Exam 1 Flashcards Preview

• EMG activity during passive training in clinically complete SCI patients.
• -Modulated by limb loading
• -Not related to muscle stretch

• Biomechanical environment
• Rhythmic coordinated movement
• Stimulate CPG
• Reach brainstem with partially intact pathways to activate higher centers
• Postural stability
• Goal oriented
• Task-specific
• Intensive

• Mid-stance limb-loading
• Terminal stance: hip extension

• -Gait is complete & task specific
• -Gait pattern must be practiced in functional context
• -Reduction in degree of difficulty results in better participation and outcome
• -Gradual increase in demand for WB and balance to wean off
• -PT free to cue/facilitate patterns

• -Control WB
• -Manually assist limb
• -Control postural alignment
• -Adjust for unilateral weakness
• -Facilitate proper gait pattern
• -Work on symmetry, weight shift
• -Facilitate hip extension
• -Begin earlier gait training
• -Observe/evaluate
• -Teach AD
• -Work on vestibular response

• -Speed from .1mph
• -Support 40% to eventually 0%
• -Assist max to min

Analyze performance→ Prioritize strengths and weaknesses→ simple interventions→ re-assess the problems→ more advanced interventions→ re-assess the problem→ starts again

• Very Initial Swing
  • Posterior elevation + anterior elevation= co-contraction
• Initial Swing
  • Anterior Elevation- concentric
• Late Swing/Initial Contact
  • Anterior Depression
  • Use of eccentric posterior elevators 
• Mid-stance to Toe Off
  • Posterior Depression

• COMPONENTS
  • Eccentric posterior elevator muscle activity to allow pelvis to lower into anterior depression at end of swing and heel strike
  • Isometric holding posterior elevation at very end of stance/initial swing transition
• BACKWARDS WALKING
  • resisted posterior elevation
• FORWARD WALKING WITH DOWEL 
  • select one part of cycle (weight transference, push-off and swing) and repeatedly resist it thru dowel.

Recovery of function occurs in specific sequence- simple tasks before complex ones

(Brunnstrom, Rood, Bobath)

We have patterns for certain movements like walking, brushing teeth

• Groups of neurons activated in response to task conditions.
• Brain initiates movement but then don't need it any more after that.

  • Ex. Such as when start walking just keep going w/out thinking about it, unless something goes wrong like a trip


• Change occurs because one control parameter or variable, reaches a critical value, which causes a change in the entire system.

• Constraint (such as speed) control parameter
• 
When variables change motor output changes
  • 
Ex of horses 


Gibson (1996)

Take home - train in actual environment with actual implements needed for the task

(Bernstein)

• multiple ways for humans or animals to perform a movement in order to achieve the same goal.

Kelso (1987)

• Ability to shift from one coordinated pattern of movement (attractor state) to another according to the conditions of the task, environment and performer
• Order parameter is the type of coordinated movement needed for the task 
• Control parameter is the force or desire that creates the phase shift

• Inhibit poor, non-functional patterns of movement 
• Train more complex, functional patterns of POSTURE (not talked about in brunstrom) and MOVEMENT 
• Ensure that the patient is an active learner

Implicit - characteristics of task (foot hitting cone, visual etc.) (environmental driven)
Explicit - Usually language based.

Children need more feedback

• Improves or produces motivation
• Provides information on errors
• Directs the learners attention towards a movement  or goal

Creates dependency (problems with withdrawal or feedback)

• SIMILARITIES
  • -Verbal
  • -Augmented
  • -Provided after movement
• DIFFERENCES (Results vs. Performance)
  • Info about goal outcome vs. Info about movement process
  • Provided as a score vs. kinematic info
  • Lab research vs. Everyday activieis

• 1. Difficult to describe
• 2. Must be observed
• 3. Bilateral loss of discriminative sense in some modalities
• 4. Dressing - non motor aspects

• 1. Practice
• 2. Repeated attempts to perform beyond capabilities
• 3. Re-learning behaviors (not new way to do them)
• 4. PT as facilitator
• 5. Structure of the session (order and amount of practice)

• 1. Hypertonicity - can be result of inadequate sensory info
• 2. Adopting end range joint position
• 3. Hyperactivity and inordinately quick responses to commands
• 4. Pressing too hard against support surfaces
• 5. Too much effort for simple tasks
• 6. Inability to perform task despite adequate strength
• 7. Inability to remember instructions
• 8. Urinary incontinence
• 9. Poor carryover
• 10. Loss of initiative
• 11. Aphasia

• What joint movements are required to perform task? (Think UE, LE, and trunk)
• Which muscles are working, and what types of contractions are being performed?
• Where do they need assistance?
  • How can you use guiding principle to provide it?
  • How can you break the task down if needed?

1. Look at any movement pattern
2. Evaluate its components
3. Identify what is missing
4.  Incorporate tx strategies that help the client achieve the desired function outcome

• NDT | PNF
• Hand open | Closed
• Contact on muscle belly | Bony prominence
• Pressure causing activation of muscles (as light as possible) | assist -> resist groups of muscles in pattern
• Task: WB | WS
• BOTH get in good alignment first

• Proprioception
• Sensory processes and postural support
• Potential to initiate automatic movement 

• 1. Alignment
• 2. Weight bearing - body on arm
• 3. Weight bearing - arm on body
  • -Isometric
  • -Eccentric
  • -Concentric
• 4. Contralateral to ipsilateral movements

• Feet hip width apart, at 90/90 - balance between abs and extensors
• Place uninvolved arm on upper thigh or edge of mat - DO NOT place it further forward or higher than involved
• Involved arm: Scapula against thorax in slight abduction and upward rotation
• Shoulder: humerus slightly flexed, abducted and ER
• Elbow: 90° to complete extension (hand below elbow)
• Forearm - pronated
• Wrist - neutral
• Hand - open on WB surface (preserve arch)

• -Progress from isometric to eccentric to concentric
• -Incorporate head and eye movements
• -Unilateral to bilateral
• -Stable surface to less stable and progressive humeral elevation
• -Forward WBing to posterior WBing
• -Progress toward more upright postures, vary WBing surfaces / step standing at dif heights
   

Scapula and tripceps

Thumb on tricep

• 1. Borders of the hand
  • -hypothenar eminence (shaft of 5th MC)
  • -Heads of Metacarpals
  • -Shaft of 1st Metacarpals 
• 2. Palmar surfaces of fingers
• 3. Any place on dorsum except thenar web space
• AVOID: center of palm. thenar eminence and web

• Open the hand from distal to proximal
• Extend the wrist last, but get and maintain neutral (or more neutral wrist deviation throughout)
• The thumb out of the palm into radial deviation is key- movement from the CMC joint not hyperextension at the MCP joint
• Spread between the MC- abduction is key
• Avoid MCP hyperextension a little short of neutral, especially of 2nd and 3rd fingers is fine

• 1. Decreased hip extension at end of stance
• 2. Decreased hip flexion in mid-swing
• 3. Decreased knee flexion at toe off and mid-swing
• 4. Decreased DF at foot contact and during stance associated with hyperextended knee
• 5. Increased knee flexion at foot contact

• 1. Bilateral knee bends
• 2. Shift to involved LE with "release" of uninvolved knee
• 3. Shift to involved LE, toe in/out with uninvolved
• 4. Shift to involved LE, step forward with uninvolved