Week 4 Flashcards
1
Q
What is cognition?
A
Process of knowing and understanding
2
Q
What is perception?
A
Ability to select those stimuli that require attention or action from the surrounding sensory
environment and interpret them
3
Q
What is executive functions?
A
Ability to plan, manipulate, and
problem solve.
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
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
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
7
Q
What are the categories of executive function?
A
- Knowledge base
* Executive system
8
Q
What are the characteristics of knowledge base category of executive function?
A
General info, learned skills, routines, procedures, rules
9
Q
What are the characteristics of executive system category of executive function?
A
Mental functions related to goal formation, planning, and achieving goals
10
Q
____ greatly impacts cognition, and memory is involved in it
A
Perception greatly impacts cognition, and memory is involved in it
11
Q
What is perseveration?
A
To be stuck on a thought or idea
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
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
14
Q
What are the characteristics of patients that lacks initiation?
A
- Need a cue
- Slow to respond, nothing spontaneous
- Inert
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
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
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
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
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
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
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
22
Q
What are the types of attention?
A
- Focused
- Sustained
- Selective
- Alternating
- Divided
- Concentration
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
24
Q
What is concentration?
A
Being immersed in the present
25
How do you keep/maintain concentration?
Increasing attention to the relevant and decrease attention to the irrelevant
26
What are the elements of concentration?
- Focusing selectively
- Focus that is maintained over a period of time
- Awareness of unfolding situation
- Can alter attentional focus as required
27
What part of the brain is affected in an episodic/semantic /long term memory issue?
Temporal lobe
28
What part of the brain is affected in an attention issue?
Parietal lobe
29
What part of the brain is affected in a visual perception issue?
Occipital lobe
30
What does the lack of awareness of memory issues do to a person?
They have the inability to compensate
31
Memory is a primary function of the ____
Memory is a primary function of the *hippocampus*
32
What are the things that the hippocampus is very susceptible to?
Metabolic changes and decreased O2
33
What are the forms of long term memory?
- Explicit (declarative)
| - Implicit (non declarative)
34
What types of things are included in explicit (declarative) memory?
- Facts (semantic)
- Events (episodic)
Steps to complete a task
35
Where does explicit (declarative) memory take place?
Medial temporal lobe
| Hippocampus
36
What types of things are included in implicit (non declarative) memory?
- Priming
- Procedural (skills and habits)
- Associative learning: classical and operant conditioning
- Non associative learning: habituation and sensitization
37
What is included in associative learning?
- Emotional responses
| - Skeletal musculature
38
Where does priming memory take place?
Neocortex
39
Where does procedural memory take place?
Striatum
40
Where does associative learning memory:emotional responses take place?
Amygdala
41
Where does associative learning memory: skeletal musculature take place?
Cerebellum
42
Where does non-associative learning memory take place?
Reflex pathways
43
What are the processes that declarative memory require?
Conscious processes, such as awareness and attention.
44
What are some strategies for patients with memory problems?
```
• DO NOT ARGUE
• External memory aides
- Notebooks
- Watches
- Beepers
- Signs and notes
• Maximize procedural memory
```
45
What is Post-Traumatic Amnesia?
Period of time following emergence from coma during
which patient is confused, disoriented, and/or
agitated
46
What are the characteristics of Post-Traumatic Amnesia?
* Confabulation and impaired attention
* Short term memory dysfunction
* Time period of PTA correlates with quantity of brain tissue destroyed
47
What are some behavioral impairments seen in patients with any type of brain injury?
* Agitation and/or aggression
* Restlessness
* Disinhibition
* Sexual inappropriateness
* Egocentricity
* Apathy/lack of concern
48
What are the characteristics of fatigue as it impacts treatment of a brain injury?
* Sleep/wake cycles
* Poor endurance/decreased tolerance for activity
* Exaggerated response to fatigue
* Negatively impact learning
* Not a behavior
49
What are some strategies for addressing brain injury?
• Medication management may be necessary
• Create busy days with appropriate physical and
cognitive activity
• Create environment conducive to sleep
50
What are the characteristics of pain in patients with brain injury?
```
• Source of pain
• Distracting
• Emotional impact
- Agitation/aggression
- Lethargy
- Withdrawal
- Labile
• Difficult to discern with communication deficits
```
51
What are the strategies for addressing patients with a brain injury?
• Alter environment to decrease stimulation
• Routine, Routine, Routine
• Incorporate meaningful, functional activities that
capitalize on positive emotion; familiar, automatic activities
52
What are the characteristics/kinds of language disorders?
* Receptive or comprehension deficits
* Expressive deficits
* Combo
* Dysarthria
* Speech quality deficits
53
What are the strategies of treating patients with language disorders?
* Don’t confuse frustration over communication limitations as behavioral problem
* Be patient
* Be consistent
54
What are the characteristics of impaired judgment or awareness?
• Lack of awareness very hard to “treat”
• Inappropriate social behavior
- Isolation, depression, lack of motivation
- Disinhibition, sexual inappropriateness, aggression
• Impaired safety awareness
55
What are the strategies for treating those with impaired judgment or awareness?
* 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
56
What are the behavior modification seen in patients with brain injury?
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
57
What are the causes of certain behavior in our patients?
* Location of injury
* Medical factors
* Loss of control
* Reality Response
* Premorbid personality
* Memory deficits
* Cultural or social issues
58
What are the causes of certain behavior in our patients caused by staff/PTs?
* 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
59
What are some strategies to address patients with behavioral issues in extreme circumstances?
* Behavioral contracts
* Reward system
* Chaining or shaping
60
What are the characteristics of bed mobility?
* Rolling (supine<>sidelying<>prone)
* Bridging and scooting
* Supine or sidelying<>sitting
61
What are the characteristics of basic transfers?
* Level surface
* Unlevel surface
* Sit<>stand
62
What are the characteristics of basic wheelchair skills?
* Propulsion
| * Pressure relief
63
What is task analysis?
Identification of link between patient’s inability to effectively use appropriate movement strategy (abnormal movement) and underlying impairments
64
What are the components of movement?
- Mobility
- Force generation
- Muscle tone
- Sensory information
- Pain
- Speed
- Endurance
- Posture
- Balance
- Coordination
- Selective capacity
- Adaptive capacity
- Cognitive and psychological
65
What are the characteristics of task and environment interaction requirements?
1. Stationary Individual and Stationary Environment
2. Moving Individual and Stationary Environment
3. Stationary Individual in Moving Environment
4. Moving Individual in Moving Environment
66
What is the temporal sequence of task performance?
- Initial condition
- Preparation
- Initiation
- Execution
- Termination
- Outcome
67
What is the goal for all our patients?
Efficient movement
68
What are the requirements of efficient movement?
* Adequate mechanical capacity
* Appropriate neuromuscular function
* Effective motor control
69
What are the characteristics of adequate mechanical capacity needed for efficient movement?
Mobility of joint, soft tissue, muscle and neurovascular
70
What are the characteristics of appropriate neuromuscular function needed for efficient movement?
Initiate contraction, adequate strength, speed and endurance
71
What are the characteristics of effective motor control needed for efficient movement?
Proper movement strategies while engaged in functional
| activity with changing task demands
72
What are the motor task requirements?
* Mobility
* Stability
* Controlled mobility
* Skill
73
What does mobility refer to?
The mechanical capacity, like flexibility, ROM
74
What does stability refer to?
Static postural control
75
What does controlled mobility refer to?
Dynamic postural control. Stability + mobility
76
What does skill refer to?
Being able to have consistent, smooth coordinated movement and integrate all the systems into the skilled task that we want to do
77
What are the common movement abnormalities?
• 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
What is a good starting position for bed mobility?
Hooklying
79
What are the parts of the hooklying position?
* Getting into position
* Stability in position
* Movement around this position
80
What are some of the activities to work on from hooklying?
* Bridging
* Scooting
* Lower trunk rotation
81
What are the characteristics of bridging?
* 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
What are the characteristics of scooting?
* 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
What is another good start position?
Sidelying
84
What are the characteristics of sidelying?
• Work on building mobility and stability with PNF
scapular or pelvic patterns
• Moving segmentally as opposed to all in one unit
85
What are the characteristics of rolling mobility?
• 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
What are the characteristics of Supine <> Sit mobility?
• 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
What are the common abnormalities and compensations of mobility?
* 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
What are the parts of the biomechanics of sit to stand?
* Pre-extension
* Extension
* Transition point
89
What are the characteristics of pre-extension?
Forward translation of body mass
| - This is the phase where most patients with neuro problems have the most difficulty with
90
What are the characteristics of extension?
Vertical translation of body mass
91
What are the characteristics of transition point?
When thighs are off surface, is when we should move to the extension part of biomechanics
92
What are the characteristics of the mobility to and from wheelchair?
• 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
What are the characteristics of the transfers in patients with contraversive pushing?
* 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
What are the characteristics of sit to stand mobility?
• 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
What are common compensations we see in patients with mobility problems?
• 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
What are the characteristics of basic wheelchair skills?
* 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
What are the components of the configuration of wheel chair?
* 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
What is the common cause of ataxia?
Damage to Cerebellum
99
What is the role of the cerebellum in motor control?
• Compares movement to intended output
• Predictive/anticipatory modifications in preparation
for movement
• Motor learning
• Learns, memorizes and stores motor programs
• Adaptation
100
What are the other roles of the cerebellum?
* 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
What are the signs and symptoms of a cerebellar infarct?
- Vertigo
- Nausea
- Vomiting
- Horizontal nystagmus
- Limb ataxia
- Unsteady gait
- Truncal ataxia
- Impaired vestibulo-occular relfex
- Headache
- Ipsilateral to the side of the lesion
102
What are the mechanisms of acquired cerebellar damage?
* Stroke
* Tumor
* Structural (Chiari malformation, agenesis, hypoplasia)
* Toxicity (alcohol, heavy metals, drugs, solvents)
* Immune-mediated (MS, gluten ataxia)
* Trauma
* Infection (cerebellitis)
* Endocrine (hypothyroidism)
103
What are the mechanisms of degenerative non-hereditary cerebellar damage?
* Multiple system atrophy
| * Idopathic late-onset cerebellar ataxia
104
What are the mechanisms of hereditary cerebellar damage?
• 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
What is ataxia?
Something that is without order or incoordination
106
What are the characteristics of ataxia?
* Slurred speech, stumbling, falling, incoordination
* Trouble eating and swallowing
* Eye movement abnormalities
* Tremors
* Cardiac issues
107
What are the outcome measures of ataxia?
• 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
What are the characteristics of the treatment of ataxia?
• 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
What are the compensatory strategies of ataxia?
* 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
What are the characteristics of basics of transfers: body position?
* “Head goes one way, butt goes the other”
| * Lean away
111
What are the characteristics of basics of transfers: hand position?
* Specific for Tetraplegics – Tenodesis Grip
| * “One hand where you are coming from, one where you are going”
112
What are the characteristics of basics of transfers: foot position?
• Shoulder width and staggered with leading leg 6” forward
113
What are the characteristics of basics of transfers: slide boards?
Set at 45 degrees under ischial tuberosity
114
What are the characteristics of Sit-Pivot Transfers?
* Patient Position: as close to the transferring surface as possible
* Setup
* Movements: several small scoots across the board
115
What are the considerations of Sit-Pivot Transfers?
```
• Quadriplegic
- Lack of Core Stability
- More shoulders doing work
• Paraplegic
- How much core dictates ease
```
116
What are the characteristics of squat-Pivot Transfers?
* 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
What are the usual therapist positions during the basics of transfers?
- In front of the patient
| - Behind the patient
118
What are the considerations of squat-Pivot Transfers?
• Quadriplegic
- N/A
• Paraplegic
- Try to get them to bear weight throughout B LE
119
What are the primary considerations when performing transfers?
* Safety
* Hand Position
* Board Position
* Foot Position
* Body Position
* Arm Rests and W/C Wheels
* Minimize Transitional Movements
* Safety
120
What should be the frequency of seated pressure relief?
Should be done every hour for 2 minutes
121
What are the types of seated pressure relief?
* Forward Lean
* Side Lean
* Recline (Tilt in Space)
* W/C Dips: puts a lot of pressure of the shoulders
122
What are the core seated exercises for transfers?
Multidirectional leans with return to midline
123
What are the pelvis seated exercises for transfers?
Seated balance on unstable surfaces
124
What are the upper extremity seated exercises for transfers?
* Dips or Press-ups
* Seated Rows and Presses
* Shoulder Stability Program - STOMPS
125
What are the components of bed mobility?
* Rolling
* Scooting Up In Bed
* Bridging
* Supine to Sit
* Sit to Supine
126
How will a quadraplegic scoot up in bed?
Will use the elbows to alternately dig into support surface and gradually scoot up
127
How will a person with quadraplegia go from supine to sit?
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
How will a person with paraplega go from supine to sit?
Go into a modified long sitting, and use hands to put legs over the edge of support surface
129
How will a person with quadraplegia go from sit to supine?
Reverse the supine to sit
130
How frequent should pressure relief in bed be?
Every 2 Hours
131
What are the common locations of pressure sores when in supine?
* Heels (post calcaneus)
* Sacrum
* Vertebrae
* Shoulder Blades
* Elbows
* Occiput
132
What are the common locations of pressure sores when in sidelying?
* Should be 30 degrees
* Elbows
* Wrists
* Greater Trochanter
* Medial and Lateral Malleolus
133
What is motor control?
The process by which our brain organizes and controls movement
134
To be optimally functional, humans are required to quickly and effectively generate
_____
To be optimally functional, humans are required to quickly and effectively generate
*movements in ways that area extremely flexible and adaptable*
135
What are the things required for motor control?
Planning, initiating, sustaining, and efficiently and accurately controlling movement
136
What are the primary movement issues?
* Activation and Sequencing Problems
* Timing Problems
* Scaling Problems
137
What are the characteristics of Activation and Sequencing Problems as seen as a primary movement issue?
* Synergies – normal and abnormal
* Coactivation: lack the ability to fractionate movement
* Impaired interjoint coordination
138
What are the characteristics of timing problems as seen as a primary movement issue?
Reaction time, movement time, termination time
139
What are the characteristics of scaling problems as seen as a primary movement issue?
Dysmetria
140
What are the flexion synergy components of the upper extremity?
- Scapular retraction/elevation or hyperextension
- Shoulder abduction, external rotation
- Elbow flexion
- Forearm supination
- Wrist and finger flexion
141
What are the extension synergy components of the upper extremity?
- Scapular protraction
- Shoulder adduction, internal rotation
- Elbow extension
- Forearm pronation
- Wrist and finger flexion
142
What are the flexion synergy components of the lower extremity?
- Hip flexion, abduction, external rotation
- Knee flexion
- Ankle dorsiflexion, inversion
- Toe dorsiflexion
143
What are the extension synergy components of the lower extremity?
- Hip extension, adduction, internal rotation
- Knee extension
- Ankle plantarflexion, inversion
- Toe plantarflexion
144
What type of synergies do most patients with strokes and TBI?
- UE flexion synergy
| - LE extension synergy
145
What are preparatory interventions for patients with movement issues?
* PNF
* NDT
* Constraint-induced movement therapy
* NMES
* Technology – robotics and VR
146
What are the characteristics for interventions in UE functional activity?
Progression to functional task and personal control of movement
147
What are the characteristics for interventions in LE functional activity?
Focus on use in functional mobility tasks
148
What are the characteristics for interventions in locomotor training?
Physiologically based approach to gait rehab incorporating intrinsic mechanisms of spinal cord
149
What are the characteristics for interventions in VR?
Immersive or non-immersive; various environments
150
What are the characteristics for interventions in mirror therapy?
Use limb movement of non paretic side to appear as if paretic side is moving
151
What are the characteristics of the interventions beyond therapy for patients with movement issues?
“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
What are the expected functional outcomes in a C1-4 lesion?
Total Assist; capability for powered mobility
153
What are the expected functional outcomes in a C5 lesion?
Still requires a great deal of assist
154
What are the expected functional outcomes in a C6-8 lesion?
More independent, may require some assist
155
What are the expected functional outcomes in a T1-9 lesion?
Independent in all basic mobility (may need equipment); gait is variable
156
What are the expected functional outcomes in a T10-L1 lesion?
Independent in all basic mobility; gait more likely, still variable
157
What are the expected functional outcomes in a L2-S5 lesion?
Independent in all; maybe need orthoses and/or AD
158
What are the preparatory interventions for a complete and seemingly permanent paralysis?
* 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
What are the compensatory movement strategies seen in patients with a complete/permanent paralysis?
• Muscle substitution
• Momentum
- Linear, angular
• Head-hips relationship
160
What are the characteristics of strengthening innervated musculature as a preparatory intervention for patients with a complete/permanent paralysis?
* Strength and endurance beyond a 5/5
| * Balanced strength around the shoulder
161
What are the characteristics of muscle substitution as a compensatory movement strategy for patients with a complete/permanent paralysis?
By synergist, gravity, tension of passive structures, use of
| close chained mechanics
162
What are the characteristics of head-hips relationship as a compensatory movement strategy for patients with a complete/permanent paralysis?
Pivot on arm, using shoulders as fulcrum; head moves one way, buttocks move opposite
163
What are the therapeutic techniques to use in patients with complete/permanent paralysis?
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
What are the interventions applied to functional activities in patients with complete/permanent paralysis?
* Functional training
* Rolling
* Transition to sitting
* Long/short sitting
* Transfers
* Basic w/c skills
* Advanced skills
165
What are the special precautions to take in patients with complete/permanent paralysis?
• 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
What are the interventions beyond “Therapy” for patients with complete/permanent paralysis?
* 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
How do we measure Flaccidity and Hypotonia?
* No real measure
* PROM
* Observation
* Palpation
168
What are the preparatory interventions for Flaccidity and Hypotonia?
• 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
What are the possible techniques for interventions for Flaccidity and Hypotonia?
* Positioning and handling
* ROM
* Weightbearing
* Facilitation techniques
* Strengthening
* Strapping/taping (shoulder)
* NMES
170
What are the Interventions Applied to Functional Activities in patients with Flaccidity and Hypotonia?
* FES
* Functional activities
* Watch for compensatory movement strategies
171
What are the Interventions Beyond “Therapy" for patients with Flaccidity and Hypotonia?
Patient, family, caregiver education
172
How do we measure hypertonia?
* Primarily Modified Ashworth Scale (MAS)
| * Tardieu Scale – R1 and R2
173
What are the Preparatory Interventions for hypertonia?
• 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
What are the inhibition techniques for hypertonia?
* Deep pressure
* Joint traction
* Rhythmic rotation
* Sustained stretch
* Thermal application – warm and cold
* Taping
* Biofeedback
* Vibration/sonic pulses
* E-stim
* acupuncture
175
What are the interventions applied to functional activities for patients with hypertonia?
* Aquatic therapy
* Quadruped
* Rolling
* Weight-bearing Activities
176
What are the interventions Beyond “Therapy” for patients with hypertonia?
• 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
