Treatment Planning and Treatment Approaches Flashcards
1
Q
Pediatric Physical Therapists assist the family with enhancing the child’s development through? (4)
A
- Positioning during daily routines & activities
- Adapting toys for play
- Expanding mobility options
- Using equipment effectively
2
Q
Pediatric Therapy Evaluation and Treatment Focuses On? (8)
A
- Mobility
- Muscle & joint function
- Strength & endurance
- Cardiopulmonary function
- Posture & balance
- Oral motor skills & feeding
- Sensory & neuromotor development
- Use of assistive technology
3
Q
Pediatric treatment includes many of the traditional components of Adult Rehabilitation? (8)
A
- ROM
- Strengthening
- Stretching
- Gait Training
- Postural Training
- Wheel chair training / management
- Pain management
- Fitness
4
Q
some differences? (3)
A
- Pediatric PT does not use a high level of modalities
- Treatment is mostly 1 on 1
- Tends to be more long term
5
Q
Treatment sessions however are ? Vary based on? with younger kids most tx session are? Style of play based on?
A
- Treatment sessions however are dynamic and change
- vary based on the response of the child
- With younger children most treatment sessions are play based, and the style of play will vary based on age
6
Q
Style of play - babies? Toddlers? Pre-schoolers? School age? Adolescents?
A
- Babies sensory motor play and exploration
- Toddlers movement based play
- Pre-schoolers more imaginative play and creating scenarios
- School age children more focused on function and functional skills with less play
- Adolescents, sporting activities, function and real exercise
7
Q
Ways to sequence activities to get the best and most from the child - go from? Use? (2) Set up? 4 other strategies? What the child needs based upon?
A
- Go from Easy to Hard activities
- Use the developmental sequence as a guide
- Work – Play – Work – Play
- Set up environment for child driven activities (ie S.I. )
- Preparation, Muscle Activation, Movement Responses, Functional Activity (i.e. NDT)
- What the child needs based upon when they are coming to you and from where
8
Q
Treating At Home - Schedule visits to? Utilize? Have? Leave? Play with?
A
- Schedule visits to accommodate the family & the CHILD’S schedule
- Utilize materials and toys from the home
- Have caregiver participate in activities
- Leave caregiver with strategies to incorporate into daily activities
- Play with siblings during therapy
9
Q
Neurodevelopmental Therapy - The overall goal of treatment and management is to? Tx involves?
A
- enhance function
- Treatment involves active participation of the individual and direct handling to optimize function with gradual withdrawal of direct input by the therapist
10
Q
NDT - Components of normal development of movement and skill are used as? These areas are then? Efficient motor function is the ability to?
A
- Components of normal development of movement and skill are used as a background to define the problem areas or missing components in an individual that are limiting function.
- These areas are then addressed in treatment to gain function that is age appropriate
- Efficient motor function is the ability to combine a variety of movements into functional activities under a wide variety of environmental conditions
11
Q
NDT Treatment focuses on? Clinicians teach? Expand?
A
- Treatment focuses on increasing function by building on a client’s strengths while addressing specific impairments through therapeutic handling
- Clinicians teach the movement with handling then gradually withdraw guidance, making the client responsible for the movement
- Expand movement to different environments
12
Q
What is handling?
A
Treatment with hand on client that provides proprioceptive, tactile, kinesthetic and vestibular input. Includes use of key points of control for guidance of movement
13
Q
What is facilitation?
A
Sensorimotor input that creates the possibility of new movements. Assists in the activation of muscles or muscle groups to perform
14
Q
What is inhibition?
A
Sensorimotor input that reduces the possibility of movement. The act of inhibiting abnormal reflex activity or movement patterns via handling and positioning
15
Q
Techniques to reduce stiffness? (5)
A
- Relaxation: includes gentle rocking, warmth, talking gently
- Pressure at muscle origin or insertion: Inhibits specific muscle activity
- Quick alternating movements: Reciprocal movements with large amplitude oscillation
- Rotation: Axial rotation breaks up total synergies, limb rotation to decrease stiffness
- Vibration: light tremor applied manually
16
Q
Techniques to reduce stiffness? (6-12)
A
- Traction: On limbs or through trunk combined with movement to inhibit agonist
- Compression: to facilitate co-contraction
- Tapping: to facilitate muscle contraction
- Use of mobile surfaces
- Incorporate movement directions of rotation and diagonals
- Treat with the movement
- Work proximally to effect distally
17
Q
Treatment Session May begin with? Incorporate? Work on?
A
- May begin with “prep work” to gain relaxation of stiffness and muscle elongation to prepare for movement or develop adequate activity for movement
- Incorporate Muscle Activation to allow integration of muscles or muscle groups into functional activities
- Work on Movement Responses, righting, balance, weight shift, protective responses
18
Q
Treatment Session - mobility can continue with? Use of? What involvement?
A
- Mobility: can continue with ideals of key points of control with facilitation techniques to improve gait
- Use of equipment, ball, bolsters, wedges, blocks
- Parental involvement
19
Q
Strengthening works on? Can be done? What is key? Can use?
A
- Works on the negative signs of UMN lesions
- Can be done best with children with isolated voluntary muscle control
- Functional strengthening is key
- Can use all modes of resistive exercise
20
Q
Motor Learning/Movement Science developed from? Focus on? (2) Uses ideas of? (6) Does not? (2)
A
- Focus on skill acquisition, learning of tasks in a context specific environment
- Uses ideas of practice, feedback, feedforward, KR, KP, affordances
- Does not rely on facilitation or handling
- Does not support transfer of training
21
Q
Neuromuscular Electrical Stimulation NMES, High intensity stimulation to? Functional Electrical Stimulation FES sequenced stimulation producing? Threshold Electrical Stimulation TES Low intensity simulation at?
A
- augment exercise using surface electrodes
- Functional Electrical Stimulation FES sequenced stimulation producing functional movement surface or implanted
- Threshold Electrical Stimulation TES Low intensity simulation at sensory threshold. - Thought to increase blood flow to muscle for growth and repair
22
Q
Kinesio Tape can be used to? (4) Always be used to? Often the trunk is? PTs can use it for? (4)
A
- facilitate movement patterns and muscle use, increase stability, and improve alignment and function. Proper application techniques are key in obtaining optimal results.
- Always be sure to use a test patch over the area to be taped for four days prior to taping, to assess for reactions to the tape.
- Often the trunk is more sensitive to tape than the extremities. A light coat of Milk of Magnesia can be used under the tape to decrease sensitivity.
- PT’s are using for Torticollis, Brachial Plexus Injury, Cerebral Palsy, Down Syndrome etc.
23
Q
Conductive Education - developed to? Conductors are? Utilizes? Uses?
A
- Developed in by Peto in Hungary, a system of education and therapy to achieve “orthofunction”
- Conductors are teachers/therapists that structure all of the days events
- Utilizes specialized equipment, plinths, ladder frames, chair, little to no bracing
- Uses task series or exercise routines in group with rhythmic initiation
24
Q
MOVE Curriculum: Movement Opportunities Via Education - used in? Uses? (2) Consists of? (7)
A
- Used in educational settings with multiply handicapped/cognitively impaired population
- Uses specific equipment
- Uses specific systematic instruction for functional tasks especially functional movement
- 6 steps, Testing, setting goals, task analysis, measuring prompts, reducing prompts and teaching skills
25
Constraint Induced Therapy - what do you do to the limbs? Then what? Therapy is given for?
- Stronger arm is restrained for 6 hours a day for 21 days
- Weaker arm is then facilitated and trained in specific age appropriate tasks
- Therapy is given for the many hours and extended days to produce changes in motor behavior and theoretically in brain activation
26
Hippotherapy Completed by professional therapist in conjunction? Hands on? The horse's movement is? The goal is? Hippotherapy is what kind of tx?
- with a professional horse handler
- Direct hands on participation by therapist at all times
- The horse's movement is essential to assist in meeting therapy goals
- The goal of hippotherapy is professional treatment to improve neurological functioning in cognition, body movement, organization, and attentional levels
- Hippotherapy is 1:1 treatment and often involves the use of NDT like handling or movement while on the horse
27
Occasional hands on? What's essential to learn riding skills? Therapeutic riding aims to? (3) In therapeutic riding, the individual is often? In therapeutic riding, focus on?
Occasional hands on assistance by riding instructor and/or volunteer, with instructor primarily teaching from center of arena.
The horse's temperament is essential to learn riding skills
Therapeutic riding aims to provide social, educational, and sport opportunities in recreational horseback riding lessons adapted to individuals with disabilities
In therapeutic riding, the individual is often taught riding lessons in a group format, which runs in "sessions". The instructor must respond to the group as a whole, in addition to fostering individual success
In therapeutic riding, focus on the group lesson is encouraged, along with emphasizing proper riding position and rein skills
28
Dolman Delacato / Patterning - based on? Use of? How popular is this?
- Based on the theories of Temple Fay who believed that motor development or sequences paralleled evolution and movement like amphibians and reptiles could help children with brain damage
- Use of systematic reciprocal movements and sensory inputs would stimulate brain cells and restore normal movement. Requires hours of parental and volunteer work on the child (passive movement)
- American Academy of Pediatrics and AACPDM have position statements against this form of intervention.
29
With our "patterning," all we were trying to do was to? Based on? He had even developed?
- awaken those inherited instincts.
- Temple Fay had long ago used the term cross pattern in his studies of how the lizard or alligator, both midbrain creatures, moved.
- He had even developed different ways of putting brain-injured children through the same motions, a procedure he called "patterning." This patterning had appeared to help but as applied had not actually succeeded in getting paralyzed children to walk.
30
How well does it work?
patterns were applied rigorously, on a specific schedule, and done with a religious zeal, brain-injured kids improved.
31
Craniosacral Therapy (CST) is a?
gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system - comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord.
32
How is CST done?
Using a soft touch generally no greater than 5 grams, or about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system.
33
Why would a child need craniosacral therapy?
One of the most common causes of pediatric problems arises from a difficult labor. Although the body is designed to withstand most forces during birth, prolonged or difficult labors can cause restrictions in the craniosacral system. Restrictions in the craniosacral system can cause a lot of symptoms
34
Restrictions in the craniosacral system in an infant? (6)
- Excessive crying, irritability, and/or wakefulness
- Startles easy
- Difficulty with suckling or wants to suck constantly
- Severe neurological impairments such as cerebral palsy or autism
- Vomiting or spitting up after feeding
- Arched back or throwing head back when held on should or side
35
Restrictions in the craniosacral system in the older infant or child? (6)
- Recurrent ear infections
- Head banging
- Thumb sucking
- Constant rocking
- Hear and/or ear pulling
- Sensitivity around the head - does not like head touched or hair combed
36
Adeli Suit used for?
neuromuscular problems particularly CP
37
Adeli suit major goal? (5)
- is to improve and change:
- proprioception (pressure from the joints, ligaments, muscles),
- reduce patient's pathological reflexes,
- restore physiological muscle synergies (proper patterns of movement)
- load the entire body with weight (process similar to a reaction of our muscles to the gravitational forces acting up us for 24 hours).
38
Adeli suit does what?
above normalizes afferent vestibulo-proprioceptive input (information arriving to the vestibular system) influencing muscle tone, balance and the position of the body in space.
39
How does the Adeli suit work?
The more correct proprioception from the joints, ligaments, muscles, tendons, joint's capsule etc., the more correct alignment. The vicious cycle (picture 1) can be interrupted and incorrect information is replaced by " new" correct information
