Contrived techniques Flashcards
“Artificial” or “deliberately created” rather than arising naturally or spontaneously; Purpose is to use a sensory system to get a motor response; Use early on as an adjunct to treatment
Contrived treatment technique
- intervention is temporary; PT needs to fade back use of techniques
- uses input system to get motor response
What are the types of input systems?
- proprioceptive
- vestibular
- exteroceptive (hearing, smell, vision, sound etc)
When would you stop using contrived techniques?
Since it’s use is temporary..
- Pt is gaining more conscious control/volitional control
- If it’s not working
What are the proprioceptive deep sensory receptors?
- Muscle Spindle - found in belly of muscle; use for facilitation
- GTO - Found at ends of muscle (PROX/DIST); Used for inhibition
- Joint Receptors - joint capsule, ligaments; Used for facilitation; ex. approximation to help postural muscles kick in and they stand
What sensory receptors are type Ia, Ib, II, III, and IV affarents?
Ia = m spindle, annulospiral ending Ib = GTO II = m spindle, flower spray III = pain and temp IV = Pain and other receptors
Toward the middle of the spindle; Annulospiral nerve endings; Respond to change in velocity (quick stretch)
Type Ia, m spindle
- dampen spasticity in shortened position
Toward the end of the spindle; Flowerspray nerve endings; Respond to increase in muscle length
Type II, m spindle
- dampen spasticity in shortened position
Sensory receptor that responds to tension; Located in the muscle tendon – at proximal and distal tendons; Used for inhibition
Type Ib, GTO
- contract/relax technique
How do use the GTO to get more ROM in a person who has spasticity?
- Stretch the muscle - SLOW/ PROLONGED stretch, so spastic m. has a chance to respond might feel m. “let go” at some point, and get more range
- have to evaluate if it’s worth it in terms of PT progress (incr ROM may only last 10 mins), BUT if pt feels better after/for the rest of the day after, it might be useful to add to ther ex
What does clonus interplay between?
M spindle and GOT
- indicates UMN lesion
What are the types of joint receptors?
- Golgi type endings - largest, respond to rate of joint movement and gravity
- Paciniform endings - respond to rapid joint movements, deep pressure, and vibration
- Rufinni’s endings - respond to rate and direction of joint movement
- Free nerve endings - signal joint pain
Joint receptors are used for facilitation; Exert strong influences on the motor system
What are they sensitive to?
- Movement
- Position
- Traction
- Compression
What are the proprioceptive facilitation techniques?
- Tapping
- Quick stretch
- Resistance
- joint approximation
- joint traction
- high frequency vibration
what type of m. contractions usually come back first when weakness is present?
Eccentric, then isometric, then concentrec
- less m units for eccentric
What does joint approximation facilitate?
postural extensor and stabilizing responses (co-contraction
- enhances joint awarenec
- contraindication = inflamed joints
What does joint approximation facilitate?
- Activates joint receptors
- Facilitates joint motion
- Enhances joint awareness
- Improve mobility, relieve muscle spasm, reduce pain
- Contraindication: hypermobile or unstable joints
What are the proprioceptive inhibitory techniques?
- inhibitory stretch
- Hold-relax method/ contract relax
- full body rotation - helps with widespread rigidity/ spasticity; disassociate the body
- oscillations - inhibits spasticity
- Low frequency vibration (<75 Hz)
Deep, maintained stretch along the longitudinal axis of tendons with positioning; Prolonged positioning in lengthened range; Activates GTO; Prolonged weight bearing to dampen tone; Weight bearing on a spastic arm; Inhibitory (serial) casting
inhibitory stretch
What ROM position should you use for inhibition? facilitation?
inhibition = midrange to shortened position facilitation = lengthened position
What spinal column contains exteroceptive input?
Dorcal column
- large, well myelinated
- apply to gate theory to inhibit stimuli from spinothalamic tracts
What are exteroceptive facilitation techniques?
- Intermittent Contact - Facilitate contraction, sensory awareness, directional cues, security/support; NDT approach comes from this
- Light Touch - Brief, light contact with the skin can facilitate; brief swipe of ice cube, light pinch; used in more involved pts
What are exteroceptive inhibitory techniques?
- maintained firm pressure
- slow repetitive stroking - paravertebral stroking 3-5 mins
- neutral warmth
- prolonged cooling - dr. m firing, inhibits tone or spasm (but can incr spasticity)
What are visual facilitation techniques?
- bright lights
2. bright colors
What are visual inhibitory techniques?
- dim lights
2. calm colors
