discussion

Question 1

What is the differences between PNF and NDT and how they are administered?

Answer 1

PNF focuses on stretching techniques combined with isometric contractions on the target muscle in order to gain better motor control, rehabilitation and flexibility.

NDT involves a great deal of patient handling and facilitation focusing on sensorimotor processing, task performance and skill acquisition during functional/meaningful movements (such as sit to stand) in order to achieve efficient motor control

Question 2

Which of the 2 treatment philosophies (PNF and NDT) adds resistance and which one reduces resistance

Answer 2

PNF adds resistance and NDT reduces resistance

Question 3

Of NDT and PNF which would you rely on in early stages of rehab

Answer 3

NDT in the earlier stage of rehab for most patients and progressively add PNF into the mix as patients gain strength. PNF affords specificity of movement with a gradient-dosed “appropriate” amount of resistance. I don’t use one or the other exclusively, I’m not a purist. I find them complementary and incorporate them both.

Question 4

Of NDT and PNF which affords specificity of movement

Answer 4

PNF affords specificity of movement with a gradient-dosed “appropriate” amount of resistance. I don’t use one or the other exclusively, I’m not a purist. I find them complementary and incorporate them both.

Question 5

The NDT principles are

Answer 5

The NDT principles include things like verbal and manual cues and techniques are the task-specific activities such as upright sit and transfers.

Question 6

PNF: Emphasis is on

Answer 6

on developmental sequencing of movement

Question 7

NDT: based on and Emphasis?

Answer 7

NDT: based on normal development and movement

Emphasis on:
    Normalizing muscle tone
    Inhibiting primitive reflexes
    Facilitate normal postural reactions
    Having patients re-learn normal movement patterns

Question 8

PNF Techniques

Answer 8

Techniques are used one at a time based on the task the clinician wants to accomplish: rhythmic initiation, replication, combination of isotonics, scapular anterior elevation, scapular posterior depression, UE D1 flexion, and UE D1 extension

Question 9

Principles used in NDT

Answer 9

verbal and manual cues.

Question 10

NDT Techniques:

Answer 10

Techniques: handling, weightbearing, and positions that encourage use of both side of body can inhibit / facilitate muscle tone through functional tasks such as hip hiking, forward & backward scoot, and transfers

Question 11

What does unidirectional versus bidirectional mean with respect to muscles?

Answer 11

unidirectional movement is targeting a single group of muscle agonists to fire in one direction

bidirectional movement targets both the agonist and antagonist muscle groups to fire allowing movement in opposite directions.

Question 12

What are the PNF techniques

Answer 12

Rhythmic Initiation- unidirectional technique

Replication- unidirectional technique

Combination of Isotonics- unidirectional technique

Question 13

What is Rhythmic Initiation Goal

Answer 13

Rhythmic Initiation- unidirectional technique
Goal is to teach patient how to move and initiate the motion and to teach therapist proper body techniques to coordinate the motion from the patient’s stand point.

Question 14

What is Replication Initiation Goal

Answer 14

Replication- unidirectional technique
Goal is to teach patient meet the specific ending position by moving their UE in particular pattern.

.

Question 15

What is Combination of Isotonics

Answer 15

Combination of Isotonics- unidirectional technique

Goal is to increase AROM, strength, coordination and endurance eccentric control.

Question 16

Explain Rhythmic Initiation Goal

Answer 16

Sequence of pain-free ROM using D2 pattern: Relax the arm -> PROM-> (command word to go up independently) AAROM-> ARROM-> AROM

Question 17

Explain Replication Initiation Goal

Answer 17

Using D2 pattern place patients joint in end position and resist stronger agonist using isometric contraction followed by relaxation, small PROM away from end position, then ask patient to return to end position with AROM or AAROM this will teach patient to reach the end position using particular pattern

Question 18

Explain Combination of Isotonics

Answer 18

Using D2 pattern resist agonist using following sequence: concentric, isometric then eccentric without relaxation.

Question 19

Which of the 3 PNF techniques is the first one used on a given patient?

Answer 19

Rhythmic Initiation is the first to be used on a given patient of the 3 PNF techniques.

Question 20

The PNF principles are:

Answer 20

Manual Contacts
    Resistance 
    Traction
    Approximation
    Quick-Stretch
    Body Mechanics and Position
    Visual Stimulus
    Verbal Stimulus
    Patterns

Question 21

How many PNF principles can you at once

Answer 21

several as many as needed

Question 22

Occupational examples: diagonal movement

Answer 22

diagonal movement- meal prep using trunk rotation and extension and reaching for items in the cupboard above the patient

Question 23

Occupational examples rotary movement

Answer 23

a child playing on a merry-go-round or dancing in circles
a child playing on a merry-go-round or dancing in circles
a child playing on a merry-go-round or dancing in circles
a child playing on a merry-go-round or dancing in circles

Question 24

Occupational examples curvilinear movement

Answer 24

a person sliding down a water slide and their body moving in a curvilinear motion

Question 25

Is the D2 UE pattern simultaneously a diagonal, rotary, and curvilinear movement?

Answer 25

s simultaneously a diagonal, rotary, and curvilinear movement. That is, the UE is moving diagonally from one’s contralateral hip toward the ipsilateral shoulder; the trunk is rotating toward the direction of the movement; and the hand is moving in a curvilinear fashion (not in straight line) as it travels across the D2 UE movement arc

Question 26

What term do use to describe permanent change?

Answer 26

A term that describes permanent change is plasticity.

Question 27

What aspects of Motor Learning should be incorporated into NDT when working with patients

Answer 27

Practice. Practice helps the task become an internal process and experience that eventually leads to a relatively permanent change in the capability for skilled behavior and is highly dependent upon patient familiarity.

Question 28

What are other synonymous terms for task-oriented learning?

Answer 28

Motor learning and function-based learning

Question 29

What are some impairments that contribute to functional limitation?

Answer 29

could be AROM strength
imbalance
incoordination
decreased sensation

so we treat the impairment with the expectation that improved strength and AROM will provide greater independence with the functional activity. I don’t think we ever directly treat the function, rather, we treat the impairment in function specific environments.

Question 30

Which of the 3 motor learning steps resonates most closely with “efficiency”?

Answer 30

Autonomous (Success) resonates most closely with “efficiency”.

Question 31

The stages of motor learning to think about when performing NDT.

Answer 31

understand the cognitive (what),
associative (how)
autonomous (success)

Question 32

What are reasons behind facilitating proper movement patterns and relearning tasks focusing

Answer 32

on proximal extremities first and moving distally.

Question 33

what is potentially driving improved limb and trunk movement to accomplish a given task.

Answer 33

neural plasticity of the CNS.

Question 34

NDT :Neuro-Development Treatment was founded by

Answer 34

Karel and Berta Bobath in the 1940’s

Question 35

NDT is a philosophy aimed

Answer 35

to restore and improve functional motor control in an individuals’ neuromuscular system

Question 36

How is NDT done

Answer 36

is done so by utilizing a problem solving sequence, key points of control, and working within a suitable environment.

Question 37

In terms of Problem Solving sequence, Therapist will:

For NDT

Answer 37

• Ask for movement
• Facilitate movement
• Assess passive movement
• Integrate movement

Question 38

“appropriate environmental construct”, what motor control theory does this sound most like?

Answer 38

Systems theory Because this theory emphasizes that the external environment can affect movement.

Question 39

provide an example of proximal key point of control for a movement of your choosing?

Answer 39

the pelvis to during standing to initiate better standing balance and postureif we consider that the trunk and LE’s are driving the movement and the pelvis is removed from these areas

Question 40

Another example is facilitating

Answer 40

shoulder joint external rotation to encourage upright sitting posture.

Question 41

The objectives of NDT are to:

Answer 41

• Normalize muscle tone
  
  • Inhibit primitive reflexes and eliminate abnormal movements
  • Facilitate normal postural reactions
  • Help clients re-learn normal movement patterns
  • Improve the quality of movement

Question 42

What are various techniques that therapists use to achieve the above objectives. Some of these techniques include:

Answer 42

• Handling techniques
  
  • Weightbearing of affected limb(s)
  • Use positions that encourage the use of both sides of the body
  • Avoid sensory input that adversely affects muscle tone
  • Avoid activities that strengthen abnormal movement responses

Question 43

NDT is goverened by:

Answer 43

The Problem Solving Sequence: 1) ask for movement, 2) facilitate movement, 3) passive movement assessment, 4) mobilize and/or stretch, and 5) integrate movement
Key Points of Control: proximal, distal
Working within an appropriate environmental construct

Question 44

A type of intervention that works to increase quality of movement by restricting abnormal movements and promoting normal functional movements.

Answer 44

NDT

Question 45

Why do we provide the patient the least amount of facilitation required when using NDT?

Answer 45

The objective is to encourage functional independence. When you provide the least amount of facilitation, you allow the patient to learn how to move with minimal dependence from another person.

Question 46

How can we document the amount of assistance delivered for NDT?

Answer 46

We can use the FIM guidelines to determine assist level and proximal versus distal key points of control as one example of documentation.

Question 47

Is it possible that the least amount of facilitation required is maximum assistance using proximal key points of control to safely transfer from sitting at bedside to a bedside chair?

Answer 47

It is possible for the least amount of facilitation to be the maximum assistance using the key points of control to safely transfer. A NDT transfer would require the least amount of facilitation to transfer and the manual contacts would be on the posterior trunk and the weaker anterior knee.

or if the client is not cognitively impaired they can still participate in problem solving and visualizing the correct sequence of movements in the transfer.

Question 48

The client should be given an opportunity to solve the problem. How does that process influence motor learning?

Answer 48

Allowing opportunities for the client to problem solve facilitates the experience and practice needed for relatively permanent motor learning. Also, clients participate in active decision making as they develop the strategies needed for motor planning and function.

Question 49

What motor learning term describes performing a variety of similar tasks even though there may have only been formal practice in a single environment?

Answer 49

generalizability

Question 50

What is the term accounting for performing similar tasks in a variety of environments?

Answer 50

resistance to contextual change