Lecture 3

Question 1

recalling UE and LE synergies

Question 2

automatic mvmt that change the position of a body part when
- another part moving voluntarily
- increased effort is used
- patient sneeze or cough
- artificially stim
- raimiste’s phenomenon

Answer 2

Associated reactions

Question 3

Brunnstorm’s stages of recovery

• recovery may ____ at any stage
• ____ skipped stage
• may still see ____ stages if pt stressed
• motor recovery ____CNS recovery

Answer 3

• stop
• NEVER
• primitive
• reflects

Question 4

stage 1 Brunnstorm

Answer 4

• flacid
• no voluntary/reflexive activity
• no associated reactions elicited
• no DTR

Question 5

stage 2 Brunnstorm

Answer 5

• spasticity developing
  - DTR present
  - MIN voluntary mvmt, all within synergy
  - partial limb synergies elicited reflexively

Question 6

stage 3 Brunnstorm

Answer 6

• performing basic mvmt synergies voluntarily (may not be able to complete w/in full PROM)
• Spaticity increased

Question 7

at which stage is spasticity at its peak (the patient’s “peak”)

Answer 7

stage 3

Question 8

stage 4 Brunnstorm

Answer 8

spacticity starts to decrease
voluntarily perform **MIN mvmt out of synergy **

Question 9

stage 5 Brunnstorm

Answer 9

• spasticity continue to decrease
• basic synergy losing dominance over movement
• may perfom combo joint mvmt OUTSIDE synergies

Question 10

stage 6 Brunnstorm

Answer 10

• slight spasm
• isolated muscle action with variety of movement patterns
• slow speed/coordination

Question 11

stage 7 Brunnstorm

Answer 11

no spasm
restoration of normal movement and function

Question 12

patient’s efferent motor response will be specific to the ____ sensory input applied

Answer 12

afferent

Question 13

the activation of neuromuscular system through stim of proprioceptors

Answer 13

PNF
PT helps enhance the patient’s voluntary control by stimulating a deficet NMSK

Question 14

for MAX learning, keep activities as ____ relevant as possible

Answer 14

functionally

Question 15

main purpose of PNF

• strengthen ____
• develop increased ____
• promote ____
• improve ____ movement

Answer 15

• muscles
• mobility (AROM / PROM)
• learning
• functional

Question 16

facilitation of alpha motor neurons of agonist will inhibit antagonist

Answer 16

reciprocal innervation/inhibition

Question 17

contraction of antagonist will allow immediate relaxation of same muscle

Answer 17

autogenic inhibition

Question 18

maximum effort of antagonists will oveflow into agonists if reversal of direction is quick

Answer 18

successive induction
(raimestes)

Question 19

max effort of stronger muscles within a pattern facilitate or overflow into weaker muscles

Answer 19

irradiation

Question 20

7 “commandments” of PNF

Answer 20

1. manual contact
2. commands/communication
3. stretch
4. traction/approximation
5. maximal resistance: to maximize pt’s response
6. normal timing: distal to proximal mvmt
7. reinforcement: timing for emphasis

Question 21

to stretch, body part is in whcih range before starting pattern?

Answer 21

in lengthened range

Question 22

what facilitates movement?
what facilitates stability?

Answer 22

traction
approximation

Question 23

allow _ to occur earliest in pattern

Answer 23

rotation

Question 24

stages of motor control

Answer 24

1. mobility
2. stability or static postural control
3. controlled mobility/dynamic postural control
4. skilled mobility

Question 25

- mvmt; isotonic contractions - patient needs adequate ROM and motor unit activation

Answer 25

mobility (first stage of motor control)

Question 26

what are PNF techniques to enhance mobility?

Answer 26

- strengthening - lengthening shortened muscles - getting the full motion "going" (aka rhythmic initiation)

Question 27

- isometric - ability to hold a body position in anti-gravity posture

Answer 27

static posture control (STABILITY) Second stage of motor control

Question 28

PNF technique to enhance stability

Answer 28

- reversals of isometrics/alternating isometrics - rhythmic stabilization

Question 29

ability to change position while maintaining postural stability

Answer 29

dynamic postural control (controlled mobility)

Question 30

what is a technique used for dynamic postural control (controlled mobility)?

Answer 30

slow reversals/reversals of isotonics

Question 31

examples of dynamic postural control

Answer 31

shifting weight on one side to free other side for non-WB mvmt proximal mvmt over fixed distal segment

Question 32

task specific movement (timed and directed) and continue for extended periods and could be combined with other mvmt

Answer 32

skilled mobility/skill

Question 33

proximal stability with distal mobility is an example of

Answer 33

skilled mobility

Question 34

what are techniques used to enhance skill/skilled mobility?

Answer 34

normal timing agonist reversals (Concentric followed immediately with eccentric)

Question 35

sequence of mvmt that progressively challenges patient to control more body segments/weight against gravity functional training (part of everyday life of patients activity)

Answer 35

developmental activities

Question 36

examples of developmental activities

Answer 36

rolling prone progression (prone on elbows, quadruped, plantigrade, modified plantigrade) sitting kneeling standing movement transitions walking basically functional training

Question 37

applications of developmental concepts

Answer 37

- you need to contorl proximal before working on distal - then timing will be distal to proximal - use it as prepatory exercises or activities with goal of independent function - enhance function via good performance of dev. activity

Question 38

NDT conceptual framework

Answer 38

- **mvmt analysis and sensory input;** used on wide range of pts and combined with other interventions - goal: minmizing limitations and working on participation goals - sensation, action, perception, cognition and emotion are interlinked and interactive - balance and posture control - motor behavior - optimizes functional independence READ slides 38/39

Question 39

T/F NDT allows the patient to be an active co-participant in therapy, slowly giving control the patient and gradually teaches themm how to manage deficits it's not a passive participaiton

Answer 39

true

Question 40

NDT

Answer 40

- assess and treat at the same time - find out what mvmt you wanna facilitate/inhibit - decide the functional skill to prepare/environment - select a technique and assess patient (if it works, continue. if it doesn't, re-assess and use a diff one)

Question 41

"every treatment is done in (contrived/functional) situations, preparing for and practiing same activites the patient will have unkertake in dialy life. in this way, rehabilitation and treatment are closely linked and direct caryy over from treatment into daily life is ensured"

Answer 41

functional

Question 42

how to challege patients to work at higher levels

Answer 42

- trying without PT help (if not skilled at step A, start doing B,C) - turn control over to pt **as soon as they begin gaining control** - grade the amount of control - allow errors!!!!

Question 43

T/F you can impose efficient movement on abnormal postural alignment

Answer 43

FALSE!! * you need to consider alignment at the beginning, during, and after movement * test quesiton

Question 44

elements of postural control IN ORDER

Answer 44

1. trunk 2. midline orientation 3. weight shift over BOS 4. head control 5. limb function

Question 45

# OR trunk: how do you progress?

Answer 45

lower trunk progress to upper trunk - anterior/posterior pelvic tilt - lateral tilt - separation between shoulders and pelvis (lateral and rotation)

Question 46

what's the point of reference for mvmt over the base?

Answer 46

midline orientation - need to be able to stabilize it, move away from it and back, cross it

Question 47

weight shifts over the BOS

Answer 47

smaller incriments precede larger - through straigt planes and diagonals

Question 48

what evolves out of trunk control?

Answer 48

head control

Question 49

how to progress limb function?

Answer 49

establishing selective movements in WB prior to selective mvmt in non-WB - free mvmt in space requires proximal stability

Question 50

which one is done first, posture control or ability to move transitionally with control?

Answer 50

posture control first then being able to move transitionally w/ control

Question 51

isometric, eccentric, concentric sequencing for easier to harder

Answer 51

isometric, eccentric, concentric

Question 52

"musts" during clinical practice

Answer 52

- distinguishing typical vs atypical - meaningful activity and task-specific - optimal selection of practice method, feedback, and environment to max. funcitonal indep - position yourself utilizing optimal body mechanics durng therapeutic activity