2.2- Neuro Techniques (Bag of tricks)- Lab Lecture

Question 1

Activates joint receptors, facilitates postural extensors and stabilizers

Answer 1

approximation (joint compression)

Question 2

Apply force through joints by gravity, manual contacts or weight belts, bouncing sitting on a ball

Answer 2

approximation (joint compression)

Question 3

Indications- instability of extensors in weightbearing, poor postural static control/weakness

Answer 3

approximation (joint compression)

Question 4

Activates joint receptors, facilitates agonists and joint awareness especially with flexor patterns especially when pulling

Answer 4

joint traction
(apply using manual traction)

Question 5

Movements are guided or actively assisted in some way

• promotes early learning during acquisition of new motor skill
• can be graded according to needs of client

Answer 5

Guided movement (GM)

Question 6

Indications- inability to move, poor tactile/kinesthetic perception

Answer 6

Guided movement (GM)

Question 7

Slow isotonic shortening contraction through the range followed by eccentric lengthening contraction using same muscle group
- used with bridging, sit to stand, step up/down

Answer 7

Agonist reversal (ARs)

Question 8

Indications- weak postural muscles, inability to eccentrically control body weight, poor dynamic postural control

Answer 8

Agonist reversal (ARs)

Question 9

Isometric holding of agonist followed by antagonist on other side of joint
- resistance applied in any direction

Answer 9

Alternating isometrics (AI)
(push on both sides- "Don't let me move you")

Question 10

Indications- instability in weightbearing, poor static postural control, weakness

Answer 10

Alternating isometrics (AI)
(push on both sides- "Don't let me move you")

Question 11

Voluntary relaxation followed by passive movement through range, then active assistance followed by light facilitory tracking resistance (can be unidirectional or bidirectional)

Answer 11

Rhythmic initiation (RI)
(passive to active assisted to resistance)

Question 12

Indications- inability to relax, hypertonicity, inability to initiate movement, motor learning deficits

(looking for abnormal pattern of movement)

Answer 12

Rhythmic initiation (RI)

Question 13

Isometric contractions of agonist followed by the antagonist, performed without relaxation using graded resistance resulting in co-contracture of opposing muscle groups

Answer 13

Rhythmic stabilization (RS)

back and forth resistance in position you want them in- push on both sides- “Don’t let me move you”

Question 14

Best at shoulder girdle, pelvic girdle, trunk

Answer 14

Rhythmic stabilization (RS)

Question 15

Indications- instability in WB, poor static postural control, weakness

Answer 15

Rhythmic stabilization (RS)

Question 15

Provides stimulation via quick stretch to the muscle spindle, applied to the muscle belly or tendon

Answer 15

Tapping

Question 16

Indications- weakness, hypotonia

Answer 16

Tapping

Question 17

Activates muscle spindles which facilitates agonist contraction and antagonist inhibition

Precaution - may increase spasticity

Answer 17

Quick stretch

Question 18

• most effective when applied in lengthened range to initiate a voluntary contraction
• actively uses the stretch reflex arc

Answer 18

Quick stretch

Question 19

Force exerted by the muscle activates spindles and GTOs which enhances muscle contraction by facilitating agonist and inhibiting antagonist, recruits additional motor units and enhances kinesthetic awareness

Answer 19

Resistance

Question 20

• techniques include manual resistance, body weight/gravity, weights
• can increase spasticity and cause substitution if too much resistance is used

Answer 20

Resistance

Question 21

Applied to sensitive ares such as the hands as light strokes with fingertips, quick icing, or light pinch/squeeze to elicit withdrawal

Answer 21

Light touch

Question 23

• patient accommodates rapidly but good to mobilize a low response pt such as TBI
• contraindicated with PT’s who have autonomic instability or are agitated/combative

Answer 23

Light touch

Question 24

Inhibit abnormal movement and tone or reflexes, also facilitates normal tone and movement patterns

Answer 24

Handling

Question 25

Indications- inability to move due to spasticity

Answer 25

Handling

Question 26

- key points of control - proximal key points (head, trunk, shoulders, pelvis) - used to develop control of proximal segments before working on distal (also help influence ton through entire limb) - distal key points (hands and feet)

Answer 26

Handling

Question 27

Handling~ 1. Head and trunk - flexion decreases ______, trunk and limb _________ 2. Humerous - _____ and ______ to 90 degrees decreases flexion tone of UE 3. Hip - Femoral _____ and _____ decreases extensor adductor ton of LE 4. Thumb - ____ and ____ with forearm _____ decreases tone of wrist and fingers

Answer 27

1. Head and trunk- flexion decreases shoulder retraction, trunk and limb extension 2. Humerous- ER and flexion 3. Hip- ER and abduction 4. Thumb- ABD and ext with forearm supination

Question 28

Done at end of limited ROM- isometric contraction at end of range followed by voluntary relaxation and passive movement into new range

Answer 28

Hold-Relax (HR) (isometric contraction against the clinician's resistance- contraction of antagonist/tight muscle- stimulates GTO) Autogenic Inhibition

Question 29

Indications- Limited ROM due to muscle tightness and spasticity

Answer 29

Hold-Relax (HR) and/or Contract-Relax (CR) and/or Contract-Relax Active Contraction (CRAC)

Question 30

Isomeric contraction at end of range followed by active contraction into new range (maintains inhibitory effects through reciprocal inhibition)

Answer 30

Hold-Relax Active Contraction (HRAC) (after isometric contraction of antagonist, pt is instructed to concentrically contract the agonist muscle to move to new range) Both Autogenic and Reciprocal Inhibition

Question 31

Isotonic movement in rotation through available range followed by isometric hold at end of range against slowly increasing resistance, then followed by voluntary relaxation and passive movement into the new range

Answer 31

Contract-Relax (CR) (pt contracts the antagonist concentrically for 10 sec against manually applied resistance) Autogenic Inhibition

Question 32

Similar to CR except movement into the new range is active not passive (maintains inhibitory effects via reciprocal inhibition)

Answer 32

Contract-Relax Active Contraction (CRAC)

Question 33

Voluntary relaxation combined with slow, passive, rhythmic rotation of the body or body part around the longitudinal axis followed by passive range out of the spasm

Answer 33

Rhythmic Rotation (RRo) (traction of the joint & rotation/wobble at the same time) Goal: to increase mobility

Question 34

Indications- hypertonia

Answer 34

Rhythmic rotation (RRo)

Question 35

Slow and prolonged activates muscles spindles & GTOs to inhibit muscle tone

Answer 35

Prolonged stretch

Question 36

Includes manual stretch, inhibitive casting, reflex-inhibiting positioning, and mechanical low load weights

Answer 36

Prolonged stretch

Question 37

Maintained contact or pressure which activates parasympathetic nervous system- causes calming effect and general inhibition and desensitizes skin receptors

Answer 37

Maintained touch

Question 38

- applied through firm manual contacts, pressure to abdomen, back, palms, or soles of feet, rubbing - good for highly aroused pts and hypersensitive

Answer 38

Maintained touch

Question 39

slow stroking applied over the PARAVERTIBRAL SPINAL REGION to cause generalized calming effect

Answer 39

Slow stroking (speed & pressure is key)

Question 40

- patient is placed in supported position such as prone or sitting with head and arms supported on a table - use flat hand to apply firm strokes down paraspinals for 3-5 min - good for highly aroused clients with increased sympathetic (fight or flight) response

Answer 40

Slow stroking

Question 41

Retain body heat which decreases generalized tone- includes wrapping with Ace or towel, snug clothing, air splints for 10-20 min - good for high arousal and spasticity

Answer 41

Neutral warmth