Final Exam Flashcards
(74 cards)
1
Q
Aquatic gurus
A
-help us understand basic principles of aquatic instruction for typically developing children
2
Q
Examples of relative density
A
RD water=1
- anything greater than 1 will sink (increased mass, empty lungs, spastic muscles)
- anything less than 1 will float (increased fat mass, full lungs, flaccid muscles)
3
Q
Benefits of buoyancy
A
PROM-buoyancy supported
AAROM=” “ assisted (motion toward the surface of the water)
ARROM=” “ resisted (movement toward the bottom of the pool)
-decrease WB for extremities and unloading of the spine
-buoyancy eliminated is motion parallel to surface of water
4
Q
Aquatic effect on WB
A
- water at c7–10% WB
- water at chest/xiphoid level–25-30% WB
- water at ASIS–50% WB
5
Q
Benefits of hydrostatic pressure
A
- helps offset blood pooling
- slowly aids in decreasing edema
- assists breathing
6
Q
Benefits of viscosity
A
- viscosity provides resistance
- increased time for normal activity
- ex. balance and equilibrium reaction with ambulation
7
Q
Surface tension
A
- streamlined vs. turbuluent movement
- streamlined=resistance proportional to velocity (continued steady movement)
- turbulent=streamlined movement squared (irregular movement)
8
Q
Benefits of resistance
A
- can use to increase intensity
- the pools’ way of having weights for strength building
9
Q
Types of resistance and examples
A
- Vertical (ex. shld horiz abd/add along water surface)
- horizontal/frontal (ex. difference bw walking fwd and sideways)
- drag forces=assist or resist mvt
10
Q
Upright exercises and benefit of H2O
A
hip flex=assisted hip ex-eliminated abd=assisted add=resisted knee flex=assisted knee ext=resisted DF=assisted PF=resisted Inv/ev=eliminated Gait training=combo Running=combo
11
Q
Supine exercise and benefit of H2O
A
abs=eliminated trunk ext=resisted hip flex=assisted hip ext=resisted hip abd=eliminated hip add=eliminated knee flex-resisted knee ext=assisted DF=assisted PF=resisted inv/ev=eliminated
12
Q
Prone exercise and benefit of h20
A
abs-resisted trunk ext-assisted hip flex-resisted hip ext-assisted abd-eliminated add-eliminated
13
Q
Balance and water
A
- on dry land, adult COG is S2
- in water, the balance point shift from COG to center of buoyancy
- COB=level of the lungs (inflated lungs=least dense body area
14
Q
Flotation considerations
A
- altered body density
- influence of asymmetrical muscle tone
- influence of differences in body regions
- improper flotation will increase anxiety and decrease effectiveness of intervention session
15
Q
Water temp
A
- warmer water for children with higher muscle tone, arthritis–>88-95 degrees
- cooler water for children with lower tone (down syndrome, hypotonia)–>82-88 degrees
- air temp 3-5 degrees warmer than pool temp if possible
- humidity ideally kept around 50%
16
Q
Possible progressions in aquatics
A
- increase reps
- increase time/duration of activity
- different equipment (more/less)
- increase surface area
- add new exercises
17
Q
Treatment plan considerations
A
- Safety
* water adjustment
* water awareness
* entry
* exit - breathing control
* holding breath
* lip closure/oral motor control - body position
* vertical/prone/supine/sidelying - Body movement
* recovery
* rotation
* isolation of extremity
* core work-abdominal function
* transition - directed play
18
Q
Aquatic therapy certifications
A
- intervention specifics (bad radgaz, watsu, halliwick)
- population specific (Ms, arthritis)
- Aquatic Therapy and Rehab Industry Cert (continuing ed)
- Aquatic Fitness Cert (several certs available)
- Adapted aquatics instructor training
- basic aquatic certs (lifesaving, water safety instructor)
19
Q
Aquatic therapy techniques and CP
A
- Ai Chi
- aquatic PNF
- aquatic feldenkrais
- bad ragaz
- halliwick
- swim sstroke
- task type
- watsu
20
Q
Hippotherapy Definition
A
The use of the horse’s movement as a tool in an integrated treatment program to address impairments, functional limitations, and disabilities in patients with neuromuscular dysfunction
21
Q
Therapeutic riding organizations
A
- NARHA (north american riding for the handicapped association)
- graduate program in hippotherapy at Western Michigan University
22
Q
Hippotherapy vs. Therapeutic riding
A
Hippotherapy–medical therapy provided under a physician’s prescription. The horse influences the client rather than the client controlling the horse
Therapeutic riding–supervised recreational riding for people with disabilities. May teach specific riding skills.
23
Q
Equine Assisted Therapy Session
A
- requires referal from MD
- Eval and treat by PT or OT
- CRI for horse control
- Documentation
- Specific riding skills not taught
- Primary objective is using horse’s movement to facilitate movement of the rider
24
Q
Why a horse?
A
- a horse’s walk is variable, rhythmic, repetitive
- resulting mvt to client is similar to human pelvic mvt in gait
- 4 step cycle results in rider’s shoulder and pelvis doing a circular movement
- illustrated by 3D movement of horse’s back
25
General objectives of equine assisted therapy session
- reduce excessive muscle tone and atypical postural compensations
- Improve:
* postural alignment and trunk control
* balance reactions
* weight shift
* rotation through the body axis
* dissociation of shoulders and pelvis
- mobile treatment tool
26
Variable rhythmic and repetitive walking of horse can improve
-muscle tone
-balance
-posture
-coordination
-strength
-flexibility
(provides variable sensory input)
27
Variations in horse's stride, speed, direction results in
constant vestibular, somatosensory, and visual feedback
| -may increase patient's awareness of BOS, postural alignment and COG
28
Patient response
- new movement strategies
- important movement learning strategies (vestibular and proprioceptive stimulation, changing visual fields, shifting COG)
- increased righting and equilibrium responses
- improved function off the horse
29
Motivation
- demands and encourages participation
- family presence
- environment and interaction with horse are pleasurable
- feeling of accomplishment
- provides sense of pride
30
Impairment indications
- abnormal tone
- impaired balance
- impaired coordination
- poor postural control
- decreased strength
- decreased flexibility
- impaired sensorimotor function
31
Functional limitations indications
- speech and language abilities
- behavioral and cognitive skills
- gross motor skills (standing, sitting, walking)
32
Diagnoses of riders
- amputation
- arhtirits
- arthrogryposis
- autism
- blind
- CP
- CVA
- deaf
- down syndrome
- HI/sizure
- MD
- MR
- MS
- polio
- sickle cell
- SCI
- scoliosis
- LD
33
Medical condition indications
- CP
- stroke
- developmental delay
- down syndrome
- autism
- spina bifida
- traumatic brain injury
- sensory integration
34
Hippotherapy precautions
- seizure activity
- vertebral laxity
- spina bifida
- craniotomy
- unstable/weak spine or pelvis
- CV problems
- sensory loss
- easy fatigability
35
Hippotherapy contraindications
- precautions in a serious state
- skin abnormalities
- SCI less than 12 months
- recent back surgery
- any condition involving fragile bones
- hemophilia
- hemorrhoids
- uncontrolled epilepsy/seizures
36
Needs and equipment
- horse leader
- 2 sidewalkers
- 1 PT/OT (preferable NAHRA certified)
- soft fleece saddle/pad
- safety helmets
NOT a riding lesson--patients have no control over the horse
37
Designing the treatment session
- greeting of rider
- rider greeting of horse
- grooming and tacking of the horse
- mounting
- warm up
- treatment
- free time
- dismount
- farewell of horse
38
Session time frame
- weekly for 30 mins
| - horses used for treatment must be gentle, patient, and adequately trained and are often small to acommodate children
39
PT responsibility
- directs the mvt of the horse
- analyzes client's response and adjust the treatment accordingly
- addresses various therapeutic goals by having patients ride in different positions (facing forward/backward, sitting sideways, standing in the stirrups, riding without holding)
40
Primary therapeutic components to consider
- developmental position of the client
- direction of the movement of the horse
- augmented facilitation provided by the therapist
41
Child lying prone over horse
- monitor speed of walking and length of stride
- may be uncomfortable
- may cause dizziness
- should be used sparingly
- safety precautions critical
42
Riding backwards
- facilitates extension and more natural pelvis
- particularly good for a rider with a posterior pelvis and kyphotic posture
- the more upright the position, the greater the challenge
43
Supine on horse's back
-may be uncomfortable
44
Sitting forward on horse
-more difficult due to more narrow BOS
45
Documentation, billing, and goals for Hippotherapy
- initial eval, documentation, discharge criteria
- billing will all follow the formation of the treating therapist
- CPT codes used for billing are chosen based on specific goals of treatment
- LTG and STG are established
46
Recognition of hippotherapy
- APTA
- AOTA
- ASHA
- lack of evidence-based research
- 3rd party payers do reimburse
47
Vestibular Disorders in Children
- BPPV
- migraine
- fistula
- otitis
- vestibular neuritis
- SNHI
- Ototoxicity
48
Peds Vestibular Disorders Treatment and Eval Considerations
- maturation of the systems
* individual systems (sensory and motor)
* nerve conduction and central mechanisms
- Maturity (cognitive/behavioral)
* unable to understand/cognitive impairment
* interest and function of the child=play
49
Somatosensory Maturation
Adult-like responses by 3-4 years of age
50
Vision Maturation
- binocularity and fusion by 3-4 years of age
| - adult like postural control-adolescent
51
Vestibular Maturation
-rotary chair adult-like after 4 years of age
52
Maturation of motor responses
- dependent upon experience/practice
- sequence initially proximal-distal
- physiologically measured responses
* short latency and long latency responses are adult-like between 3 and 4 years of age (EMG)
53
Maturation of Integration Abilities
- critical period=4-6.5 years of age
* increased variability
* cannot resolve conflicts of sensory cues
- adult-like after 15 years of age
54
Developmental Milestones related to balance
- sit=8 mon
- stand=12 mon
- walk=15 mon
- SLS EO: 3 sec @ 3, 6@4, 10@54
- SLS EC, 3@5, 8@6
- Turn 180 degrees-54 mons
- balance beam (3.5 in: 4 steps @ 4, 8ft@54 mon, tandem walk @ 6)
- walk on a straight line for 10 ft=5 years
55
Functional reach norms
```
5-6yr=6.7 in
7-8yr=8.2 in
9-10 yr=10.2 in
11-12 yr=11.9in
13-15 yr=11.8 in
Adult=16.7 in
*not height adjusted
```
56
Functional reach with heigh adjustment
- children over 7 years and adults were similar
| - to correlate with COP, UE crossed, measure children at shoulder, adults measure from pelvis
57
Peripheral and Central Vestibular Dysfunction in Children
- children often unable to describe symptoms
- clinicians must rely on parent reporting
- challenge to determine if it's peripheral, central, or motor
58
Peripheral causes of vertigo and disequilibrium in children
- otitis media
- BPPV
- vestibular neuronitis
- meniere's disease
- genetic and congenital disorders (SNHL, congenital temporal bone malformation, congenital infections)
- drug induced ototoxicity
59
Central causes of vertigo and disequilibrium in children
- migraine
- penign paroxysmal vertigo of childhood (BPVC)
- seizure disorder
- neurovascular disorders (AVM, aneurysm, vasculitis)
- posterior fossa tumor
- most common: viral infections, migraine, bpvc, otitis media, bppv, vestibular neuritis
60
Peripiheral vestibular dysfunction
- damage to the SCC, otoliths or CN VIII
- children will present with either
* unilateral vestibular hypofunction (UVH)
* bilateral hypofunction (BVH)
61
UVH Causes
- unilateral vestibular hypofunction
- viruses
- trauma
- vascular events
- otitis media
62
UVH Symptoms
- brain thinks the person is spinning toward the side that is intact bc of resting firing rate of CN VIII
- resting nystagmus if sudden onset 9subsides after 3-7 days due to central compensation)
- loss of vestibulospinal reflexes on one side (may fall toward side of damage)
- nausea
63
UVH-PT's should address
- gaze instability
- postural instability
- disequilibrium
64
BVH-common causes
- bilateral vestibular hypofunction
- ototoxicity
- usher syndrome
- genetic sensorineural hearing loss
65
BVH-symptoms
- children with BVH since birth may not realize they have oscillopsia since they have never experienced "normal"
- postural instability forces them to rely on vision and somatosensory to balance (unsafe if dark or uneven)
- no vertigo or nystagmus (unless asymmetry)
- no VOR causes oscillopsia (bouncing of the world)
66
Diagnostic testing
-conducted by otolaryngologist, neurologist, ENT, audiologist
67
Horizontal canal test
- water caloric testing (children will not tolerate)
* cool (inhibit) or warm (facilitate) endolymph causing nystagmus
* gold standard to determine asymmetry or response
* electronystagmography (ENG) records eye movements to determine avg peak velocity gain (eye velocity/head velocity) recorded for each of 4 irrigations
* R & I warm irrigation, followed by cool
* asymmetry compaired
* 20-30% assymetry is abnormal
68
Rotary chair testing (children will tolerate)
- ENG is recorded to determine VOR gain and phase in responses to rotational stimuli in the dark
* children can sit in parents lap, less invasive)
- sinusoidal stimuli (chair moves side-to-side) at frequences of 0.01, 0.04, 0.08, 0.16, 0.32 Hz
- Trapezoidal testing (chair spins) at 100 deg/sec for 60 sec
* outcomes=gain, phase,
69
Vestibular Autorotation Test (VAT)
- VOR gain and phase is measured during active head oscillations
- horizontal and vertical gain can be measured at frequencies 2-5 hz
- not commonly used bc of low sensitivity for UVH and it is difficult for most pts to move head above 3.9 Hz.
- also patients can use central pre-programming since the head movements are active
70
Utricle and Saccule Testing
- vestibular evoked myogenic potentials
| - subjective visual verticle
71
Vestibular evoked myogenic potentials
- VEMP
- test integrity of saccule
- stimulus=clicks
- record
- EMG over SCM
- works through medical vestibulospinal tract
72
Subjective Visual Vertical
- SVV
- tests integrity of utricle
- patient must set a line to vertical
- can have no visual or somatosensory reference
- healthy subjects can set line to within 2.5 deg of error
73
Implications of balance and motor development impairments
- effects of a vestibular deficit on the development of postural control
* children with BVH do not have a VOR and therefore can't see when the head is moving at more than 100 deg/sec
* if BVH is present since birth, they may not notice they are off balance
* they may avoid sports or activities that require balance and eye-foot or eye-hand coordination
- 63-80% of children born with sensorineural hearing loss have BVH with consequant impairments
74
Effects of vestibular deficit in development of gross motor abilities
- progressive motor develop delay in young children with BVH
| - children with chronic otitis media with effusion present with motor delays and postural control deficits
