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Week 4 Flashcards

1
Q

What is cognition?

A

Process of knowing and understanding

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2
Q

What is perception?

A

Ability to select those stimuli that require attention or action from the surrounding sensory
environment and interpret them

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3
Q

What is executive functions?

A

Ability to plan, manipulate, and

problem solve.

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4
Q

What are cognitive impairments?

A
  • Altered levels of consciousness
  • Memory loss and orientation deficits
  • Impaired attention
  • Poor insight or awareness
  • Impaired executive functioning
  • Impaired problem solving/reasoning
  • Perseveration
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5
Q

What are the characteristics of executive control?

A
  • Ability to control impulses
  • Utilize feedback to control behavior
  • Effective evaluation of consequences of behavior
  • Self regulation; functions that direct and organize behavior
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6
Q

What are the impairments of executive functioning?

A
  • Difficulty with integration
  • Reduced initiation
  • Poor self-monitoring/self-inhibiting
  • Poor planning/organization
  • Egocentricity
  • Perseveration
  • Poor regulation of emotion/behavior
  • Poor self awareness/evaluation
  • Poor decision making
  • Lack of flexible problem solving
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7
Q

What are the categories of executive function?

A
  • Knowledge base

* Executive system

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8
Q

What are the characteristics of knowledge base category of executive function?

A

General info, learned skills, routines, procedures, rules

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9
Q

What are the characteristics of executive system category of executive function?

A

Mental functions related to goal formation, planning, and achieving goals

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10
Q

____ greatly impacts cognition, and memory is involved in it

A

Perception greatly impacts cognition, and memory is involved in it

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11
Q

What is perseveration?

A

To be stuck on a thought or idea

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12
Q

What area of the brain do you think might be damaged in a person who displays impaired executive function?

A

Frontal lobe and sub cortical limbic system

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13
Q

What does a person with impaired executive function look, sound, act like?

A
  • Impulsive
  • Tangential
  • Socially inappropriate
  • Can’t monitor, judge, or read situations
  • One track mind
  • Can’t adapt/accommodate to changing environmental factors
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14
Q

What are the characteristics of patients that lacks initiation?

A
  • Need a cue
  • Slow to respond, nothing spontaneous
  • Inert
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15
Q

What are the characteristics of patients that lacks Self Monitoring/Self Awareness?

A 
• Lack of insight
• Totally unaware
• Denial
• May be resistant to treatment
• Unawareness of deficit vs unawareness of
consequences
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16
Q

What are the characteristics of patients that lacks planning and organization skills?

A
  • Determine needs and wants
  • Conceptualize something different from present
  • Consider alternatives, weigh options, make decisions
  • Flexibility
  • Processing strategies
  • Foresight and sustained attention
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17
Q

What are the characteristics of patients that lacks problem solving skills?

A

• Integration of cognitive skills
• Key ingredients: attention, information access,
planning, feedback system
• Deficits may include: concrete thinking, impulsivity,
problems sequencing, inability to learn from
experience, not knowing where to start

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18
Q

What are the characteristics of patients that lacks mental flexibility and abstraction skills?

A
  • Deficits in conceptual thinking
  • Perseveration
  • Limited imagination
  • Unable to think beyond current situation
  • Problems perceiving similarities and differences
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19
Q

What are the characteristics of patients that lacks generalization and transfer skills?

A

• Effect of training specific skills and extent to which
these abilities facilitate or limit new learning
• Generalization is ability to use newly learned strategy
in novel situation

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20
Q

What are the characteristics of patients that lacks orientation?

A

Quicker recovery of orientation to person as opposed to place and time, because place and time are constantly changing

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21
Q

What are the characteristics of patients that lacks attention?

A

• No attention = no information processing
• Process for determining what sensations and
experiences are relevant
• Attention –> interpretation -> processing –> making memory

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22
Q

What are the types of attention?

A
  • Focused
  • Sustained
  • Selective
  • Alternating
  • Divided
  • Concentration
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23
Q

What are the characteristics of memory?

A

• Involves many cognitive skills
• Requires attention
• Perception that has been stored previously and can be
called up later
• Starts with sensory input (sensory memory), then
goes to working memory, then finally long term
memory

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24
Q

What is concentration?

A

Being immersed in the present

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25
Q

How do you keep/maintain concentration?

A

Increasing attention to the relevant and decrease attention to the irrelevant

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26
Q

What are the elements of concentration?

A
  • Focusing selectively
  • Focus that is maintained over a period of time
  • Awareness of unfolding situation
  • Can alter attentional focus as required
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27
Q

What part of the brain is affected in an episodic/semantic /long term memory issue?

A

Temporal lobe

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28
Q

What part of the brain is affected in an attention issue?

A

Parietal lobe

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29
Q

What part of the brain is affected in a visual perception issue?

A

Occipital lobe

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30
Q

What does the lack of awareness of memory issues do to a person?

A

They have the inability to compensate

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31
Q

Memory is a primary function of the ____

A

Memory is a primary function of the hippocampus

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32
Q

What are the things that the hippocampus is very susceptible to?

A

Metabolic changes and decreased O2

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33
Q

What are the forms of long term memory?

A
  • Explicit (declarative)

- Implicit (non declarative)

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34
Q

What types of things are included in explicit (declarative) memory?

A
  • Facts (semantic)
  • Events (episodic)

Steps to complete a task

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35
Q

Where does explicit (declarative) memory take place?

A

Medial temporal lobe

Hippocampus

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36
Q

What types of things are included in implicit (non declarative) memory?

A
  • Priming
  • Procedural (skills and habits)
  • Associative learning: classical and operant conditioning
  • Non associative learning: habituation and sensitization
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37
Q

What is included in associative learning?

A
  • Emotional responses

- Skeletal musculature

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38
Q

Where does priming memory take place?

A

Neocortex

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39
Q

Where does procedural memory take place?

A

Striatum

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40
Q

Where does associative learning memory:emotional responses take place?

A

Amygdala

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41
Q

Where does associative learning memory: skeletal musculature take place?

A

Cerebellum

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42
Q

Where does non-associative learning memory take place?

A

Reflex pathways

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43
Q

What are the processes that declarative memory require?

A

Conscious processes, such as awareness and attention.

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44
Q

What are some strategies for patients with memory problems?

A 
• DO NOT ARGUE
• External memory aides
  - Notebooks
  - Watches
  - Beepers
  - Signs and notes
• Maximize procedural memory
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45
Q

What is Post-Traumatic Amnesia?

A

Period of time following emergence from coma during
which patient is confused, disoriented, and/or
agitated

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46
Q

What are the characteristics of Post-Traumatic Amnesia?

A
  • Confabulation and impaired attention
  • Short term memory dysfunction
  • Time period of PTA correlates with quantity of brain tissue destroyed
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47
Q

What are some behavioral impairments seen in patients with any type of brain injury?

A
  • Agitation and/or aggression
  • Restlessness
  • Disinhibition
  • Sexual inappropriateness
  • Egocentricity
  • Apathy/lack of concern
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48
Q

What are the characteristics of fatigue as it impacts treatment of a brain injury?

A
  • Sleep/wake cycles
  • Poor endurance/decreased tolerance for activity
  • Exaggerated response to fatigue
  • Negatively impact learning
  • Not a behavior
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49
Q

What are some strategies for addressing brain injury?

A

• Medication management may be necessary
• Create busy days with appropriate physical and
cognitive activity
• Create environment conducive to sleep

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50
Q

What are the characteristics of pain in patients with brain injury?

A 
• Source of pain
• Distracting
• Emotional impact
  - Agitation/aggression
  - Lethargy
  - Withdrawal
  - Labile
• Difficult to discern with communication deficits
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51
Q

What are the strategies for addressing patients with a brain injury?

A

• Alter environment to decrease stimulation
• Routine, Routine, Routine
• Incorporate meaningful, functional activities that
capitalize on positive emotion; familiar, automatic activities

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52
Q

What are the characteristics/kinds of language disorders?

A
  • Receptive or comprehension deficits
  • Expressive deficits
  • Combo
  • Dysarthria
  • Speech quality deficits
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53
Q

What are the strategies of treating patients with language disorders?

A
  • Don’t confuse frustration over communication limitations as behavioral problem
  • Be patient
  • Be consistent
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54
Q

What are the characteristics of impaired judgment or awareness?

A

• Lack of awareness very hard to “treat”
• Inappropriate social behavior
- Isolation, depression, lack of motivation
- Disinhibition, sexual inappropriateness, aggression
• Impaired safety awareness

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55
Q

What are the strategies for treating those with impaired judgment or awareness?

A
  • Age appropriate treatment
  • Be honest, but not reactive
  • Do not take it personally
  • Be clear and simple
  • Re-focus on the goals
  • Caution with joking and sarcasm
  • Don’t respond with laughter
  • Always be respectful
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56
Q

What are the behavior modification seen in patients with brain injury?

A

A: Antecedents
- Everything that occurs before behavior; external and
internal
B: Behaviors
- Behaviors needing change must be clearly defined with
clear picture of target behavior
Consequences
- What happens after behavior that make behaviors more or less likely to occur

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57
Q

What are the causes of certain behavior in our patients?

A
  • Location of injury
  • Medical factors
  • Loss of control
  • Reality Response
  • Premorbid personality
  • Memory deficits
  • Cultural or social issues
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58
Q

What are the causes of certain behavior in our patients caused by staff/PTs?

A
  • Inconsistency
  • Over-identification
  • Discomfort with emotional responses
  • Encouraging inappropriate behavior
  • Expecting patient to control behavior
  • Modeling bad behavior
  • Being punitive
  • Reacting and retaliating
  • Being judgmental
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59
Q

What are some strategies to address patients with behavioral issues in extreme circumstances?

A
  • Behavioral contracts
  • Reward system
  • Chaining or shaping
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60
Q

What are the characteristics of bed mobility?

A
  • Rolling (supine<>sidelying<>prone)
  • Bridging and scooting
  • Supine or sidelying<>sitting
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61
Q

What are the characteristics of basic transfers?

A
  • Level surface
  • Unlevel surface
  • Sit<>stand
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62
Q

What are the characteristics of basic wheelchair skills?

A
  • Propulsion

* Pressure relief

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63
Q

What is task analysis?

A

Identification of link between patient’s inability to effectively use appropriate movement strategy (abnormal movement) and underlying impairments

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64
Q

What are the components of movement?

A
  • Mobility
  • Force generation
  • Muscle tone
  • Sensory information
  • Pain
  • Speed
  • Endurance
  • Posture
  • Balance
  • Coordination
  • Selective capacity
  • Adaptive capacity
  • Cognitive and psychological
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65
Q

What are the characteristics of task and environment interaction requirements?

A
  1. Stationary Individual and Stationary Environment
  2. Moving Individual and Stationary Environment
  3. Stationary Individual in Moving Environment
  4. Moving Individual in Moving Environment
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66
Q

What is the temporal sequence of task performance?

A
  • Initial condition
  • Preparation
  • Initiation
  • Execution
  • Termination
  • Outcome
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67
Q

What is the goal for all our patients?

A

Efficient movement

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68
Q

What are the requirements of efficient movement?

A
  • Adequate mechanical capacity
  • Appropriate neuromuscular function
  • Effective motor control
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69
Q

What are the characteristics of adequate mechanical capacity needed for efficient movement?

A

Mobility of joint, soft tissue, muscle and neurovascular

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70
Q

What are the characteristics of appropriate neuromuscular function needed for efficient movement?

A

Initiate contraction, adequate strength, speed and endurance

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71
Q

What are the characteristics of effective motor control needed for efficient movement?

A

Proper movement strategies while engaged in functional

activity with changing task demands

72
Q

What are the motor task requirements?

A
  • Mobility
  • Stability
  • Controlled mobility
  • Skill
73
Q

What does mobility refer to?

A

The mechanical capacity, like flexibility, ROM

74
Q

What does stability refer to?

A

Static postural control

75
Q

What does controlled mobility refer to?

A

Dynamic postural control. Stability + mobility

76
Q

What does skill refer to?

A

Being able to have consistent, smooth coordinated movement and integrate all the systems into the skilled task that we want to do

77
Q

What are the common movement abnormalities?

A

• Inability to incorporate R or L UE and/or LE (primarily
persons with hemiplegia)
• Ataxia with movements (cerebellar damage)
• Poor initiation
• Inability to move segmentally
• Apraxia/motor planning issues
• Poor movement awareness (sensory loss)

78
Q

What is a good starting position for bed mobility?

79
Q

What are the parts of the hooklying position?

A
  • Getting into position
  • Stability in position
  • Movement around this position
80
Q

What are some of the activities to work on from hooklying?

A
  • Bridging
  • Scooting
  • Lower trunk rotation
81
Q

What are the characteristics of bridging?

A
  • Prerequisite for moving in bed
  • Important for dressing or toileting in bed
  • Great warm up for upright activities
  • 101 ways to do bridging… use good clinical reasoning to progress from easiest to hardest
82
Q

What are the characteristics of scooting?

A
  • Also called bridge and place
  • Requires a bridge plus lateral pelvic shifts + lifting and lateral movement of shoulders
  • Initiate with trunk/pelvis, drive with LEs
  • Manipulating the support surface can be a big facilitator of improved motion
83
Q

What is another good start position?

84
Q

What are the characteristics of sidelying?

A

• Work on building mobility and stability with PNF
scapular or pelvic patterns
• Moving segmentally as opposed to all in one unit

85
Q

What are the characteristics of rolling mobility?

A

• Normally use controlled mobility of extremities on
dynamically stable trunk
• Combination of UE, LE, and trunk
• Everyone has a preferred strategy to initiate
• In persons with hemiparesis, will be more successful rolling toward weaker side
• How can we make an easier task??

86
Q

What are the characteristics of Supine <> Sit mobility?

A

• In persons with BI, typically want to roll to sidelying to
start (as opposed to supine to long sit)
• Requires multiple movements, good selective
movements of LEs
• Segments moving in different directions
• In persons with hemiparesis, will be more successful coming up from stronger side (but harder to roll to get into this position)

87
Q

What are the common abnormalities and compensations of mobility?

A
  • Asymmetries in movement
  • Lack of segmental movement
  • Use of momentum
  • Choosing to go only one direction
  • Moving an impaired part with a stronger part
  • Overuse of UEs on bed, bed rails, etc
88
Q

What are the parts of the biomechanics of sit to stand?

A
  • Pre-extension
  • Extension
  • Transition point
89
Q

What are the characteristics of pre-extension?

A

Forward translation of body mass

- This is the phase where most patients with neuro problems have the most difficulty with

90
Q

What are the characteristics of extension?

A

Vertical translation of body mass

91
Q

What are the characteristics of transition point?

A

When thighs are off surface, is when we should move to the extension part of biomechanics

92
Q

What are the characteristics of the mobility to and from wheelchair?

A

• Sit-Pivot – only using UEs (ie person with SCI)
• Squat/scoot pivot – just elevating body enough (using
UEs/LEs) to clear surface; not coming fully upright; pivot on LEs
• Stand pivot – essentially sit to stand, but with quarter
turn to sit on other surface

93
Q

What are the characteristics of the transfers in patients with contraversive pushing?

A
  • First work on forward weight shift and fear of falling forward
  • Toward paretic side initially may be easiest
  • Progress to transferring in both directions
94
Q

What are the characteristics of sit to stand mobility?

A

• Start on elevated surface to decrease difficulty and train mechanics
• May incorporate reaching forward or weightbearing of
UEs on a forward surface to facilitate forward translation
• Don’t forget to practice stand to sit… lots of eccentric control required

95
Q

What are common compensations we see in patients with mobility problems?

A

• Overuse of UEs
• Overuse of stronger side
• Rapid movement to avoid mid range control
(especially with ataxia)
• Use of momentum (may be necessary compensation
in some diagnoses)
• Asymmetry of movement
• Avoidance of transfers in one direction

96
Q

What are the characteristics of basic wheelchair skills?

A
  • Dependent on configuration of the wheelchair
  • May use bilateral UEs or may use 1 UE and LE
  • Most efficient push stroke and minimizing risk for UEs
  • Forward, backward, turns
  • Part management
  • Door management
  • Negotiation of obstacles
  • Challenging environments
97
Q

What are the components of the configuration of wheel chair?

A
  • Appropriate height of seat to allow optimal push with UEs
  • If using LEs, optimal seat height to allow LE to reach and propel along ground
  • Appropriate size and weight
98
Q

What is the common cause of ataxia?

A

Damage to Cerebellum

99
Q

What is the role of the cerebellum in motor control?

A

• Compares movement to intended output
• Predictive/anticipatory modifications in preparation
for movement
• Motor learning
• Learns, memorizes and stores motor programs
• Adaptation

100
Q

What are the other roles of the cerebellum?

A
  • Balance and equilibrium
  • Control of muscle tone
  • Accurate direction, extent, force and timing
  • Movement compositon
  • Role in speech production
  • Control of eye movement and gaze
101
Q

What are the signs and symptoms of a cerebellar infarct?

A
  • Vertigo
  • Nausea
  • Vomiting
  • Horizontal nystagmus
  • Limb ataxia
  • Unsteady gait
  • Truncal ataxia
  • Impaired vestibulo-occular relfex
  • Headache
  • Ipsilateral to the side of the lesion
102
Q

What are the mechanisms of acquired cerebellar damage?

A
  • Stroke
  • Tumor
  • Structural (Chiari malformation, agenesis, hypoplasia)
  • Toxicity (alcohol, heavy metals, drugs, solvents)
  • Immune-mediated (MS, gluten ataxia)
  • Trauma
  • Infection (cerebellitis)
  • Endocrine (hypothyroidism)
103
Q

What are the mechanisms of degenerative non-hereditary cerebellar damage?

A
  • Multiple system atrophy

* Idopathic late-onset cerebellar ataxia

104
Q

What are the mechanisms of hereditary cerebellar damage?

A

• Autosomal dominant disorders (episodic ataxias,
spinocerebellar ataxias)
• Autosomal recessive disorders (Friedreich ataxia, early onset cerebellar ataxia)
• X-linked disorders (mitochondrial disease, fragile X- associated tremor)

105
Q

What is ataxia?

A

Something that is without order or incoordination

106
Q

What are the characteristics of ataxia?

A
  • Slurred speech, stumbling, falling, incoordination
  • Trouble eating and swallowing
  • Eye movement abnormalities
  • Tremors
  • Cardiac issues
107
Q

What are the outcome measures of ataxia?

A

• Traditional function/activity measures
- FIM
- Balance/Postural control measures
- Gait measures
• Ataxia specific
- International Cooperative Ataxia Rating Scale (ICARS)
- Scale for the Assessment and Rating of Ataxia (SARA)

108
Q

What are the characteristics of the treatment of ataxia?

A

• Not lots of evidence
• Treat the symptoms
• Postural stability
• Gait practice
• Balance practice
• Accuracy of limb movements
• Intensive long term motor training
• Supervised as well as home exercise programs
• Intensive coordination training
• HEP focused on static and dynamic balance activities
- Sitting and standing
- Effect on walking
• Body weight supported treadmill training
• Use of biofeedback and/or bandwith feedback
• Decreasing degrees of freedom
• Activities that focus on stability, co-contraction,
midrange control
• Use of resisted movements

109
Q

What are the compensatory strategies of ataxia?

A
  • Slow down movements
  • Reduce number of segments moving at any given time
  • Widen BOS
  • Minimal environmental distractions
  • Weighting (axial v limb)
  • Assistive devices
  • Orthotics
110
Q

What are the characteristics of basics of transfers: body position?

A
  • “Head goes one way, butt goes the other”

* Lean away

111
Q

What are the characteristics of basics of transfers: hand position?

A
  • Specific for Tetraplegics – Tenodesis Grip

* “One hand where you are coming from, one where you are going”

112
Q

What are the characteristics of basics of transfers: foot position?

A

• Shoulder width and staggered with leading leg 6” forward

113
Q

What are the characteristics of basics of transfers: slide boards?

A

Set at 45 degrees under ischial tuberosity

114
Q

What are the characteristics of Sit-Pivot Transfers?

A
  • Patient Position: as close to the transferring surface as possible
  • Setup
  • Movements: several small scoots across the board
115
Q

What are the considerations of Sit-Pivot Transfers?

A 
• Quadriplegic
   - Lack of Core Stability
   - More shoulders doing work
• Paraplegic
  - How much core dictates ease
116
Q

What are the characteristics of squat-Pivot Transfers?

A
  • Patient Position: as close to the mat as possible
  • Setup: one hand where you’re coming from and one where you are going
  • Movements
117
Q

What are the usual therapist positions during the basics of transfers?

A
  • In front of the patient

- Behind the patient

118
Q

What are the considerations of squat-Pivot Transfers?

A

• Quadriplegic
- N/A
• Paraplegic
- Try to get them to bear weight throughout B LE

119
Q

What are the primary considerations when performing transfers?

A
  • Safety
  • Hand Position
  • Board Position
  • Foot Position
  • Body Position
  • Arm Rests and W/C Wheels
  • Minimize Transitional Movements
  • Safety
120
Q

What should be the frequency of seated pressure relief?

A

Should be done every hour for 2 minutes

121
Q

What are the types of seated pressure relief?

A
  • Forward Lean
  • Side Lean
  • Recline (Tilt in Space)
  • W/C Dips: puts a lot of pressure of the shoulders
122
Q

What are the core seated exercises for transfers?

A

Multidirectional leans with return to midline

123
Q

What are the pelvis seated exercises for transfers?

A

Seated balance on unstable surfaces

124
Q

What are the upper extremity seated exercises for transfers?

A
  • Dips or Press-ups
  • Seated Rows and Presses
  • Shoulder Stability Program - STOMPS
125
Q

What are the components of bed mobility?

A
  • Rolling
  • Scooting Up In Bed
  • Bridging
  • Supine to Sit
  • Sit to Supine
126
Q

How will a quadraplegic scoot up in bed?

A

Will use the elbows to alternately dig into support surface and gradually scoot up

127
Q

How will a person with quadraplegia go from supine to sit?

A

Put both hands together in front of them, rock back and forth, and uses the momentum to get on their side. Then use hands to scoot the knee into a flexed position, and drop over the edge of the support surface and use hands to come up

128
Q

How will a person with paraplega go from supine to sit?

A

Go into a modified long sitting, and use hands to put legs over the edge of support surface

129
Q

How will a person with quadraplegia go from sit to supine?

A

Reverse the supine to sit

130
Q

How frequent should pressure relief in bed be?

A

Every 2 Hours

131
Q

What are the common locations of pressure sores when in supine?

A
  • Heels (post calcaneus)
  • Sacrum
  • Vertebrae
  • Shoulder Blades
  • Elbows
  • Occiput
132
Q

What are the common locations of pressure sores when in sidelying?

A
  • Should be 30 degrees
  • Elbows
  • Wrists
  • Greater Trochanter
  • Medial and Lateral Malleolus
133
Q

What is motor control?

A

The process by which our brain organizes and controls movement

134
Q

To be optimally functional, humans are required to quickly and effectively generate
_____

A

To be optimally functional, humans are required to quickly and effectively generate
movements in ways that area extremely flexible and adaptable

135
Q

What are the things required for motor control?

A

Planning, initiating, sustaining, and efficiently and accurately controlling movement

136
Q

What are the primary movement issues?

A
  • Activation and Sequencing Problems
  • Timing Problems
  • Scaling Problems
137
Q

What are the characteristics of Activation and Sequencing Problems as seen as a primary movement issue?

A
  • Synergies – normal and abnormal
  • Coactivation: lack the ability to fractionate movement
  • Impaired interjoint coordination
138
Q

What are the characteristics of timing problems as seen as a primary movement issue?

A

Reaction time, movement time, termination time

139
Q

What are the characteristics of scaling problems as seen as a primary movement issue?

140
Q

What are the flexion synergy components of the upper extremity?

A
  • Scapular retraction/elevation or hyperextension
  • Shoulder abduction, external rotation
  • Elbow flexion
  • Forearm supination
  • Wrist and finger flexion
141
Q

What are the extension synergy components of the upper extremity?

A
  • Scapular protraction
  • Shoulder adduction, internal rotation
  • Elbow extension
  • Forearm pronation
  • Wrist and finger flexion
142
Q

What are the flexion synergy components of the lower extremity?

A
  • Hip flexion, abduction, external rotation
  • Knee flexion
  • Ankle dorsiflexion, inversion
  • Toe dorsiflexion
143
Q

What are the extension synergy components of the lower extremity?

A
  • Hip extension, adduction, internal rotation
  • Knee extension
  • Ankle plantarflexion, inversion
  • Toe plantarflexion
144
Q

What type of synergies do most patients with strokes and TBI?

A
  • UE flexion synergy

- LE extension synergy

145
Q

What are preparatory interventions for patients with movement issues?

A
  • PNF
  • NDT
  • Constraint-induced movement therapy
  • NMES
  • Technology – robotics and VR
146
Q

What are the characteristics for interventions in UE functional activity?

A

Progression to functional task and personal control of movement

147
Q

What are the characteristics for interventions in LE functional activity?

A

Focus on use in functional mobility tasks

148
Q

What are the characteristics for interventions in locomotor training?

A

Physiologically based approach to gait rehab incorporating intrinsic mechanisms of spinal cord

149
Q

What are the characteristics for interventions in VR?

A

Immersive or non-immersive; various environments

150
Q

What are the characteristics for interventions in mirror therapy?

A

Use limb movement of non paretic side to appear as if paretic side is moving

151
Q

What are the characteristics of the interventions beyond therapy for patients with movement issues?

A

“Transfer package” component
• Needs to be safe, able to be done in home/community
• Education on movements
• Development of problem solving
• Caregivers involved – goals, when to assist or not assist

152
Q

What are the expected functional outcomes in a C1-4 lesion?

A

Total Assist; capability for powered mobility

153
Q

What are the expected functional outcomes in a C5 lesion?

A

Still requires a great deal of assist

154
Q

What are the expected functional outcomes in a C6-8 lesion?

A

More independent, may require some assist

155
Q

What are the expected functional outcomes in a T1-9 lesion?

A

Independent in all basic mobility (may need equipment); gait is variable

156
Q

What are the expected functional outcomes in a T10-L1 lesion?

A

Independent in all basic mobility; gait more likely, still variable

157
Q

What are the expected functional outcomes in a L2-S5 lesion?

A

Independent in all; maybe need orthoses and/or AD

158
Q

What are the preparatory interventions for a complete and seemingly permanent paralysis?

A
  • Goals become more compensation/substitution
  • Pharm: corticosteroids early; typical low mobility meds – DVT prevention, spasticity management, pain management, bowel and bladder, ED
  • Development of compensatory movement strategies
  • Strengthening Innervated Musculature
  • Development and preservation of ROM
  • Equipment – vital; make or break for function
159
Q

What are the compensatory movement strategies seen in patients with a complete/permanent paralysis?

A

• Muscle substitution
• Momentum
- Linear, angular
• Head-hips relationship

160
Q

What are the characteristics of strengthening innervated musculature as a preparatory intervention for patients with a complete/permanent paralysis?

A
  • Strength and endurance beyond a 5/5

* Balanced strength around the shoulder

161
Q

What are the characteristics of muscle substitution as a compensatory movement strategy for patients with a complete/permanent paralysis?

A

By synergist, gravity, tension of passive structures, use of

close chained mechanics

162
Q

What are the characteristics of head-hips relationship as a compensatory movement strategy for patients with a complete/permanent paralysis?

A

Pivot on arm, using shoulders as fulcrum; head moves one way, buttocks move opposite

163
Q

What are the therapeutic techniques to use in patients with complete/permanent paralysis?

A

All based on the movement strategies necessary
• Strengthening
- Fairly typical in many ways
- How do we strengthen very weak muscles?
- Equipment?
- Extra caution strengthening UEs
• ROM and Stretching
- Challenge is often how to self-stretch

164
Q

What are the interventions applied to functional activities in patients with complete/permanent paralysis?

A
  • Functional training
  • Rolling
  • Transition to sitting
  • Long/short sitting
  • Transfers
  • Basic w/c skills
  • Advanced skills
165
Q

What are the special precautions to take in patients with complete/permanent paralysis?

A

• Spine precautions
- Orthosis, restricted motions, lifting restrictions
- C spine – avoid strong contractions of shoulder and avoid abd or flex > 90
- L spine – avoid strong contraction of hip and avoid flex > 90; restrict SLR to range without vertebral motion
• Fracture prevention
• Skin protection
• Orthostatic hypotension
• Autonomic dysreflexia

166
Q

What are the interventions beyond “Therapy” for patients with complete/permanent paralysis?

A
  • Patient, family, caregiver education
  • Patient needs to be able to verbally direct all care
  • HEP that focuses on flexibility and strengthening
  • Continued functional practice/training
  • Regular cardiovascular exercise
  • Nutrition
167
Q

How do we measure Flaccidity and Hypotonia?

A
  • No real measure
  • PROM
  • Observation
  • Palpation
168
Q

What are the preparatory interventions for Flaccidity and Hypotonia?

A

• Beginning at stability and/or mobility stage of MC
• NMES possibly
• Compensatory strategies to minimize risk of injury or
secondary impairment
• Lots of education and training

169
Q

What are the possible techniques for interventions for Flaccidity and Hypotonia?

A
  • Positioning and handling
  • ROM
  • Weightbearing
  • Facilitation techniques
  • Strengthening
  • Strapping/taping (shoulder)
  • NMES
170
Q

What are the Interventions Applied to Functional Activities in patients with Flaccidity and Hypotonia?

A
  • FES
  • Functional activities
  • Watch for compensatory movement strategies
171
Q

What are the Interventions Beyond “Therapy” for patients with Flaccidity and Hypotonia?

A

Patient, family, caregiver education

172
Q

How do we measure hypertonia?

A
  • Primarily Modified Ashworth Scale (MAS)

* Tardieu Scale – R1 and R2

173
Q

What are the Preparatory Interventions for hypertonia?

A

• Does it interfere with QOL or function?
• Pharmacological – in conjunction with therapy
- Oral, injection, implantation
• Surgical
- Tendon lengthening
- Selective dorsal rhizotomy
- Deep brain stimulation
• Sustained positioning and PROM
- Splinting and serial casting for low load sustained stretch
- PROM manually or with equipment
• Handling and physical inhibition
- NDT and Feldenkrais – intense physical cueing, gentle
positioning and handling techniques
• Equipment – orthotics, seating and positioning,
passive stander

174
Q

What are the inhibition techniques for hypertonia?

A
  • Deep pressure
  • Joint traction
  • Rhythmic rotation
  • Sustained stretch
  • Thermal application – warm and cold
  • Taping
  • Biofeedback
  • Vibration/sonic pulses
  • E-stim
  • acupuncture
175
Q

What are the interventions applied to functional activities for patients with hypertonia?

A
  • Aquatic therapy
  • Quadruped
  • Rolling
  • Weight-bearing Activities
176
Q

What are the interventions Beyond “Therapy” for patients with hypertonia?

A

• Patient, family, caregiver education
• Opportunities for the following at home:
- Weight bearing
- Low load sustained stretch
- Use of devices – donning/doffing, safety, wearing schedule
- Standing program

Neuromuscular practice- Adutls (8 decks)

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