Evidence-Based Intervention to Improve Motor Control

Question 1

challenging the system with the potential to heal is known as

Answer 1

neural adaptation

Question 2

what are the 3 degrees of recovery following CNS injury

Answer 2

spontaneous
function-induced recovery
compensation

Question 3

what are the 3 stages of motor learning

Answer 3

cognitive
associative
autonomous

Question 4

list sources of intrinsic feedback

Answer 4

proprioception, visual, vestibular, cutaneous

Question 5

list sources of extrinsic/augmented feedback

Answer 5

visual, auditory and manual cues, biofeedback, force plates, virtual reality

Question 6

what type of practice is best for motor learning

Answer 6

random

Question 7

changes that occur from the natural repair process shortly after injury - body heals itself

Answer 7

spontaneous recovery

Question 8

CNS modified itself due to changes in activity and environment that promote restoration of ability to move in the same or similar manner as before the injury (use dependent cortical reorganization)

Answer 8

function-induced recovery

Question 9

development of new patterns of movement results from adaptation by remaining strategies or body segments

Answer 9

compensation

Question 10

what is super important when dosing patients to promote recovery

Answer 10

doing lots of reps

Question 11

describe constraint induced movement therapy

Answer 11

Uninvolved limb is restrained for 90% of waking hours which forces use of involved limb

Question 12

Based on the theory that concentrated and repetitive practice of the involved UE shapes motor behavior

Answer 12

constraint induced movement therapy (CIMT)

Question 13

Process of decreasing a pt’s body weight by a given percentage using support harnesses and counter balancing system often used in combination with overground gait training or treadmill training

Answer 13

body weight support treadmill training (BWSTT)

Question 14

what type of practice is BWSTT

Answer 14

masses practice

Question 15

what is the minimum number of steps/session for BWSTT

Answer 15

3000 steps/session

Question 16

new CPG recommends high intensity gait training for what patients

Answer 16

CVA, TBI, iSCI > 6 months

Question 17

BWSTT advantages

Answer 17

• Produces an enriched environment that promotes brain plasticity
• Decreased energy expenditure
• Highly repetitive
• Decreases anxiety/fear of falling
• Allows quantitative documentation of improvement
• “Hands free” intervention for PT
• PT must assure that pt is experiencing quality reps, not just quantity → but it is okay if it looks ugly/wonky to begin

Question 18

BWSTT disadvantages

Answer 18

• Harness discomfort/appearance
• False sense of proximal stability → the harness provides stability even if pt has weak trunk control
• Augmented proprioception may delay motor learning
• Increased HR reported with high levels of support
• Treadmill limitations - must go below .5 mph
• Intervention parameters not clear to produce significant better outcomes
• Manpower involved
• Inconsistent research regarding efficacy

Question 19

what type of recovery techniques is the exoskeleton

Answer 19

compensatory

Question 20

advantages of exoskeleton

Answer 20

• Computer controlled “suit” activated by minimal muscle cx or electrode to facilitate gait
• Can be used in rehab to facilitate upright, walking patterning, endurance, preventing falls, functional tasks
• Can be long term solution for certain pts mobility needs
  Some use FES to facilitate muscle cx
• With SCI → helps increase bone mineral density due to being upright

Question 21

what types of populations is the exoskeleton commonly used for

Answer 21

CVA, SCI, MS

Question 22

disadvantages of exoskeleton

Answer 22

• Bulky, heaving, extremely costly → not covered by insurance
• Limited gait speed and use in all environments
• Changes from functional induced recovery strategy in early stages to compensation in long term
• Can only be used in certain pts (SCI level, spasticity, cognitive ability)
• Compensatory, NOT restorative

Question 23

An immersive, interactive experience that occurs in real time and is created by a computer interface

Answer 23

augmented reality (VR)

Question 24

augmented reality (VR) advantages

Answer 24

• Allow experiential learning in a safe, but challenging environment
• Allows ability to control environment completely
• Allows objectively scoring the response to the stimulus
• Encourages early training in complex environments which may improve outcomes for rehab
• Encourages self learning
• Encouraging results to improve plasticity in new CPG for locomotion

Question 25

disadvantages of VR

Answer 25

• Cost - some systems take up multiple rooms and require multiple staff to operate
• Additional research required on proper dosing and scope of use
• Fear of technology

Question 26

what types of interventions do impairment specific interventions focus on

Answer 26

improving strength/power/muscle endurance, aerobic training, improve flexibility through ROM exercises/passive stretching/facilitated stretching, spasticity management/serial casting, activities to improve postural control and balance, strategies to reduce fall risks, interventions to improve coordination and agility, gait training/WC mobility, relaxation training

Question 27

Use task analysis to determine extent to which impairments contribute to functional limitations, Prioritize interventions to improve performance

Answer 27

impairment specific interventions

Question 28

should you do strength training on a pt with spasticity

Answer 28

yes - will NOT increase spasticity

Question 29

strength training principles

Answer 29

• higher load/resistance offers better improvements in strength
• > 70% 1 RM, multiple reps/sets

Question 30

aerobic training principles

Answer 30

Moderate intensity: 40-70% max O2 consumption, 64-77% HR max

3-5 days/week for 20-30 minutes or multiple 10 minute session

Question 31

how to stretch a pt with spasticity

Answer 31

Use firm, constant pressure over bony or non-spastic arears when stretching or ranging a person with spasticity - avoid direct pressure over spastic mm - use rotation to elongate out of shortened range - maintain stretch positions for 10 minutes

Question 32

what is the foundation for skilled learning in NDT

Answer 32

postural control

Question 33

what do you need first, proximal or distal stability

Answer 33

proximal

Question 34

Structured application of sensory stimuli to improve arousal and attention and to improve sensory function in persons with altered responses

Answer 34

senstory stimulation tecnhiques

Question 35

what brace can be used to decrease knee hyperextension

Answer 35

Swedish knee brace