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Neuromuscular practice- Adutls > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is an essential aspect of stroke care and should be a priority in redesign efforts?

A

The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration

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2
Q

What are the recommended rehab interventions for stroke patients?

A

Receive rehab at an intensity commensurate with anticipated benefit and tolerance

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3
Q

Differences in the amount of practice performed

during therapy were NOT correlated with: ___

A
  • Patient age
  • Patient’s current level of function
  • Therapists level of experience
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4
Q

What are some inconsistent approaches to rehabilitation?

A

• Lack of evidence based intervention
- Have evidence, not consistently applying
• Lack of consistency in approach
- Various camps/approaches
• Use of approaches that don’t focus on motor
learning/neuroplasticity

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5
Q

The key to recovery of a neuro dysfunction is ____

A
  • Intensity of practice
  • Enriched environment
  • Task specificity
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6
Q

When do we use augmented interventions?

A

When normal rehab strategies are not possible due to limited motor function

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7
Q

What is neuromuscular facilitation?

A

Use of facilitation techniques - Enhanced capacity to initiate movement response through increased neuronal activity and altered synaptic potential

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8
Q

What is activation as found under neuromuscular facilitation?

A

Actual production of movement response; reaching critical threshold for neuronal firing

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9
Q

What kind of technique does neuromuscular facilitation include?

A

Includes techniques used for inhibition of unwanted motor

activity – decreased capacity to initiate movement response through altered synaptic potential

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10
Q

What is an additive facilitative technique?

A

Inputs applied simultaneously often combined (ie PNF); collectively produce desired motor response
• Spatial summation: input from multiple presynaptic cells…
sums to get action potential

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11
Q

What is another way that facilitative technique works?

A

Repeated stimulation may produce desired response

• Temporal summation: repeated input from single neuron

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12
Q

What are some neuromuscular facilitation techniques?

A
  • Resistance
  • Quick Stretch
  • Tapping/repeated quick stretch
  • Prolonged stretch
  • Joint approximation
  • Joint traction
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13
Q

What population was the neurodevelopmental treatment (NDT) created for?

A

Persons with stroke and cerebral palsy

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14
Q

What does neurodevelopmental treatment (NDT) center around?

A

Specialized handling that inhibited spastic and reflex
patterns and promoted normal postural control and
movements

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15
Q

Neurodevelopmental treatment (NDT) was initially based on ____

A

Hierarchical theory of motor control

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16
Q

____ is foundation for skilled learning

A

Postural control

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17
Q

What are the characteristics of Neurodevelopmental treatment (NDT)?

A

• Control of posture and movement in progressively more challenging postures and activities
• Use of therapeutic handling techniques- facilitation and inhibition
• Manual contacts guide and direct movement
• Key points of control: optimal body part(s) for control of inhibiting or
facilitating movement
• Avoids compensatory movements
• Taught in continuing education courses
• Not supported by evidence as being superior over other approaches

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18
Q

Sensory stimulation technique are things that involve __

A

Touch, visual, auditory, olfactory

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19
Q

What are sensory stimulation techniques used to do?

A
  • Increase alertness, attention, arousal
  • Sensory discrimination
  • Initiation of movements
  • Used to augment task specific/activity training
  • Sensory stimulation in those with low arousal
  • Watch for increased sensitivity to sensory stimulation in some persons
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20
Q

What are the sensory stimulation techniques?

A
  • Sensory Retraining
  • Biofeedback
  • Neuromuscular Electrical Stimulation
  • Functional Electrical Stimulation
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21
Q

What is the sensory retraining sensory stimulation technique?

A

Sensory re-education, tactile kinesthetic guiding, repetitive sensory practice, desensitization

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22
Q

What is the biofeedback sensory stimulation technique used for?

A

Used with severe motor weakness; must be part of activity-based, task oriented training

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23
Q

What is the neuromuscular electrical stimulation sensory stimulation technique used for?

A

Muscle re-education, improve ROM, reduce spasticity, decrease edema, manage disuse atrophy

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24
Q

What is the functional electrical stimulation sensory stimulation technique used for?

A

Recruits muscles in synergistic sequence for purpose of functional movement

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25
Q

What is the Brunnstrom method?

A

Recovery from stroke in stages from no movement
to synergistic movement to out of synergy; encouraged
synergistic movements

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26
Q

What is the Rood method?

A

Facilitation and inhibition; focused on cutaneous stimulation; joint compression/distraction, use of
stretch/resistance/reflexes; stroking, brushing, icing, warmth,
pressure and vibration

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27
Q

What is continuum of care?

A

Provision of care from the entry of the patient into the

healthcare system until care is no longer needed

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28
Q

What are the requirements of an inpatient rehab facility?

A

Patient has to be able to tolerate a minimum of 3 hours of rehab

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29
Q

What are the keys to coordination?

A
  • Need a team and the patient/caregiver are the center of this team
  • Need EARLY investigation of options and prognostication of future need
  • Education, Education, Education
  • Good communication with hand-off to next facility
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30
Q

What is the 1st step in the acute management of stroke?

A

Rapid diagnosis – Ischemic v Hemorrhagic

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31
Q

What are the components of the rapid diagnosis of a stroke?

A
  • CT scan preferred
  • Candidate for tPA?
  • Endovascular intervention
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32
Q

What are the acute management options for a stroke?

A
  • Platelet antiaggregants
  • Treatment of fever
  • BP management
  • Continuation of statins
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33
Q

What are the acute management thing to do for an hemorrhagic stroke?

A
  • Control bleeding

* Reducing pressure

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34
Q

What kind of situations is supportive care needed?

A

If there is a small bleed

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35
Q

What type of surgical treatment options for a stroke?

A
  • Repair of vessel

* Removal of AVM

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36
Q

What are the acute management options for a TBI?

A

• Establish severity – GCS
• Stabilization
• Prevention of intracranial hypertension
• Adequate and stable cerebral perfusion pressure
• Optimization of cerebral hemodynamic and
oxygenation
• Avoidance of secondary insults
• Mechanical ventilation
• Seizure medication

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37
Q

What are the things that can increase Intracranial Pressure?

A

Edema, abnormal fluid dynamics or hematomas

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38
Q

What is normal ICP?

A

4-15 mmHg

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39
Q

What can a severe increase in ICP result in?

A

Brain herniation

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40
Q

What is an increased ICP associated with?

A

Increased mortality and

poorer outcomes

41
Q

In what kind of cases is a drug induced paralysis done?

A

In cases with increasing ICP

42
Q

What are the kinds of drugs used to induce paralysis and in what cases are they used?

A

• Pentobarbitol: strong barbituate; acts on smooth and
skeletal mm; need careful monitoring of cardio resp
status
• Pavulon: blocks impulse at NMJ; affects skeletal mm
only

43
Q

What are the management options for an unstable ICP management?

A

• Ventriculostomy open to drain
• Hyperventilation - decreases PCO2 = vascular constriction = decreased space taken up in cranium = decreased pressure (ICP)
• Osmotherapy with Diuretics/Mannitol - decreases
edema only in areas with intact cells and vasculature = decreased edematous pressure = decreased ICP

44
Q

What are the parameters for early and safe mobilization for acute patients?

A
  • Monitoring
  • Upright tolerance
  • Out of bed to chair
  • Ther ex
  • Sitting, standing, gait
45
Q

What are the management in the field and ER?

A
  • Saving the life is the priority
  • Stabilizing the spine to minimize damage
  • Preserve neurologic function and minimize secondary damage and complications
46
Q

What are the life saving ABCs to always check incase of a spinal cord injury?

A

Airways
Breathing
Circulation

47
Q

When should a possible spinal injury be assumed?

A
  • Spinal pain/tenderness
  • Motor or sensory loss
  • Paresthesias
  • Altered mental status
  • Intoxication
  • Other painful injury that could mask spinal pain
48
Q

What are the acute medical management of a SCI?

A 
• Stabilized medically 
  - ABCs
  - Necessary diagnostics
  - High doses of methylprednisolone (within first 8 hours)
  - Enhancing arterial blood pressure
• Stabilized orthopedically
  - Stabilization of spine
  - Necessary diagnostics
  - Fracture management
49
Q

What are the fracture management for a C spine injury if surgery won’t be done right away?

A 
• Traction for the C-Spine
  - Halo
  - Tongs
• Positioning
   - Conservative mgmt of thoracic and lumbar
• Orthoses
• Surgery
• Combo of above
50
Q

When should surgery for a SCI be done?

A
  • When fracture unstable
  • Non-reducible
  • Gross misalignment
  • Continued cord compression
  • Worsening neuro status
51
Q

What are the types of surgery done for an SCI?

A
  • ORIF

* Decompression

52
Q

Is early or late surgery better for an SCI?

A

Early

53
Q

What are the implications of a spinal fusion?

A
  • Hypomobility
  • Hypermobility above and below the level
  • Respiration, swallowing, and speech if surgery is done anteriorly
  • Scapular precautions if surgery was done posteriorly
54
Q

What are the functions of a spinal orthoses?

A
  • Promotes fusion
  • Limits mobility
  • Prevents deformity
  • Reduces pain
  • Protects neural tissue
  • Unloading
55
Q

What are the medical management options for a bladder dysfunction?

A

Indwelling vs intermittent catherization

56
Q

What are the medical management options for a GI dysfunction?

A

Nasogastric tubes, Bowel program

57
Q

What are the medical management options for a GI dysfunction?

A

Equipment, positioning, education

58
Q

What are the medical management options for a respiratory dysfunction?

A

Ventilation, CPT, positioning, assisted cough

59
Q

What are the medical management options for a cardiovascular dysfunction?

A

Bradycardia, orthostatic hypotension, AD, DVT, CAD

60
Q

What are the DVT treatments?

A
  • Pharmacological anticoagulant
  • Compression stockings
  • IVC Filter
  • Mobilization
61
Q

What type of regulation does the insula and hypothalamus contribute to?

A

The autonomic system

62
Q

What are medullary neurons responsible for?

A

For maintaining the peripheral vascular tone and the arterial blood pressure

63
Q

What do medullary neurons innervate?

A

The spinal sympathetic preganglionic neurons that are located in the lateral horns of the spinal gray matter of the thoracic and upper spinal segments

64
Q

What do medullary neurons synapse with?

A

The post ganglionic neurons that send axons to innervate target organs as well as heart and blood vessels

65
Q

What does the vagus nerve synapse with?

A

The pericardium

66
Q

What is orthostatic hypotension?

A

Sustained drop in BP > 20 mmHG systolic, or >10 mmHG diastolic within 3 minutes of supine to upright

67
Q

What are the causes of orthostatic hypotension?

A
  • Decreased vasoconstriction
  • Decreased venous return
  • Dehydration
68
Q

What are the presentation of orthostatic hypotension?

A
  • Pale
  • Dizziness
  • Nausea
  • Light headed
  • Blurry vision
  • Shortness of breath
69
Q

What are the differential diagnosis or thing that orthostatic hypotension can present as?

A
  • Low BP
  • Vestibular Dysfunction
  • Low Oxygen Saturation
  • Stress/anxiety
70
Q

What are the management options of orthostatic hypotension?

A
  • Abdominal binder
  • TEDS, ACE Wraps, Tubigrip
  • Meds
  • Initial mobilization to w/c
  • Tilt table
  • Hydration
71
Q

What is an acute condition that will need to be addressed in a person with SCI?

A

Bowel and Bladder dysfunction

72
Q

What are the characteristics of a bowel and bladder dysfunction?

A
  • Serious medical complication
  • Impact on participation
  • Self-esteem/psychosocial issues
  • Can be very limiting
73
Q

What are some MSK complications that can come with an SCI?

A
  • Osteoporsis
  • Hetertopic ossification
  • Pain
  • Spasticity/spasms
  • Post traumatic Cystic Myelopathy (syringomyelia)
74
Q

What are the implications of osteoporosis in a person with an SCI?

A

Ambulation, prolonged standing, e-stim

75
Q

What are the implications of hetertopic ossification in a person with an SCI?

A

ROM, NSAIDs, acetic acid ionto, surgery

76
Q

What type of pain can be seen in a person with an SCI?

A

Neurogenic or musculoskeletal

77
Q

What are common pharmacological interventions for dysfunctions associated with a SCI?

A 
• GI system
  - Bowel management
  - Prevention of ulcers
• Neuromuscular
  - Control spasticity
  - Manage pain
• Cardiovascular
  - DVT prophylaxis
  - Regulate BP
  - AD
78
Q

What are the effects of positioning as a PT intervention in a SCI?

A
  • To prevent skin breakdown
  • Improve respiratory function
  • Improve flexibility and prevent contractures
  • Normalize posture/biomechanics
  • Normalize BP
  • Manage spasticity
79
Q

What are the effects of upright tolerance as a PT intervention in a SCI?

A
  • Bed
  • Recliner
  • Upright chair
  • Tilt table
80
Q

What are the things to monitor in a patient with aa SCI?

A

Vitals, eyes, color, subjective

81
Q

What are the types of aids used in a patient with a SCI?

A

TED hose, abdominal binder, any muscle activity

82
Q

What are the components of skin management in a patient with a SCI?

A
  • Education if KEY
  • Monitor skin
  • Proper bed
  • Positioning program
  • Cleanliness
  • Cushion selection
  • Training in pressure relief
  • w/c selection to promote pressure relief
83
Q

What are the components of functional flexibility in a patient with a SCI?

A
  • Early intervention
  • Multi-person intervention
  • Establish a routine
  • Use hyper and hypo-flexibility to patient’s advantage
84
Q

What are the characteristics of the selective flexibility needed in a patient with a SCI?

A
  • Low back: mild tightness of extensors
  • Shoulders: excessive extension and ER
  • Elbows: full ext
  • Wrist: full flex and ext
  • Hands: tight long finger flexors
  • Hamstrings: 110-120°
  • Hips: neutral to full ext
  • Ankles: neutral to full
85
Q

What are the respiratory components to evaluate in a person with a SCI?

A
  • Respiratory muscle strength
  • Breathing pattern
  • Cough
  • Chest mobility
  • Postural Alignment
  • Breath support for speech
86
Q

What are the components of strengthening as a PT intervention in a patient with a SCI?

A
  • Contraindications
  • Maximize/protect what is intact
  • Establish stability
  • Creative ways to allow pt to exercise the little movement remaining
  • Para focus: shoulder depressors and elbow extensors
  • Tetra focus: shoulder flex/ext, horizontal adductors, elbow flex/ext, wrist ext
87
Q

What are the components of education for a patient with a SCI?

A
  • Needs to begin day one
  • All about empowering the patient
  • Explain all the whys
  • Allow patient to choose
  • Hot topics
88
Q

What are the hot topics to educate a patient with a SCI on?

A
  • Skin inspection
  • Pressure relief
  • AD
  • PROM
  • Proper positioning
89
Q

What are the components of early mobility seen in a person with a SCI?

A

• Bed mobility

  • Log vs segmental rolling
  • Prop on elbows
  • Supine>
90
Q

During what stage after a stroke is there a time limited window of heightened plasticity?

A

Early after stroke

91
Q

What kind of factors does a stroke trigger?

A

Factors that create heightened conditions of axonal growth and synaptic proliferation

92
Q

____ intervention is the best for any neuro dysfunction

A

EARLY intervention is the best for any neuro dysfunction

93
Q

Can recovery of a neuro dysfunction be done in the chronic stage?

A
  • Evidence of substantial motor improvements > 1 year post stroke
  • Improvement despite previous diagnosis of “plateau”
  • Seen with participation in novel, task-specific, repetitive motor practice
94
Q

What are the 2 phases of learning?

A
  • Fast phase

* Slow phase

95
Q

What is included in the fast phase of learning?

A
  • Initial, fast improvements
  • Seen in single session or first few sessions
  • Activation of striatum and cerebellum
96
Q

What is included in the slow phase of learning?

A
  • Slow, evolving
  • Moderate gains, progressing across multiple sessions
  • Motor cortex
  • Increase in number of synapses
97
Q

What is a plateau?

A
  • Common in all areas of neuromuscular performance
  • Achieving an adaptive state
  • Stable training stimulus = stabilization of max performance
  • Not indication of diminished capacity for motor improvement
98
Q

What can we do when patient plateaus?

A

oExpect recovery
oPeriodization
➢Adjust exercise delivery so that positive adaptations continue
➢ Modify intensity, session duration, changing routine, etc…
➢Task specific, repeated practice protocols
➢CHALLENGING exercise regimens

Neuromuscular practice- Adutls (8 decks)

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