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Therapeutic interventions > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What is motor control?

A

Ability to regulate or direct mechanisms essential to movement

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2
Q

Movement is constrained by factors related to the ___

A
  • Individual
  • Task
  • Environment
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3
Q

Movement ___ from the constraints

A

Movement emerges from the constraints

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4
Q

The individual generates movement to meet the demands of ___ within the specific ___

A

The individual generates movement to meet the demands of task within the specific environment

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5
Q

True or false

We prescribe a movement

A

False

We DO NOT prescribe a movement

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6
Q

What are the systems underlying motor control that is contributed by the individual?

A
  • Motor/action
  • Sensory/perceptual
  • Cognitive
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7
Q

What systems are in charge of the motor/action systems underlying motor control?

A
  • Neuromuscular system

- Bio-mechanical system

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8
Q

What are degrees of freedom?

A

The number of independent position variables that are necessary to specify the state of a structure

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9
Q

How many degrees of freedom are in the whole body?

A

244

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10
Q

What controls/manages the degrees freedom?

A

The motor/action motor control system

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11
Q

What is the sensory portion of the sensory/perceptual system underlying motor control?

A

Information that is taken in from the peripheral sensory organs and nerve endings for things like light touch, proprioception, pain and temp

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12
Q

What is the perceptual portion of the sensory/perceptual system underlying motor control?

A

The integration of sensory information into meaningful information and it involves a lot of higher level processing

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13
Q

If you have normal ____, you have to have normal ____

A

If you have normal perception, you have to have normal sensory

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14
Q

You can have normal ___, but have abnormal ___

A

You can have normal sensory, but have abnormal perception

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15
Q

What is involved in the cognitive system underlying motor control?

A

Attention, planning, problem solving, motivation, and emotional aspects that underlie intent/goals of movement

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16
Q

What are the categories of task in the task constraints?

A
  • Discrete vs Continuous
  • Closed vs. Open
  • Stability vs. Mobility
  • Manipulation vs. Non-manipulation task
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17
Q

What are the distinguishing attributes in the discrete category of task?

A

Discrete movement task such as kicking a ball or moving from sitting to standing or lying down have a recognizable beginning and end

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18
Q

What are the distinguishing attributes in the continuous category of task?

A

In continuous movements such as walking or running, the end point of the task is not an inherent characteristic of the task, but is decided arbitrarily by the performer

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19
Q

What are the distinguishing attributes in the open movements category of task?

A

Open movement tasks such as playing soccer or tennis require performers to adapt movement strategies to a constantly changing and often unpredictable environment

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20
Q

What are the distinguishing attributes in the closed movements category of task?

A

Closed movement task are performed in relatively fixed or predictable environment

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21
Q

What are the distinguishing attributes in the stability movements category of task?

A

Stability tasks such as sitting or standing are performed with a non-moving base of support

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22
Q

What are the distinguishing attributes in the mobility movements category of task?

A

Mobility tasks such as walking or running require moving the bas of support

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23
Q

What are the distinguishing attributes in the manipulation movements category of task?

A

Manipulation tasks involve movement of the upper extremities

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24
Q

A closed/predictable environment coupled with a stability/ nonmoving BOS creates what type of task constraint?

A

Sitting or standing on a nonmoving surface

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25
Q

A closed/predictable environment coupled with a mobility/ moving BOS creates what type of task constraint?

A

Walking/nonmoving surface

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26
Q

An open/unpredictable environment coupled with a mobility/ moving BOS creates what type of task constraint?

A

Walking on an uneven or moving surface

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27
Q

An open/unpredictable environment coupled with a stability/nonmoving BOS creates what type of task constraint?

A

Sitting or standing on a foam or rocker board

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28
Q

What are the 2 environmental constraints of motor control?

A
  • Regulatory features

- Non-regulatory features

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29
Q

What are the regulatory features of the environmental constraints?

A

Things that shape/direct movement

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30
Q

What are the non-regulatory features of the environmental constraints?

A

May impact performance, but doesn’t define movements

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31
Q

What are the 3 tasks that contribute to movement?

A
  • Postural control
  • Upper extremity function
  • Mobility
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32
Q

What are motor control theories?

A

Description of unobservable structures and processes and their relationship to observable events

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33
Q

What does the reflex theory say?

A

Movement is a sum of reflexes that was strung together and that sensation is necessary for the reflexes to generate movement

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34
Q

Why isn’t the reflex theory true?

A
  • We can turn off reflexes
  • Sensation is not required for movement
  • We can anticipate something that will require movement to be altered
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35
Q

What does the hierarchical theory/top down model say?

A

The brain is in control of movement and it drives everything below, and when we have damage to the higher centers/brain things in the lower centers go wonky, because they don’t have the inhibition from the higher centers

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36
Q

Why isn’t the hierarchical theory true?

A
  • We can disconnect the spinal cord from the brain and the re will still be movement
  • Reflexes come and go as needed as opposed to being controlled by the brain
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37
Q

What does the motor programming theory say?

A

We have a pattern/program for every motion that is needed to occur and we store the rules for general movement somewhere in the body, and there is no need for sensation

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38
Q

Why isn’t the motor programming theory true?

A
  • We have too many degrees of freedom to be able to control with general programmed rules
  • Cognitive storage will be too large
  • Much of our movement is context dependent, and we can’t have a stored pattern for an unfamiliar context
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39
Q

What does the systems theory say?

A

Control is distributed across various systems, sometimes it was the higher control systems, other times the reflexes, or centers in between. Interactive, cooperative system, where movement occurred based on internal and external forces

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40
Q

Why isn’t the systems theory true?

A

IDK, there is no real contradictory evidence to it

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41
Q

___ is a further projection of the systems theory

A

*The dynamic action (dynamic systems) is a further projection of the systems theory

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42
Q

The dynamic action (dynamic systems) theory is based on the idea of ___ and movement emerges as a result of ___

A

The dynamic action (dynamic systems) theory is based on the idea of self-organization and movement emerges as a result of interacting elements

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43
Q

What does the ecological theory say?

A

Information from the environment controls movement. Motor control evolved to cope with environment around us and perception is the key element to movement

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44
Q

What is the well accepted theory of motor control?

A

The dynamic action (dynamic systems) theory

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45
Q

Which motor control theory is the best?

A

None of them, motor control is a combination of a number of the theories

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46
Q

What is motor learning?

A

The acquisition and or modification of movement or the reacquisition of movement skills lost after an injury.

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47
Q

Motor learning talks about the ___

A

The process associated with practice or experience leading to permanent changes in skill

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48
Q

Motor learning is the ___ of acquiring capability for skill, that results from ___ or ____

A

Motor learning is the process of acquiring capability for skill that results from experience or skill

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49
Q

How is the concept of motor learning measured?

A

It is inferred from behavior

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50
Q

Motor learning produces relatively ___ changes in behavior

A

Motor learning produces relatively permanent changes in behavior

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51
Q

When is learning assumed to have taken place?

A

Learning can only be assumed to have taken place when patient can perform task effectively and without thinking about it in a variety of circumstances and contexts

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52
Q

Motor learning is learning new strategies for ____ as well as moving

A

Motor learning is learning new strategies for sensing as well as moving

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53
Q

Motor learning emerges from ____

A

Motor learning emerges from perception, cognition, action processes

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54
Q

Motor learning is described as a search for ____, emerging from ____

A

Motor learning is described as a search for task solution, emerging from interaction of individual with task and environment

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55
Q

Motor learning emerges from the interaction of the ___

A
  • Task
  • Environment
  • Individual
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56
Q

How do you test for retention in a patient’s motor learning?

A

There has to be a break in practice, then retest after the break. If the skill is at the same level as at the end of practice, then we have retention, hence true motor learning has occurred

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57
Q

What are the 2 types of long-term memory?

A
  • Declarative memory

- Non declarative memory

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58
Q

Declarative memory is also known as ___ memory

A

Declarative memory is also known as explicit memory

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59
Q

Non declarative memory is known as ___ memory

A

Non declarative memory is known as implicit memory

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60
Q

The types of learning that occurs in declarative memory requires ____

A

The types of learning that occurs in declarative memory requires conscious processes like awareness, attention, and reflection

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61
Q

What are the types of learning in the declarative memory?

A
  • Semantic

- Episodic

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62
Q

What does semantic learning mean/entail?

A

The recall of facts. Book learning, knowledge

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63
Q

What does episodic learning mean/entail?

A

Memories related to events

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64
Q

When do we use declarative memory in learning?

A

When we are teaching a series/steps of tasks and hopefully it transfers to the non-declarative memory

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65
Q

What are the types of learning in the non-declarative memory?

A
  • Procedural (skills & habits)
  • Priming
  • Non associative learning
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66
Q

What is procedural learning?

A

When learning a task can be performed automatically without attention or thought, like a habit

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67
Q

Procedural learning develops ____

A

Procedural learning develops slowly through, repetition over many trials

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68
Q

Procedural learning is expressed through ___

A

Procedural learning is expressed through improved performance of the task

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69
Q

True or false

Procedural learning requires awareness, attention, or higher cognitive processes

A

FALSE

Procedural learning DOES NOT requires awareness, attention, or higher cognitive processes

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70
Q

What area of the brain does semantic learning occur?

A

Cortical association areas

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71
Q

What area of the brain does episiodic learning occur?

A

Medial temporal lobe & neocortex

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72
Q

What area of the brain does procedural learning occur?

A

Striatum

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73
Q

What area of the brain does conditioning learning occur?

A

Amygdala

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74
Q

What area of the brain does nonassociative learning occur?

A

Reflex pathways

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75
Q

What are the 2 forms of non-associative learning?

A
  • Habituation

- Sensitization

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76
Q

We use habituation to treat patients with ___

A

We use habituation to treat patients with dizziness related vestibular problem, by exposing them to the conditions that make them dizzy in order to habituate them/ make them less affected by it

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77
Q

What is conditioning?

A

The type of learning where we predict relationships of one stimulus to another

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78
Q

What are the 2 forms of conditioning?

A
  • Classical

- Operant

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79
Q

What is operant conditioning?

A

Trial and error learning, where we associate a certain response with a specific consequence

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80
Q

What does the Schmidt’s Schema theory talk about?

A

Open loop control and generalized motor program. Motor programs as generalized rules for specific types of movements or schema

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81
Q

In the schmidt’s schema theory, there is a ____ and ___ schema

A

In the schmidt’s schema theory, there is a recall and recognition schema

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82
Q

In the schimdt’s schema theory, what are the 4 things that are available for short term memory?

A
  • The initial movement conditions
  • The parameters used in the general motor program
  • The outcome of the movement in terms of knowledge of results
  • Sensory information/consequences of the movement
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83
Q

What is recall used for in the schimdt’s schema theory?

A

To select a specific response

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84
Q

What is recognition used for in the schimdt’s schema theory?

A

To evaluate the outcome of the specific response chosen in the recall

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85
Q

The schimdt’s schema theory predicted that variability of practice improved ___

A

The schimdt’s schema theory predicted that variability of practice improved motor learning

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86
Q

What are the limitations of the schimdt’s schema theory?

A

Support is mixed for variable practice, doesn’t account for immediate acquisition of coordination

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87
Q

What does the ecological theory state?

A

We search strategies for optimal strategies to solve task, given a task constraint

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88
Q

According to the ecological theory, motor learning is task that increases coordination between ___ and ____

A

According to the ecological theory, motor learning is task that increases coordination between perception and action

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89
Q

In the ecological theory, there need to be exploration of ___/___ workspace

A

In the ecological theory, there need to be exploration of perceptual/motor workspace

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90
Q

What is perception in the ecological theory?

A

Understanding goal, feedback, structures

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91
Q

What are the stages in the fitts and posner 3-stage model of motor learning?

A
  • Cognitive stage
  • Associative stage
  • Autonomous stage
92
Q

What is included in the cognitive stage of the fitts and posner 3-stage model of motor learning?

A
  • Acquisition of knowledge

- Trial and error stage

93
Q

What is included in the associative stage of the fitts and posner 3-stage model of motor learning?

A
  • Refining of skill

- Less variability

94
Q

What is included in the autonomous stage of the fitts and posner 3-stage model of motor learning?

A
  • Automaticity of skill

- Low degree of attention

95
Q

What is the key component of the bernstein’s 3 stage model?

A

Controlling or mastering degrees of freedom (DOF)

96
Q

What are the 3 stages in the bernstein’s 3 stage model?

A
  • Novice stage
  • Advance stage
  • Expert stage
97
Q

What is included in the novice stage of the bernstein’s 3 stage model?

A

Simplify movements to decrease DOF

98
Q

What is included in the advance stage of the bernstein’s 3 stage model?

A

Gradual release of DOF

99
Q

What is included in the expert stage of the bernstein’s 3 stage model?

A

Release of all DOF

100
Q

What is the stage 1 goal of the gentile’s two-stage model?

A

Develop understanding of dynamics of task

101
Q

What are the task dynamics of the stage 1 goal of the gentile’s two-stage model?

A
  • What are the requirements of movement?

- What is the goal/environment of the movement?

102
Q

What is the stage 2 goal of the gentile’s two-stage model?

A

Refining the movement, performing it consistently and efficiently. Fixation and diversification

103
Q

___ is an important stimulant for neuroplastic change and remediation of maladaptive
patterns

A

Task specific motor learning is an important stimulant for
neuroplastic change and remediation of maladaptive
patterns

104
Q

Brain continuously remodels to encode ___and cause ____

A

Brain continuously remodels to encode new experiences and cause behavior change

105
Q

Plasticity is dependent upon ___

A

Plasticity is dependent upon learning

106
Q

Skill learning leads to rewiring of ____

A

Skill learning leads to rewiring of motor cortex

107
Q

Recovery/functional improvement is a ____ process

A

Recovery/functional improvement is a relearning process

108
Q

The brain relies on ___ neurobiological processes when relearning a skill, that it used to acquire skill initially

A

The brain relies on the same neurobiological processes when relearning a skill, that it used to acquire skill initially

109
Q

____ not ____ leads to increased numbers of synapses in motor cortex

A

Motor learning, not motor activity leads to increased numbers of synapses in motor cortex

110
Q

What is the PT goal for all patients?

A

Recovery

111
Q

What does recovery mean for patients?

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”

112
Q

What does compensation entail as it regards to patient function?

A
  • Neural tissue acquires function it didn’t have premorbid
  • Performing old movements in a new way
  • Successful task completion using alternative “parts”
113
Q

Recovery is ____ changes in neural activation, organization, and structure

A

Recovery is permanent changes in neural activation,

organization, and structure

114
Q

Recovery is a restoration /remodeling toward ___ state of organization

A

Recovery is a restoration /remodeling toward NORMAL state of organization

115
Q

What is compensation?

A

Compensation is a behavioral substitution; alternative behavioral strategies adopted to complete the task; use of remaining parts

116
Q

Compensation leads to ___

A

Compensation leads to learned non-use

117
Q

Compensation creates conditions in which CNS does not engage in___

A

Compensation creates conditions in which CNS does not engage in processing critical for recovery of motor control

118
Q

Compensation may itself be the primary reason that ___ remain.

A

Compensation may itself be the primary reason that motor deficits remain.

119
Q

What are the mechanisms by which functional improvement can occur?

A

Recovery and Compensation

120
Q

Both mechanisms by which functional improvement can occur can be observed at ____ and ____ levels

A

Both mechanisms by which functional improvement can occur can be observed at behavioral and neural levels

121
Q

Recovery of function is a ____ neuroplasticity, while compensation is a ____ neuroplasticity

A

Recovery of function is a positive neuroplasticity, while compensation is a negative neuroplasticity

122
Q

Compensatory behaviors are key in ___ response to brain injury

A

Compensatory behaviors are key in “normal” response to brain injury

123
Q

Reliance on less-affected limb is associated with ___ and ___ in non-affected hemisphere

A

Reliance on less-affected limb associated with reorganization and neuronal growth in non-affected hemisphere

124
Q

Patients often can only make ___ solutions that eliminate the ____

A

Patients often can only make short term solutions that eliminate the long term
possibilities.

125
Q

What is the goal of motor rehab?

A

The goal of motor rehab is to

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

126
Q

According to the WHO, what is health?

A

The state of complete physical, mental, and social well being, and not merely the absence of disease

127
Q

The ICF model can characterized as a ____

A

The ICF model can characterized as a *biopsychosocial model that integrates abilities and disabilities and provides a coherent perspective of various aspects of human functioning and disability as they relate to the continuum of health

128
Q

The ICF model is designed to put less emphasis on ___ and greater emphasis on how ____

A

The ICF model is designed to put less emphasis on disease and greater emphasis on how people who are affected by health conditions live

129
Q

What is classification?

A

A tool for organizing the knowledge of complex relationships among health status, functioning and disability in a useful way

130
Q

Classification delivers a foundation for ___

A

Classification delivers a foundation for *effective health care services, and the theoretical framework upon which practice can be organized and research can be based

131
Q

Classification can facilitate ___

A

Classification can facilitate effective management and care of patients reflected by the integration of meaningful functional outcomes

132
Q

According to the ICF model, health conditions are ___

A

According to the ICF model, health conditions are acute or chronic diseases, disorders or injuries that have an impact on a person’s level of activity

133
Q

How are health conditions characterized?

A

By a set of abnormal findings indicative of alterations or interruptions of structure or function of the body and are primarily identified at the cellular, tissue, or organ system level

134
Q

Health condition is generally the basis of a ____

A

Health condition is generally the basis of a medical diagnosis conserved to trigger medical intervention

135
Q

What are the two basic components of the ICF model?

A
  • Functioning and disability

- Contextual factors

136
Q

The functioning and disability component of the ICF model can be divided into __

A
  • Body functions and structure
  • Activity
  • Participation
137
Q

Impairments in body function include problems with ___

A

Impairments in body function include problems associated with the function of body systems including physiological and psychological functions

138
Q

Impairments in body structure include problems with ___

A

Impairments in body structure include problems with anatomical features of the body, such as significant deviation, or loss affecting all body systems

139
Q

Activity limitations include ____

A

Activity limitations include difficulties an individual may have in executing actions, tasks or activities

140
Q

Participation restrictions include problems an individual may experience in ___

A

Participation restrictions include problems an individual may experience in involvement in life situations, including difficulties in participating in self care, responsibilities in the home, workplace, or community and recreational, leisure or social activities

141
Q

The contextual factor component of the ICF model include __

A
  • Environmental factors

- Personal factors

142
Q

Environmental factors include factors associated with ___

A

Environmental factors include factors associated with physical, social, and attitudinal environment in which people conduct their lives

143
Q

Environmental factors may serve as ___

A

Environmental factors may serve as facilitators of functioning or barriers that hinder functioning

144
Q

Personal factors include ____

A

Personal factors include features of the individual that are not part of the health condition or health state, such as age, gender, race, lifestyle habits, coping skills, character, affect, cultural or social background and education

145
Q

Does adverse changes in one component of the ICF model have adverse effects on the other components?

A

No it doesn’t

146
Q

According to the guide to PT practice, what is an intervention?

A

Purposeful interaction of the physical therapist with an individual to produce changes in the condition that are consistent with the diagnosis and prognosis

147
Q

When does intervention occur in PT?

A
  • Multiple point during evaluation and examination as well as after the PT has determined the diagnosis, prognosis, and POC
148
Q

What is the selection of interventions based upon?

A
  • Examination findings including data collected from the history, systems review and tested measures
  • Evaluation and a diagnosis that supports PT intervention
  • A prognosis that is associated with improved or maintained health status through risk reduction, health wellness and fitness programs, or the remediation of impairments, activity limitations, participation restrictions or environmental barriers
  • Goals and outcomes that have been developed in collaboration with the individual
149
Q

Impairments can be seen as ___

A

Impairments can be seen as consequences of pathological conditions, encompassing signs and symptoms that reflect abnormalities at the body system, organ or tissue level

150
Q

Impairments of __, ___, and ____functions and structures of the body are a reflection of a person’s health status

A

Impairments of physiological, anatomical, and psychological functions and structures of the body are a reflection of a person’s health status

151
Q

PTs provide care to patients with impairments of ___ and or ___ that are part of the movement system as a whole

A

PTs provide care to patients with impairments of body function and or body structure that are part of the movement system as a whole

152
Q

What are the common MSK disorders managed through PT intervention?

A
  • Pain
  • Muscle weakness/reduced torque production
  • Decreased muscular endurance
  • Limited range of motion
153
Q

What are the common neuromuscular disorders managed through PT intervention?

A
  • Pain
  • Impaired balance, postural stability, or control
  • Incoordination, faulty timing
  • Delayed motor development
  • Abnormal tone (hypotonia, hypertonia, dystonia)
  • Ineffective/inefficient functional movement strategies
154
Q

What are the common cardiovascular/pulmonary disorders managed through PT intervention?

A
  • Decreased aerobic capacity
  • Impaired circulation
  • Pain with sustained physical activity
155
Q

Limited ROM could be due to..?

A
  • Restriction of the joint capsule
  • Restriction of peri-articular connective tissue
  • Decreased muscle length
  • Joint hypomobility
156
Q

Primary impairments arise directly from ___

A

Primary impairments arise directly from the health condition

157
Q

Secondary impairments are the result of ___

A

Secondary impairments are the result of preexisting impairments

158
Q

Primary impairments could include ___

A
  • Pain
  • Limited ROM
  • Weakness
159
Q

Composite impairments occur as a result of ___ and arises from _____

A

Composite impairments occur as a result of multiple underlying causes and arises from a combination of primary or secondary impairments

160
Q

In PT the impairment based approach of care is …..?

A

In PT the impairment based approach of care is a straight forward one. If there is stiffness, we stretch, and so on. But this is no bueno on its own

161
Q

What are the key point in managing impairments?

A
  • Impairments manifest differently from one patient to another
  • Not all impairments are necessarily linked to activity limitations and participation restrictions or lead to disability
  • Important key to effective management is recognition of functionally relevant impairments
  • Elimination or reduction of functionally relevant impairments is necessary during treatment
162
Q

What are the strategies for establishing relevance?

A
  • When possible, use reliable and valid tests with known predictive validity
  • Consider when testing of an impairment alters familiar
    symptoms
  • Consider when intervention to address an impairment
    corresponds with positive changes in signs and/or symptoms
  • Consider when improvements in an impairment correspond with positive changes in signs and/or symptoms
163
Q

Activity limitations, which is analogous with functional limitations occur at the level of the ___

A

Activity limitations, which is analogous with functional limitations occur at the level of the whole person, when a patient has difficulty executing or is unable to perform tasks or actions of daily life

164
Q

Activity limitations may be ___, ___, or ___ in nature

A

Activity limitations may be physical, social, or psychological in nature

165
Q

True or false

Interventions that directly address activity limitations may be beneficial in rehabilitation

A

True

166
Q

What is an activity based approach?

A

An intervention approach addressing Activity Limitations

167
Q

Overlap in activity limitation and impairment does what for the PT?

A
  • May establish relevance

* Activity-based approach often able to address impairments

168
Q

Participation restrictions and disability include ___

A

Participation restrictions and disability include problems a person may experience in involvement in life situations as measured against social
standards

169
Q

What are some of the areas of functioning associated with participation restrictions and disability?

A
  • Self-care
  • Mobility in the community
  • Occupational tasks
  • School-related tasks
  • Home management (indoor and outdoor)
  • Caring for dependents
  • Recreational and leisure activities
  • Socializing with friends/family
  • Community responsibilities and service
170
Q

___ is the core of patient- centered care

A

Attention upon reducing participation restrictions is the core of patient- centered care

171
Q

What are the things that can make intervention meaningful to an individual receiving care?

A

Reducing disability and improving participation in relevant areas of function

172
Q

The ICF can help the PT organize the clinical data collected through the ___ and __ processes, such that the inner relationships between an individual’s health condition, functioning and disability, and contextual factors can be considered in making meaningful decisions for the person as a whole

A

The ICF can help the PT organize the clinical data collected through the examination and evaluation processes, such that the inner relationships between an individual’s health condition, functioning and disability, and contextual factors can be considered in making meaningful decisions for the person as a whole

173
Q

What is manual therapy?

A

Skilled hand movements and skilled passive movements of joints and soft tissue

174
Q

What are some manual therapy techniques?

A
  • Manual lymphatic drainage
  • Manual traction
  • Massage
  • Mobilization/manipulation
  • Neural tissue mobilization
  • Passive range of motion
175
Q

What are the intentions of manual therapy as it relates to body functions and structure
Impairments?

A 
• Improve tissue extensibility
• Increase range of motion
• Induce relaxation
• Mobilize or manipulate soft tissue and joints
• Modulate pain
• Reduce soft tissue swelling,
inflammation, or restriction
176
Q

What are the intentions of manual therapy as it relates to activity limitations/
participation restrictions?

A 
• Enhance health, wellness, and fitness
• Enhance or maintain physical
performance
• Increase the ability to move
• Improve physical function
177
Q

What is mobilization/manipulation?

A

Manual therapy techniques
comprising a continuum of skilled passive movements to joints and/or related soft tissues at varying speeds and amplitudes, including a
small-amplitude/high-velocity therapeutic movement

178
Q

What are the criterias included in the description of mobilization/manipulation?

A
  • Rate of force application
  • Location in range of
    available movement
  • Direction of force
  • Target of force
  • Relative structural
    movement
  • Patient position
179
Q

What is the rate of force application in the description of mobilization/manipulation?

A

Describes the rate at which the force is applied

180
Q

The location in range of available movement describes ___

A

The location in range of available movement describes whether motion is intended to occur only at the beginning of the available range of movement, towards the middle of the available range of movement, or at the end point of the available range of movement

181
Q

The direction of force describes ___

A

The direction of force describes the direction in which the therapist imparts the
force

182
Q

The target of force describes the ____

A

The target of force describes the location to which the therapist intends to apply the force

183
Q

The relative structural movement describes which ___

A

The relative structural movement describes which structure or region is intended to remain stable and which structure or region is intended to move, with the moving structure or region being named first and the
stable segment named second, separated by the word “on”

184
Q

The patient position describes the ___

A

The patient position describes the position of the patient, for example, supine, prone, or recumbent. This would include any pre-manipulative positioning of a region of the body, such as being positioned in rotation or side bending.

185
Q

What are the 3 primary principles of the “law of the artery” according to osteopathic medicine?

A
  • The body is a unit
  • Structure and function are reciprocally inter-related
  • The body possesses self regulatory mechanisms for rational therapies based on an understanding of body unity, self-regulatory mechanism, and the inter relations structure and function
186
Q

According to osteopathic medicine, addressing ___ within the ___ could be used to improve health and treat diseases

A

According to osteopathic medicine, addressing somatic dysfunction within the musculo-skeletal system could be used to improve health and treat diseases

187
Q

Chiropractic is based on the ____

A

Chiropractic is based on the law of the nerve

188
Q

What is the subluxation theory according to the law of the nerve?

A

A vertebrae becomes subluxed, impinging on other structures such as nerves, blood vessels and lymphatics, passing through the intervertebral foramen and as a result, the function of the corresponding segment of the spinal cord and its connecting spinal and autonomic nerves is interfered with and the function of nerve impulses is impaired

189
Q

Most of the historical perspective on mechanisms of manual therapy focuses on ___

A

Most of the historical perspective on mechanisms of manual therapy focuses on select biomechanical and
pathoanatomic constructs

190
Q

What are are mechanical mechanisms of manual therapy?

A
  • Joint motion with at least transient biomechanical effects
  • No evidence for lasting positional change
  • Forces are dissipated over a large area
  • Difficult to assert specificity of techniques
  • Kinetic parameters vary widely among clinicians performing same technique
191
Q

Interactions between ___ and ____ may be affected by manual therapy

A

Interactions between inflammatory mediators and peripheral nociceptors may be affected by manual therapy

192
Q

What are the spinal neurophysiological mechanisms as it relates to manual therapy?

A
  • Manual therapy may act as a counter irritant to modulate pain by bombarding central nervous system with sensory
    input from proprioceptors
  • Decreased activity dorsal horn of the spinal cord following manual therapy
  • Neuromuscular responses such as changes in afferent discharge, motoneuron pool activity, and muscle activity
  • Hypoalgesia via inhibition of temporal summation
    and selective blocking of neurotransmitters
193
Q

What is one of the most powerful mechanism through which manual therapy exerts its effects?

A

Supraspinal Neurophysiological

Mechanisms

194
Q

____ can be viewed as a desirable response to manual therapy and considered a physiological process following manual therapy

A

Placebo analgesia can be viewed as a desirable response to manual therapy and considered a physiological process following manual therapy

195
Q

What are the physiological responses of placebo analgesia following manual therapy?

A

• Decreased activity dorsal horn of the supraspinal regions responsible for
changes in central pain processing following manual therapy
• Potential descending inhibition due to associated changes in the autonomic
responses, opioid system, dopamine production, and central nervous system

196
Q

What are the psychological responses of placebo analgesia following manual therapy?

A

• Psychosocial factors may be pertinent in mechanisms of manual therapy
- Expectation of effectiveness
- Conditioning
• Negative emotions are known to diminish placebo effects

197
Q

Which mechanisms are greater contributor to the effects observed in the association of clinical use of manual therapy techniques?

A

Neurophysiological Mechanisms

198
Q

What is regional interdependence?

A

With respect to MSK problems, regional interdependence refers to the
concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated
with, the patient’s primary complaint

199
Q

What are the mechanisms of regional interdependence?

A
  • MSK
  • Somatovisceral
  • Biopsychosocial
  • Neurophysiological
200
Q

What is the redefination of regional interdependence?

A

The concept that a patient’s primary musculoskeletal symptom(s) may be directly or indirectly related or influenced by impairments from various body regions and systems regardless of proximity to the primary symptom(s)

201
Q

What are the practical strategies for implementation in the region of primary complaint?

A

• Should not be ignored
• Should be examined initially
• Treat as indicated in accordance with current best evidence
• Screen regions directly above and below the area of primary complaint within the first two visits
• In cases of recalcitrant and persistent symptoms, consider that symptoms may
be due to associated functional limitations and impairments in more distant body regions as well as other body systems
• Work to prioritize intervening in these regions during the course of care

202
Q

What does the patient response based model do?

A
  • Considers pain reproduction and reduction occurring with positioning or movement as
    determined in assessment
  • Patient response during and after intervention guides selection and progression treatment parameters (i.e. direction, amplitude, force, speed)
  • Does not necessarily rely upon specific biomechanical model for diagnostic assessment, rather it is the sign and symptoms based model
203
Q

What is the 1st step in implementing the patient response-based model and what does it entail?

A

Assess

• Identify signs and symptoms
deemed to be comparable to the patient’s complaints and relevant to patient’s outcomes (aka. patient response triggers or asterisk signs)

204
Q

Subjective asterisk signs include ___

A

Subjective asterisk signs include signs and symptoms identified by the patient through the course of an interview

205
Q

Objective asterisk signs include those ___

A

Objective asterisk signs include those identified through physical examination, including physical signs relevant to the complaint of a patient

206
Q

What is the 2nd step in implementing the patient response-based model and what does it entail?

A

Treat

  • Provide intervention based on best available evidence, and influenced significantly by judgements provided regarding presentation, including the SINSS as determined by the PT
  • Interventions should be responsive to patient’s values and abilities
207
Q

What is the 3rd step in implementing the patient response-based model and what does it entail?

A

Reassess

• Reassess to determine if any changes can be associated with administered intervention
• Consider previously designated asterisk signs as
comparable to complaints and relevant to function
• Consider temporal nature of changes
- Within-session changes
- Between-session changes
• Additional treatment parameters adjusted
according to response

208
Q

What is the 4th step in implementing the patient response-based model and what does it entail?

A

Instruct

• Instruct patient in activities to promote maintenance of gains attained through manual therapy

209
Q

What are the benefits of the patient response based model?

A

• Adaptability to individual patients and symptoms even as
presentation changes throughout treatment
• Facilitates specificity of treatment
• Not overly reliant upon particular diagnostic or biomechanical models
• Respects diagnosis, but guides treatment decision making based upon impairment-based findings
• Small, but growing body of evidence to support use of model in clinical reasoning
• Relatively intuitive and easy to learn
• Provides framework for integrating evidence into practice

210
Q

What are the limitations of the patient response based model?

A

• Time and energy intensive
• Initially assumes relevance of all findings and that each
finding has potential to influence decision making and
progress
• Within-session or even between-session improvements do not always equate to long-term improvements
• Requires concerted and clear communication between
clinicians and patients
• No utterly compelling evidence to support use of model as compared to others

211
Q

What are the contraindications of manual therapy?

A 
• Multi-level nerve root pathology
• Worsening neurological function
• Unremitting, severe, nonmechanical pain
• Unremitting night pain
(preventing patient from falling asleep)
• Relevant recent trauma
• Upper motor neuron lesions
• Spinal cord damage
212
Q

What are the precautions to manual therapy?

A 
• Local infection
• Inflammatory disease
• Active cancer
• History of cancer
• Long-term steroid use
• Osteoporosis
• Systemically unwell
• Hypermobility syndromes
• Connective tissue disease
• Recent manipulation whether
by another health professional
or lay individual
213
Q

What are some key questions to ask before the PT can decide whether or not to use certain manual therapy techniques?

A
  • Does the PT have the requisite arm length to administer the technique
  • Is there a significant mismatch between the weight of the PT and the patient?
214
Q

What are the various supine thoracic manipulation techniques?

A
  • Scoop
  • Active flexion
  • Scoop with a bolster
  • Active flexion with bolster
  • Reach across table
215
Q

What is the grade I (non-thrust) in the grading mobilization/manipulation technique?

A

• Small-amplitude movement near the starting position of available range

216
Q

What is the grade II (non-thrust) in the grading mobilization/manipulation technique?

A

• Large-amplitude movement that carries well into available range occupying any part of range that is free from resistance

217
Q

What is the grade III (non-thrust) in the grading mobilization/manipulation technique?

A

• Large-amplitude movement that moves into resistance (i.e. between R1 and R2)

218
Q

What is the grade IV (non-thrust) in the grading mobilization/manipulation technique?

A

• Small-amplitude movement maintained within resistance (i.e. Between R1 and R2)

219
Q

What is the grade V (thrust) in the grading mobilization/manipulation technique?

A

• Low-amplitude, high-velocity movement commonly, but not always, performed at end of available range

220
Q

What does R1 in the grading mobilization/manipulation technique mean?

A

R1 = Perceived first resistance from target tissues

221
Q

What does R2 in the grading mobilization/manipulation technique mean?

A

R2 = Perceived end range

resistance from target tissues

222
Q

What does L in the grading mobilization/manipulation technique mean?

A

L = Absolute limits of normal available range

223
Q

What are the things the PT should do when selecting a grade of mobilization/ manipulation technique?

A
  • Remain disciplined in consideration of all three pillars of evidence-based
    practice paradigm
  • Consider patient’s overall presentation with respect to severity, irritability, and
    nature of their symptoms
  • Proceed into manual assessment and intervention with clear intent
224
Q

What are some more things the PT should do when selecting a grade of mobilization/ manipulation technique?

A
  • Continually monitor patient’s responses and attempt to
    associate this with what is being perceived through
    manual contact upon patient
  • Consider relationship of movement to pain and tissue
    resistance to clarify and correlate associations between the occurrence of symptoms and perceived tissue resistance, which can inform grading selection
  • Modify technique based upon continual assessment of
    patient’s signs and symptoms in conjunction with changes in tissue resistance that may be occurring as perceived through manual contacts
225
Q

What are some key factors to consider for selecting a manual therapy technique for use for a patient?

A 
• Reflect upon current best
evidence
• Match technique selection
and grading to the patient’s
presentation, positional
tolerance, and size
• Consider your own size
relative to the patient as
well as your own skill level
with particular techniques
• Respect the values of the
patient

Therapeutic interventions (8 decks)

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