L1: Framework for Neurological Physiotherapy Flashcards

Question

What are 2 features in identify activity limitations related to functional motor tasks involving patient/client in problem solving process in client centre and and goal orientated?

Answer 1

1. Establish short-term goals with patient / client (Eg. can you stand up from the bed? Can you walk to the toilet?) 2. Re-assessment demonstrates progress - shift in goals 3. towards long term outcomes (eg. able to go to the toilet)

Answer 2

1. Establish specific aims that address the impairments 2. Select & apply evidenced based interventions with informed consent 3. Re-assess impairments – improvement linked to ST goals

Answer 3

1. the patient will be able to roll over with the assistance of the spouse and be made comfortable in side lying in 1 week; 2. (the patient will be able to independently sit for 5 minutes in 1 week) – able to sit in chair to eat dinner 3. (the patient will be able to stand up holding a cup independently 3 times in 10 seconds in 2 weeks) – able to stand up without hand holding an object 4. (the patient will be able to perform activities in standing for 10 minutes in 2 weeks.) – able to clean teeth, have ashower while standin SMART goal

Answer 4

1. the patient will be able to walk independently on firm surfaces at discharge home with a self rated confidence of 8/10. – Able to walk around the home independently without fear 2. the patient will be able to walk independently on all surfaces prior to discharge from the active rehabilitation phase – walk from the rehab facility to the shops and move around the shops – self rated confidence 7/10.

Answer 5

1. relevant context / stage for rehabilitation 2. addresses the activities / movement problems identified by the client 3. Applies motor learning principles during task practice Functional motor tasks relevant to the patient / client are identified

Answer 6

1. establish an active role for the client rather than use practices where the client is a passive recipient of the program eg independent practice of tasks/exercises or mental / verbal rehearsal of steps to master whole task 2. work with spouse/carer as early as practical following diagnosis of a neurological disorder 3. encourage responsibility for health / life-style issues * 5-6 hours of rehab/day --\> self management and independence * Needs to feel hard and tired * Once medically stable --\> need to encourage independence

Answer 7

Knee hyperextends in mid stance of gait

Answer 8

1. Weak inner range quads? * Poor co-contraction of quads and hamstrings 2. Poor proprioception at knee? 3. Tight gastroc? 4. Spasticity / overactivity of gastroc or quad? * Snaps knee back Mid-stance for walking * Highest point but knee is not fully extended * Some PF and DF (2 degrees) * Need movement in ankle but don't need a lot of range * Hip Trendelenburg * Hip extension Faster the walking --\> more range needed

Answer 9

1. Identification of the problems interfering with functional motor tasks to provide a basis for discussion with the client 2. Prioritising the problems to be addressed so that a program can be developed with the client and empowers the client to work towards immediate (short term) and long term goals. 3. Implementation of a program that facilitates the client/carer to take some/all responsibility for execution of the program. 4. Reflection and evaluation of the efficacy of the strategies applied to address the dysfunction 5. Prediction of likely outcomes for clients (forward planning process)

Answer 10

1. Gathering information from client records 2. Initial observations of client / movement 3. Patient interview 4. Functional task and movement analysis/observation (ORDER) 5. Impairment assessment * Differentially diagnose contributions to movement dysfunction 6. Objective outcome assessment- Gives a number but doesn’t give a "WHY" --\> only do at the end 7. Gather info from other team members 8. Problem list

Answer 11

1. Plan short and long term goals in conjunction with client 2. Plan \*reassessment 1. functional task analysis / recording to re-evaluate motor control 2. outcome measures to reflect these goals 3. Review of impairments to capture change 3. Develop & implement intervention program 1. select strategies that are appropriate / effective / with established efficacy 2. discuss options/benefits etc with client & gain informed consent before proceeding 3. determine the frequency and timing of treatment 4. Intervention program * Task and high dose oriented * Functional task limitations – contributing factors * Primary impairment (eg hemiparesis, bradykinesia) * Secondary impairment (eg pain) * Prevention of secondary changes (eg contracture) 5. Reassess with \*outcome measures planned * Assess with movement observation – improved movement to nearer normal? * Assess with \* tests – achieving ST / LT goals?

Answer 12

1. functional task analysis / recording to re-evaluate motor control 2. outcome measures to reflect these goals 3. Review of impairments to capture change

Answer 13

1. select strategies that are appropriate / effective / with established efficacy 2. discuss options/benefits etc with client & gain informed consent before proceeding * Getting them onboard with the rehab (eg. are you happy and understanding what's going on at the moment 3. determine the frequency and timing of treatment * Eg. 5 mins every hour

Answer 14

1. Functional task limitations – contributing factors 1. Primary impairment (eg hemiparesis, bradykinesia) 2. Secondary impairment (eg pain) 2. Prevention of secondary changes (eg contracture)

Answer 15

1. Primary impairment (eg hemiparesis, bradykinesia) 2. Secondary impairment (eg pain)

Answer 16

1. Assess with movement observation – improved movement to nearer normal? 2. Assess with \* valid tests – achieving ST / LT goals? * But not always sensitive to changes (eg, improvements)

Answer 17

progress goals & Rx program

Answer 18

1. change goal 2. change treatment method 3. patient may have reached ‘a plateau’ in recovery 4. ? Discharge or continue treatment.

Answer 19

1. discharge / long term follow -up 2. consider home program / adapted physical program 3. discharge letter to referral source / alternate service 4. refer to community resources / services

Answer 20

Task Oriented Training

Answer 21

motor control

Answer 22

Functional needs of the clients 1. Basic functional motor tasks (roll/sit/stand/walk) 2. Work-related tasks 3. Recreational tasks **Integrates physiotherapy handling skills and specificstrategies that address the cause of movement dysfunction**

Answer 23

Treatment commences as early as possible after diagnosis or recognition of a movement disorder

Answer 24

Active learning

Answer 25

Motivation; environment

Answer 26

Functional movement analysis

Answer 27

biomechanics; kinesiology

Answer 28

1. Focusing attention 2. Feedback 3. Practice 4. Transfer of learning

Answer 29

1. Demonstration 2. Instruction 3. Ensuring tasks are concrete and goal oriented rather than abstract

Answer 30

1. Visual 2. Auditory 3. Proprioceptive

Answer 31

1. Practice of relevant components of functional tasks- Break the task into smaller components 2. Followed immediately by practice of the whole task 3. With part practice simulating load demands of whole task 4. Multiple repetitions with feedback (gradually withdrawn) 5. Retraining of affected side is stressed during task practice – minimise compensatory behaviour 6. Motivation of client to be a responsible independent learner

Answer 32

1. Practice of relevant tasks * Emphasise functional tasks that are of immediate use in the ward environment and later in the home/work/community environments 2. Goal setting * use of relevant short and long term goals that have been set by actively involving the patient * useful so that the patient is committed to 3. Practising the movements to be learnt 4. Patient responsibility for independent practice 1. The patient needs to become responsible for the execution of practice outside formal therapy time 5. Patient responsibility for independent practice 1. The therapist needs to identify what and how such practice should be carried out and to review the efforts of the patient 2. Practice books or any set of clear instructions, provide the guide for practice

Answer 33

1. Measurement and charting of progress and repetitions attempted to master task 2. Positive attitude by patient, family and therapist, and a therapist who is committed with a genuine interest in clients

Answer 34

1. Simple, closed skill performance 2. Task variation 3. Added task variation from external factors 4. Complex, open ended tasks

Answer 35

involves a predictable environment in which the movements are easy to reproduce * e.g. practice of walking in a well-lit gymnasium on a level non-slip floor surface

Answer 36

Task variation is introduced that requires demand on movement execution but in a predictable environment * walking at increased speed * stopping and starting and changing direction * (dual task)

Answer 37

Added task variation comes from an external factor in relation to the task, but still the environment is predictable and allows for movements to be reproduced * walking could now be practiced over different surfaces e.g. carpet, grass * walking up slopes or stairs * walking while holding a stationary object and later a moving object such as a child * walking while throwing and catching a ball Can still assist --\> feedback (provide tactile, verbal)

Answer 38

Complex, open ended tasks involve demanding environments that can be unpredictable and require diversifying movements * walking in a crowded area e.g. a shopping centre or busy footpath near traffic * crossing roads * walking on a travelator or a bus or train while it is in motion

Answer 39

1. Normal movement requires selective activation of muscles with appropriate force & specificity to meet task demand

Answer 40

1. Reduce stereo-typed movement patterns 2. Elicit correct timing, selection, specificity and force generation of muscle function * Activation and deactivation of muscles 3. Use techniques to drive muscle spindle activation..Stretch or FES 4. Promote alignment & attention to body & space during movement 5. Use effective & sensitive handling to support, regain alignment & control, guide the body / body parts during whole / part practice of motor tasks

Answer 41

1. postural stability and control of body segments while a position is held 2. control of the body during postural adjustments & at the limits of stability with selective activation & recruitment of muscles

Answer 42

1. Practice relevant functional motor tasks for home / immediate outdoor environment & access 2. Use specific cues / strategies with established efficacy to improve performance of motor tasks – eg Parkinson Disease 3. Use validated outcome measures &/or measurable outcomes

Answer 43

1. Pathophysiology (cause) of the brain injury and neural plasticity 2. Secondary changes in peripheral tissues 1. Rapid changes occur secondary to loss of motor control; habitual resting positions and learned non-use. 3. Cognitive and emotional factors

Answer 44

There is increasing evidence that rehabilitation can affect brain reorganisation – PET, TMS studies post stroke * Note brain reorganisation can be maladaptive e.g learned non-use

Answer 45

1. Use learning capacity / adaptability of brain 2. Initiate effective early intervention to maximise potential for recovery 3. Anticipate and avoid maladaptive changes 4. Recovery can occur years after the event

Answer 46

1. Learned non-use of affected limbs 2. Soft tissue changes / injury 3. Disuse effects 4. Muscle over-activity /imbalance 5. Incorrect motor learning - compensatory strategies (synergies)

Answer 47

1. muscle mutability: length associated changes according to immobilised position/habitual resting position * shortening * lengthening 2. decreased muscle and connective tissue compliance (Thyxotrophy) * decreased yield of muscular and collagen fibres * increased tension 3. soft tissue changes: decreased / less efficient force generation 4. loss of joint mobility (stiffness) secondary to immobilisation 5. decreased bone density associated with decreased WB / load 6. decreased cardiorespiratory fitness 7. pain secondary to changes / injury * influences the resting / active tension generation (force) * interferes with quality of movement * influences emotional attitude to body part / movement

Answer 48

1. actively manage residual pain/ stiffness/ length changes to enable ‘normal’ generation of tension 2. regain optimal length of muscles for efficient tension generation to meet task demand 3. introduce WB / appropriate load as early as tissue repair permits 4. develop specificity of force generation (related to task demand) 5. re-develop optimal musculoskeletal and cardiorespiratory endurance

Answer 49

1. Motivation (Eg. controlled anxiety/depression --\> brain injury --\> anxiety/depression reappears (brain unable to cope) 2. Attention /concentration 3. Responsibility for self care / responsiveness to information 4. Influence of previous injury / emotional response to treatment

Answer 50

1. Use of relevant tasks that address client needs 2. Plan goals with the client to foster responsibility for the rehabilitation program 3. Negotiate tasks to be addressed when noncompliance presents 4. Flexibly deliver task related programs for sustained attention during task practice 5. Actively listen and respond to client needs 6. Provide a supportive environment that is client focused.

Answer 51

1. Mobility & stability requirements of a task varies 2. Task demands vary re joint ranges / muscle length / flexibility / type of muscle contractio 3. Varying forces / speed demands required during tasks 4. Endurance of muscle function is required for functional task performances

Answer 52

1. Sensory systems feed-forward for anticipatory motor responses (vision, auditory, somatosensory & vestibular mechanisms) –apply this knowledge when assessing / retraining motor tasks after ABI 2. Vision most critical early in training * Maximise use of visual cues early in training * Less critical once motor programs are established 3. Place progressive demand on somatosensory/vestibular systems as motor control is reestablished 4. Ongoing use of sensory information is required in new environments / novel tasks – apply when progressively re-training motor tasks / progressing to new environs 5. ABI may interfere with effective use of some sensory mechanisms – specific strategies required to * Identify & select strategies to manage primary sensory deficits * Manage problems associated with perceptual / visuo-spatial mechanisms (inattention, neglect) * Minimise adaptive changes – eg learned nonuse

Answer 53

Will assist to regain optimal motor performance of everyday tasks, specific to the individual’s lifestyle and context.