Week 7 Flashcards
What are the key ingredients for necessary ROM?
• Neutral hip extension for standing; Hip extension for gait
• Neutral knee extension for standing; neutral extension to
moderate knee flexion for gait
• Slight DF for standing; max DF and significant PF for gait
What are the key ingredients for necessary force production?
• Extensors in standing, extensors (primarily PFs) during
stance in gait, flexors for swing
• Lack of ROM increases need for force production
What are the key ingredients for facilitating improved upright posture?
- Necessary range of motion
- Necessary force production
- Sensory systems
- Perception
- Cardiovascular/pulmonary systems
What are key components in the sensory systems that facilitate improved upright posture?
- Vision
- Vestibular
- Somatosensation
What are the activities to facilitate upright posture?
- Elevated sitting
- Kneeling
- Half-kneeling
- Static standing
- Standing + controlled mobility
- Standing + cognitive task
Progress from with UE support to without
Where do we start when trying to help a patient facilitate upright posture?
Supported standing. Mechanically or with people
What is the sequence of motor task requirements?
- Mobility
- Stability
- Controlled mobility
- Skill
What is the goal of forced use activities in standing?
Prevent learned non-use of involved side and over use of non-involved side
What are the characteristics of forced use activities?
• Can actually be started in sitting… How?
• Good closed chain activity to increase activity in LE
• Many ways to gradually progress to more use of
affected LE
• Need to provide or facilitate stability to support these
What are the key points of control for standing(places that the therapist might have to help for control)?
- Lower leg
- Thigh
- Hip/lower trunk
- Head, arms, trunk
What are some pre-gait activities to help facilitate upright posture and gait?
- Isolated practice of stance
- Isolated practice of swing, forward and backward
- Turns
- Regression of UE support
- Regression of therapist control
What is the presentation of gait following neurological impairments?
- SLOW
- Fall risk
- Laborious
- Lack of stance stability
- Poor swing limb clearance
- Lack of normal weight shift/weightbearning
- Compensatory
- Reliant on UE support
What are the risks resulting from altered gait?
- Additional impairments
- Potential musculoskeletal sequalae/problems
- Increased energy expenditure
- Falls
- Activity limitations and participation restriction
- Stigma
- Decreases in QOL
What are the characteristics of the stance phase of gait in patient with a neurological dysfunction?
• Instability of stance is COMMON in neuro
diagnoses/disease
• Requires proximal AND distal stability (esp. plantarflexors in mid to terminal stance)
• Often overlooked or not understood
• Not often treated correctly do to lack of understanding
What are the characteristics of the swing phase of gait in patient with a neurological dysfunction?
- Most commonly identified, described, and addressed
- Greatly dependent on the stance phase
- Fairly easy to compensate for distal impairments of swing phase
- An orthotic solution often does not completely reestablish swing limb clearance
Swing depends on ___
Swing depends on stance
What are the functional categories of pathological mechanisms of gait?
- Deformity
- Muscle weakness
- Sensory Loss
- Pain
- Impaired Muscle Control
What is a deformity?
Lack of sufficient passive mobility and not being able to achieve normal postures and ROM necessary for standing or walking
What is the most common cause of a deformity?
Contracture
What causes a contracture?
Structure change in connective tissue component of muscles
• Elastic
• Rigid
What are some of the deformities we see in stance?
- PF contracture (most common in patients with neuro disease)
- Knee flexion contracture
- Hip flexor contracture
- Adductor contracture
What are some of the deformities we see in swing?
- PF contracture(most common in patients with neuro disease)
- Knee flexion contracture
- Adductor contracture
What does R1 and R2 being really far apart indicate?
That there is some form of hypertonicity present
What parts of the stance phase does a PF contracture disrupt?
- Initial contact
- Mid stance
- Terminal stance
What does a knee flexion contracture in stance result in?
- Increased energy expenditure
- Abnormal IC
- Mid and terminal stance will be affected
What does a hip flexion contracture in stance result in?
- Mid and terminal stance are greatly affected
Pre-swing won’t be accomplished
What does an adductor contracture in stance result in?
- Abnormal forward foot placement/line of progression
What does a PF contracture in swing result in?
- No neutral DF in initial swing, mid, and terminal swing
What does a knee flexion contracture in swing result in?
Mostly impacts ability to achieve knee extension in terminal swing. Step will be shorter
What does an adductor contracture in swing result in?
Results in a decreased BoS, and swinging limb will be too close to the stance limb
What is the primary problem we think of when talking about sensory loss during gait?
Problems with proprioception or kinesthesia
What do problems with proprioception result in during gait?
- Inconsistent gait pattern
- Intact motor – substitutions for lost sensation
- Impaired motor + sensory loss = inability to substitute
What are balance disorders in gait a consequence of?
Both motor control and/or sensory dysfunction
Reactions to pain can cause what during gait?
Deformity and muscle
weakness
• Deformity: resting postures
• Muscle weakness: reduced activity, protective reflex
What is muscle weakness?
Weakness and/or insufficient recruitment or activation
What are the possible origins of muscle weakness?
- Upper motor neuron lesion
- Lower motor neuro lesion
- Muscle pathology
What are the things we should be looking at in the presence of muscle weakness?
- MMT
- Muscle endurance
- Lever length
What does quad weakness in stance result in?
Hyperextension early in stance
(IC or LR); inability to accomplish LR
What does PF weakness in stance result in?
Extensor thrust in MSt to TSt
OR excessive ankle DF, and knee flexion throughout
What does hip extensor weakness in stance result in?
Excessive hip flexion at IC
and LR
What does hip abductor weakness in stance result in?
Contralateral pelvic drop MSt
What does anterior tibialis weakness in stance result in?
Foot slap at LR
What does anterior tibialis weakness in swing result in?
Flat foot or forefoot IC; decreased foot clearance throughout swing
What does knee flexor weakness in swing result in?
Decreased knee flexion in MSw to TSw
What does knee extensor weakness in swing result in?
Doesn’t achieve full extension at TSw
What does hip flexor weakness in swing result in?
Difficulty initiating PSw and ISw (lack of balance between flexors)
What is the bottom line of muscle weakness during swing?
Poor limb clearance
Impaired motor control usually happens in those with what type of lesion?
Upper motor lesion
Impaired motor control is a combination of…?
- Muscle weakness
- Impaired selective control
- Emergence of primitive locomotor patterns
- Spasticity
What are the characteristics of torque production after stroke?
• Decrease in maximum voluntary torque
• Other aspects of torque production are disordered after stroke:
- Decreased speed in torque generation
- Selective muscle weakness at shortened range
• So what?
- Target strengthening of muscles in shortened lengths to promote recovery
- Speed/Power has to be trained
What is the dynamic systems theory?
Movement emerging out of constraints on the system
• Individual
• Task
• Environment
What are the gait clinical presentations in patients with CVA and TBI (unilateral weakness)?
- Stance instability
- Swing limb clearance impairment
- Impaired balance, impaired or absent sensation
- Decreased walking speed
- Increased energy expenditure
- Spasticity
- Decreased selective motor control
What are the typical foot/ankle abnormalities during the swing phase in patients with a hemiplegic presentation in patients with stroke/BI on their affected side?
– Poor swing limb clearance
– Equinovarus posture
– Poor prepositioning for initial contact
What are the typical foot/ankle abnormalities during the stance phase in patients with a hemiplegic presentation in patients with stroke/BI on their affected side?
– Foot flat or forefoot contact
– Medial/lateral instability
– Varus ankle
– Lack of pronation(esp in chronic cases)
– Lack of dorsiflexion
– Absent first rocker
– Absent or impaired second, third, and forth rocker
What are the stance phase problems in patients with stroke/BI?
• More than just decreased weight shift to affected side
• Less time on paretic limb
• Reduced load on paretic limb
• Non-paretic step length is
shortened
• Acute and chronic phase: weakness of PFs is primary
impairment
• Chronic phase: Weakness of PFs along with PF contracture
and/or hypertonicity
• Often not identified, described, or addressed
What are the typical knee abnormalities in patients with stroke/BI?
Instability
• Poor tibial control and/or quadriceps weakness
- Knee buckling. Once if it is a quad problem, continuous is a PF problem
Compensations for knee instability
• Forward trunk lean
• Knee hyperextension
- Hyperextension could be from weak quadriceps but in patients with CVA/TBI, more likely cause is weak PFs later in phase
What are the typical hip and pelvis abnormalities in patients with stroke/BI?
Hip weakness
• Forward trunk lean to help stabilize knee
- Increases energy costs and shortens step length
Pelvic retraction
• Decreases momentum that can be generated
• Makes hip flexion activation more difficult
• Again causes decrease in step length
No direct orthotic intervention; intervene at ankle or maybe
knee/ankle to manage this by stabilizing base of support
What are the typical head, arm and trunk abnormalities in patients with stroke/BI?
Lateral trunk lean
• Over-reliance on sound side
• Lean away from weaker side to assist with swing
Forward trunk lean
• Often due to knee instability
Decreased arm swing
• Often due to decreased gait speed, but lack of trunk and pelvic rotation contribute to this
No direct orthotic intervention; intervene at ankle or maybe
knee/ankle to manage this by stabilizing base of support
What are the common impairments seen in the swing phase in patients with a stroke/hemiplegia from stroke or BI?
• Weakness – flexors primarily(hip and DF); knee extensors at terminal swing • Spasticity – extensors primarily • Decreased ROM – dorsiflexion • Decreased sensation
What are the common impairments seen in the stance phase in patients with a stroke/hemiplegia from stroke or BI?
• Weakness – plantarflexors, hip abductors, adductors, and
extensors(early in stannce), knee extensors(early in stance), ankle everters
• Spasticity – extensors, primarily plantarflexors(will disallow forward progression of the tibia)
• Decreased ROM – dorsiflexion
• Decreased sensation
What is the presentation of hemiplegia gait in acute stroke?
- Low/limited activation
- Possible hypermobility
- Weakness
- Develop compensations
- High Fall Risk
What is the presentation of hemiplegia gait in chronic stroke?
- Over activation
- ROM restrictions
- Weakness
- Compensations
- High Fall Risk
What is the presentation of patients with MS?
- Ataxia
- Sensory loss
- Fatigue
- Hypertonicity
- Weakness
- Unilateral or bilateral deviations and impairments
- Slower preferred speed
- Longer double limb support
- Decreased swing times
- Wider BOS
What are the abnormal dynamics in walking patterns in patients with MS?
- Linear decline in walking speed in 12MWT
- Robust correlation with subjective fatigue
- Even those with mild disability differed significantly from controls in walking speed
- Degree of U-shape attenuated in persons with MS
What are the characteristics of the gait deviations seen in patients with a SCI?
• Depends on: level of injury, degree of motor and
sensory sparing (the higher the worse)
• Often bilateral presentation of symptoms, but potentially not symmetrical
• Compensatory(complete) versus restorative(incomplete)
What are the presentations of the gait deviations seen in patients with PPS or LE Peripheral Neuropathy?
• Often significant quadriceps weakness • Extensive knee hyperextension through all of stance phase • Often a true genu-recurvatum • “flail limb” • Low tone, low reflexes
What are the presentations of the gait deviations seen in patients with CMT?
- Inherited neurological disorder
- Peripheral neuropathy, both motor and sensory
- Typically see weakness of foot and lower leg muscles
- Results in foot drop and high “steppage” gait
- Frequent falls
- Can progress to complete breakdown of foot and ankle
What are the presentations of the gait deviations seen in patients with Diabetic Peripheral Neuropathy?
• Gait deviations consistent with sensory loss (what are they) • Impaired swing limb clearance • Potential instability in stance • Pain with gait
What is the highest level of evidence when it comes to rehabilitation of patient with gait limitations after stroke?
Intensive, repetitive, mobility task training
In what post stroke patients is an AFO recommended?
In individuals with remediable gait impairments (eg. foot drop) to compensate for foot drop and to improve mobility and paretic ankle and knee kinematics, and energy cost of walking
What is a reasonable approach to improve walking in patients post stroke?
Group therapy with circuit training
Incorporating ____ and ____ is reasonable to consider for recovery of gait capacity and gait related mobility task in post stroke patients
Incorporating cardiovascular exercise and strengthening interventions is reasonable to consider for recovery of gait capacity and gait related mobility task in post stroke patients
___ is reasonable to consider as an alternative to AFO for foot drop in post stroke patients
NMES is reasonable to consider as an alternative to AFO for foot drop in post stroke patients
What may be reasonable for recovery of walking function in post stroke patients?
Practice walking with either a treadmill (with/without body weight support) or overground walking exercises training combined with conventional rehab
______ to improve motor function and mobility after stroke in combination with conventional therapy may be considered
Robot-assisted movement training to improve motor function and mobility after stroke in combination with conventional therapy may be considered
What interventions may be considered for patients who are non-ambulatory or have low ambulatory ability early after stroke?
Mechanically assisted walking (treadmill, electromechanical gait trainer, robotic device, servo-motor) with body weight support
How do we begin task specificity in therapeutic exercise?
• Analyze task and find deficits
• Hypothesize causative impairments for identified
deficits
• Test out hypotheses to ID causative impairments
• What is the norm, in terms of motor activity, ROM, sensation, etc…?
What should task specific therex look like?
- Ther ex would match the key characteristics of the task:
- Type of contraction
- Range of motion
- Training to fit demand: load, repetition, lever arm
What are the components of functional walking that we must rehab?
- Muscle power
- Neural control
- Balance
- CV fitness
What is the component of walking specific motor control as it applies to the optimization of walking?
Repetitive step training, w/ or w/o PBWS
What are the component of cardiorespiratory fitness as it applies to the optimization of walking?
- Aerobic conditioning
* Does not have to be gait specific
What is the component of dynamic balance control as it applies to the optimization of walking?
Progressive balance retraining program, central and peripheral processes of balance
What is the component of muscular strength as it applies to the optimization of walking?
- Progressive resistance training
- Need to strengthen paretic and non-paretic side, as well as trunk
- Make strengthening as task specific as possible
What is the component of muscle power as it applies to the optimization of walking?
Must include components of speed in our strengthening
What are the characteristics of strength training for gait?
• Moderate evidence to support improvement in gait
efficiency
• Questionable transference of strength gains to function
• Training needs to be specific
• Fair to strong evidence supporting increased strength,
gait speed, improved functional outcomes, and improved quality of life (without increase in spasticity)
What are the effects of Partial Body Weight Support Treadmill training in patients with acute stroke?
Fastest speed – longer stride lengths, increased between-limb symmetry, greater muscle activation, higher RPE
What are the general effects of Partial Body Weight Support Treadmill training?
- Facilitate walking recovery and induce activity-dependent plasticity
- Increase strength, endurance, walking function while minimizing risk of overuse injuries
- Enables higher repetition of stepping than could be achieved over ground
- Still many questions on dose, who responds best, when intervention is best
What are the characteristics of High Intensity Dynamic Step Training?
- Looks at continuous stepping practice at multiple, variable environments
- Cardio training at 70-80% HR reserve or 15-17 RPE
- 40- 1 h training sessions over 10 weeks
- Limited BWS, reduced as quickly as possible
- Session included forward treadmill walking, variable walking on treadmill (skill-dependent treadmill training), over ground training, and stair climbing
- Primary focus to increase speed to reach aerobic target intensities as quickly as possible
What is circuit training?
A mode of task-specific exercise using a series of systematically progressed workstations to encourage greater intensity of practice and repetition
What is the primary use of FES for ambulation?
For providing dorsiflexion assist for patients who present with decreased foot clearance (AKA drop foot) during swing phase of gait
What are the effects of FES for ambulation post stroke?
• Faster walking speeds than walking training alone or no
intervention
• Evidence inconclusive
• Further walking distance compared with walking training
alone or no intervention
• FES appears to moderately improve activity compared with
no intervention and training alone
What is the orthotic impact on gait?
- Improve quality of gait, improve gait speed, and reduce energy expenditure during ambulation
- Immediate improvements in functional ambulation categories
- Immediate improvements in gait speed, quality, and endurance
- Increased step or stride length
What is the orthotic impact on balance and other function?
- Immediate improvements in balance
- Decreased fall risk
- Not detrimental to stair climbing and sit<>stand
- Less postural sway, improved weight distribution symmetry
- No data on impact on quality of life or participation
What are the things that PTs need to do when rehabilitating patients in gait post neuro dysfunction?
- Normalize biomechanics
- Control/limit degrees of freedom
- Anticipate problems
- Understand patterns of recovery and treat appropriately
- Facilitate the capacity to walk without abnormal patterns
- Work to make walking automatic
- Match demand to capacity
- Task specific practice and task specific training
- Find a way to increase speed
- Create opportunities for motor learning
What are the principles of Locomotor Training (LT)?
- Maximize Weight Bearing on the Legs
- Optimize Sensory Cues
- Optimize Kinematics for Each Motor Task
- Maximize Recovery Strategies; Minimize Compensation Strategies
❖These are also the basic principles for all recovery based therapy
How do we maximize WB on the LE?
• Maximize WB through all activities
- Minimize the body weight support below 35%, be doing a least 65%
- Minimize UE use
• Carryover of standing during all activities outside of LT environment, progressing the loading through the LE, while minimizing UE compensatory strategies.
Task-specific training needs appropriate ____ sent back to the spinal cord for all posture, standing, and stepping activities as prior to the injury
Task-specific training needs appropriate sensory cues (afferent input) sent back to the spinal cord for all posture, standing, and stepping activities as prior to the injury
How do we optimize sensory cues for Locomotor Training (LT)?
• Increasing treadmill speed to at least 2.0 mph (0.89 m/s)
- Normal Walking is 2.5 mph (1.12 m/s) – 4.0 mph (1.79 m/s)
• Necessary for terminal hip extension
- Combination of loading and hip extension sends signals to the spinal cord which activates the contralateral hip flexors and sends signals that the next
action for the ipsilateral hip flexors is to engage.
• Minimize sensory blocks during LT (ie. heavy shoes)
• Challenge with variation (alternating TM speed, stepping over objects, dynamic or cognitive tasks)
How do we optimize kinematics for Locomotor Training (LT)?
- Must facilitate normal kinematics for all posture, standing, stepping activities to provide optimal sensory (afferent) input.
- Avoid reinforcing compensatory strategies that lead to abnormal kinematics during motor tasks.
How do we maximize recovery,
minimize compensation for Locomotor Training (LT)?
• Activity-dependent plasticity occurs with all activities, so must train/enforce that plasticity with recovery techniques.
• Utilizing the least restrictive device, progressing to eliminating all compensatory external devices.
• Promote independence and develop programs for carryover
when not in the clinic.
What is manually assisted locomotor training?
When you’re utilizing some harness system and facilitating the motion through the legs
What is the evidence behind manually assisted locomotor training?
- Significant improvement in BERG for AIS C and D groups
- Significant improvement in walking distance and speeds in AIS C and D groups
- AIS D had greater magnitude of improvement than AIS C
What is the evidence behind robotic assisted locomotor training?
• LT with robotic assistance is beneficial for improving walking
function in SCI and CVA.
• LT with robotic assistance was not significant for gait speed and endurance for iSCI
• Limited evidence that LT with robotic assistance is beneficial for MS, TBI, or PD
What is the evidence behind robotic assisted locomotor training + Antispasmotics?
- Significant improvements in walking speed in both groups
- No significance for either group over the other
- Antispasmotic did improve the training in the higher-tone individuals
What are the effects of locomotor training in the SCI population?
- For Treadmill, BWS at <30%, speeds with RPE 13/20
- For Overground, cued to walk as fast as possible
- No significant differences in-between groups for speed.
- OG demonstrated greatest improvements with distance.
- Effect size and speed were greatest in OG.
- Speed was same for TS and TM.
- No effect noted for LR.
What is the evidence behind Robotic Assisted LT vs OG?
- Significant Differences in 6 min walk test – UMN/LMN
- Higher Scores for LEMS and FIM-locomotor - UMN/LMN
- Non-significant for 10 MWT, WISCI II
What are the effects of LT- a review?
At this time there is not a significant treatment strategy for
improving gait parameters in patients with incomplete SCI. All forms of LT are equal
What are the effects of locomotor training in patients with stroke?
Even after a year, they can continue to progress in their rehab, with intensive training
What were the interventions used in the STEPS trial by sullivan?
Body-weight supported treadmill training (BWSTT), Limb-loaded resistive leg cycling (CYCLE), LE muscle specific progressive resistive exercise (LE-EX), and UE
Ergometry (UE-EX)
What were the exercise program for each intervention in the STEPS trial?
• BWSTT: 5 min bouts, 20 minutes total walking at 1.5 -2.5 mph, followed by 50 foot overground distance.
• CYCLE: 10 sets of resisted 15-20 revolutions w/ 2 min rest
breaks between sets.
• LE-EX: isotonic exercises for hip flex/ext, knee flex/ext, DF/PF;
with weights/tubes for 3 x 10 each.
• UE-EX: 10 sets of resisted 20 revolutions (alternating
forward/backwards)
Each session lasted 1 hour.
What were the results of the STEPS trial?
• BWSTT combined with UE-EX/LE-EX/CYCLE all demonstrated significant improvements in walking distance (6 min walk test), self-selected and fast-selected walking speed (10 meter walk test).
• Task-specific training using treadmill walking with BWS is
more effective in increasing walking speed than a less taskspecific, resisted cycling training program.
• Endurance improvements were noted for both BWSTT and
CYCLE groups.
• Moderate-intensity LE progressive resistive exercise program did not provide added (significant) benefits after stroke
What are the effects of Robotic LT in the MS Population?
- Significant improvements in FIM and EDSS post-treatment.
- No significant differences in gait parameters between groups post-treatment.
- Gait and functional parameters returned to baseline at 6 months
What is the predominant concern of a caregiver burden of a patient with a TBI?
Less personal time
What is the presentation a female Caregiver Burden of Patients with TBI?
Psychological depression and anxiety
What is the presentation a male Caregiver Burden of Patients with TBI?
Exhaustion and agitation
What are the characteristics of the Caregiver Burden of Patients with TBI?
- Siblings tend to be understudied, but likely have same stress issues
- Lots of persons with TBI will lose their intimate partner
- Dealing with the loss all around
- Recommendations: caregiver education, resources for stress management
What are the characteristics of the Caregiver Burden of Patients with SCI?
• Long duration of care
• Greater risk of physical, psychological and social difficulties in comparison with caregivers of other chronic patients
• Various studies have reported an elevation in levels of physical stress, emotional stress and isolation, which
lead to burnout, fatigue, anger, depression, ill-health, dropping behind social and leisure activities, and financial difficulties
• Potentially a great deal of high physical demand caregiving
• Dealing with physical loss
What are the main sensory impairments seen in patients?
hyposensitivity, hypersensitivity,
anesthesia, reduced discrimination, reduced registration, sensory neglect
What is the impact on function of sensory impairments?
Wide reaching functional impact – walking, other mobility, ADL, vocation
What are the sensory impairments and the prognosis in patients with stroke?
- Total or partial sensory loss, sensory neglect, and or hypersensitivity.
Prognosis: Varied; some sensory return expected
What are the sensory impairments and the prognosis in patients with a TBI?
Hyposensation, hypersensation, paresthesia, or a combination of all.
Prognosis: Sensory abilities change over time as part of recovery; may progress from hyposensitivity (during coma) to hypersensitivity and irritation to more normalized sensation, some deficits may be permanent
What are the sensory impairments and the prognosis in patients with MS?
Loss of sensation, altered sensation, tingling, numbness, and/or painful paresthesia
Prognosis: Progressive demyelination; symptoms come and go but get worse over time; may respond to treatment
What are the sensory impairments and the prognosis in patients with SCI?
Partial or total loss of sensation depending on level and type of injury
Prognosis: Permanent damage; will need compensatory strategies to prevent secondary impairments
What are the sensory impairments and the prognosis in patients with peripheral nerve injury?
Partial or total loss of sensation (and motor function), reflective of the level and type of injury.
Prognosis: Partial or full recovery occurs overtime; may respond to therapy
What are the preparatory intervention for sensory impairments?
• Facilitating sensory recovery and/or compensating for
impairments
• Remember, sensory input may be uncomfortable or difficult to process
• Address underlying or comorbid impairments weakness, tightness, endurance
Sensory intervention not only leads to improvements at the impairment and functional levels but may also affect ___ Providing cutaneous, muscle, and/or articular input through various sensory interventions activates both sensory and motor cortices for up to an hour, providing opportunities for retraining/relearning of both sensory and motor systems
Sensory intervention not only leads to improvements at the impairment and functional levels but may also affect brain plasticity. Providing cutaneous, muscle, and/or articular input through various sensory
interventions activates both sensory and motor cortices for up to an hour, providing opportunities for retraining/relearning of both sensory and motor systems
What are some specific techniques for addressing hyposensitivity as it relates to sensory integration?
- Sensory Integration Therapy – enhanced sensations and active participation
- Consistent participation in sensory modalities may lower sensory threshold required for firing and processing, leading to improved motor outcomes
- Specific recommendation for decreased proprioception – provide deep pressure to joint and muscle sensory receptors
- Activities can’t be random and without purpose – part of bigger picture
What is sensory integration?
The neurological process that
organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment” - Dr. Ayers, 1972
What are some specific techniques for addressing hyposensitivity NOT related to sensory integration?
• Participation in functional training and motor learning
exercises – making the sensory and motor connection
• Intermittent pneumatic compression – effective in treating decreased sensation
• Thermal modalities – effective for hyposensation; alternating hot/cold** Caution **
• Sensory retraining – active exercises to improve localization, increasing awareness and interpretation
• NMES and TENS
What are some compensatory strategies in patients with hyposensitivity?
- Home and workplace modifications
- Use of assistive devices
- Cushions, mattress overlays, etc…
- Translating sensory input from a hypo functioning are to intact area
What are some specific techniques for addressing hypersensitivity?
• Sensory Integration Therapy • Brushing Protocol • Vibration *Caution • Compensatory Strategies - Environment mods - Avoidance of sensory stim - External compression
What are some specific techniques for addressing parathesia?
- Altered and uncomfortable sensations, including numbness, tingling, stinging, burning, or pain
- Estim
