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Neuromuscular practice- Adutls > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What does the neuromuscular system impact/affect?

A
  • MOVEMENT of all types
  • Mobility
  • UE function / ADL
  • Speech
  • Swallowing
  • GI/GU
  • Sexual function
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2
Q

What can disorders of the neuromuscular system impact?

A
  • Consciousness
  • Sensory/perceptual system
  • Speech/language
  • Cognition/memory/executive function
  • Psychological function
  • Autonomic function
  • Cardiovascular function
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3
Q

How are improvements in function of a neuromuscular problem accomplished?

A

By increased motor unit firing rates

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4
Q

What is the focus of neuromuscular dysfunction treatment?

A

Correcting the diminished and interfering patterns of CNS malfunction rather than toward striated musculature

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5
Q

What are the effects of a neuromuscular dysfunction(stroke) on torque production?

A
  • Decrease in maximum voluntary torque
  • Decreased speed in torque generation
  • Selective muscle weakness at shortened range
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6
Q

What should be the considerations taken when rehabilitating a patients with a neuromuscular dysfunction(stroke) in regard to torque production?

A
  • Target strengthening of muscles in shortened lengths to promote recovery
  • Speed/Power has to be trained
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7
Q

What is muscle tone?

A

Tension in muscle, determined by mechanical factors and motor unit activity

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8
Q

What is muscle tone range?

A
  • Flaccidity
  • Hypotonia
  • Normal
  • Hypertonia
  • Rigidity
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9
Q

What is hypertonia?

A

Abnormally increased resistance to externally imposed movement about a joint

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10
Q

What causes hypertonia?

A

May be caused by spasticity, dystonia, rigidity, combination of features

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11
Q

What is spasticity?

A

Velocity-dependent resistance of muscle to stretch

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12
Q

Spasticity is hypertonia in which 1 or both of what signs are present?

A

1) resistance to externally imposed movement increases with increasing
speed of stretch and varies with the direction of joint movement, and/or
2) resistance to externally imposed movement rises rapidly above a threshold
speed or joint angle

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13
Q

What is the direct causation between spasticity and function?

A

No direct causation between spasticity and function

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14
Q

Hypertonia associated with a contracture is more related with an abnormal movement may be more about _____

A

Hypertonia associated with a contracture is more related with an abnormal movement may be more about stiffness of passive tissues

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15
Q

What is that excess muscle activity?

A
  • Compensatory behavior

* Over recruitment when demand exceeds capacity

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16
Q

What are the things to do when trying to determine if a patient has spasticity?

A
  • Improve our movement analysis to discern causes of abnormal movement
  • Manipulate the person, environment, and/or task to get a more normal movement
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17
Q

What are the ways to manipulate the person, environment, and/or task to get a more normal movement?

A
  • Fix biomechanical constraints or compensate for them
  • Manipulate task and/or environment difficulty to better match demand to capacity
  • Increase patient’s capacity(strengthening, practice)
  • Decrease degrees of freedom
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18
Q

What are the basic aims of neuro rehabilitation?

A
  • MAKE MOVEMENT BETTER
  • IMPROVE FUNCTION
  • INCREASE/RESTORE PARTICIPATION
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19
Q

What are the classifications of therapy for neuro rehab?

A
  • Functional Training
  • Body system or impairment training
  • Augmented feedback training
  • Learning-based sensorimotor retraining
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20
Q

What is functional training?

A

Practice of functional skill; task oriented

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21
Q

What does body system or impairment training focus on?

A

Focus on correcting body system problem. Do a lot of strengthening, and such

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22
Q

What is augmented feedback training needed for?

A

Need for external feedback and control over motor program running target task. Can do this by limiting the answer options available for a question

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23
Q

What is learning-based sensorimotor retraining used for?

A

Improving sensory discrimination dysfunction.

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24
Q

What are the treatment strategy categories for neuro rehab?

A
  • Compensation Training
  • Substitution Training
  • Habituation Training
  • Neural Adaptation
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25
Q

How does compensation training treatment strategy work?

A

Compensate for permanent impairment or lost body system function

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26
Q

How does substitution training treatment strategy work?

A

Use of different sensory system or muscle(s) to substitute for lost function of another system

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27
Q

How does habituation training treatment strategy work?

A

Activity-based provocation of symptoms with goal of symptom reduction

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28
Q

How does neural training treatment strategy work?

A

Driving changes in structure and function of CNS or PNS with repetitive, attended practice

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29
Q

What word is neural adaptation akin to?

A

Recovery

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30
Q

What is neural adaptation?

A

Permanent changes in neural activation, organization, and structure

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31
Q

What are the other definitions of neural adaptation?

A
  • Recovery of neurophysiological activity in affected cortical areas
  • Restoration/remodeling toward NORMAL state of organization
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32
Q

What are the goals of recovery?

A
  • Restoring function in neural tissue that was lost
  • Restoring ability to perform movements in same manner as premorbid
  • Successful task accomplishment using typical “parts”
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33
Q

What are the goals of compensation?

A
  • Neural tissue acquires function it didn’t have premorbid
  • Performing old movements in a new way
  • Successful task completion using alternative “parts”
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34
Q

What is compensation?

A

A behavioral substitution; alternative

behavioral strategies adopted to complete the task; use of remaining parts

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35
Q

What does compensation lead to?

A

Learned non-use

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36
Q

What kind of conditions does compensation create?

A

Conditions in which CNS does not engage in processing critical information for recovery of motor control. May itself be the primary reason that motor deficits remain.

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37
Q

What are the mechanisms by which functional improvement can occur in a person with a neural dysfunction?

A
  • Recovery

- Compensation

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38
Q

On what levels can recovery and compensation be observed?

A

At behavioral and neural levels

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39
Q

What does movement emerge from?

A
  • Organism
  • Task
  • Environment
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40
Q

What is the strategy of neural restoration?

A

Re- engaging residual brain areas initially dysfunctional after injury or disease

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41
Q

What is the functional platform of neural restoration?

A

Internal and external redundancy

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42
Q

What is the neural mechanism of neural restoration?

A

Recovery

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43
Q

What is the strategy of neural recruitment?

A

Engaging new residual brain areas

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44
Q

What is the functional platform of neural recruitment?

A

External redundancy

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45
Q

What is the neural mechanism of neural recruitment?

A

Compensation

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46
Q

What is the strategy of neural retraining?

A

Training residual brain areas to perform new functions

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47
Q

What is the functional platform of neural retraining?

A

Internal and external redundancy

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48
Q

What is the neural mechanism of neural retraining?

A

Compensation

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49
Q

What are the different theories of how recovery takes place?

A
  • Reversal of diaschisis
  • Compensation
  • Physiological and neuroanatomical reorganization
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50
Q

What is the reversal of diaschisis theory of recovery?

A

Spontaneous recovery

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51
Q

What is the compensation theory of recovery?

A

Functional improvement while significant impairment remains

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52
Q

What is the physiological and neuroanatomical reorganization theory of recovery?

A
  • Changes in response to intrinsic neuronal networks
  • Alterations/increase in neurotransmitter levels
  • Dendritic branching, axonal sprouting, synaptogenesis
  • Neurogenesis
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53
Q

How long does it take for a person with a spinal nerve injury to experience reversal of diaschisis if it happens?

A

24-48 hours

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54
Q

What is plasticity, according to Kleim JA?

A

The possession of a structure weak enough to yield to an influence, but strong enough not to yield all at once

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55
Q

According to Kleim JA, what is special about organic matter, especially nervous tissue?

A

It seems endowed with a very extraordinary degree of plasticity

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56
Q

What are the scientific definition of neuroplasticity?

A
  • Fundamental property of the brain
  • Capacity for neurons to structurally and functionally adapt
  • Reorganization of neural circuits
  • Innate capability of the brain to grow new neurons, reorganize cortical representations, access latent circuits, bypass damaged circuits
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57
Q

What is the definition of neuroplasticity for the therapist?

A
  • “Opportunity to train new brain to perform old functions”
  • Neural strategies for motor improvement
  • True recovery of function
  • Maximizing motor recovery
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58
Q

What does the mechanisms of neuroplasticity involve?

A

Peri-infarct tissue as well as network of sensorimotor structures indirectly affected by injury

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59
Q

What are the structural components of the mechanisms of neuroplasticity?

A 
• Dendritic arbor, spine density
• Synapse number
• Axonal arbor
• Receptor density
   - Effects population of neurons by changing structure, thickness, gray matter density
60
Q

What are the functional components of the mechanisms of neuroplasticity?

A

• Excitatory postsynaptic potential
• Neural activity
• Intrinsic excitability
- Effects population of neurons by changing sensory and/or motor maps, measured by variety of neuro diagnostics

61
Q

What are the categories of the mechanisms of neural plasticity?

A
  • Synaptic Plasticity
  • Non-Synaptic Plasticity
  • Neurogenesis
62
Q

What is synaptic plasticity?

A

Increases in synaptic strength

63
Q

What contributes to non-synaptic plasticity?

A

Changing number of ion channels, increasing or decreasing responsiveness to synaptic inputs

64
Q

What is are the characteristics of neural reorganization in the absence of rehab?

A
  • Compensatory behaviors key in “normal” response to brain injury
  • Reliance on less-affected limb associated with reorganization and neuronal growth in non-affected hemisphere
  • Can be maladaptive and interfere with relearning in affected limbs
65
Q

What is the goal of motor rehab?

A

To facilitate the neural reorganization that underlies relearning of motor skills and function following damage to the CNS

66
Q

What is motor relearning?

A
  • Reacquisition of motor patterns
  • Adaptation of remaining motor elements
  • Integration of alternative motor elements
67
Q

What is motor recovery?

A

Reappearance of elemental motor patterns

68
Q

What is motor compensation?

A

Appearance of new motor patterns resulting from adaptation or substitution

69
Q

Skill learning leads to a rewiring of the ____

A

Skill learning leads to a rewiring of the motor cortex

70
Q

What is the best hope for brain remodeling?

A

Learning

71
Q

_____ causes reorganization

A

Learning

72
Q

Brain injury changes how the brain responds to ____

A

Brain injury changes how the brain responds to learning

73
Q

Impaired learning after multiple concussions and ____ are related

A

Impaired learning after multiple concussions and decreased synaptic plasticity related

74
Q

Functional improvement is a ____ process

A

Functional improvement is a relearning process

75
Q

____ not motor activity, leads to increased

numbers of synapses in motor cortex

A

Motor learning

76
Q

What the 1st therapeutic for a neuro dysfunction patient?

A

Be an attempt to recover those specific behaviors disrupted by the brain injury

77
Q

When should interventions for a neuro dysfunction patient be done and why?

A

Interventions should be as early as possible to minimize the possibility that the individual will shift from the damaged neural system and attempt to compensate

78
Q

What are the key factors that make therapy effective?

A
  • INTENSIVE THERAPY

- TASK SPECIFICITY

79
Q

What are the key factors that drive activity dependent plasticity?

A
  • Task Complexity
  • Task Difficulty/Intensity
  • Task Specificity
  • Sensory Experience
80
Q

What are the principles of experience- dependent plasticity?

A
  1. Use it or lose it
  2. Use it or improve it
  3. Specificity
  4. Repetition matters
  5. Intensity matters
  6. Time matters
  7. Salience matters
  8. Age matters
  9. Transference
  10. Interference
81
Q

What is the description of principle of experience- dependent plasticity: Use it or lose it?

A

Failure to drive specific functions can lead to functional degradation

82
Q

What is the description of principle of experience- dependent plasticity: Use it or improve it?

A

Training that drives a specific brain functions can lead to an enhancement of that function

83
Q

What is the description of principle of experience- dependent plasticity: specificity?

A

The nature of the training experience dictates the nature of the plasticity

84
Q

What is the description of principle of experience- dependent plasticity: repetition matters?

A

Induction of plasticity requires sufficient repetition

85
Q

What is the description of principle of experience- dependent plasticity: intensity matters?

A

Induction of plasticity requires sufficient training intensity

86
Q

What is the description of principle of experience- dependent plasticity: time matters?

A

Different forms of plasticity occur at different times during training

87
Q

What is the description of principle of experience- dependent plasticity: salience matters?

A

The training experience must be sufficiently salient to induce plasticity

88
Q

What is the description of principle of experience- dependent plasticity: age matters?

A

Training- induced plasticity occurs more readily in younger brains

89
Q

What is the description of principle of experience- dependent plasticity: transference?

A

Plasticity in response to one training experience can enhance the acquisition of similar behaviors

90
Q

What is the description of principle of experience- dependent plasticity: interference?

A

Plasticity in response to one experience can interfere with the acquisition of other behaviors

91
Q

What are the components of intensity?

A
  • Repetition
  • Time in therapy
  • Frequency of therapy
  • Cardiovascular response
  • RPE
  • Functional
  • Challenging
  • Load
  • Speed
92
Q

What are the active ingredients required to drive neuroplasticity?

A
  • Practice should be challenging
  • Practice should be progressive and optimally adapted
  • Solicit motivation and active participation
93
Q

What are the components of the challenge that can drive neuroplasticity?

A
  • Difficult but not too difficult (require new learning)
  • Specific
  • Intense
94
Q

What are the components of the progressive and optimally adapted practice that can drive neuroplasticity?

A
  • “Repetition without repetition”

* Timing matters

95
Q

What are the components of the motivation and active participation that can drive neuroplasticity?

A
  • Active and engaged
  • Motivation enhances motor learning
  • Salient and meaningful
96
Q

What is motor learning?

A

Acquisition and/or modification of movement

97
Q

What is the process of motor learning associated with?

A

Practice or experience leading to permanent changes in skill

98
Q

What are the concepts of motor learning?

A
  • Process of acquiring capability for skill
  • Results from experience or practice
  • Can’t be directly measured; inferred from behavior
  • Produces relatively permanent changes in behavior
99
Q

What are the other components associated with motor learning?

A
  • Learning new strategies for sensing as well as moving
  • Emerges from perception, cognition, action processes
  • Search for task solution, emerging from interaction of individual with task and environment
100
Q

What are the key factors in motor learning?

A
  • Practice
  • Feedback
  • Attention
  • Motivation
101
Q

What are the “familiar” factors in motor learning?

A
  • Practice Levels
  • Feedback
  • Practice Conditions
102
Q

What is the most important factor in retraining motor skills?

A

The amount of practice

103
Q

What are the types of feedback used in motor learning?

A

• Intrinsic
• Extrinsic
- Knowledge of Results (versus Knowledge of Performance)

104
Q

What are the practice conditions of motor learning?

A 
• Massed v Distributed
• Constant v Variable
• Random v Blocked
   - Contextual Interference
• Whole v Part
• Transfer
• Mental Practice
• Guidance v Discovery Learning
105
Q

What are massed practice conditions?

A

Amount of practice time in trial ˃ amount of rest between trials

106
Q

What are distributed practice conditions?

A

Amount of rest between trials ≥ amount of time for trial

107
Q

What is the effect of massed practice in continuous tasks?

A

Massed practice decreases performance

(fatigue), not much affect on learning

108
Q

What is the effect of variable practice?

A

Increases ability to adapt and generalize

109
Q

When is the Constant v Variable practice condition most useful?

A

When learning tasks performed in variable conditions

110
Q

What are the benefits of random practice conditions?

A

Better retention and transfer

111
Q

What are the benefits of blocked practice conditions?

A

Better performance

112
Q

What is the contextual interference of random v blocked practice conditions?

A

Increased difficulty initially make learning more effective

113
Q

When may random practice be inappropriate?

A

Until earner understands dynamics of task

114
Q

What are the characteristics of whole v part practice conditions?

A
  • Interim steps via task analysis
  • Practice parts before combining into whole
  • Takes things out of context
  • Quick, discrete skills and continuous skills should be practiced as whole
  • Serial skills are ok to do part-whole
  • Bottom line, have to get to the WHOLE practice sooner rather than later
115
Q

What is a transfer practice condition?

A

A task learned in one condition transferred to another

116
Q

What do transfer practice conditions depend on?

A

Similarities between tasks or environments

117
Q

What are the characteristics of mental practice, practice conditions?

A
  • A cognitive rehearsal
  • Enhance learning when physical practice not possible
  • Has been shown to significantly increase efficacy of repetitive task specific practice
  • Retention of motor improvements have been demonstrated to last at least 3 months in patients with stroke
118
Q

What are the characteristics of guidance v discovery learning practice conditions?

A
  • We often use guidance in neuro rehab
  • Unguided conditions less effective during acquisition, but more effective for retention and transfer
  • Replace with discovery learning – patient allowed to explore “perceptual motor workspace”
  • Trial and error discovery of best strategies and perceptual cues
119
Q

What type of feedback is the best?

A

Intrinsic

120
Q

What type of extrinsic feedback is better for learning?

A

Knowledge of results

121
Q

What does attention learning have to do with?

A

External focus

122
Q

What does motivation learning have to do with?

A
  • Enhanced expectancies

- Autonomy

123
Q

What are the types of focus of attention that we can have during motor learning?

A

External or internal

124
Q

What is external focus of attention?

A

Concentration on movement effect

125
Q

What is internal focus of attention?

A

Concentration on body movements

126
Q

What does feedback promoting external focus do?

A

– Enhances learning

– Promote automaticity

127
Q

Does frequent with external focus negatively impact learning/retention?

A

No it doesn’t

128
Q

What does autonomy increase?

A

Motivation, performance, and learning

129
Q

What mediates autonomy?

A

Self efficacy

130
Q

What does expectancy focus on?

A

Positive feedback

131
Q

What kind of effect does expectancies have on self efficacy?

A

Positive effect

132
Q

What does enhanced expectancies do?

A
  • Warn and prepare for further positive outcomes, impact cognitive, emotional and motor preparatory activity
  • Influence goal setting and increase positive affect
  • Buffer against responses that would detract from optimal performance
  • Couple goals with desired outcomes
133
Q

What does autonomy support do?

A
  • Facilitate learning indirectly by enhancing expectancies
  • Role of autonomy for triggering switches between neural networks needed for given task success (efficient goalaction coupling)
  • Perception that actions have effects on environment important for motivation
  • Heighten sense of personal agency and personal expectations for positive outcomes
134
Q

What are the values that skilled decision making incorporates?

A
  • Functional goals from beginning
  • Intentional prevention for optimal health
  • Patient-centered/family-centered decisions
  • Holistic approach
  • Evidence based
  • Emphasis on carryover to home activities
135
Q

How should interventions be driven/centered?

A

Patient centered not diagnostically driven

136
Q

What are the 3 parts of interventions?

A
  • Coordination, communication, documentation
  • Patient/client related instruction/education
  • Procedural intervention
137
Q

What is the flow of the hypothesis- oriented algorithm for clinicians II (HOAC II)?

A
  • Collect initial data –>
  • Generate patient- identified problems (PIPs) list —>
  • Formulate examination strategy (consultation if needed) —>
  • Conduct the examination, analyze data, refine hypothesis, and carry out additional examination procedures needed to confirm or deny hypothesis —>
  • Add non- patient- identified problems (NPIPs) to the problem list —->
  • (for each existing problem: generate a hypothesis as to why the problem exists) (for each anticipated problem: identify the rationale for believing anticipated problems are likely to occur unless intervention is provided) —->
  • Go to refine problem list —->
  • For each problem: establish one or more goals
  • For each existing problem: establish a testing criteria. For each anticipated problem: establish predictive criteria (consultation if needed) —>
  • Establish a plan to reassess testing and predictive criteria. Establish a plan to assess the status of problems and goals (consultation if needed) —>
  • Plan intervention strategy based on hypothesis and anticipated problems (consultation if needed) —>
  • Plan tactics (consultation if needed) —>
  • Implement tactics
138
Q

What is the sequence of the temporal stages of movement?

A
  • Initial conditions
  • Preparation
  • Initiation
  • Execution
  • Termination
  • Was outcome achieved?
139
Q

What are the components of the initial conditions in the temporal stages of movement?

A
  • Posture
  • Ability to interact with the environment
  • Environmental context
140
Q

What are the components of the preparation in the temporal stages of movement?

A
  • Stimulus identification
  • Response selection
  • Response programming
141
Q

What are the components of the initiation in the temporal stages of movement?

A
  • Timing
  • Direction
  • Smoothness
142
Q

What are the components of the execution in the temporal stages of movement?

A
  • Amplitude
  • Direction
  • Smoothness
143
Q

What are the components of the termination in the temporal stages of movement?

A
  • Timing
  • Stability
  • Accuracy
144
Q

What type of feedback negatively impacts learning?

A

Internal feedback

145
Q

What is autonomy?

A

When a patient is allowed to have some decision making power in what is going on in their plan of care

Neuromuscular practice- Adutls (8 decks)

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