Interventions of Neuro 1 Flashcards
(101 cards)
1
Q
Recovery
A
- Ability to do what they want to do the way they did it before
2
Q
Compensation
A
- Still get to do what they want to do, but they do it differently
3
Q
Neural adaptation
A
- is the foundation of learning.
- Learning or relearning occurs through establishing and strengthening neural connections
- Maximizing neural adaptation requires attention, repetition over time, positive feedback, goal direction, motivation and commitment
4
Q
Plasticity
A
= neural recovery
-New research using fMRI has reinforced that the adult brain has more potential for plasticity than previously thought
-Resolution of edema allowing resumption of nerve conduction
-Regeneration of axonal sprouts or
Development of collateral sprouts
5
Q
Plasticity - cortical representation
A
- Active movement and sensory input result in an expansion of the cortical representation
- Studies have shown differentiation in cortical representation secondary to motor experience and practice in typical adults and in response to treatment after brain injury
- Cortex is mapped according to body part but also by function or activity performed
6
Q
Mental imagery
A
- 30% of the neurons that fire while performing a task also fire when mentally visualizing performing the task
- Neurons not active when taken passively through the task
- Studies have shown significant gains in performance from mental imagery alone
- Not as good as mental and physical practice together
7
Q
ICF
A
Health Condition
- -> Body functions/ structures
- -> Activity
- ->Participation
- Environmental factors
- Personal factors
8
Q
OTPF
A
Health Condition
- ->Client factors
- ->Performance skills
- ->Performance in areas of Occupation
- ->Performance patterns
- Activity Demands
- Context
9
Q
Compensation for weakness
A
Decrease object weight Decrease energy - Assistive or Adaptive Equipment - power tools - use both hands
10
Q
Compensation for low endurance
A
- Pacing Slow down Rest breaks - Assist/AdaptEquipment - power tools - decrease environmental stressors
11
Q
Compensation for limited ROM
A
- Long-handled AE
- Build-up handles
- Strategic placement
12
Q
Compensation for Incoordination
A
- Stabilize object
- Distal Mobility___
Proximal Stability - Assistive Devices
Dycem
shelf liner
shelfs/ledges - Weighted utensils, tools, etc.
13
Q
Compensation for One sided use
A
- Devices
- Strategies
14
Q
Compensation for Decreased Sensation
A
- Protect affected areas
- Promote intact structures
15
Q
Compensation for Memory & Organization Skills
A
Devices Strategies
16
Q
Compensation for Blindness
A
- Organization
- Voice/Auditory activation
- Tactile feedback
17
Q
Compensation for Low Vision
A
- Color contrast
- Lighting
- Magnification
- Simplicity
- Scanning Techniques
18
Q
Motor control
A
- Study of the nature, cause, and mechanisms of posture and movement control
- Purpose to the movement has a lot to do with motor control
- Basal ganglia –> automatic movement (Parkinson’s, tremors, bradykinesia)
- Voluntary movement –> primary sensory cortex –> CST (stroke, lose initiation of voluntary movement)
- Important to check out sensory & motor to see if just one or the other
19
Q
Motor control theory:
A
-Understanding how movement is governed, organized and executed
- Physiological: the neuromuscular processes that lead to movement
- That is: how do humans control their muscles and joints so as to produce an action involving movement?
- Psychological: the behaviors that promote the movement skill
- That is: what does a human do to gain skill?
- Understanding how injury/disability leads to movement impairment
20
Q
Why learn motor control theory?
A
- Understanding the neuromotor processes underlying motor skill will enable you to, for a client with poor motor control,:
- Set appropriate LTG and STGs
- Choose appropriate therapy activities
- Then, in combo with motor learning theory…
- Design the best sequence of therapy activities
- Provide the best type of feedback on the best schedule
- Choose the best type of and amount of practice
21
Q
Process of Intervention
A
- First therapist generates hypotheses of why the client is having problems based on their knowledge of the client, the condition and theories of motor control
- Then hypotheses are tested during intervention and modified according to results
22
Q
Reflex chaining & Hierarchical Models
A
-Have influenced the “traditional” OT/PT motor control interventions (e.g., Brunnstrom, NDT etc.)
23
Q
Motor Program & Systems Models
A
-Have influenced “contemporary” OT/PT motor control interventions (e.g., CIMT, robotic assisted therapy, Saebo etc)
24
Q
Reflex Model
A
- Sherrington (1947)
- Motor control as reactions to sensory input
- Reflexes can be elicited through sensory stimuli
- He said movement was in response to sensory input
- i.e. Might use flexor withdrawal by pinching the palm of their hand to see if can elicit that very basic withdrawal reflex to get muscles to contract
25
Hierarchical Model
- Top down motor control – higher cognitive centers control lower
- Assumes linear neuromaturation as the basis for development
- Assumes damage to controlling influences of higher level cortex ("king") resulting in release of lower level reflexes.
- Many practice frameworks based on this model, NDT, SI, Bruunstrom, PNF, Rood
- Synergistic pattern – UE flexion & LE extension/adduction
26
Neurological injury/disease (Hierarchical)
- Damage to higher centers leads to the liberation of reflexes controlled at lower centers
- Damage to the government ("king")
- Evidence = “spasticity”
- Because normal movement requires constant cortical modifications to reflex patterns, loss of the integration leads to the patient locked into a few combinations of stereotypical reflexive movement patterns
27
Commonalities of OT treatment approaches based on traditional motor control models
- All movement impairment can be traced to CNS damage as its cause
- Treatment is aimed at re-establishing the cortical control of movement (based on neuroplasticity)
- Normal movement is facilitated via sensory stimulation (facilitation of or inhibition of reflex behaviors)
- Motor recovery follows a developmental sequence:
- Cephalocaudal
- Proximodistal
- (These are somewhat limiting – not an always statement – if don’t have proximal stability, but provide proximal stability, get distal mobility)
- Any deviation from normal movement was considered abnormal/variable.
28
Current Modifications to Hierarchical Model
- Reflexes may not be ‘abnormal’
- Flexor withdrawal, tonic labyrinthine
- Hierarchical control is not just top down
- Each level can act upon other levels
- Reflexes are just one of many processes important to generation and control of movement
- i.e. Go into synergistic pattern to stand on top of a small peg (doesn’t mean have brain damage)
- Abnormal reflexes & synergistic patterns can be helpful sometimes
- If control degrees of freedom, can have more control sometimes
29
Motor Programming Theories
- Studies show that motor movement can occur even when sensory input or reflexive activity is not available (sensory nerve cut)
- This movement is referred to as a central pattern generator (spinally initiated)
- Cortical motor programs store rules for movement so that similar movements can be produced by different parts of the body
30
Systems Theory
- Bernstein (mid 1900s) – output of nervous system thru mechanical system of body
- Body is mechanical system with mass, subject to both external forces, such as gravity, and internal forces including both inertia and movement dependent forces.
- Same central command could result in different movements because of interplay between external forces and variation in initial conditions
- Degrees of freedom problem – variety of joints & planes of movement make for multiple degrees of freedom.
- Hypothesizes hierarchical control simplifies degrees of freedom by activating lower levels of control which activates muscle synergies (muscles working together as a unit)
- i.e. Parameters of the system project how hold remote for example
- Weight, lever arm, purpose, attention, etc.
31
Dynamical Action Theory
- 1980 …
- Based on chaos theory or principles of self organization
- Suggests movement can emerge as a result of interacting elements without the need for specific commands or motor programs within the nervous system
- Motor control is dependent on numerous properties within the system, not just structures and functions of the body
- i.e: 14 y/o boy --> at 12 y/o he was a basketball star, but now at 14 y/o he can’t hit the broadside of a barn
- Has to learn how to adjust motor learning due to changed parameters (lever arms have changed)
32
Control Parameters
These are called control parameters
- Eg. Horse: Velocity – walk until you reach a certain velocity at which point you break into a trot until you reach a certain velocity and then break into a gallop
- Attractor states are preferred patterns of movement
- The degree of flexibility from these attractor states is diagrammed as an attractor well
- Shallow = flexible
- Deep = stable
33
Pattern stability
- Pattern becomes less stable just before change
- Intervention – may see more variability before change
- What parameter will need to change to make that movement pattern more effective? (A lot of trial & error in this)
- In book, shallow wells & deep wells - how stable is that pattern? When first learning, a lot of variability. As become better, less variability occurs.
- i.e. Stroke --> deep or stable well --> get stuck in synergistic pattern (pick up stuff the same no matter what the object is) have to come up with big changes to come up with a new movement pattern
34
Dynamical Systems Theory
Blending of the dynamical action theory and systems theory = Dynamical systems theory
35
Ecological Theory
- Motor control is goal oriented
- Organization of action is specific to the task and the environment in which the task is being performed
- Instead of viewing the nervous system as sensory- motor system reacting to environmental variables it is seen as a perception action system that actively explore the environment to satisfy its own goals.
- Organism – environment interphase
- More psychology theory
- Meaning matters
- People are more inclined to do a purposeful movement if have goal in mind
- Organism interacts with the environment and will produce best results
36
Motor control theory directing current evidence based OT
- Synthesizing aspects of these theories you get:
- Movement emerges from an interaction between the individual, the task, and the environment
- The OTPF says: Occupational performance emerges from an interaction between the individual, the task, and the environment
- Current therapeutic views incorporate learning and contextual issues using functional tasks.
- Dynamical systems theory is most current --> movement pattern emerges from all factors involved (environ, task, person)
- Take all factors from activity analysis & figure out which one to manipulate to get ‘er done better
37
Motor Development
- Acquisition of motor skills through maturation and learning
- A strictly neuromaturational theory of motor development minimizes the effects of environment and learning
- Therapy based on specific developmental sequence and motor development starts at the client’s current level.
- Drawbacks include long periods of therapy without development of functional skills and social incompatibility
- Current theory incorporates context for a more varied (less linear) view of development
38
Motor Learning or Relearning
-The study of the acquisition and/or modification of movement
-Process of acquiring capability for skilled action
-Results from experience or practice
-Inferred, based on behavior, not measured directly
-Produces permanent changes in behavior
(Schmidt and Lee, 1998)
-Newel (1991) broadened definition = search for a task solution that emerges from an interaction of the individual with the task and the environment to provide new strategies for perceiving and acting.
-Learning = relatively permanent change
-Involves retention or saved proficiency after a period of no practice
-Inferred through observed performance over time
-Performance = temporary change seen during practice sessions
-Observed performance
39
Nonassociative learning
Habituation
| Sensitization
40
Associative Learning
Classical conditioning
Operant conditioning
Declarative
Procedural
41
Habituation
= decreased response to repeated exposure to nonpainful stimulus
- Tactile defensiveness (repeated experience with stimuli to promote habituation)
- Vestibular dysfunction (repeated provoking of dizziness to promote habituation
42
Sensitization
= increase response following noxious stimuli
- Heighten awareness of hazards
- (i.e. if were at Boston marathon, would jump at loud noises b/c senses heightened)
- be aware of pain level, etc. b/c habituation & sensitization may be heightened
43
Classical Conditioning
= Pairing two stimuli
- E.g. Pavlov’s dog
- Therapy – verbal cue with physical assist – fade to verbal cue
44
Operant Conditioning
- Trial and error
- E.g. Skinner’s rat
- Therapy – set up for success – increase motivation
- Therapy – biofeedback
45
Declarative
- controlled
- Consciously recalled
- Requires awareness, attention & reflection
- Allows mental rehearsal
46
Procedural
- Repetition over many trials
- Vary contextual factors
- Requires less attention and cognition
- Eventually develop the movement schema
47
Fitts and Posner’s (1967) 3 stage process
1. Cognitive
- Attending to perceptual input and cognitively organizing
2. Associative
- Practice to refine
3. Autonomous
- Habitual and accurate under constant environmental expectations
48
What is goal of motor skill you are teaching?
-ROUTINE
-Repetitive without task variation –developing habit
-TASK SPECIFIC
- Teaching a task that will be done over and over with some variation in environmental constraints.
-Learn targeted behavioral sequences
Eg. Brushing teeth, putting on a button up shirt
-GENERALIZABLE
- Overall rules and strategies that can be applied to many different situations
-Requires better cognitive skills
-Eg. Finding car in parking lot, making a can of soup
49
How you measure proficiency or learning?
1. Amount of response - number of repetitions, endurance extaneous movement reduced
2. Latency of response - Reaction time – time elapsed between presentation of a stimulus and the initiation of a response
3. Rate of response -Time that starts when movement has been initiated and when movement is completed
4. Error - Kind of error, number of errors, location of errors
5. Trials - Time per trial, number of trials necessary to reach specified proficiency level
6. Client satisfaction with response
50
Practice
- Blocked vs Random
- Part vs whole
- Massed vs Distributed
- Constant vs Variable
- Guidance vs Discovery
51
Blocked vs. Random
- Blocked = Numerous repetitions of one task and then moving to different task (over & over & over in the same way)
- Efficient for learning a specific task develop blocked practice at the beginning, the same way, start basic over & over
- Random practice = Practicing different tasks in random order (something different each time) would do toward the end (outpatient or home health)
- Slower learning of task
- Better retention and generalizability
-Results are dependent on cognitive factors and may not hold for people with motor planning problems
52
Part vs. Whole
- Part – Whole = Can a task be broken down into component parts that are practiced separately and then put together as a completed movement?
- Results mixed – more research needed
- Possibly some tasks that have readily identifiable parts or steps can be learned better in this manner than those that require numerous components simultaneously
53
Massed vs. Distributed
- Massed – practice time greater than rest
- Fatigue may be a factor
- Distributed – rest = or > than practice
- Results appear to depend on task and client
54
Constant vs. Variable
- Constant – minimal variation
- Variable – trial and error – maximum variation
- Constant faster performance curve but poorer retention and generalizability.
55
Guidance vs. Discovery
- Guidance – physically moving someone through the skill (hand over hand)
- Discovery – letting client practice without guidance
- Guidance results in quicker acquisition of the skill but poorer retention and transfer
56
Feedback
- Extrinsic
- Knowledge of results (KR)
- Knowledge of performance (KP)
- Intrinsic
- How much feedback?
57
Extrinsic
- Knowledge of results (KR)
- Eg. You poured the coffee without spilling
- Observation of success or failure of attempted task
- Encouragement while letting the client try a variety of strategies to receive intrinsic feedback.
- Knowledge of performance (KP)
- Details of aspects of the movement that need revising
- Eg. You didn’t stabilize your elbow.
- Used when the client’s intrinsic feedback is questionable or disordered to increase awareness.
58
Intrinsic
Perceptual feedback from sensory systems
59
How much feedback?
- Studies suggest that tasks are retained better when feedback is less frequent.
- Individual dependent and task dependent
- Possibilities
- Faded feedback
- Bandwidth feedback
- As they’re getting it & it’s more variable, keep quiet & let them figure it out
60
Other learning factors
- Motivation
- Attention
- Sensory modulation
- Environmental distractions
- Previous experience
61
Designing an intervention session
- Assess learning needs and readiness
- Set Patient-Specific Learning Goals
- Create Learning Opportunities Throughout Treatment
- Evaluate Achievement of Learning Goals
62
Considerations in Designing Treatment - Person
Person
- What postural and movement patterns does the client have?
- What factors are constraints on functional movement?
- Strength
- Balance
- coordination
- Tone
- Contractures
- Pain
- Motivation
- Attention
- Cognition
- Sensation
63
Considerations in Designing Treatment - Context
Context
- What context will the task be done in?
- Physical Setting Social
- Cultural
- Personal
- Spiritual
- Temporal
- Virtual
64
Considerations in Designing Treatment - Occupation
Occupation
- What are the demands of the activity
- Objects used
- Space demands
- Social demands
- Sequence/timing
- Required actions
- Required body functions and structures
65
NDT History
- Often referred to as Bobath approach because developed by Berta & Karel Bobath
- Begun in1940s continues to develop today
- Postgraduate certification
- 8 week pediatric course
- 3 week adult course
- 3 week baby course
66
Clinical use of NDT
- One of most commonly used treatment approaches in OT for treatment of:
- children with neurological deficits
- adults with hemiplegia (stroke)
67
Assumptions of NDT
- Models of motor control
- Originally described using hierarchical organization of CNS
- Has been modified to a distributed model of motor control
- Dysfunction from CNS damage results in
- Loss of effective movement responses
- Development of abnormal tone & mvmt
- Function improved through use of effective movement patterns
- Handling
- Key points of control
- facilitation/ inhibition
68
NDT theoretical stuff
- aka. NeuroIfrah
- Hierarchical – spinal cord – brainstem- cortical
- Cephalo-caudal, proximal – distal, gross to fine
- Distributed – more systems approach – organized around accomplishment of specific tasks
- Initially focus on feedback of the system (especially proprioception) – Now focus on feedforward and feedback and feedback of more sensory systems such as vision.
- Papers done in class mention that there are so many different ‘theories’ floating around now as has evolved
- Associated Reactions – involuntary and nonfunctional changes in limb position and muscle tone associated with difficult or stressful activities
69
Facilitation
– manual techniques and other processes including tactile and verbal feedback used to help the patient achieve a more normal quality of movement
70
Inhibition
– manual techniques and positions used to decrease or eliminate the effects of spasticity and/or abnormal reflex activity
71
Handling
– manual hands on interventions designed to change muscle tone and normalize the quality of the pateint’s movements. Handling is used for inhibition and facilitiation.
72
Positive & Negative Signs
-Motor Impairments Result in Movement Dysfunction
-Positive Signs
-Spasticity
-Impaired Muscle Activation
-Impaired Motor Execution
-Negative Signs
-Insufficient Force Generation – Weakness
-Impaired Anticipatory Postural Control
-Hypokinesia: Poverty of Movement
-Loss of Fractionated or Dissociated Mvmts
-Can’t break up patterns
–end up with flexion patterns
73
Spasticity
- “component of an upper motor neuron disorder that is characterized by velocity-dependent increases in tonic stretch reflexes with exaggerated tendon jerks and clonus resulting from hyperexcitability of the stretch reflex”
- Enhanced excitatory input
- Increased depolarization from segmental afferents,
- Enhanced regional exitatory interneurons
- Enhanced monosynaptic descending pathways
- Reduced inhibitory input
- Reduced reciprocal inhibition of antagonist motor neuron pools by Ia afferents
- Decreased presynaptic inhibition of Ia afferents
- Decreased nonreciprocal inhibition by Ib afferents
74
Changes in thought of Spasticity
- In early NDT research spasticity was thought to be the primary impairment creating movement dysfunction
- Recent research has shown that even when spasticity is inhibited through medication, positioning, biofeedback or dorsal rhizotomy movement dysfunction remains and is more related to negative symptoms of strength, timing, and sequencing.
- Can build strength by more myofibrils – more actin/myosin bonds
- Tone is the tension or set point of muscles
- Spastic muscles are weak too, so you DO strengthen the spastic muscles after you normalize tone
- Spasticity is very dependent on pain, tension, stress --> teach them how to MANAGE their tone
75
Impaired Muscle Activation
- Excessive Co-activation (Co-contraction)
- Creates joint stiffness
- Reduction in degrees of freedom strategy
- Referred to often in NDT as ‘fixing’
- Impaired Muscle Synergies
- Functional linking or coupling of muscle groups
- Patterns can be so strong (stereotypical) that they restrict adaptation to conditions for variable and fluid movement
76
Impaired Motor Execution
- MODULATION & SCALING OF FORCES
- Difficulty executing appropriate force & tension for grasp & release
- Difficulty controlling acceleration & deceleration
- TIMING
- difficulty initiating, slow performance, & difficulty terminating movement
- Inadequate force generation to overcome gravity, inertia or antagonist restraint
- Inadequate speed of force generation
- Insufficient ROM to allow movement
- Reduced motivation to move
- Abnormal postural control
- SEQUENCING
- Activate muscles in the wrong sequences
- Muscles firing in opposition to the mvmt
- Prolonged contraction in a movement
- Firing wrong muscle
- OVERFLOW
- Widespread contractile activity in same body segment or far removed (eg. controlateral)
- Part of normal development
- Can be used therapeutically (associated movements)
77
Insufficient Force Generation- Weakness
- inability to generate enough force for posture & movement
- PRIMARY CAUSES:
- Insufficient descending motor message converging on final motor neuron pool
- Reduced number of motor units
- Difficulty modulating firing frequency
- SECONDARY CAUSES:
- Atrophy from disuse
- Atypical development of fiber type and dispersion in CP
78
Impaired Anticipatory Postural Control
- Generation of force prior to intended movement to set posture
- Need to anticipate force, velocity, and direction of intended movement and objects involved
79
Hypokinesia: Poverty of Movement
- Child with CP develop movement that is stereotypical
- Lack fluidity, variety, or complexity
- Ranges of movement small
- Usually flexion & extension without rotation
- Adults with stroke have paucity of movement
- Do not automatically adjust postural position in sitting (risk of decubiti)
- Do not spontaneously practice movements
80
Loss of Fractionated/Dissociated Movements
- Difficulty making precise, independent joint movements
- Results in stereotypic patterns
- Loss of hand dexterity
- Loss of trunk rotation
81
Sensory Impairments Result in Movement Dysfunction
-Tactile, proprioceptive, vestibular, visual
- Inability to:
- Detect & identify incoming information
- Interpret input
- Modulate inputs to match task & environmental demands
- Match information with experience, memory, & specific tasks
82
Secondary Impairments in Musculoskeletal System Result in Movement Dysfunction
Joints
- Hypermobility – hypotonia (chronic stretch and malalignment) subluxation
- Hypomobility – hypertonia (contractures)
- Different joints are prone to one or other depending on pattern of hypo and hypertonia involved.
Muscles
-Loss of sarcomeres with atrophy from disuse or restricted movement
Skin & fascia
-Become tight & adhere to muscles, tendons, & bones
83
Principles of treatment
- Goal is to retrain efficient movement responses on patient’s hemiplegic side
- Avoid activities that increase abnormal tone or strengthen abnormal movements
- Use techniques to suppress or inhibit these movements
- Use activities that strengthen normal movement patterns
- Use existing motor control on hemiplegic side for occupational performance
- Use adaptations and compensations that encourage use of affected side and decrease abnormal movement patterns.
84
Components of Neurodevelopmental Treatment
- Postural Alignment - how body parts relate to each other and gravity - 1st make sure postural alignment is correct!
- Postural Control - ability to assume and maintain postures during static and dynamic activity.
- Base of Support - cannot move a body part that has weight on it
- Weight Shift - i.e. step on R foot to step with L foot --> where going to plant it? Etc…
- Reflex Inhibiting postures - patterns that counteract the pull of tight or spastic muscles. Used to reduce tone to prepare for movement.
- Key points of control - places to put hands that are most effective for controlling the patient’s movement - proximal & distal
- Inhibition - prevent movement
- Facilitation - creating movement
- Dissociation of movement - ability to differentiate movements between various parts of the body. Dissociation is part of developmental process and part of breaking up fixed patterns – increases degrees of freedom
- Stability/Mobility -
- Stability: axial – postural muscles --> wider base of support
- Mobility: “w sit” and really stable, but not mobile --> narrow base of support to be more mobile
- Rotation - diagonal movements around trunk – requires dissociation most movements occur on a diagonal pattern with rotation
85
Role of Sensation
- Original theory- normal movement is learned by experiencing what normal movement feels like – now adapted contemporary motor control and motor learning theory for effective movement
- Feedback initially focused on proprioception
- Now incorporating more sensations such as vision
- Importance of motor learning being an active (not passive) process
86
Underlying tone
– generally hypotonicity – spasticity occurs during movement
87
Fixing
– voluntary co-contraction
88
Use of inhibition techniques
- Decrease abnormal muscle tone that interferes with passive and active movement
- Restore normal alignment in the trunk and extremities by lengthening spastic muscles
- Stop unwanted movements and associated reactions from occurring during movement and function
- Teach methods for decreasing the abnormal posturing of the arm and leg during task performance.
- i.e. Anterior tilt to inhibit extensor mvmt
- Bring leg up to less than 90 degrees (one leg flexed/one leg extended), then scoot bottom & anterior tilt pelvis wheelchair wedge with bottom higher causes anterior tilt
- Acute angle at hips / anterior tilt
- ALWAYS POSITION HIPS FIRST!!! Then build blocks upon that….
89
Passive elongation
- Shortened muscles lose strength because they are contracting at end of joint range
- Passive ROM – gentle – used to elongate and prepare muscles
- slow, even pressure
90
Proximal dissociation
- Synergistic (attractor) patterns are strong
- Dissociating or breaking up patterns helps inhibit synergy
- Eg.
- Shoulder depression for neck rotation
- One leg flexed/ other extended
- Scapula and humerus
91
Reflex Inhibiting Patterns
-Use of positioning to inhibit attractor patterns (previously termed reflex patterns)
Eg.
-Flexion at hips to inhibit extensor thrust
-Raising arm overhead to inhibit neck and arm flexion
-Abduct and externally rotate arm to inhibit trunk and arm flexion
-Forward reach inhibits scapular retraction
92
Inhibitory Positioning and Orthotics
- Wedges, seat belts, cushions
- Arm trough, lap tray
- Orthotics (pros and cons)
- pillows for positioning in bed
93
Weight shifting & Active movement
- Weight shifting over small ranges relaxes tone
- Can be trunk over proximal base of support
- Can be body over distal base of support
94
Limb oscillation
Shaking limbs reduces tone
95
Use of Facilitation Techniques
- Give patients sensation of normal movement.
- Provide system for relearning normal movements of e trunk, arm, & leg.
- Stimulate muscles directly to contract isometrically, or isotonically (concentric & eccentric).
- Allow patient to practice movement while therapist maintains some constraints
- Teach ways to incorporate involved musculature into functional tasks & occupations
96
Similar to Rood
- Joint compression / traction
- Manual resistance
- Weight shifting
- Pressure tapping
97
Sweep tapping
- Quick brisk slaps of muscle belly in upward sweep
| - Most frequently used on abdominals
98
Placing and lowering
- Positioning limb and asking client to hold it
- Start in antigravity position
- Work up to holding against gravity / resistance
99
Points of control
- Where therapist facilitates from (where place hands)
- Proximal or distal control
- Key points of control for inhibiting postures
- Hips, shoulders, neck
100
Inhibition of Spasticity in the Hemiplegic Arm using RIP
1. Position patient in sitting
2. Place hands on hemiplegic arm using proximal & distal key points of control. Pts arm will be in flexed, adducted position.
3. Correct adduction of humerus first, leaving elbow in flexion.
4. Maintain humerus in neutral rotation by side of body & use pressure on top of forearm to extend elbow gradually. If forearm is supinated, pronate it first.
5. When tension in biceps has decreased, slide your hand from top of forearm to wrist & hand. Extend wrist to neutral first, leaving fingers flexed.
6. When tension in wrist flexors decreased, open fingers, keeping wrist in neutral position.
7. Maintain arm in extended position & proceed to weight bearing or guided movement.
101
Process of Facilitation
1. Restore alignment of the segments to be moved using key points of control
2. Assist the desired movement using light hands
3. Proceed slowly and feel for the patient’s response
4. Repeat movements until patient can actively assist
5. Lighten messages of your hands so that the patient moves with less assistance. Give verbal feedback during this phase.
6. Gradually withdraw control. The patient’s movement control may decline but should not produce an abnormal response.
7. Provide practice opportunities through use of activities.
