Final Flashcards
1
Q
Normal Muscle Tone
A
Resistance of muscle to passive elongation or stretching
Normal muscle tone is:
High enough to resist gravity
Low enough to allow voluntary movement relies on normal functioning
2
Q
Normal Muscle tone relies on normal function of
A
Cerebral cortex Cerebellum Basal Ganglia Midbrain Spinal Cord Normal Stretch reflex Musculoskeletal system
3
Q
Normal muscle tone allows for
A
- Effective stabilization of proximal joints
- Ability to move against gravity/resistance
- Ability to maintain the position
- Balance tone between agonists and antagonists
- Ease of shift from mobility to stability and reverse
- Ability to use muscles in groups or individually
- Slight resistance to passive movements
4
Q
Flaccidity vs Hypotonus
A
Flaccidity: Tone: None Reflex: No stretch reflex Voluntary Movement: None Reason: spinal or cerebral chock or PNS damage Notes: ROM >normal Hypotonus Tone: Decreased Reflex: Slight increase in tone when testing stretch reflex Voluntary Movement: Minimal Reason: stroke Notes: ROM>Normal
5
Q
Hypertonus vs Spasticity vs Rigidity
A
Hypertonus:
Tone: Increased
Reflex: Hyperactive
Voluntary Movement: Movement in synergies
Reason: UMNL such lesion to premotor cortex, basal ganglia or descending pathways
Notes:
ROM
6
Q
Considerations in tone assessments
A
- Tone might fluctuate in response to intrinsic (infections) or extrinsic factors (room temp, noise, anxiety)
- It is preferable to test the person the same time of the day
- Testing position for upper extremity: sitting, symmetrical head in midline
- The room should be not too cold and not too warm
- The therapists hand should not be cold
- Do not hold the person’s hand too firmly
7
Q
Testing muscle tone:
Holding the limb:
A
Grasp the limb proximal and distal to the joint, hold the limb on the lateral sides to avoid giving tactile stimulation to the muscle belly
8
Q
Testing muscle tone:
hypertonic
A
- Move the joint through its ROM slowly
- Note the presence and location of pain
Label as:
0 flaccid - no active movement and limb feels heavy
9
Q
Testing muscle tone:
Spasticity:
A
Move the joint through its ROM rapidly
Label as: mild, moderate or severe
10
Q
Testing muscle tone:
Rigidity and hypertonia
A
Move the joint through its ROM slowly
label as: mild, moderate or severe
11
Q
Ashworth Scale
A
0 no increase in muscle tone
1 slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension
1+ slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
2 More marked increase in muscle tone though most of the ROM, but affected part(s) easily moved
3 Considerable increase in muscle tone, passive movement difficult
4. Affected part(s) rigid in flexion or extension
(not very reliable)
12
Q
Other Considerations in Testing Muscle Tone
5 points
A
- Heterotopic ossification (formation of new bone is soft tissue or joints) as a result of ABI and SCI might have caused ROM limitation
- Determine how much of the active movement is because of synergy
- Identify in which direction of movement hypertonicity occurs and how it affects function
- MMT is not valid for people who have moderate to severe hypertonicity
- Do sensation test (two-point discrimination, kinesthesia, proprioception, pain and light touch)
13
Q
Benefits of Spasticity
A
- aiding with standing and transfers
- maintaining muscle bulk
- preventing deep vein thrombosis, osteoporosis and edema
14
Q
Intervention is necessary if spasticity
A
- interferes with function: ADL, gait, sleep, wheelchair positioning
- Causes deep pain and limits hygiene
- Causes contracture and bed sore
15
Q
What are secondary problems of spasticity
A
- Deformity especially distal parts of limb
- Impaired ability to manage basic activities
- Loss of reciprocal arm swing when walking
- Risk of fall
- Pain syndrome especially in glenohumeral joint
16
Q
Pain syndrome especially in glenohumeral joint
Might cause limitation in
A
Rolling in bed
Transferring
Putting on shirt or blouse
Bending to reach for the feet to put on shoes and socks
-In long term…. causes depression
17
Q
Spasticity Management Principles
A
- Maintain soft tissue length
- Prevent Pain
- Guide appropriate use of available motor control
- Avoid using excessive effort during movements
- Encourage slow and controlled movements
- Teach specific functional synergies during tasks
- Avoid use of repetitive compensatory movement patterns
18
Q
OT interventions for managing Spasticity
A
1.Weight bearing on the limb
2. USe of the limb in activities as much as possible
3. Positioning in a pattern opposite to the synergy pattern
4. Use of hand in bilateral activities
5. Teach upper limb ROM to your Client
6, Teach your client to apply 60 sec stretches
7. Serial casting if the contracture was present for less than 6 months
19
Q
Pharmacological agents
A
Oral medications
–> beware of medications side effects such as visual hallucinations, sedation and hypotension
–>For diazepam and baclofen: sudden discontinuation may cause seizures
Short term nerve blockers
Long term nerve blocks
–> Nerve block provide time for therapists to strength the antagonist and improve function
20
Q
Intrathecal Baclofen pump:
A
Enters baclofen in spinal level, used for severe spasticity associated with spinal cord injury and MS
21
Q
Physical Agents
A
Cold therapy
Superficial heat (do not use if there is acute injury in the limb, do not use if there is oedema)
Neuromuscular electrical stimulation (physiotherapy)
22
Q
OT interventions to manage rigidity Inhibition
A
- Heat
- Massage
- Stretching
- ROM exercise
23
Q
OT interventions to manage rigidity ADL
A
- When rigidity increases a return person to wheelchair or a reclining chair as sitting decreases rigidity
- Before ADl, ask the person to do the followings:
- relaxation
- Rocking back and forth before standing
- Stretching
24
Q
OT interventions to manage flaccidity
A
- Weight bearing
- Bed positioning
- Passive ROM
25
OT interventions to manage flaccidity ADL
1. Position the limb:
- Position in bed
- Position in Chair
eg. when eating, place arm on the dining table
2. Educate person and family on proper positioning at all times
26
Human Gait Cycle: Stance
-need to generate both horizontal forces against support surfaces and vertical forces (to support body mass against gravity
-initial contact
-loading response
-midstance
-terminal stance
-pre-swing
(62%)
27
Human gait cycle: Swing phase
```
advancement of swing phase and repositioning the limb in preparation for weight acceptance
-initial swing
-midswing
-terminal swing
(38%)
```
28
Step Length
distance from one foot strike of the other foot
29
Stride Length
distance covered from one heel strike to the next of the same foot
30
Developmental Sequence for Walking
1. Initial Stage
2. Elementary Stage
3. Mature stage
31
inital Stage
```
difficulty maintaining upright posture
unpredictable loss of balance
ridgid, halting leg action
short steps
flat-footed contact
toes turn outward
wide base of support
flexed knee at contact followed by quick leg extension
```
32
Elementary Stage
```
Gradual smoothing of pattern
step length increased
Heel-toe contact
Arms down to sides with limited swing
Base of support within the lateral dimensions of trunk
Out-toeing reduced or eliminated
Increased pelvic tilt
```
33
Mature stage
Reflexive arm swing
narrow base of support
relaxed, elongated gait
Definite heel-toe contact
34
Locomotion in older adults: Temporal And distance Factors:
-Decreased in walking velocity, step length and step rate
35
Locomotion in older adults: Kinematic Analysis
- changing s stepping patterns and posture (COG)
- Guarded walk
- Decreased dynamic stability during stance
36
Locomotion in older adults: Changes in muscle activation patterns
Increased co-activation (increase stiffness)
37
Locomotion in older adults: Kinetic Changes
- Decreased power generation at push-off
| - Decreased power absorption at heel strike
38
Locomotion in older adults: Reduced Reactive and Proactive Adaption
slips and trips
39
Locomotion in older adults: Pathology in Gati Changes
- Cognitive Factors: limitations with walking while performing another task requiring more attentional resources, limitations with information processing, fear of falling, decreased memory, anxiety, depression)
- Sensory Impairments
- Muscle Weakness
40
Effect of motor Impairments on Gait
Neuromuscular Impairments
Weakness/Paresis
-Abnormal Tone
-Difficulties with Coordination
41
Effects of sensory Impairments on Gait: Somatosensory Deficits:
Result in gait ataxia
42
Effects of sensory Impairments on Gait: Visual Deficits
- Used to regulate gait on local (step-by-step) and global level (routine-finding)
- Obstacle avoidance
43
Effects of sensory Impairments on Gait: Vestibular Deficits
the vestibular system plays a role in the coordination of motor responses (stabilizing eyes; maintaining postural stability)
44
Effects of Cognitive and Perceptual Impairments on Gait: Body Scheme Disorders
Trunk lean, inappropriate foot placement, difficulty controlling COM
45
Effects of Cognitive and Perceptual Impairments on Gait: Spatial Relation Disorders
- Involved in navigational strategies
| - Topographic disorientation
46
Effects of Cognitive and Perceptual Impairments on Gait: Cognitive Impairments
- Dementia/Alzheimer's Disease
| - Effects of attentional Demands
47
Weakness/Paresis
Neural and non-neural components of force production
Inability of muscles to generate motion and control motion
-Dorsi-Flexor Weakness
-Quadriceps Weakness
-Hip Extensor Weakness
-Hip-Abductor Weakness (Trendelenburg Gait)
-Hip Flexor Weakness
48
Compensatory strategies used to advance the swing leg a as a result of inadequate hip flexion
a. Activation of abdominal muscle in conjunction with posterior tip of the pelvis
b. Circumduction
c. Contralateral Vaulting (because of extra length of the foot because of foot drop)
d. Leaning the trunk laterally
49
How is a typical hemiplegic gait
Wait for lecture
50
Gait ataxia
- Wide based
- No arm swings
- Uneven step length
- Tendency to fall
- If one sided cerebellar lesion: tendency to fall to one side
51
OT Interventions
1. Home modifications
2. Retraining dynamic gait skills
3. Prescription of assistive devices and education for use of assistive devices
52
What activities can be used to help with retaining dynamic gait skills? How can they be graded?
Wait till lecture
53
Mobility other than gait
```
Transfers
Sitting to Standing
Supine to Sit
Raising from bed
Rolling
```
54
Clothing
Cloths for people with low trunk control
| -Shoes-easy to put on
55
Three factors that contribute to upper extremity control
1. Individual Task
2. Type of Task
3. Environment
56
Neuromuscular components related to upper extremity function
1. Musculoskeletal components
2. Neural Components
- -> muscle tone
- ->motor reflexes/reactions
- -> Control of voluntary movements
57
Neural Components
a. Muscle tone
b. Motor reflexes/reactions
- -> existence of normal reflexes/reactions
- -> absence of abnormal reflexes
c. Control of voluntary movements
- -> eye-hand coordination
- -> Bilateral integration: Using both arms in an activity
- ->Crossing midline: crossing the midline when doing activities
- ->Fine motor movement: when small muscles in the hand, fingers and thumb are being used for precise movements
- ->Gross motor control: when larger muscles are being used such as reaching for an object
58
Systems that contribute to reach and Grasp :Sensory Systems
Visual pathways related to visual regard, reach and grasp:
Dorsal stream pathway: going from the visual cortex
--> provides action-relevant information about object position, structure and orientation
Ventral Stream pathway: going from visual cortex to the temporal lobe
-->provide our conscious visual perceptual experience
59
Systems that contribute to reach and Grasp: Shoulder Complex
Glenohumeral Joint
Scapulo-humeral rhythm
Acromio-clavicular (AC joint)
60
Functional Shoulder ROM
100 flexion
90 abduction
30 external rotation
70 internal rotation
61
Forearm and Wrist
- Supination
- Pronation
Wrist flexion/extension
Hand:
Finger and thumb flexion/extension
Abduction/adduction
62
Grasping
- Vary according to location, size and shape of object to be grasped
- Power or Precision grips
- Intended activity
- Involves the position of the thumb and that of the fingers
- Two requirements for grasp
- -> Hand must adapted to the shape and size and use
- -> Finger movement must be timed appropriately in relation to transport and close on the object
63
Alignment
- Trunk Control
- Midline orientation
- Head control
- Limb function and control on the trunk
- Facial/oral motor function
64
Shoulder Subluxation
- Occurs in 50% of stroke patients because of impaired glenohumeral rhythm
- Caused by weight of the arm pulling the humerus when the supraspinatus and deltoid muscles are weak
- Can be identifiable by palpation
- Causes pain if handled inappropriately
- Causes limited ROM and might turn into Shoulder Hand Syndrome
65
Evaluation - Subluxation Grading
```
0-normal
1 - V-Shaped widening
2- moderate subluxation
3 - Advanced subluxation
4 - Dislocation
`
```
66
Pain syndrome especially in glenohumeral joint
Might cause limitation in
- Rolling in bed
- Transfering
- Putting on shirt or blouse
- Bending to reach for the feet to put on shoes and sock
- In long term.... depression
67
Glenohumeral Joint -Key Handling Points.
- Manually reduce subluxation before elevating arm
- Medial rotation of the arm must accompany flexion
- Lateral rotation of the arm must accompany abduction
Make sure client does not do passive or active assistive ROM for shoulder above flex 90 if there is subluxation of shoulder
68
Positioning for arm when sitting or standing
Bobath shoulder support
Bobath Axial roll
Cuff Type Arm sling
Trough Arm Sling
69
Can Slings Prevent Shoulder Subluxation
can be helpful but do not prevent it
70
Sling advantages
- Protection during transfers
- easier for therapist to control trunk
- Prevent Soft tissue stretching
- Decrease pressure over neuromuscular bundle
- Support weight of arm
- Prevent oedema
71
Sling Disadvantages
- May contribute to neglect
- May contribute to learn non-use
- May increase flexion in limb
- Passive position/prevent hand function/block sensory input/block hand swing in walking
- Increased risk of shoulder hand syndrome/shortened internal rotators
- Does not reduce subluxation
72
Assessments: (upper limb problem)
1. Observation: involving them in a functional activity
functional performance analysis
2. Interview
3. Assessment tools
73
Assessment tools
1. Motor assessment scale (MAS-36)
2. Jebsen Test of Hand function
3. Nine-hole peg test
74
Other considerations (assessments for upper limb)
```
Cognition and Perception
-Attention and neglect
-Problem solving and Apraxia
Musculoskeletal problems
-Sensory Problems
-Weakness
-Edema and pain
```
75
OT interventions: Functional Activity
Functional activity vs exercise ?
Task Specific training
- Learning sequencing complex functional tasks
- Using virtual environment
- Dominance training
- Training the less affected hand
- Training handwriting
Increased frequency of use
- CIMT
- Bimanual training
76
Treatment Strategies: Positioning on affected side
Head/neck: neutral and symmetrical
affected upper limb: protracted forward with elbow extended, hand supinated, wrist neutral, fingers extended, and thumb abducted
Trunk: straight and aligned
Affected lower limb: Knee Flexed
Unaffected lower limb: knee flexed and supported by pillow
77
Treatment Strategies: Passive ROM exercises performed by therapist/patient
1. Shoulder joint
- no movement beyond 90 degrees during abduction and flexion
- External and internal rotation while keeping shoulder, adducted
- Pain complains --> stop --> if needed, next session, do not go beyond that point
2. Elbow joint, forearm (pronation/supination), wrist joint
- no restriction to PROM
- Pain complains --> stop--> if needed, next session, do not go beyond that point
3. Meteacarpophalengeal (MCP) joint and interphalangeal (IP) joint of finger and thumb
- MP supported to move PIP
- PIP supported to move DIP
- Move 1 joint at a time
- Support wrist in neutral for fingers flexion and extension
78
Treatment Strategies: Encourage Trunk Rotation
- Often a block-like pattern, upper and lower trunk is not disassociated
- Find activities to facilitate trunk rotation
- Proper rotation also opens the pectoral muscles -prevents kyphosis
- Without Trunk stabilization-unable to use the extremities properly
79
Benefits of Trunk Rotation
- Increased sensory input
- Improved weight bearing
- Improved awareness
- Training compensation for visual field deficits
- Varying height of task-incorporates shoulder and pelvic girdle mobilization
80
Treatment Strategies: Increase Muscle Power
Task parameters that can be manipulated to increase strength:
- Gravity
- Weight of objects
- Amount of external support (use of table to slide hand or moving hand against gravity)
- External resistance such as using weight or resistance by therapist
81
Treatment Strategies: Constraint-induced Movement Therapy (CIMT)
Hemiparesis can lead to learned non-use
-Based on a theory of brain plasticity and cortical reorganization
Two main Elements:
1. Repetitive, task oriented training of the affected UE; 6 hours or more per day
2. Use of the unaffected UE is restrained with mitten or sling for 90% of walking hours
-Goal: to counteract the effects of learned non-use
82
Modified CIMT in Practice
| what modified CIMT looks like at Trillium Health Partners in Mississauga
-2 modified CIMT sessions/week for 0.5h-1 h
--> + at home modified CIMT program for some clients
-Circuit-Training format, where each activity is performed for 8-10 minutes
-As many repetitions of task/activity as possible in time allotted
--> Emphasis on repetition of movements, not the quality of the movement
-Use of mitt on the unaffected hand is dependent on client
Modified CIMT activities: washing dishes; bean toss; folding laundry; clean a window or wall; flip over playing cards; place clothes pegs on a rack; open/close jars; wringing out wash cloths; stacking cones; screwing and unscrewing pegs
-Some activities are more functional than others
83
Treatment Strategies: Imagery
Cognitive rehearsal of motor act or task
Provides opportunity promote repetitive movements
Audiotape (10 to 20 min):
--> relaxation
--> mental practice of tasks such as drinking from a cup or writing
84
Treatment Strategies: Mirror therapy
Person sits beside a mirror
The person can see only the non-involved hand in the mirror
Ask the person to move his/her fingers and wrist of the unaffected hand
Ask the person to use the affected hand the same way
85
Treatment Strategies: Splinting for hemiplegia
- Static splints for preventing deformity
| - dynamic splints
86
Treatment Strategies: (list of 9) upper limb
1. Positioning
2. Passive ROM by therapist/patient
3. Encourage Reaching
4. Encourage trunk rotation
5. Increase muscle power
6. CIMT
7. Imagery or mental practice
8. Mirror therapy
9. Preventing shoulder subluxation
87
Treatment Strategies: Encourage Reaching
While seated, reach down and let the arm dangle
| reach to the sides and behind
88
Coordination
```
Ability to produce accurate, controlled movement,
Movement with coordination
- is smooth
-has rhythm
-Has appropriate speed
-muscles involved:
-->Minimum # of muscles used
-->Appropriate muscle tension
-->Postural tone
-->Equilibrium
```
89
Part of the brain involved with Coordination
Cerebellum and extrapyramidal system
90
Incoordination
Error in rate, rhythm, range, direction and/or force of movement
91
Types of incoordination: Cerebellar Disorders
1. Ataxia
2. Adiadochokinesia
3. Dysmetria
4. Rebound phenomenon of Holmes
5. Nystagmus
6. Dysarthria
7. Intention Tremor (resting and essential familial tremor)
92
Types of incoordination: Extrapyramidal disorders
1. Chorea
2. Athetoid movements
3. Dystonia
4. Ballism
5. Tremor
i. Resting tremor
ii. Essential Tremor
93
Ataxia
```
Cerebellar dysfunction
Poor coordination of agonists and antagonists
Delayed initiation of movement responses
Errors:
-Range
-Force
-Rate
-Regularity
Disappear during sleep
```
94
Gait Ataxia
- Wide base
- No arm swings
- Uneven step length
- Tendency to fall
- If one sided cerebellar lesion: tendency to fall to one side
95
Adiadochoinesis
inability to perform rapid alternating movements
| flipping hands test
96
Dysmetria
```
Inability to estimate ROM necessary to reach the target movement
(finger to nose test)
Types:
-Hypermetria
-Hypometria
```
97
Rebound Phenomenon:
inability to stop a motion quickly to avoid striking something
bend elbow at 90 degrees.... put resistance.... let go quickly .....will not be able to stop the movement
98
Nystagmus
involuntary movements in the eyeball
Types:
- Up and down direction
- Back and forth directions
- Rotating
99
Dysarthria
Explosive or slurred speech (similar to people that are drunk or talking like a robot)
100
Chorea
irregular, purposeless, involuntary, quick, jerky, and dysrhythmic movements even during sleep
Related conditions: tardive dyskinesia and Huntington's (Autosomal mutation)
101
Athetoid movements:
Continuous, slow, wormlike arrhythmic movements especially in distal not seen during sleep
Related conditions: Wilson's disease (Accumulation of copper in tissues) and cerebral anoxia
102
Ballism
Continuous abrupt contractions of the axial and proximal musculature of the extremities-cause limb to fly
103
Intention tremor
a trembling of a part of the body when attempting a precise movement
104
Resting tremor
an involuntary tremor occuring when the person is at rest
105
Festinating gait
a manner of walking in which a person's speed increases in an unconscious effort to "catch up" with a displaced center of gravity
106
Assessment: Observation
1. Ask what roles the person has, what areas of participation are affected by the involuntary movements
2. Assess the muscle tone and joint mobility first (sitting)
3. Observe the person during functional upper extremity movements in one of the activities related to areas of concern
- observe proximal to distal
- What movements are harder: away from or towards the body?
- Check if the function improves when stabilizing proximal joints
- Check if using a weight cuff improves the function (be careful adding weight increases fatigue)
107
Assessment (what should you also be thinking about when doing observation assessments- upper limb)
Does movement in eyes change the function
Does the person's emotional status change the function?
Watch for corrective movements
-Check for abnormal reflexes and find out if they impact the severity of the involuntary movements
108
Assessment: Standard tests
```
Purdue Pegboard test
Minnesota Rate of a Manipulation test
Jebsen-Taylor hand function test
-9-hole Peg test
(show people they are improving) -frustrated patients need to show them they need to continue working
```
109
Assessments: Non-equilibrium tests of coordination
-Get info fro lab
110
Incoordination Management (9 steps)
1. Determine the activity of concern
2. Complete an activity analysis and understand what tasks are affected by the involuntary movement
3. Set functional goals
4. Grade the task
5. Consider client's safety
6. More stability in the proximal joints by putting weight on the limb and joint approximation
7. Move in small range of motion
8. Pay attention to the activity rather than the movement
9. Start with using planes of movements and directions that are easier for the person
* *show the client that there is improvement although small.
* * In most cases, OT intervention is focused on change of equipment to improve self-care and ensure person's safety
111
Examples of Strategies (Incoordination management)
Look at. chart (strategy and reason)
112
Eye Structure name parts
- Macula
- Fovea
- Retina
- Optic nerve
- Vitreous gel
- Iris
- Cornea
- Pupil
- Lens
- Iris
113
Components of vision
1. Sensory component
2. Cognitive/Perceptual component
3. Motor Component
114
Hierarchy of visual Perception
- Oculomotor control --> Visual field and visual acuity (should be tested first)
- Attention = alert and attending
- Scanning
- Pattern recognition
- Visual Memory
- Visual Cognition
- Adaptation through vision
115
Visual Function
1. Visual acuity
2. Visual field
3. Oculomotor functions
4. Fixation
5. Accommodation
116
Visual acuity
sharpness of vision
Test: measured for distance at 20 feet (6 meters) and for near tasks at inches (40cm)
- 20/20 is normal visual acuity which means the person can see the letter that a person with normal vision can see at 20 feet.
- 20/200 = person requires 10 X magnification (severe visual impairment)
- 20/1000 = near total visual impairment ``
117
Managing visual acuity impairments `
1. Identify the nature of the visual acuity problem
2. Identify how this impairment is impacting the person's function:
- Biomechanical
- Psychoemotional
- Sociocultural
118
Visual Acuity Rehabilitation Strategies
- Increase Size
- Increase illumination
- Increase Contrast
- Decrease Clutter
- Improve Organization
- Technology Aids
119
VIsual field (VF)
```
The boundary of what is seen while looking straight
Normal VF:
-50 degrees superiorly
-70 degrees inferiorly
60 degrees nasally
90 degrees temporally
```
Two eyes
-Horizontally: 180 degrees
120
Visual Field (talking about what part of the brain)
Left visual Field for both eyes go to right hemisphere (the right side of both eyes)
Right visual Field for both eyes go to left hemisphere
121
Visual Fields conditions: Hemianopia
Damage in visual pathways resulting i loss of vision in one half of the visual fields in the eyes
122
Visual Fields conditions: Quadrantanopia
Loss of vision in a quarter of the visual field
123
Visual Fields conditions: Tunnel Vision
Damage to the optic nerve resulting in loss of peripheral vision while central vision is intact
124
Visual field problems result in functional problem such as
- Difficulty finding the way in a dark or unfamiliar place
- Bumping into people or obstacles
- Difficulty reaching for objects
- Driving difficulties
- Difficulty in finding objects
125
Intervention strategies for hemianopia
- Compensatory in nature
- Find out if the person is aware of the problem or not
- Strengthening the person's attention to the blind hemi-field
- Improve the ability to direct gaze movements toward the involved side
- Explore the involved side more efficiently - turning head to the side and screening
126
Oculomotor function: Saccades
ability to shift the area of clearest vision back and forth in order to find or identify visual targets
127
Oculomotor function: Smooth Pursuits
When tracking and following moving targets, the eyes try to keep the object in the area of clearest vision
128
Oculomotor function: Convergence
When an object moves toward the face, the eyes move toward each other, usually in an effort to maintain single binocular vision when viewing an object that is moving closer to viewer.
129
Oculomotor function: Fixation
The ability to steadily and accurately gaze at an object for sustained periods
130
Oculomotor function: Accommodation
The ability to maintain focus when switching one's gaze from one object to another differing in distance in the visual field.
131
Visual Attention
- Required for visual processing
- Two visual processes seamlessly coexist
- ->central process and Peripheral process
- The amount of attention devoted to each process depends on the task
132
Central Process
Attends to visual detail for analysis and and identification of visual targets
133
Peripheral Process
Provides background information about the viewer's whereabouts in space
134
Visual Search or Scanning
- the motor response to the desire to shift visual attention from one visual target to another
- Visual search is accomplished using saccadic eye movements, which can originate reflexively or voluntarily
135
Unilateral Neglect
"The failure to report, respond or orient to novel or meaningful stimuli presented to the side opposite a brain lesion, when this failure cannot be attributed to either sensory or motor deficits"
- Most often seen with damage to the right side of the brain
- Affects between 1/2 and 1/2 of people who have had a stroke and who are receiving rehab
- Major source of stroke-related long-term disability
136
Neuroanatomical Region Associated with Neglect
- Inferior parietal lobe
- Dorsolateral frontal lobe
- Cingulate gyrus
- Thalamus
137
Types of neglect
1. Unilateral body/personal neglect
| 2. Unilateral spatial/extrapersonal neglect
138
Unilateral body/Personal Neglect
- Failure to report, respond or orient to the body on the side contralateral to the brain lesion
- Performance issues including difficulties with shaving, combing, washing, and applying makeup on the contralateral (usually left) side of the body
- -> increased difficulty integrating affected side during bed mobility, transfers, and bilateral activities
139
Unilateral spatial/extrapersonal neglect
Inattention to or neglect of visual stimuli presented in the extrapersonal space of the side contralateral to a brain lesion
- Near extrapersonal
- -> Neglect of environment within reaching distance
Far extrapersonal
-->neglect of environment beyond reaching distance
*Can Experience near and/or far extrapersonal neglect
140
Neglect and Function
- Rehab takes longer for those with neglect -many associated impairments
- Presence of neglect as well as its severity are significantly related to functional outcomes for reading and writing
- Impacts cognitive-communicative functional performance and outcome
- Impact ADLs, especially when concurrent body and extrapersonal neglect
141
Assessment
- need to differentiate between visual field loss and neglect
1. Tabletops tests
- Star/letter cancellations
- Line bisection
- Design Copying tasks
- Drawing Tasks (e.g., Clock Drawing Test)
2. Performance-Based tests (e.g., A-one, AMPS)
142
Interventions for Unilateral Neglect
- Awareness training
- Scanning Training
- Limb activation/Spatio-motor curing
- Mental imagery
- Partial visual occlusion
- Video feedback
- Computerized training
- Environmental adaptions
- Prisms (seems to be most effective intervention)
143
Visual Spatial skills and their relationship to function:
| Depth Perception
process of the visual system that interprets depth and information from the viewed scene (3D perception)
-Monocular vision is poor for determining depth
Examples of tasks that require depth perception
- Pouring water into a glass
- Catching a ball
- Stepping up and down a curb
- Reaching for equipment
- Parking a car
144
Visual Spatial skills and their relationship to function: Spatial relations
ability to process and interpret visual information about where objects are in space (relating objects to each other and to the self )
Examples of task that require spatial relations:
- Applying toothpaste on toothbrush
- Body position during transfer
- Indoor/outdoor mobility
- Way finding
145
Visual Spatial skills and their relationship to function: R/L Discrimination
Ability to apply and use the concept of left/right
Examples of tasks that require R/L discrimination:
following directions related to personal space and during mobility
146
Visual Spatial skills and their relationship to function: Figure ground discrimination
ability to distinguish objects in the foreground from the background
Examples of tasks that require figure ground discrimination
- Locating a white shirt on a white bed sheet
- Locating a pen in a clutter drawer
147
Interventions for visual spatial impairments: Dressing
- Sit beside the person rather than in front of them
- Deemphasize visual demonstration - use verbal instructions
- Decrease use of spatial-based language such as under, ober, right, behind, "left arm in the right sleeve" - say "wrong sleeve"
- Use cues eg. if the shirt is worn backwards say "are you sure you finished?"
- Use clothes that have a different colour in each section
- Use an audio recording to cue the sequence of dressing
148
Interventions for visual spatial impairments: Meal preparation
- Decrease clutter
- Label or colour code
- All cooking equipment in the same place
- Touch the table top when moving an object
- Place coloured tape on the handle of the fridge
- Encourage the client to work slowly and safely
- Label cabinets based on content
149
Fatigue - a common symptom
- Most common and debilitating symptom in many neurological conditions (50 - 95%)
- Negative impact on quality of life and health status
- Role change
- Unemployment
150
Types of Fatigue
Physical Fatigue or cognitive
Acute vs chronic
Perceived vs observed
Primary vs Secondary
151
Primary vs Secondary Fatigue
```
Primary to the condition
Secondary to consequences of a condition
-Pain
-Sleep problems
-Medication side effects
-Deconditioning
-Depression, stress, anxiety
-Nutrition
-Mobility problems
```
152
Dimensions of fatigue
- Intensity
- Timing
- Impact
- Quality (e.g. fatigue as a result of physical strain or is it lack of motivation??)
153
Fatigue Impact
Physical
Cognitive
Psychosocial
(all connect to) Significant Decrease in Activity and Participation
154
Fatigue Assessment Tools
- Fatigue Impact Scale
- Fatigue Severity Scale
- Visual analogue scale
155
MS Fatigue Management: Pharmacological Interventions
-Amantadine
-Modafinil
-Permolin
Problem: Not effective for many people. Also side effects
156
MS Fatigue Management: Non-Pharmacological Interventions
-Exercise
-Yoga
-Relaxation
-Energy Conservation techniques
Problem: How to integrate them into life routines?
What other changes are needed?
Self-management
157
Managing Fatigue: Fatigue self-managment Strategies
-Budgeting and banking energy
-Incorporating resting periods through the day
Learning to communicate personal needs to others
-Using good body mechanics and posture
-Separating tasks into components
-Prioritizing and setting standards for activities
158
Managing Fatigue: Literature on effectiveness of the program: Face-to-face program
- Decrease fatigue impact
- Increase Quality of life
- Increase Self-Efficacy
But.... not accessible for:
those living in rural and remote areas
-those who have transportation problems
159
Summary of Fatigue
- Fatigue impacts activity and participation
- Self-management is an option for managing fatigue
- Both Face-to-Face and online version of the fatigue self-management Program improve fatigue
- Further studies are required to evaluate effectiveness of the Online Fatigue Self-managment program
160
What is cognition
Integrated functions of the human mind that result in thought and goal-directed behaviour
161
Cognition functions:
- Orientation
- Attention
- Memory
- Judgement
- Reasoning
- Language
- Executive Function
- Metacognition
- Language
- Executive function
- Metacognition
162
What are cognitive neurosciences?
Set of sciences that study systematically the mind and intend to discover the neurobiological processes that underlie them
Includes:
- Occupational Therapy
- Psychology
- Neuropsychology
- Speech Therapy
- Neurology
- Psychiatry
- Biology and more
163
Orientation
Awareness of self in relation to person, place, time and circumstance
-Individual must have a sense of place and time in order to perform higher-level cognitive functioning
164
Attention
- The taking possession of the mind, in clear and vivid form, of one of what seem several simultaneously present objects or train of thought
- Focalizations, concentration of consciousness are of its essence. It implies withdrawal from some things in order to deal effectively with others
165
Attention --> Arousal:
- A state of responsiveness to sensory stimulation or excitability
- Required in order to be able to respond to incoming visual, auditory or tactile cues during task performance
166
Relationship between arousal and perfromance
under arousal, optimal arousal and overall arousal
| How to optimize performance: reduce stimuli, level of distraction
167
Sustained Attention
Ability to maintain attention over time during continuous activity
168
Selective Attention
Ability to concentrate on one set of stimuli while ignoring completing stimuli
169
Alternating attention
Ability to flexibly shift attention between multiple operations
170
Divided Attention
Ability to respond to two tasks simultaneously
171
Attention Impairments (Distractibility)
- Breakdown in selective attention
| - Inability to block out external or internal stimuli when trying to concentrate on a task
172
Attention Impairments (Field-dependent behaviour)
- Distracted by and acting on an irrelevant impulse that interferes with activit performance and takes over goal-directed activity
- Person may end up distracted by tangential stimuli and then become fully absorbed in that stimuli
173
Memory (steps)
Encoding --> Storage --> Retrieval
174
Memory
| immediate or short-term memory
-Storage of limited information
-->only 7 (+/- 2 items)
-for a limited amount of time
-->only lasts about 20 seconds
Information must be within one's focus of attention
-->e.g. Cocktail party effect
-E.g. ability to remember instructions, numbers just provided
175
Working memory
Active manipulation of information that is in short-term memory
- Impacts ability to do mental calculations, follow rules in a game
- Information must be concentrated on in working memory for approx 30 seconds in order to proceed to long-term memory
176
Work memory steps
Phonological store visual spatial Store
177
Long Term memory
-Relatively permanent storage of information with unlimited capacity
178
Types of Declarative Memory:
| Semantic Memory
-Knowledge of general words facts, function of objects, vocabulary, etc.
E.g. dates of holidays. names of world leaders
179
Types of Declarative Memory: Episodic Memory
Autobiographic memory for contextually specific, personally experienced events
180
Memory Impairments:
| Anterograde amenesia
-Decreased memory of events occurring after ABI
-Deficit in new learning, inability to form new memories
E.g. can't recall staff names, new therapy strategies
181
Memory Impairments: Retrograde amnesia
- Loss of ability to recall events that occured before ABI
- May be worse for 4 recent events as opposed to older memories (e.g. from childhood)
- E.g. can't remember autobiographical or historical information and/or personally experienced events
182
Executive Functioning
if other parts of the brain are damaged, neurological illness can result in the loss of language, memory, perception, or movement. Yet the essence of the individual, the personality core, usually remains intact. All thing changes when illness strikes at the frontal lobes. What is lost then is no longer attribute of your mind
- the mental capacities necessary for the formulation of goals, the planning of how to achieve them and the possibility of carrying out these plans efficently
- Define them as "the skills to maintain an appropriate set of problem solving to achieve a future goal
183
Cognitive Communication
Deficits resulting from underlying cognitive or thinking difficulties in attention, memory, organization, reasoning, executive functions, self-regulation, or impaired information processing
184
Cognitive communication May impacts a person's ability to:
- Listen and comprehend
- Understand written information
- Express themselves in written format
- Interact socially, communicate ideas
- Follow a conversation, self-monitor
- Report on their injuries and functional impairments
185
Metacognition
"thinking about thinking"
| -Higher order self-awareness and monitoring of a person's own cognitive processes
186
Cognitive Assessment
| Why do it?
- To measure baseline, progress, and/or outcome status
- To understand the patient's cognitive strengths, weaknesses, and capacity for strategy use in order to plan intervention
- To estimate the patient's ability to safely perform everyday activities
187
Cognitive assessments
| Who can do it?
Anyone given adequate training
| -Standard cognitive assessment should initially be supervised by a clinical neuropsychologist
188
Different types of assessment (cognitive assessments)
1. Self-reported measures
- ->collateral sources of information
2. Standard cognitive assessment
3. Performance-based assessment
4. Informal Observation
189
Types of cognitive assessments chart (goal)
Standard cognitive Assessment
- Measure specific cognitive functions
- Detect the presence of a particular impairment
Performance-based assessment
-Detect the impact of underlying impairment on performance
190
Types of cognitive assessments chart (Characteristics)
Standard cognitive Assessment
- high structured task, generally desktop with standardized administration and instruction
- Bottom-up
Performance-based assessment
- Structured observation of performance of common functional activities
- Top-down
191
Bottom-up
Bottom-up
- Evaluate specific cognitive and perceptual impairments
- May be required t differentiate among impairments in order to make an effective treatment
192
Top-Down
- Roles are the starting point of assessment
- Discrepancies between past and present performance determined
- Specific tasks identified and evaluated
- Level and type of support to performance tasks
- Find out why the task cannot be performed
193
Types of cognitive Assessments
Standard cognitive Assessment
Disadvantages and examples
- Low ecological validity
- Do not allow integration of motor, visual cognitive or perceptual skills
Examples:
- California Verbal Learning Test
- Stroop
- Rivermead Behavioural Memory Test
- Behavioural Assessment of the Dysexecutive syndrome
194
Types of cognitive Assessments: Performance-Based Assessment
Disadvantages and examples:
- Require training on observation and interpretation skills
- Less established
Examples:
- Executive function Performance Test (EFPT)
- Multiple Errands Test (MET)
- Assessment of Motor and Process Skills (AMPS)
195
Informal Observation Look at:
- Task performance skills
- Performance patterns
- Activity demands
- Environment as facilitator or barrier
- Effects of fatigue and other impairments
- -> e.g. person with MS, asking her to organize a cluttered kitchen
196
Factors Influencing Cognitive Perfromance
- Demographic factors (age, education)
- Neurobiological
- Affective
- Environmental factors
- Langauge barriers
197
Cognitio Diagram with 4 cirles
-Chronic pain
Catastrophizing Thought patterns
Hopelessness
Lack of intervention
198
Obtaining Consent with client with severe cognitive issues
- you have to communicate the incapacity findings, the reasons and allow them to review
- Take reasonable measures to confirm the SDM, and inform the client the SDM will make the final decision related o the occupational therapy services
- Involve the client whenever possible
- use interpreters or augmentative communication tools, if necessary to ensure that the client understands the consent process
199
Cognitive Interventions Approaches:
| 1. Restitution/Recovery
- Aim: to restore an impaired capacity, decrease severity of impairment
- Assumes the improved components will automatically translate into functional activities
200
Cognitive Interventions Approaches:
| 2. Compensation or adaptive
- Aim: to decrease activity limitations and participation restrictions
- Develop new ways to circumvent the problem
- Can involve changing the context, helping re-establish habits and routines, acquiring compensatory skills and metacognitive strategies
201
Cognitive Interventions Approaches:
| 3. Integrated
-Balance between remediation and compensatory/adaptive approach
202
Approaches (cognitive)
1. Skill-task-habit training
2. Strategy training
3. Task-environment modification
4. Cognitive stimulation therapy
5. Process-specific training
The first 3 improve occupational performance
203
Skill-Task-Habit Training
Habits--> relatively effortless, automatic systems
| --> little or no contribution of the conscious mind
204
Strategy Training
Metacognitive strategies to overcome occupational problems
1. Acquisition
2. Application
3. Adaption
205
Let's get back to memory....
| Functional examples for memory problems a
- Missing appointments
- Not remembering your name
- Misplacing your keys, cards
- Misplacing bus tickets, wallets
206
Memory Strategies: Internal Memory Stategies
a. Association techniques
| b. Organizational techniques
207
Memory Strategies: External memory strategies
a. Checklists- to perform tasks, or their steps
b. Timetables- for daily activities
c. Day planners/organizers and assistive technology- alarms, notes
d. Objects
e. Tile Mate
208
Task - environment modification
Lowering cognitive demands improves occupational performance
209
Strategies for significant others;
- Understand the nature of the condition
- Simplify environment, decrease excessive stimuli
- Help of organizer, planner, checklists
- Keep everything tidy; in its place
- Fatigue, stress, other conditions can affect memory
- Keep back up items (e.g glasses, meds...)
- Be a safety back-up
- Use photographs
210
Strategies for significant others: Communication tips
- Use short and direct sentences
- Highlight the key aspects of information
- Avoid conversations that rely on memory
- Sentences to start with the most important information
- Repeat
- Don't argue or contradict
211
What about attention Stategies
- Avoid overstimulating/distracting environment
- Face away from visual distractors during tasks
- Label cupboards and drawers
- Reduce clutter and visual distractors
- Use self-instruction strategies
- Self-manage effort and emotional responses during task
212
Generalization
-will not occur spontaneously but need to be addressed explicitly in an intervention plan
To enhance likelihood of generalization:
- Avoid repetitively teaching same activity in same environment
- Practice the same tasks strategy across multiple tasks and environments
- Include metacognitive training in the intervention
- Generalization continuum: near, intermediate, far, very far transfer
213
Factors influencing sucess of intervention
- Motivation
- Coordination of care-teamwork
- ->role of caregivers/family in supporting intervention
- Metacognitive capacity of the person
- Complexity of the impairments - How are other systems (e.g motor, visual, perceptual) functioning?
- Time course and pattern of recovery
- ->stages of recovery and type /intensity of service provision
214
Visual Perception disorders
- Agnosia
- Metamorphopsia
- Prosopagnosia
- Simultanagnosia
215
Agnosia
Problem naming object just by seeing them
- the problem is not because of aphasia
- if you let the person touch the object or smell it, the person can name it
Intervention: Remediation: practice identifying objects
Compensation:
-Keep the object in consistent location
-Use sensory modalities
216
Metamorphopsia
Visual distortion of objects such as physical properties of size and weight
Assessment: Ask the person to put objects in the order based on their weight or size
Interventions:
- Ask the person practice distinguishing objects
- Using puzzles, board games, computer games
217
Propopagnosia
Problem with recognizing familiar faces
-Interpreting facial expressions
Interventions:
- Rely on auditory input
- Face-matching exercise
- Providing pictures of family and friends and asking the person to remember their name by associating the face with other characteristics like weight, height, hair style
218
Simultanagnosia
- Inability to recognize and interpret a visual array as a whole
- Able to figure out the details but not the overall scene
Intervention:
- Use verbal cues
- Provide intervention is familiar context
219
Visual-Spatial Perception disorders
- Figure ground discrimination dysfunction
- Form constancy dysfunction
- Position in space
220
Figure Ground Discrimination
Ability to perceive the foreground from the background in the visual array
Assessment: localized objects of similar colour in a disorganized visual array
Interventions:
- Modify the environment
- Decrease the complexity
- Marking common objects with colour taped
221
Position in Space (spatial relations)
-Relative orientation of a shape or object to the self
Assessments:
- Ask the Person place common objects in relation to self or other
- Up/down, top/bottom, in/out
Interventions:
-Provide opportunities to experience the organization of objects in the environment
222
Right-Left Discrimination
Ability to accurately use the concepts of right and left
Assessment: Ask the person to point to various body parts or navigate the environment through verbal commands using right and left
Interventions: Practice reciting right and left while interacting with his or her body or environment
223
Characteristics of praxis system
-Most often lateralized to left hemisphere
Functions:
-Store motor skill information for future use
-Facilitates interaction with the environment
-Provides a processing advantage- new panning is not required each time activity is started
-2-Step process resulting in execution of purposeful activity
-Conceptual/ideation: What to do
-Production/planning: How to do it
224
What is Apraxia
- Loss of praxis
- Deficit of motor perception
- A disorder of purposeful skilled movement that cannot be attributed to sensorimotor, loss of joint position sense) or comprehension deficits
- Often seen in combination with other impairments (e.g. aphasia)
225
Who is impacted by apraxia?
- 1/3 of those with left brain damage present with apraxia
- ->Corticobasal degeneration
- ->Alzheimer's
- ->Parkinson's
- ->Huntington's
In many cases aphasia and apraxia happen concurrently
226
Ideational/Conceptuall Apraxia
- Breakdown of knowledge of what is to be done to perform
- Loss of mental concept of what the activity involves
Performance Issue:
- Does not know what to do with the toothbrush or toothpaste
- Uses tools inappropriately (e.g. smears toothpaste on face)
- Problem in using objects
- Problem in sequencing multi step tasks
227
Ideomotor Apraxia (motor Apraxia)
- Loss of access to kinesthetic memory patterns, disrupting planning and sequencing of movements
- Idea and purpose of task is understood
- Seen when formulas for movement are damaged in left parietal lobe or in regions anterior to this area or connecting pathways
228
Common Performance Issues related to Ideomotor Apraxia
- Awkward, imprecise, or clumsy movements- grasping, reaching, manipulating objects difficult
- Difficulty performing movement without using an actual object related to the object
- No problem with using objects
- Difficulty following instructions for exercises e.g raise your arm (but if you show them they can follow you)
- Using a body part as an object when asked to pantomime use of an object
229
Dressing Apraxia
-Inability to dress self due to body scheme deficits, spatial relation disorders or motor planning problems
- Problem; Difficulty locating components of a shirt
- Top from bottom
- Left from right
- Armhole
230
Occupational Performance Issues (apraxia)
- Eating
- Meal Prep
- Bathing
- Grooming
- Toileting
- Dressing
- Work
231
Assessments (Apraxia): Before starting assessment:
- Perform sensory function and muscle strength and dexterity tests before testing for apraxia
- Use the unaffected hand for testing
- Get input from speech pathologist on what to do and how to communicate with the person
- Caution: impairment tests aimed at diagnosing the impairment of apraxia are performed out of context and cannot be generalized to real-world performance
- ->only use as a screening tool
232
Assessment (Apraxia)
-Structure observation (e.g, A-ONE, AMPS) of the errors that people make during functional activities is a valid method of assessing apraxia
-Include functional items in your assessment
Such as:
-Show how you brush your teeth'
-Show how you cut with scissors
-Show how you use a hammer
233
Assessment of disability resulted from apraxia
| Goal:
1. To assess presence of disability
2. Gain insight about style of action and type of error
3. Prepare treatment goals
234
Assessment of disability resulted from apraxia: Method
- Observe the person performing following activities:
- Personal hygiene (washing face and upper body)
- Dressing: putting on a shirt or blouse
- Feeding: preparing and eating a sandwich
- An individualized task
235
Assessment of disability resulted from apraxia
```
Scoring
0 totally independent, no help --> 3 Cannot perform task
Course Activity:
1. initiation
2. Execution
3. Control
```
236
Recovery (apraxia)
- Recovery seems to plateau after first few months of recovery
- Those who improve during rehab on functional measures may worsen when discharged home
- Generalizability of learning may not happen
237
Intervention: Intiation
Developinga. plan of action, selecting necessary and correct objects
--> Instructional strategy (e.g., verbal instruction, auditory or tactile cues, etc.)
238
Intervention: Execution
Performance plan
| -Assistance strategy (e.g. verbal assistance sucha s stimulating verbalization of steps, naming objects, etc.)
239
Intervention: Control
Control and correct activity to ensure adequate end result
| -Feedback strategy (e.g., knowledge of results, review of video of performance)
240
Intervention --> Apraxia
- No improvement in ADL if left to spontaneous recovery
- Continued practice and ADL participation needs long-term to maintain gains in specifically trained tracks
- Transfer of training is difficult to achieve: Focus on specific activities in a specific context close to the person's normal routines
- Should focus on functional activities, which are structured and practice using errorless learning approaches
241
If physical guidance of the limb is needed
- Put your hand over the whole hand of the patient down to fingertips
- Keep talking to minimum
- -Guide both sides of the bod if needed
- Move along the surface to increase tactile feedback
- Involve whole body to challenge posture
- Positive changes to improve resistance during activity
- Allow patient to make mistakes, give opportunity to problem solve
242
For people with Ideational apraxia
- Simplify the task
- Limit degree of freedom
- Limit number of tools
- Limit number of steps of the task
- Use clear and short instructions
- Use multiple cues: visual, verbal, tactile
- Demonstrate while sitting parallel to the patient
- Encourage verbalization of what to do
243
Facilitators and barriers to learning: Client Related
- Attention level
- Distractibility
- Fatigue and pain
- Sensory or motor impairments
- Literacy level
- Language and communication skills
- Cultural aspects of interaction
- Values and goals
244
Facilitators and barriers to learning: External
- Physical environment: noise, temperature, light, movement, clutter
- Behavioural of therapist
- Presence or absence of significant others
- Accessibility to comfort needs: toilet, fluids, food
245
Grading
- No magic or prescribed formula
- Needs to consider factors such as
- ->Duration and frequency
- ->Energy demands
- Complexity: contextual interference, environmental demands, nature of tasks and activities
- Information processing
- Therapeutic use of self: communication and social skills, verbal and non-verbal roles
246
Shaping
- Any behaviour that approximates desired performance is rewarded
- Goal performance is analyzed and broken down into sequential stages
- Once component or level of behaviour are gradually reduced and stopped
247
Cueing
- Process of guiding and directing performance
- Frequent and simple cues provide maximum guidance and support in early stages of practice
- ->Help to avoid failure
- Fade out as performance improves
- Visual-demonstration
- Tactile- guiding or placing a body part
- Verbal-spoken or written instructions
- Environmental- e.g, colour coding items or areas
248
Chaining
Forward
-->client completes first stage of task, therapist completes the remainder
-->Builds on stages until total task is completed
Backward
-->therapist completes all but the last stage of task, which client completes
-Can be more satisfying for client as more proximal to actually doing the task
249
Effortless Learning
- The learner only experiences the correct way to undertake a task
- Therapist provides instructions, cues or prompts such that no mistakes are made
- Demands on problem solving and judgement are minimal
- Environment and context of task remain the same
Use when transferability is not expected
250
Patterns of Practice: Blocked Practice
- Repetition of the same sequence of actions repeatedly
- Blocks of practice can be chained; each element in a sequence is rehearsed repeatedly on its own before the whoe is put together
- Better performance during process of acquisition/reduced cognitive demands
251
Patterns of Practice: Random Practice
- Repetition of skill or task sequence, but with varying contextual demands
- Increases the variability of demands upon performance, with increased contextual interference
Better retention and transferability of skills
252
Feedback
- Positive or negative
- Given immediately, delayed, at intervals, or as a summary
- To highlight errors, draw attention to aspects of performance, or highlight relationship between actions and consequences
- Attention, motivation, emotion all factors
253
Levels for Feedback
Less Support
1. No feedback
2. Verbal in terms of knowledge of results
3. Verbal feedback to tell them use senses to evaluate results
4. Physical feedback - Acknowledge of results (posture, position of limbs)
5. Physical feedback by pointing or handing objects
6. Verbal feedback in terms of performance
7. Physical feedback in terms of performance
8. Control of the task and correct errors
More support
