CVA, Motor Control, PNF, and Synergies

Question 1

Agonistic Reversals

Answer 1

• Controlled mobility, skill
• Isotonic concentric contraction against resistance followed by alternating concentric and eccentric contractions with resistance.

Question 2

Alternating Isometrics

Answer 2

• Stability, strength
• Isometric contractions are performed alternating from muscles on one side of the joint to the other side without rest.

Question 3

Contract-relax

Answer 3

• Mobility
• Passive movement to point of limitation, then maximal ISOTONIC contraction of antagonist muscle group through full ROM against resistance.
• You are contracting and relaxing the range limiting muscle.

Question 4

Hold-relax

Answer 4

• Mobility
• Passive movement to point of limitation, then maximal ISOMETRIC contraction of antagonist muscle group through full ROM against resistance.
• Holding (isometric) and relaxing the range limiting muscle.

Question 5

Hold-Relax Active Movement

Answer 5

• Mobility
• Passive movement to shortened range within the pattern and isometric hold of range limiting muscle in its shortened position there.
• Relaxation and passive movement to lengthened muscle position to stretch.
• Pt isotonically moves exxtremity back to shortened muscle position.

Question 6

Joint Distraction

Answer 6

• Mobility
• Constant manual traction to joint, usually in combo with other joint mobs.
• Proprioceptive technique to increase range at a particular joint.

Question 7

Repeated Contractions

Answer 7

• Mobility, strength
• Quick stretch then isometric or isotonic contraction of range limiting muscle.
• Used to initiate movement in a weak movement pattern or a weak point in the pattern.

Question 8

Rhythmic Initiation

Answer 8

• Mobility
• Movement through pattern progressing from passive, to active-assisted, to active, to resisted.
• Used for hypertonia

Question 9

Rhythmic Stabilization

Answer 9

• Mobility, Stability
• Isometric contractions of all muscles around a joint with perturbations by the therapist.

Question 10

Slow Reversal

Answer 10

• Stability, Controlled mobility, Skill
• Slow resisted concentric contractions of agonists and antagonists around a joint through the full ROM within the pattern.
• No break between reversals
• Improve control of movement and posture

Question 11

Slow Reversal Hold

Answer 11

• Stability, Controlled mobility, Skill
• Same as slow reversal + isometric hold at each extreme of ROM to gain stability.

Question 12

Sensory Facilitation Techniques

Answer 12

• Joint approximation
• Joint compression
• Icing
• Light touch
• Quick stretch
• Resistance
• Tapping
• Traction

Question 13

Sensory Inhibition Techniques

Answer 13

• Deep pressure
• Prolonged stretch
• Warmth
• Prolonged cold

Question 14

How many stages are in Brunnstrom’s stages of recovery (CVA)?

Answer 14

7

Question 15

Brunnstrom Stage 1

Answer 15

No volitional movement initiated

Question 16

Brunnstrom Stage 2

Answer 16

• Appearance of basic limb synergies
• Beginning of spasticity

Question 17

Brunnstrom Stage 3

Answer 17

• Synergies performed voluntarily
• Spasticity increases

Question 18

Brunnstrom Stage 4

Answer 18

• Spasticity begins to decrease
• Some out of synergy movement

Question 19

Brunnstrom Stage 5

Answer 19

Further decrease in spasticity with independence from synergy patterns.

Question 20

Brunnstrom Stage 6

Answer 20

Isolated joint movements are performed with coordination.

Question 21

Brunnstrom Stage 7

Answer 21

Normal motor function restored.

Question 22

Mobility

Answer 22

The ability to initiate movement through a functional range of motion.
- Can you get there?

Question 23

Stability

Answer 23

The ability to maintain a position or posture through cocontraction and tonic holding of a joint.
- Can you hold it?

Question 24

Controlled Mobility

Answer 24

The ability to move within a weight bearing position or rotate around a long axis.
- Can you multitask and move while you are there?

Question 25

Skill

Answer 25

The ability to consistently perform functional tasks and manipulate the environment with normal postural reflex mechanisms and balance reactions. - Can you put it all together into something functional?

Question 26

Synergy

Answer 26

A group of muscles working together to produce a purposeful motion.

Question 27

UE Flexor Synergy

Answer 27

- Scapular elevation and retraction - Shoulder ABduction and external rotation - Elbow flexion - Forearm supination - Wrist flexion - Finger flexion and adduction - Thumb flexion and adduction

Question 28

UE Extensor Synergy

Answer 28

- Scapular depression and protraction - Shoulder adduction and internal rotation - Elbow extension - Forearm pronation - Wrist extension - Finger flexion and adduction - Thumb flexion and adduction

Question 29

LE Flexor Synergy

Answer 29

- Hip ABduction and ER - Knee flexion - Ankle dorsiflexion and supination - Toe extension

Question 30

LE Extensor Synergy

Answer 30

- Hip extension, IR, and adduction - Knee extension - Ankle plantar flexion and inversion - Toe flexion and adduction

Question 31

Characteristics of Left CVA

Answer 31

- Weakness and paralysis of R side - Increased frustration - Decreased processing - Possible aphasia - Possible dysphagia - Possible motor apraxia - Decreased discrimination between R and L - R hemianopsia

Question 32

Characteristics of Right CVA

Answer 32

- Weakness and paralysis of L side - Decreased attention span - Left hemianopsia - Decreased awareness and judgement - Memory deficits - Left inattention - Decreased abstract reasoning - Emotional lability - Impulsive behaviors - Decreased spatial orientation

Question 33

Characteristics of Brainstem CVA

Answer 33

- Unstable vital signs - Decreased consciousness - Decreased swallowing ability - Bilateral weakness - Bilateral paralysis

Question 34

Characteristics of Cerebellar CVA

Answer 34

- Decreased balance - Ataxia - Decreased coordination - Nausea - Decreased ability for postural adjustment - Nystagmus

Question 35

Anterior Cerebral Artery Occlusion

Answer 35

- Paraplegia - Incontinence - Abulic aphasia - Personality changes due to frontal lobe damage - Akinetic mutism due to frontal lobe damage

Question 36

Middle Cerebral Artery Occlusion

Answer 36

- Cerebral cortex damage - Contralateral hemiplegia and sensory impairment - Dominant hemisphere impairment results in Broca's, Wernicke's, or global aphasia. - Lobe dependent impairments due to damage to larger portion of cortex.

Question 37

Posterior Cerebral Artery Occlusion

Answer 37

Thalamic Pain Syndrome: - Abnormal sensation of pain, temp, touch, and proprioception. Cortical Blindness: - Vision loss due to damage to visual portion of occipital cortex - Physically normal eye, still constricts and dilates with light/dark

Question 38

Vertebral-basilar Artery Occlusion

Answer 38

- Wide variety of presentations due to complex vascularity of this artery system. - Wallenberg Syndrome (lateral medullary infarct): ipsilateral facial pain and temp impairment, ipsiateral ataxia, vertigo, contralateral pain and temp impairment of body. - Severe: locked-in syndrome, coma, vegetative state.