Impairments: Voluntary Mvmt: Exam 1 Flashcards
(134 cards)
1
Q
Think about this!!!
Weakness
Dyscoordination
A
- related to which health cond, disorder or disease?
- related to which activity limitations?
2
Q
When Dr. Cohen says “Coordination”
You say…..
A
Cerebellum!!!!!!!
*NOTE: also when he says “Dyscoordination” you say Cerebellum!!!
3
Q
What is Weakness?
aka Asthenia
A
- Inability to gen. normal lvls of mm force
- aka Asthenia
4
Q
Weakness leads to secondary changes in muscle
what are they?
A
Loss of type I and type II mm fibers
type I–slow twitch
type II–fast twitch
5
Q
Weakness is a predictor of _____ ______ following stroke
A
Poor Outcome following stroke
6
Q
Weakness may do 3 things:
A
- INC fall risk
- INC energy exp. during gait
- foster activity intolerance
7
Q
Weakness
Fosters activity intolerance
leads to….
A
- Sedentary lifestyle
- DEconditioning
- Disuse atrophy
- DEC in ADL status
8
Q
3 other problems that present as weakness:
A
- Bradykinesia
- Akinesia
- Apraxia
9
Q
Bradykinesia or….
A
EXTREME slowness of mvmt
10
Q
Akinesia or…
A
Inability to initiate mvmt
*getting the mvmt started
11
Q
Apraxia or…
A
- inability to perform purposeful mvmts ALTHOUGH there are NO sensory or motor impairs.
-
PROBLEM W/ MOTOR PLANNING
- If challenged to do it—-> becomes more diff.
-
PROBLEM W/ MOTOR PLANNING
ex. Dr. Cohen’s pt who was sitting in chair and stood up, but when asked to “get up” —–could NOT do it
12
Q
Limit to Strength Testing
Traditional strength testing
A
- Trad. strength testing assumes person being tested has normal motor control
- remember if it is NOT normal—–> DESCRIBE what you see
13
Q
Limits of strength testing….
if the pt does not have normal motor control….
A
Standard mm tests are not valid!!!
14
Q
Strengthening acts in people w/ CNS probs is STILL beneficial in 3 ways:
A
- Improves alpha-gamma coactivation
- uses neural pathways
- results in peripheral strength gains
15
Q
Strengthening w/ CNS patho is still beneficial, but improvements in strength are NOT assoc’d w/ INC’d____________
A
NOT assoc’d w/ inc in mm tone
16
Q
strengthening beneficial in CNS patho?
A
Strengthening programs appear to be effective in improving strength across dx groups
17
Q
4 Interventions for Weakness
A
- PREs
- Isokinetics
- Biofeedback
- FES
18
Q
Interventions for Weakness
Absence of active mvmt
0 or 1 on MMT scale
use….
A
- Facilitation techniques
- utilize stretch reflex path. for autogenic facilitation
- tapping, vibrating, lt. touch
- Modify functional task/environment
19
Q
Autogenic Facilitation
A
0 or 1 MMT
Process of inhibiting the muscle that generated a stimulus (palpable contraction), while providing an excitatory impulse to the Antagonist muscle
20
Q
Interventions for Weakness
Lack anti-gravity power
2 or 3 on MMT scale
A
- Use gravity eliminated pos’s
- begin PREs
- functional tasks
NOTE: remember w/ gravity eliminated put them in an alternative position and you support the limb during activity!!!
21
Q
Interventions for Weakness
Lack full mm power
<4 on MMT scale
A
- Resistance
- PREs w/ wts
- manual resist. ex’s
- Consider body pos.
- use trunk and extremity mm power
- endurance
22
Q
Strength training considerations and transfer effects?
A
- Exercise is:
- action-specific
- velocity-specific
- angle-specific
***transfer effects typ. not great**
23
Q
Research: Transfer of Training
Weiss, A., et al (2000)
High intensity strength training improves strength and functional performance after stroke
Exercise training x12 wks
A
- Findings:
- mm strength gains
- rep’d chair stand times DEC’d
- stair climb time DEC’d (not sig.)
- 12% improve MAS
- 12% improve Berg
24
Q
What does the research say:
High-int. strength training
A
CAN improve strength and balance
25
What does research say:
## Footnote
**Task-oriented strength training**
improves task performance and inc's strength in the relevant mm's
improves mm extensibility and stiffness
26
what does research say:
strength training and hypertonia
CAN have effect on **reducing hypertonia** in spastic muscles/mm groups
27
PNF or
Proprioceptive Neuromuscular Facilitation
28
PNF orig. developed for what?
combat **weakness** assoc'd w/ **polio**
Polio==LMN disorder
29
UE scapular and pelvic diagonal PNF patterns:
improve what?
* Specific mvmt patterns and tech's to improve:
* **Flexibility**
* **Strength**
30
Principles of PNF:
## Footnote
**Mass Mvmt**
* Mass mvmt is **characteristic of NORMAL motor activity**
* ****brain knows only of mvmt
* **Mass mvmt req's 2 things:**
* ****tissue *shortening*
* tissue *lengthening*
31
Neurodevelopmental Treatment
**NDT**
Bobaths 1960s
challenges what?
* Challenges **trunk mm's and prox. mm stability**
* ****use of resistance NOT advocated
* causes **abnorm. mm recruitment**
* Has **Functional relevance**
32
Constraint Induced Mvmt or
CIM
aka
"Forced Use"
of the **affected limb**
33
Constraint Induced Mvmt: CIM
"Forced Use"
Taub and Wolf, 1990's
* uses **motor learning principles** to INC active mvmt and function in UE
* **restricts mvmt of unaffected side**
34
Specific strengthening ideas?
## Footnote
**Gen UE/LE weakness**
* Gen. weakness---\>
* multiple major mm groups
* multijoint mvmts
* BIG, COMPLEX mvmts
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Specific strengthening ideas?
## Footnote
**DF weakness**
**Hip flexor weakness**
* address **WHERE** thes motions/mm's will be NEEDED and treat THERE
* keep it **functional**
## Footnote
****
36
Probs w/ **coordination** arise from where?
* DCML
* Cb
* afferent and efferent tracts
37
DYScoordination is a problem w/ _______ and _______ of mvmt
Timing
Amplitude
\***manifests in sev. ways**
38
Ataxia or
Drunken sailor gait
39
Gen. term used to describe **abnormal coordination**
Ataxia
40
Ataxia
abnorm. coord.
**demonstrated by deficits in.......**
speed
amp. of displacement
directional accuracy
force of mvmt
41
Dysmetria or ...
problem w/ **distance**
## Footnote
**dys=problem**
**metria=distance**
**ex. putting pen cap onto pen**
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Dysmetria
over/undershooting
Inaccurate **amp. and timing** of mvmt
==\> OVERshooting (hypermetria) OR
UNDERshooting (hypometria)
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In Dysdiadochokinesia we NEED **smooth reversal of agonist/antagonist**
They LACK this
44
Dysdiadochokinesia
diff. performing something
Diff. performing **rapid alternating mvmts**
mvmts are clumsy, slow
* TESTS:
* sup/pro forearms fast
* DF/PF ankle fast
45
oscillatory mvmt due to alternating contractions of agonists and Antagonists
Tremors
46
Tremors
oscillatory mvmt due to **alternating contractions** of agonists and Antagonists
47
Intention or **voluntary** Tremor
occurs *during movement of limb*
## Footnote
**absent @ rest**
**coordination problem**
48
This tremor is ABSENT @ rest
coordination problem
Intention or voluntary tremor
49
Resting Tremor
Present @ rest
NOT typ assoc'd w/ **dyscoordination**
50
This tremor is PRESENT @ rest
NOT assoc'd w/ dyscoord.
**Disappears w/ voluntary mvmt**
Resting tremor
51
Resting tremor typ. assoc'd w/
Basal gang
higher brain centers
52
Examining Coord:
## Footnote
**Finger to Nose test**
* indiv tries to touch index finger of examiner w/ outstretched arm
* OBSERVE FOR:
* delay in mvmt initiation
* terminal tremor (appears when they get there)
* dysmetria (over/undershoot)
* NOTE: **can be done in standing to ID diff w/ posture stabilization**
53
Examining Dyscoord:
Heel to Shin Test aka
**Frankel's Test**
* should be smooth
* Pt places heel of one leg on shin of other, near knee, slides heel down shin towards foot **then reverse**
54
Examining Dyscoord:
Rebound Test
Really checking for ....
"Lack of Check"
55
Examining Dyscoord:
Rebound Test:
* Isometric contraction resisted by examiner----**suddently releases opposing force**
* **In an individual w/ cerebellar dysfunction:**
* ****the mvmt of the limb continues unchecked (meaning that they don't stop it once you let go), and the person moves the limb forcefully
56
Dysdiadochokinesia
## Footnote
**rapid alternating mvmts**
* testing **rapidly alternating mvmts**
* performed w/ forearm Pro/Sup, finger flex/ext, DF/PF ankle
57
Romberg Test aka...
Old-School balance test
58
Romberg Test set up
pt stands still w/ eyes open then closed
59
Romberg Test
## Footnote
**Pts w/ Cerebellar Ataxia**
Show an INC in **observable body sway under eyes CLOSED condition**
**NOTE:** Not a very **specific** test bc anyone w/ balance prob may have a positive finding
60
Interventions for **Coordination**
we want **Smooooooth mvmts**
CUE your pts w/ this!!!
"Nice and Smoooooooth"
61
Interventions for Impaired Coord.
Train when?
During **functional mvmts**
62
Intervents for impaired **Coord.**
Training during **Functional mvmts:**
* external constraints
* encourage **smooooooth mvmts**
* verbal cueing
* alter lvl of diff.
* **sustained force generation---isometrics**
* ****involve production of **rapid initial burst of agonist activity**
* ****followed by sustained contraction
* **quick stretch!!!**
* **Open and closed tasks**
* ****closed==\> pt controls timing
63
Interventions for Impaired Coord.
Consider three things:
1. support cond's
2. timing constraints
3. environmental context
64
Interventions for Impaired Coordination:
## Footnote
**Increasing Complexity**
* w/draw **external control and guidance**
* **do not guide them**
* encourage inc amplitude of mvmt
* bigger!! Larger ROM
* add tasks which req. **speed alterations, changes in amp, direction, force**
* ****change directions, add more resist.
* INC balance req's
* req. that complex mvmt **stopped on command**
65
**Activities** for Impaired Coord.
* targeting acts.
* targeted mvmts
* stairs
* darts
* ball into hoop (basketball)
* walking TM
* jump/plyo's
* Weighting of UE/LEs
NOTE: **Always consider FUNCTION!!!**
66
PNF initially for...
polio
LMN disorder
\***can be used for neuro/ortho deficits**
67
PNF broken down
Proprioceptive--\> regarding sensations of body pos. and mvmt
NMSK--\> mm's and nerves
Facilitation--\> make easier, inc ease of performance of action or task
68
Functional mvmts accomplished w/ 2 things:
Mass mvmt patterns of:
1. limbs
2. trunk mm's
69
PNF basics
**Functional Mvmts**
* mass mvmts
* all 3 planes
* balance b/w **agonist, antagonist, synergist**
70
PNF enhances: (5 things)
1. stability
2. mobility
3. balance
4. posture and/or coordination
71
What does the effect of PNF really depend on?
Verbal cues!! --- what you **say**
manual contacts!! --- how you **touch** them
72
Manual Contacts
## Footnote
**Strength or Power**
**Proper manual contact does what?**
INC strength of contraction
**Can be on surface corresponding to desired direction mvmt (indirect)**
**OR**
**On skin OVER the mm in question (direct)**
73
Manual Contacts
**Direction of Mvmt:**
**Tactile cues**
Very strong!!
\***specific cueing elicits MORE approp. response**
**mult. contacts or poor placement facilitates mvmt in WRONG DIRECTION**
74
In PNF
when it comes to **resistance....**
* use the "correct" amount
* this could just be **assistance**
* ****literally having them "**assist"** w/ the mvmt
* "Ok now you do it WITH me"
75
In PNF...
Using the appropriate resistance elicits **smooth contraction**
**Not too easy or too hard**
**results in:**
* INC mm fiber recruitment
* INC kinesthetic awareness by INC force of contraction
76
Types of Contraction:
## Footnote
**Consider the type you want!!!**
**Concentric:**
* Commands
* "push" or "pull"
77
Types of Contraction:
Consider the type you want!!!
**Eccentric:**
* Kinesthetic awareness
* Commands:
* "Let go slowly"
78
Types of Contraction:
Consider the type you want!!!
**Isometric**
* Intention:
* maint. position against **external resist.**
* **PT matches force gen'd by pt**
* **Commands:**
* ****"hold still"
* "don't let me move you"
79
Types of Contraction:
## Footnote
**Maintained or Stabilizing**
**\*NOT an isometric, per se\***
* using a contraction to "initiate" the mvmt
* start w/ **concentric contraction** in which PT allows only **minimal** motion FOLLOWED BY STOPPING MVMT (**isometric)**
80
Types of Contraction:
Maintained or Stabilizing
**Used to facilitate what?**
* facilitates **stabilization**
* ****treats deficits of **strength or kinesthesia t/o ROM**
81
Types of Contraction:
Maintained or Stabilizing
**Commands:**
* "Keep it there"
* "don't let go"
so essentially... you will initiate the mvmt and bring them thru some kind of ROM....then at various points in the ROM you STOP the mvmt (isometric) and have them HOLD it in that one particular spot!!!
82
4 Neurophys. basis for PNF
1. Irradiation
2. Successive Induction
3. Reciprocal Inhibition
4. Autogenic Inhibition
83
PNF:
## Footnote
**Irradiation**
* spread mm response from one mm group to another by **altering emphasis of resistance**
84
PNF:
**Successive Induction**
* INC'd response of **agonist** AFTER contraction of its **antagonist**
85
PNF:
## Footnote
**Reciprocal Inhibition**
* facilitation of **agonist** results in **simultaneous inhibition** of **antagonist**
**Contraction an agonist RELAXES its antagonist**
**ex. bridging---** fires EXT's, FLEX's relax
86
PNF:
## Footnote
**Autogenic Inhibition**
* STRETCH ASPECT OF PNF
* Stimulation of **GTO's** results in **MM relaxation**
* **This is your PNF stretching that you know already!!!**
87
Where can irradiation occur?
ipsi/contralat.
trunk to extremities
**w/in same extremity**
88
This can facilitate **contraction in desired mm's**
Irradiation
PNF
89
If TOO MUCH resistance....
Irradiation can create
Undesired motions
90
Approximation:
* compresses jt. surfaces
* co-contraction around jts
* **inc's stability**
91
Traction or distraction
* **separation** of jt. surfaces
* DEC pain
* facilitates MVMT
92
Verbal Commands
* simple
* concise
* audible
* **SPECIFIC**
93
Other cues/stimuli you can use....
* Visual
* eyes follow hands during UE mvmts
* **Timing for Emphasis**
* ****tactile + verbal cues MUST be timed to elicit appr. response
94
2 Parts to ALL PNF Activities!!!
1. Movement Pattern
2. Exercise Technique
95
UE Diagonal Patterns:
## Footnote
**D1**
See pics
distinguish b/w Flexion and Extension
96
D1 Pattern
**Shoulder**
remember "Wonder Woman"
see pics
97
UE Diagonal Patterns
## Footnote
**D2**
see pics
98
D2 Pattern:
## Footnote
**Shoulder**
see pics
"think holding a tray out and up"
99
What are the **D1 Components** of the Scapula?
Scapular **Anterior Elevation** (Up and Forward)
Scapular **Posterior Depression** (Down and Back)
100
What are the **D2 Components** of Scapular motion?
Scapular **Anterior Depression**
Scapular **Posterior Elevation**
101
Scapular Patterns
In terms of a clock face ---- meaning the DIRECTION OF THE MOTIONS
What is the clock/motion for Anterior Elevation-Posterior Depression
**D1 scap. pattern**
1:00 to 7:00
102
Scapular Patterns
In terms of a clock face ---- meaning the DIRECTION OF THE MOTIONS
What is the clock/motion for Anterior Depression-Posterior Elevation
**D2**
11:00 to 5:00
103
Pelvic PNF Patterns
* Pelvic Anterior Elevation/Posterior Depression
* **1:00 to 7:00**
* **remember get in line w/ the motion!!!**
* Pelvic Anterior Depression/Posterior Elevation
* **10:00 to 4:00**
* **get in line w/ the motion!!!**
104
Scapular Patterns
105
Pelvic Patterns
106
PNF Activation Techniques
**Rhythmic Initiation**
* Passive--\> Active assist--\> Resistive
* You do it for them
* have them help you
* now resist them
107
PNF Activation Techniques
## Footnote
**Combination of Isotonics**
Concentric Eccentric, stabilizing contractions
108
PNF Activation techniques
## Footnote
**Reversal of Antagonists**
**Isotonic Reversal**
Alternating **Concentric** isotonic contractions
109
PNF techniques
Reversal of Antagonists
**Stabilizing Reversals**
Alternating Isometrics OR maintained isotonics
110
PNF Activation techniques
Reversal of Antagonists
**Repeated Quick Stretch**
Quick stretch--\> contraction of agonist---\> quick stretch--\> repeat
111
**Quick Stretch**
**The stimulus:**
* quick elongation of a muscle to INC **responsiveness**
* synch'd w/ verbal cues and IMMEDIATELY FOLLOWED BY appropriate resist. w/ desired manual contact
112
Quick Stretch
## Footnote
**The Response**
* DOES NOT WORK ON FLACCID MUSCLE
* used to facilitate **stronger muscle contraction**
113
Do NOT use Quick Stretch if....
if painful!!!
NO BOUNCING!!!
114
PNF Stretching
Relax/Stretch Techniques
2 types
1. Contract Relax
2. Hold Relax
115
Relax/Stretch PNF
**Contract Relax**
* Contraction of **agonist** followed by **PROM**
116
Relax/Stretch PNF
## Footnote
**Hold Relax**
* **Isometric** OR **Stabilizing** contraction followed by **PROM**
117
BOTH relax/stretch PNF tech's do what?
**Inhibition** **to REDUCE mm tension in muscle**
118
3 sensory systems @ play
1. visual
2. auditory
3. proprio.
119
Visual Input
How is it helpful?
Cueing where pt LOOKS can help facilitate resp.
"Where the eyes go, the head goes, and where the head goes the trunk goes!"
120
Auditory Input
How is it helpful?
* **tone** and **rhythm** of your voice
* simple, precise, SPECIFIC
* preparatory command
* "*annnddddddd.....**pull down"***
121
Proprioceptive Input
3 elements:
1. tactile
2. **therapist position**
3. appropr. resistance
122
Tactile Input
consider pts pos. -----**use gravity!!!**
Lumbrical grip!!!
123
Tactile Input
Helpful tips...
* PT's contact stim's skin/pressure recepts **to facilitate desired response**
* WHAT YOU TOUCH IS WHAT YOU GET
* **If you want FLEX....touch FLEXORS**
* **hand place. should control and guide desired resp.**
* ****IN LINE OF MVMT DESIRED
124
THERAPIST POSITION
IMPORTANT!!!
* pos. yourself to **move w/in the diagonal pattern of mvmt**
* **use whole body**
* **move so that pt can move w/ you**
* ****"stay in the groove"
* prep and time mvmts to assist or resist
125
Therapist's pos.
MORE TIPS
* @ either end of mvmt
* **Shoulders and hips (ASISs) FACING THE DIRECTION OF MVMT**
* Forearms should be pointed IN THE DIRECTION OF DESIRED MVMT
PRACTICE!!! YOU GOT THIS!!!
126
Therapist's Pos.
## Footnote
**Body Mechanics**
* use WHOLE body to gen mvmts
* **Your mvmt should be in the arc and line of mvmt YOU DESIRE FROM YOUR pt**
* Resist. should come from your **trunk/pelvis, NOT EXTREMITIES**
127
Appropriate resistance
* smooth/coord'd effort t/o desired mvmt
* **may also be assistance**
* reinforces awareness of mvmt pattern
* achieves desired effect
128
Appropriate Resistance
## Footnote
**Coordination:**
LESS resistance, EMPHASIS on **control**
"nice and smooooooooth"
129
Appropriate Resistance
## Footnote
**AROM**
Resistance varies to allow ROM
work them thru ROM
130
Appropriate resistance
## Footnote
**Strength**
GRADUALLY inc resistance t/o ROM
131
Appropriate Resistance
**Initiation**
Gradually inc resistance **@ beginning of ROM**
## Footnote
**force them to "fight" you to get the mvmt started**
132
Appropriate Resistance
## Footnote
**Stabilization**
SLOWLY apply resistance **until contraction is isometric**
**slowly resist them and once they have the pattern down the STOP and HOLD**
133
Use variety of muscle contractions **that are specific to the pt's NEEDS**
Mvmt vs. Stabilization
Concentric vs. Eccentric
"LET THE CASE GUIDE YOU!!!!"
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