with practice.
- Motor Control – Outcome of Motor Learning; Ability to produce purposeful movements of the extremities and postural adjustments in response to activity and environmental demand
Describe dynamic systems theory.
Dynamic Systems Theory – Motor behavior is a dynamic interaction between client factors, the context, and the occupations that must be performed to enact the client’s roles. Multiple systems are working together to do task. Very ot. Ie; teaching bathing, first wash arm/face, get pattern first then transfer to shower.
Heterarchical Model – Views each component as critical in a dynamic interaction supporting the client’s ability to engage in occupation.
Describe the task oriented approach and how and why it is relevant to occupational therapy.
Task-Oriented Approach – based on dynamic systems principles. Occupational performance and motor recovery occur from a dynamic interaction of the person, the environment, and the occupations they are performing. Get movement pattern down for specific task- what do you have to get back to doing?
Describe the basic principles of Constraint-Induced Movement Therapy.
Constraint-Induced Movement Therapy (CIMT): also part of current motor learning theories: forces involved hand to do all the work. Like put good hand in mitt. Contractures/deconditioning of good hand. Safety with only one hand. Bilateral hand. Frustration level.
