Lecture 3

Question 1

T or F: There are specific named approaches for physical therapy of neuro conditions that are better than others

Answer 1

F, according to Cochrane review there’s no evidence that one is better than the other

Question 2

T or F: according to the Brunnstrom approach, Patient’s can skip stages of recovery

Answer 2

F, they will progress through each phase no matter what

Patient’s can also plateau at any stage

Question 3

What is a movement synergy

Answer 3

Group of muscles that work together as a bound unit in a primitive/automatic way

Question 4

What is an associated reaction and what can cause it?

Answer 4

Automatic movements of one bodypart due to

-another bodypart moving
-increased effort
-sneeze/cough
-artificially stimulated
-raimiste phenomenom

Question 5

T or F, in brunnstrom stages of recovery the UE and LE are staged together

Answer 5

F, they are staged separately

Question 6

What stage has flaccidity, no reflexes, and no associated reactions?

Answer 6

Brunnstrom’s stage 1

Question 7

What brunnstrom stage is the first where you can ilicit reflexes

Answer 7

Stage 2

Question 8

Stage 2 of brunnstrom includes what kind of movement

Answer 8

minimal voluntary movement only within synergies

Question 9

How much spasticity does stage 2 of brunnstrom have?

Answer 9

Developing spasticity

Question 10

What brunnstrom stage has peak spasticity?

Answer 10

Stage 3

Question 11

Which Brunnstrom stage can the patient preform basic movement synergies voluntarily

Answer 11

stage 3

Question 12

At what brunnstrom stage can a patient break synergies “1 joint out of synnergy with spasticity”

Answer 12

stage 4

Question 13

at what brunnstrom stage does a patient start to have decreasing synnergy

Answer 13

stage 4

Question 14

At what brunnstrom stage can a patient have multiple joints moving outside of synergies, with spasticity also decreasing

Answer 14

stage 5

Question 15

What is the difference between Brunnstrom stage 4 and stage 5 synergies?

Answer 15

Stage 4 can only minimally move outside of synnergies

stage 5 can move 2+ joints outside of the synnergies

Question 16

At what stage do you start to see minimal spasticity with simularity between the affected and non-affected side with slow speed/coordination

Answer 16

stage 6

Question 17

At what stage is spasticity completely gone and normal movement recovered

Answer 17

stage 7

Question 18

How are brunnstrom classifications used?

Answer 18

Descriptively in research and in the clinic to describe limbs

“Pt has a brunnstrom stage 5 R UE”

Question 19

What theory states that you can activate the neuromuscular system through stimulation of proprioceptors

Answer 19

PNF

Question 20

T or F, PNF states that patients need repetitions for motor learning

Answer 20

T

Question 21

What is successive induction

Answer 21

maximal efforts of antagonist muscles will overflow into the agonist muscles if reversal of direction is quick

Question 22

what is irradiation

Answer 22

maximum effort of stronger muscles within a pattern will overflow into weaker muscles

Question 23

What are the 7 elements of PNF

Answer 23

1. Manual contacts- hands are used to stimulate muscles
2. Commands - short and directive instructions timed with movement
3. Stretch - Activation of muscle spindles
4. Traction/approximation - Traction facilitates movement, approximation facilitates stability
5. Maximal resistance - depends on patient, apply the max they can take without breaking
6. Normal Timing - Distal to proximal movement, allow rotation to occur earliest
7. Reinforcement - can use timing for emphasis to increase strength of response

Question 24

What are the 4 stages of motor control in PNF

Answer 24

1. Mobility - pt needs adequate ROM
2. Stability
3. Controlled mobility/ dynamic posture control
4. Skilled mobility - coordinated movements that allow interaction with environment

Question 25

What is quadruped?

Answer 25

on hands and knees

Question 26

What is plantigrade

Answer 26

Weight bearing through the feet and hands

Question 27

What is modified plantigrade?

Answer 27

PT is weightbearing with feet on floor and hands on a raised surface

Question 28

What is the prone progression of developmental activities in PNF

Answer 28

Prone on elbows -> quadruped -> plantigrade -> Modified Plantigrade

Question 29

T or F: In PNF, developmental concepts must be fully mastered before moving onto the next progression

Answer 29

F, you should simultaneously work on multiple stages at the same time, whatever the patient can manage example: Pt can work on walking even if they havent mastered sitting balance

Question 30

In PNF, ___________ needs to happen before skilled distal movement In PNF, when a movement is mature the timing will be ________________

Answer 30

proximal control Distal to proximal

Question 31

the NDT approach emphasizes what?

Answer 31

Neuroplasticity

Question 32

How does NDT technique's teaching differ from what we know about motor learning

Answer 32

A therapist gradually gives over control to the patient (which minimizes mistakes) With motor learning we should be letting the patient make mistakes

Question 33

You cannont super impose _________________ on abnormal postural alighment

Answer 33

efficient movement. Meaning you can't force patients with abnormal posture to move perfectly throughout their therapy activities

Question 34

When must alignment be considered during therapy activities in NDT

Answer 34

At beginning/initiation during execution of movement after completion/termination of movement

Question 35

What is the first element of postural control in NDT

Answer 35

Trunk

Question 36

Which part of the trunk is emphasized first in postural control

Answer 36

Lower Trunk progressing to upper trunk

Question 37

What is the second component of postural control in NDT

Answer 37

midline orientation pt must be able to stabilize in midline, move away and back to midline

Question 38

Before a patient has midline orientation, they have to have ___________

Answer 38

trunk control

Question 39

What is the 3rd element of postural control in NDT

Answer 39

Weight shift over base of support -through straight planes and diagonals -smaller incriments first

Question 40

what is the 4th element of postural control in NDT

Answer 40

head control -evolves out of trunk control

Question 41

What is the 5th element of postural control in NDT

Answer 41

Limb function -establish selective movements in WB before non-WB -LE to support full bodyweight

Question 42

What are the 5 elements of postural stability in order

Answer 42

-trunk -midline orientation -weight shift over BOS -head control -limb function

Question 43

What is easiest and what is hardest amongst these 3: Isometric, concentric, eccentric

Answer 43

Easiest: Isometric Eccentric Hardest: Concentric

Question 44

___________ in position precedes the ability to move transitionally with control

Answer 44

postural control

Question 45

What is NEURO-IFRAH

Answer 45

different approach for treating neuro patients with no evidence

Question 46

5 Elements of postural control: Trunk -> ______ -> weight shift over BOS -> head control -> limb function

Answer 46

Midline orientation

Question 47

NDT posture control: ________ -> Midline orientation -> Weight shift over BOS -> Head control -> __________

Answer 47

Trunk Limb Function