Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MSK 2 > 3c - TBC Mvmt Control & Path > Flashcards

3c - TBC Mvmt Control & Path Flashcards

1
Q

what is mvmt control and what is it influenced by

A

way in which nervous system controls posture and mvmt to perform given motor task

influenced by:
- available mvmt of passive systems
- available mvmt of active systems
- control/timing of NM system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

passive vs active system factors and examples of each

A

passive = no volitional control
- joint
- bone
- cartilage
- ligament
- neural structures

active = volitional, can turn on and off
- contractile structures
- endurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are 3 components of NM system control which ultimately impact mvmt control

A

ms activation
acquisition
assimilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the 2 main components of mvmt control schema

A

local mobility
global stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

local mobility vs global stability

A

local mobility:
- lumbar spine and adjacent regions should (I) possess adequate neural and joint mobility and soft tissue compliance

global stability:
- ms of lumbar spine generate isolated activation can be coordinated w various joint mvmts and incorporated into ADLs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

mvmt control vs motor control

A

mvmt control DOES NOT EQUAL motor control
- stability part of motor
- motor component of mvmt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what types of structures fall under local mobility and what are 3 examples

A

passive structures
- neural mobility
- joint mobility
- soft tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how does neural mobility impact local mobility and how can this be assessed

A

can nerves tolerate mechanical loading
- tension, glide, elongation, angulation

neural tension tests
- slump test, SLR, fem n. tension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how does joint mobility impact local mobility and how can this be assessed

A

does lumbar spine possess proper joint alignment and ability to move freely w/i physiologic limits

PPIVMS, PAIVMS, shear test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how does soft tissue impact local mobility and are examples of these tissues

A

can soft tissue of/around lumbar spine undergo elastic deformation when manual pressure or passive change of joint position are applied

hamstrings, quads, QL, psoas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the continuum of components which fall under global stability

A

activation
acquisition
assimilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is activation (component of global stability) and what are common examples of deficits in activation

A

ability of individual to generate isolated contraction and/or simple mvmt pattern

TrA, multifidi, scap retractors, breathing pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is acquisition (component of global stability) and what are common examples of deficits in acquisition

A

whether mvmt is dissociated or coordinated between lumbar spine and adjacent regions
- can mvmt be maintained in higher level intensity things

active SLR, active hip ext, active hip ABD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is assimilation (component of global stability) and what are common examples of deficits in assimilation

A

assesses how newly acquired skills are integrated in ADLs utilizing multiplanar mvmts under dynamic loading condition

squats, lunges, rotational mvmt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are examples of activation interventions

A

training activation of hypoactive ms or isolated mvmt patterns

ex: ab hollowing, scap retraction, breathing pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are examples of acquisition interventions

A

training to acquire skill of dissociated or coordinating mvmts of lumbar spine and adjacent regions

ex: single plane co-contraction exercises, balance, and coordination exercises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are examples of assimilation interventions

A

training to assimilate loaded multiplanar mvmts into ADLs

step up/down progression
STS progression
multi-planar progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

is motor control different in those with LBP

A

trunk ms activity
trunk alignment, posture, and mvmt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how is trunk ms activity different in those w LBP, why and what is the problem with this?

A

deeper ms like TrA and multifidi more consistently inhibited
superficial ms inc

when in pain, body adaptively tenses up to protect you
- results that superficial ms are often first to engage since easiest -> creates cycle of not activated deep stabilizing structure

problem bc deep ms line of pull is best for stability w/o too much compression or shear
- superficial ms line of pull is different bc meant to move spine, not stabilize

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how is trunk alignment, posture, and mvmt different in people w LBP

A

tend to find larger postural sway

dynamic mvmt tasks are typically performed slower

stronger coupling of thoracic and pelvic mvmts and dec variability of trunk mvmt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the 3 main ms targeted for activation interventions

A

TrA
multifidi
pelvic floor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

screening vs clinical vs diagnostic assessments for TrA activation

A

screening:
- abdominal draw in supine
- palpation

clinical:
- abdominal drawing in prone w PBU

diagnostic:
- measure of deep ms function w fine wire EMG, real time US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

cues for teaching action of TrA and what are considerations

A

relax abs
draw up and in
slow and controlled, hold for 10sec

avoid trunk, pelvis mvmt
dissociate breathing
- count outloud if trouble dissociating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the ab draw in test prone w PBU and why doesn’t Mr. Steve like to do this

A

PBU inflated to 70mmHg
breath out and hold
draw in slowly
hold 10sec x10reps
norm: dec of 6-10mmHg

he doesn’t do this much bc he wants them out of activation phase so don’t want to train them in activation phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are compensatory patterns for a weak TrA to watch for (7)
breath holding oblique activation inc rectus ab activity trunk forward flex inc WBing thru feet post pelvic tilt mvmt of pelvis, trunk, or LEs
26
how can you tell if there is oblique activation compensating for TrA
if ms pops out - should feel ms flatten and draw out w activation
27
where is the easiest spot to palpate multifidi
off PSIS and move slightly in and up
28
what is a cue for multifidi activation in prone and what do you look for when palpating multifidi in standing
"swell out into my fingers" activation, activity w mvmt, feedforward mechanism - can they maintain engagement
29
most people will have problems actively engaging their multifidi, what is a cue that can help
draw in TrA
30
how can you teach pts to turn on multifidi themselves
utilize feed forward mechanism - have them shift forward, left to right, chop arm up - have them palpate the ms activation --> after feel the contraction w mvmt, try to have them do an isometric contraction *don't let them get frustrated, just try again later
31
what are cues for pelvic tilts
PT place hand under lower back - have them apply pressure onto hand (post tilt) have them put their hands on hips in C shape - passively rock hips back and forth and pay attention to way hands move ---> external cue that can transition from supine to standing
32
at what point do we determine someone is ready to move on from activation to acquisition
once they have achieved TrA, pelvic tilt, and multifidi
33
what are 6 acquisition interventions
active SLR dead bug w PBU bent knee fall outs w laser hooklying flies/OH abs w laser anti-rotational punch (palloff) ball sitting
34
what is the major ms are we targetting in PBU dead bugs in mvmt acquisition
psoas - if unable to dissociate and hip comes up, see lumbar spine enter ext as psoas pulls eccentrically on it
35
what is a consideration w external cues like a laser being used in mvmt acquisition interventions
people get good at compensating - make sure not drawing in and using rectus
36
what mvmt acquisition intervention assesses a higher level of endurance and control
double leg lower and isometric hold - can they maintain a neutral pelvis
37
what are 6 mvmt assimilation interventions
HKE back facing rotation squatting w pelvic neutral lunging w pelvic neutral step ups jumping
38
what is the issue w squatting w your chest out
stability is coming from passive structures and as a result are putting more stress on them
39
what is the bridge between TBC mvmt control and functional optimization
endurance
40
what is the bridge between TBC sx modulation and mvmt control
mobility
41
what are components to complete a higher level clinical eval of spinal control
lateral ms test extensor endurance test flexor endurance test
42
the the ratio from lateral ms endurance testing isn't 1:1, what is this a predictor of
recurrent back pain
43
what is the lateral ms endurance test
side plank test pt maintains position as long a possible w proper form time length should be a 1:1 ratio b/w sides
44
who is not appropriate for an extensor endurance test
someone just out of sx modulation stage or w a lot of pain - not ready and tissues not ready for it
45
what is the extensor endurance test
prone w lower body on table and torso off table - pt hold in neutral as long as possible w proper form
46
what is the flexion endurance test and what is a common compensation seen
back is at 60deg from horizontal w hips and knees in 90deg alignment - pt holds for as long as possible w proper form ex: excessive flexion of spine
47
what is the flexion to extensor strength endurance ratio and why
flexor:extensor should be <0.75 extensors should be stronger than flexors bc often fighting gravity - gravity is often on side of flexors w bending over, etc.
48
what does OPTIMAL stand for in the OPTIMAL Theory of Motor Performance
Optimizing Performance Through Intrinsic Motivation and Attention for Learning
49
what are the common theories for motor performance and what does Mr. Steve have qualms about their use
blocked vs random variable vs constant factors approach learner as a computer-like processor of info and not taking into account motivational factors
50
cultural vs social context to behavior
cultural: - norms and stereotypes ab appropriate or expected activities for a certain age, gender, or ethnic group social: - motor behavior observable and often performed in public - the presence of another person may provide reassurance or additional pressure
51
how does cognitive context impact motor learning
can slow or speed - focus on coordination or intended mvmt effects respectively
52
what are the 3 main things to think about when setting up exercises that will facilitate motivation
1. enhance expectancies 2. autonomy support 3. external focus of support
53
what is the concept of enhanced expectancies
idea of improving the learner's forward directed anticipatory or predictive cognitions or beliefs ab what is to occur - building their confidence and self-efficacy
54
self-efficacy vs confidence
confidence - past successful experiences or lack thereof - primary theoretical determinant of self-efficacy self-efficacy - individual's situation-specific confidence or prospective sense that he or she will be able to affect actions that bring about task outcomes
55
what are strategies to enhance expectancies in pts
positive feedback challenge them but not too much - perceived task difficulty - conceptions of ability positive affect extrinsic reward (happy in environment) self-modeling social comparative feedback
56
what is autonomy support and what is a strategy to facilitate this
allowing individuals to exercise control over environment give learners choices even if incidental - existence of inherent reward w exercise of control
57
what pt population will benefit from encouraged autonomy support as a strategy
chronic pain
58
external vs internal focus of attention and which is more effective
external focus on intended mvmt effect - ex: on an implement internal focus on body mvmt - ex: squeeze your glute ms
59
what is the result of learners adopting an external focus
mvmt kinetics start to resemble those typically seen at later stages of learning (experts)
60
what are directions to give to facilitate an external focus of attention
instructions directing attention away from one's body parts or self and to intended mvmt effect
61
age demographic of isolated acute HNP vs disc degeneration
isolated acute HNP = younger pts degen = 40s-50s
62
what are 4 types disc dysfunction seen
protrusion (bulge) herniation/extrusion - disruption of annular lig / PLL sequestration (free floating) derangement - breakdown of integrity of annulus but no bulging
63
where in the spine are disc prolapses most common
L4/5 L5/S1 L3/4
64
what is a consideration of disc prolapses picked up on imaging
they can often be asymptomatic
65
how can the location of disc herniation affect the presentation and what are examples
post lateral - nerve root **most common** post central (large) - cauda equina syndrome - (B) sx far lateral - nerve root variations (ie IVF)
66
what is a consideration for a lateral disc herniation impacting the nerve root at the IVF
might not see all changes in the LQ scan - but for true radiculopathy, have to see changes in all
67
what TBC classification categories are disc dysfunction associated with
SM: traction/ active rest SM: direction preference ext SM: direction preference flex SM: direction preference lateral shift mvmt control functional optimization
68
L3-4 disc (L4 NRCS): strength, sensation, reflexes, pain
strength: quads, tib ant sensation: med first toe, ant-med calf reflexes: patellar pain: ant thigh
69
L4-5 disc (L5 NRCS): strength, sensation, reflexes, pain
strength: ext of big toe sensation: lat calf reflex: none pain: back of thigh, lat calf
70
L5-S1 disc (S1 NRCS): strength, sensation, reflexes, pain
strength: gastroc plantar flex sensation: lat foot and heel reflexes: achilles pain: back of thigh and calf
71
what is spinal stenosis and what is it on the continuum of
can be anything that narrows the spinal canal or intervertebral foramen continuum of DJD/OA
72
why and how can the presentation of spinal stenosis vary
if more lateral = nerve root more central = spinal canal
73
spinal stenosis: demographics
>50yo
74
spinal stenosis: MOI
insidious in older individuals (>50yo)
75
spinal stenosis: aggravating factors
extension based activity - walking, standing, standing from a chair
76
spinal stenosis: relieving factors
sitting, leaning forward, grocery cart - similar to flex directional preference
77
spinal stenosis: ROM, joint play
limited/painful ext hypomobile lumbar/thoracic spine hypomobile fem acetabular joint
78
spinal stenosis: ms strength/control/endurance, flexibility and ms length
weak glut max/med poor pelvic control poor TrA, multifidi activation stiff psoas and/or rectus fem
79
spinal stenosis: neuro exam
may have myotomal weakness may have sensory deficits depends on location of stenosis (lat)
80
spinal stenosis: significant special tests
(+) two-stage treadmill test possible signs of neurogenic claudication possible signs of NRCS - dependent on location of stenosis (lat)
81
neurogenic claudication vs vascular claudication
neurogenic: - intermittent pressure on the SC vascular: - insufficient blood supply d/t PVD
82
two-stage treadmill test and how can it be used to differentiate
begin walking on treadmill normally, record time to sx rest 5min walk on treadmill w incline until sx uphill facilitates lumbar flex - as you flex opens up foraminal areas - can walk longer than if PVD on incline - early onset w no incline significant correlation to spinal stenosis vascular - uphill requires more work and more effort placing higher stress load on CV system - shorter walking time on incline associated w PVD
83
what are the 4 areas of intervention for stenosis
pain control centralization/specific exercise and traction mobility/manip conditioning/stabilization
84
what are 6 specific interventions for stenosis
traction/joint mobs flex specific exercise (based on direction preference) aerobic exercise (bike) posture (neutral to flex bias) body mechanics - post pelvic tilt education on provocative positions
85
what is the prognosis/natural course of stenosis
majority do not progress - this is the stenosis itself, sx can get much better
86
what are medical interventions for stenosis
pain control via rest & analgesics epidural/cortisone injections surgery - decompression (ie laminectomy) - discectomy for lumbar disc prolapse
87
what are surgical indications for spinal stenosis
cauda equina syndrome - (B) leg pain, saddle anesthesia - urinary retention/incontinence, loss of rectal tone pain persistent at least 6wks of non-op treatment - leg pain >back pain at least 12wks - (+) neuro signs, progressing - evidence of path corresponding w levels of sx
88
decompression vs laminectomy
decompression - shave bone out laminectomy - remove lamina and give more room for SC
89
what spinal stenosis surgical procedure had the best outcome and what is the caveat to that
discectomy - faster relief than conservative management doesn't appear to be a long term difference, same functional outcomes to conservative care
90
what are 3 common precautions after a spinal stenosis surgical procedure
avoid excessive bending, lifting, twisting - 6wks corset - prevents excessive strain across site avoid sitting prolonged intervals (compression) **read the post-op note!
91
what types of exercises might you emphasis post surgery in spinal stenosis
flexion biased exercises
92
what are education points for individuals post op for spinal stenosis
protect, ms control, body mechanics
93
what TBC categories does spinal stenosis fit into
SM: mob/manip SM: traction / active rest SM: direction preference flex mvmt control
94
spondylolysis vs spondylolisthesis
spondylolysis - defect in pars articularis spondylolisthesis - ant slippage of vertebra
95
spondylolisthesis: demographics
adolescents (women) gymnasts/ volleyball/swimming - ext based
96
spondylolisthesis: pain patterns
pain d/t affected structures - typically back pain
97
spondylolisthesis: aggravating and relieving factors
aggravating: - jumping (landing), running, twisting, ext motions relieving: flex biased motions
98
spondylolisthesis: posture
excessive lordosis lumbosacral step
99
spondylolisthesis: joint signs/mobility
hypermobile PA (+) shear
100
spondylolisthesis: muscle function
ms imbalance b/w hip flex and ABD
101
what are 4 categories of interventions for spondylolisthesis
pain control centralization / specific exercise and traction mobility / manipulation conditioning / stabilization
102
what is a thought about pts w spondylolisthesis in the TBC sx modulation group
moves to mvmt control quickly likely sx as a result of having trouble finding neutral
103
what are specific conservative interventions for spondylolisthesis
restore posture and quality of ROM flex biased exercise (TBC SM DP flex) stabilization (neutral spine) --> TBC mvmt control education
104
when are surgical interventions indicated for spondylolisthesis and what are 2 examples of interventions
w neural compromise fusion decompression
105
what TBC groups do spondylolisthesis fit into
mvmt control SM DP: flex
106
facet dysfunction: demographic
age 20-40yo - all ages possible
107
facet dysfunction: MOI
quick twist, SB - "threw my back out"
108
facet dysfunction: sx description
sharp localized pain may relieve as day goes on described feelings of stuck
109
facet dysfunction: aggravating factors
ext pattern / quadrant prolonged standing / positions
110
facet dysfunction: relieving factors
sitting flexion w mvmt
111
facet dysfunction: exam findings
+/- list (lateral shift) para-vertebral tenderness (+) quadrant / compensated mvmts (+) unilateral PPIVMS/PAIVMS
112
if someone has facet dysfunction what do you have to decide in order to proceed w interventions
if d/t: - hypomobility - hypermobility
113
facet dysfunction d/t hypomobility interventions
pain control (earlier on if reactive) mobility/manips - restore ROM education
114
facet dysfunction d/t hypermobility interventions
mobility/manip - restore ROM conditioning/stabilization - prevention - trunk stabilization - motor control - aerobic exercise
115
what TBC categories does facet dysfunction fit into
SM: manip/mob SM: traction/active rest mvmt control SM DP: lat shift
116
what is the pathophys of spondylosis (DJD, OA)
result of new bone formation in areas where structures of spine are sressed
117
typical clinical findings of lumbar spondylosis
usually no sx - usually no findings unless complication ensues
118
spondylosis: subjective demographics and c/o
older person 60+ insidious arthritic complaints - worse in morning, better w mvmt, worse w too much mvmt
119
spondylosis: exam findings
loss ROM ext and ipsi SB and rot - one side more than the other (+) joint signs multiple levels
120
spondylosis interventions
pain control mobility/manip - joint mobs, ROM, flexibility conditioning/stabilization - aerobic program - posture
121
what is hypermobility and what can this lead to
loss of spinal stiffness can result in spondylothesis
122
hypermobility: demographic and pain pattern
age <40 recurrent pattern, switches sides, unstable
123
hypermobility: aggravating factors
walking STS prolonged positions changing positions
124
hypermobility: (+) exam findings
thigh climbing, catch pain thru motion, reverse lumbar lordosis (+) shear, (+) PA testing, protective spasm poor ms patterning, dec tone SLR >91deg (+) prone instability test aberrant motion present
125
what TBC category does hypermobility fit in
mvmt control - sx often not severe - if severe sx, figure out direction preference and then move to mvmt control

MSK 2 (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions