Traditional Treatment Approaches Flashcards
Brunnstrom Approach
-post stroke recovery for hemiplegia
-synergies after stroke and ability to progress through them
-UE and LE scored differently
-spinal affects mostly
-stages can’t be skipped
-recovery can stop recovery
Associated Reactions
-automatic movements that change the position of body part when:
-another part moves voluntarily
-increased effort
-patientt sneezes/coughs
-artificially stimulated
-can include raimiste’s
Brunnstrom Stage 1
-flaccidity
-no voluntary mmt
-no associated reacttions
-no DTRs
UE: Supine; move UE passively in synergistic pattern to elicit response
(-): no activation
(+): increase tone or synergy, move to 2
LE: Same ^^
Brunnstrom Stage 2
-spasticity is developming
-DTRs present
-minimum volutnary mmt
-all movement within synergy
UE: Supine; move UE into synergistic pattern by resisting LE, elecit extension syngery
(+): trace activation of involved, elbow flexors
LE: Same ^^
Brunnstrom Stage 3
-can perform basic synergies voluntarily
-Spasticity at peak
UE:
Sitting; ask pt to move into ext and flx synergies
(+): able to initiate movement in synergyistic pattern with spasticity
LE:
Supine; ask pt to move into flx synergy first
(+): able to move through flx synergy up to 90deg with spasticity
Sidelying; asking to move into ext synergy
(+): able to move through ext synergy with spasticity
Brunnstrom Stage 4
-spasiticty starts to decrease
-can voluntarily perform min movements out of synergy
UE:
Sitting; bring arm out of synergies
(+): able to perform tasks partially with some movement combinations not in synergy, with some spasticity
LE:
Supine; ask pt to abduct leg with knee straight
Sitting; 1) Lift knee to chest 2) slide foot under chair 3) with heel on floor, raise toes/ankle 4) straighten knee out completly
(+): able to perform 2/3 times
(-): pt performs movements <2 times, go to 3
Brunnstrom Stage 5
-spasticity conttinues to decrease
-basic synergies lose dominance
-can perform movement combinations outside of synergies
UE:
Sitting; 1) raise arm to side, elbow straight, palm up; 2) raise arm overhead; 3) straightten elbow, palms up and down
(+): 1) able to abuduct 90deg; 2) able to flec shoulder 90-180; 3) able to supinate and pronate, elbow extended
LE:
Sitting; 1) Pump ankles, knees straight; 2) Turn ankle in and out with knee bent, heel on floor
Standing; 1) Extend hip while bending knee; 2) Abduct hip with knee straight
(+): pt able to perform with less spasticity
Brunnstrom Stage 6
-slight remnant of spasticity
-isolated muscle action with a variety of patterns
-slow speed/coordination
UE:
Sitting; asses for timing and coordination fo movements out of synergy
-1) How many reps of sup/pro in 15s
2) How many marbles to pick ip
(+): Coordination and speed of movement similarly Bilat with no spasticity
LE:
Sitting; asses for timing and coordination fo movements out of synergy
-tap foot for 15s
-draw circles with foot
(+):Coordination and speed of movement similarly Bilat with no spasticity
Brunnstrom Stage 7
-no spasticity
-restoration of normal movement and function
PNF
-activation of NMSK through stimulation of he proprioceptors
-stimulate a deficient NMSK
Give pt info about:
-limbs in space
-speed required for mmt
-amount of force needed
-what muscles are needed
Purpose:
-muscle strengthening
-increase mobility
-motor learning
-inprove functional movement
Reciprocal Inhibition
-using contraction of agonist to inhibit antagonist
-facilitate of alpha motor neurons
Autogenic Inhibition
-contraction of antagoist will allow relaxation fo the same muscle
Successive Induction
-max effort of antagonists will overflow into agonist if reversal is quick
Irradiation
-max effort of stronger muscles within a pattern to overflow to weaker muscles
-Ramesties
7 Commandments of PNF
- Manual Contacts
- Commands/Communication
- Stretch
- Traction/Approximation
- Maximal Resistance
- Normal Timing
- Reinforcement
7 Commandments of PNF: Manual Contacts
-hands stimulate specific groups of muscles to direct line of movement
7 Commandments of PNF: Commands
-tone of voice
-prep instructions
-action commands: short, directive, timed with movement
7 Commandments of PNF: Stretch
-activation of muscle spindle to stimulate agonist
-quick stretch added for reflexive component to movement initiation
7 Commandments of PNF: Traction/Approximation
-traction facilitates movement
-approximation facilitates stability
7 Commandments of PNF: Maximal Resistance
-max resistance pt can take witthout breaking
7 Commandments of PNF: Normal Timing
-distal to proximal movement (open hand before arm)
-allow rotation tot occur earlier in pattern
7 Commandments of PNF: Reinforcement
-timing for emphasis or combinations of patterns to increase strength of a response
Stages of PNF Motor Control: Mobility
-movement
-isotonic contractions
-needs ROM and motor unit activation
PNF Strategies:
Strengthening
-repeated contractions
-hold-relax-active-motion
-timing for emphasis
-Reversal of antagonists
Lenthening short muscles
-hold/contract relax
Get Going
-Rhythmic initiation
Stages of PNF Motor Control: Stability/Static Postural Control
-isometric contractions
-hold body in antigravity position
PNF Strategies:
Reversal of isometrics/Alternating Isometrics
Rhythmic Stabilization
Stages of PNF Motor Control: Controlled Mobility/ Dynamic Postural Control
-ability to change position while maintaining postural stability
PNF:
Slow reversals
Stages of PNF Motor Control: Skilled Mobility
-coordinated movements to interact with environment
-task specific movements
PNF:
Agonist reversals (concentric followed immediately by eccentric)
Normal Timing
Developmental Activities
-movements that progressively challenges the patient to control body segments against gravity
-proximal control before distal
Ex:
-functional training
-rolling
-prone progresion
-sitting
-kneeling
-sttanding
-walking
Neurdevelopmental Technique
- Individualized problem solving treatment approach
- Minimize Activity Limitations
- Clinical Based Practice
- Balance and Postural Control
- Typical Motor Behavior
- Strive to Optimize Independence
Elements of Postural Control: Trunk
-required to have control elsewhere
-lower trunk»upper trunk
Elements of Postural Control: Midline Orientation
-point of reference for movement over base
-stabilize in midline, move away from and back to it, cross midline
Elements of Postural Control: Weight Shift
-straight lines and diagonals
Elements of Postural Control: Head Control
-evolves out of trunk control
Elements of Postural Control: Limb Function
-last
-selective movements in WB prior to selective mmts non-WB
