Neuromuscular 2 Unit 1

Question 1

IV STEP’s Four P’s

What is Prevention?

Answer 1

Prevent the onset of disease (or disability) to stop its progress and minimize consequences

Question 2

IV STEP’s Four P’s

What is Prediction?

Answer 2

Optimal response to intervention choice is fundamental to effective practice; begins with meaningful system diagnosis and measurement
- Task Analysis

Question 3

IV STEP’s Four P’s

What is Plasticity?

Answer 3

Capacity of cerebral neurons and neural circuits to change structrally and functionally in response to experience
- In other words, capacity for CNS to change

Question 4

IV STEP’s Four P’s

What is Participation?

Answer 4

“Involvement of people in all areas of life or the functioning of a person as a member of society. Participation restrictions are problems an individual may experience in involvement in life situations” - WHO ICF framework

• Quality of Life

Question 5

With Neuro, what is the Goal of Physical Therapy?

Answer 5

Improve motor function and muscle performance

Question 6

What are the 3 different Intervention Categories to improve Motor Function?

Answer 6

• Restorative Interventions
• Impairment-specific and Augmented Interventions
• Compensatory Interventions

Question 7

Interventions to improve Motor Function

What is Restorative Interventions?

Answer 7

Restorative Interventions focus on targeted movement deficiencies and are using activity-based interventions and motor learning strategies to work to improve motor function. Also implementing elements of neuroplasticity principles

Question 8

Which Neuro Conditions would benefit from Restorative Interventions?

Answer 8

• Stroke, Incomplete SCI, TBI, GBS, RRMS

Question 9

What are the 3 basic elements of Restorative Interventions?

Answer 9

• Repeatitive and intense practice of the task
• Strategies that enhance active motor learing and motivation or adherence-enhancing behaviors
• Strategies that encourage use of the more imparied body segments or segments, while trying to limit or restrict use of the less-impaired body segment

Question 10

With Restorative Interventions, what are 3 elements of Activty-Based Intervention?

Answer 10

• Resolve or minimize impairments as well as prevent secondary impairments
• Apply effective task-specific strategies to the re-training of functional activities
• Adapt strategies to changing task and environmental conditions

Question 11

Restorative Interventiosn: Motor Learning strategies

What are the 3 stages of Motor Learning?

Answer 11

• Cognitive
• Associative
• Automous

Question 12

Restorative Interventiosn: Motor Learning strategies

What is the difference between Intrinsic and Augmented (Extrinsic) feedback?

Answer 12

Intrinsic feedback includes: Visual, Auditory, Proprioceptive, Vestibular, and Tactile

Augmented feedback includes: Knowledge of performance and knowledge of results

Question 13

Restorative Interventiosn: Motor Learning strategies

With Augmented Feedback, what does Knowledge of results (KR) mean?

Answer 13

• Terminal feedback about the movement outcome
• This is provided by an instructor or clinician
  –Usually verbal
  –Can be visual or auditory

Question 14

Restorative Interventiosn: Motor Learning strategies

With Augmented Feedback, what does Knowledge of Performance (KP) mean?

Answer 14

• This is information about the pattern of a movement
  –Kinematic feedback: speed, velocity, displacement
  –Kinetic or EMG feedback if equipment: force and muscle activity
  –Quality of movement: no reference to goal or outcome

Question 15

Restorative Interventiosn: Motor Learning strategies

What is Summary Feedback?

Answer 15

Feedback after a set number of trials

Question 16

Restorative Interventiosn: Motor Learning strategies

What is Faded Feedback?

Answer 16

Feedback given less frequent with ongoing practice

Question 17

Restorative Interventiosn: Motor Learning strategies

What is Bandwidth Feedback?

Answer 17

Feedback given if performance falls outside a predetermined error range

Question 18

Restorative Interventiosn: Motor Learning strategies

In Practice Progression, What is Massed vs. Distributed progression?

Answer 18

Masses: has more practice time vs rest time

Distributed: has more rest time vs practice time

This depends on the patient, either can be chosen, however usually progressed TO massed in the autonomous stage

Question 19

Restorative Interventiosn: Motor Learning strategies

In Practice Progression, What is the difference between Constant vs. Variable practice?

Answer 19

Constant: Task is practiced in the same way with no variety; This is better for performance

Variable: Task is practiced in variable conditions and parameters; This is better for learning

Question 20

Restorative Interventiosn: Motor Learning strategies

In Practice Progression, What is the difference between Blocked vs. Random practice?

Answer 20

Blocked: 1 task repeated throughout whole practice time; This promotes performance

Random: A variety of task are practiced during practice time in random order; This promotes learning

Question 21

What are Augmented Interventions?

Answer 21

These interventions include aspects of guided movement. These movements are guided or facilitated to try to promote some voluntary control and help jump start the recovery or promote positive neuroplastic changes by maybe incorporating a more involved body segment

Question 22

What are some examples of Augmented Interventions?

Answer 22

It inlcudes general neuomuscular facilitation, PNF, Neurodevelopment Treatment (NDT), Bobath, NeuroIFRAH, etc.

Question 23

Who would benefit from the use of Augmented Interventions?

Answer 23

• Patients early in recovery
• Patients with limited voluntary movement

Question 24

Why would you use Augmented Interventions?

Answer 24

These interventions can help bridge the gap between absent or severely disordered movements and more active and controlled movements. Once the patient develops more adequate voluntary control these interventions are generally conterproductive and should be discontinued

Question 25

When is Augmented Approach Indicated and Contraindicated?

Answer 25

**Indicated** - Lack of voluntary movement - Demonstrates insufficient motor recovery - Difficulty initiating or sustaining movement **Contraindicated** - Demonstrates sufficient active movement control

Question 26

What are Compensatory Interventions?

Answer 26

This involves the resumption of function using less involved body segment(s)

Question 27

# Compensatory Interventiosn What are alternative ways to accomplish tasks?

Answer 27

- Substitution - Adaptation ## Footnote (Not really an alternative way), we also use AD to accomplish different forms of movement

Question 28

With Compensatory Interventions, what is Substitution?

Answer 28

Substitutions are going to be changes that are made to the individual's overall approach to a functional task ## Footnote Ex. a pt has a Right CVA, L Hemiparesis is taught to do all there dressing tasks with their R UE as opposed to using both UE

Question 29

With Compensatory Interventions, what is Adaptation?

Answer 29

Adaptation is going to be the modification of the environment to facilitate the relearning of skills or the performance of movement and to optimize motor performance

Question 30

# Augmented Interventions (Neuromotor Approaches) Augmented Interventions are Indicated to those patients who:

Answer 30

- Lack voluntary movement control - Demonstrate insufficient motor recovery - Have difficulty initiating or sustaining movement

Question 31

# Augmented Interventions (Neuromotor Approaches) When are Augmented Interventions Contraindicated?

Answer 31

When the patient demonstrates sufficient active movement control => activity based/task oriented approaches emphasizing active motor control

Question 32

# Intro to NDT Augmented Interventions NDT was designed to emphasize what?

Answer 32

NDT was designed to emphasize inhibition of abnormal reflexes and abnormal tone prior to focusing on function ## Footnote Neuro-developmental treatment (NDT) is a hands-on therapy that helps people with neurological challenges improve their movement and function

Question 33

# Intro to NDT Augmented Interventions What are Indications of using NDT?

Answer 33

- Poor grading of muscle activity - Muscle Imbalance - Motor Fatiguability - Spasticity - Incorrect initiation of movement - Incorrect timing and sequencing

Question 34

When should you not use NDT?

Answer 34

Pt has sufficient motor control to create effective movement

Question 35

# Intro to NDT Augmented Interventions With NDT, what are 5 body segment that offer key points of control for postural control and movement?

Answer 35

- Head and Neck - Upper Trunk - Lower Trunk - UE - LE

Question 36

# Intro to NDT Augmented Interventions With NDT, what is the order in helping a patient progress to produce movement?

Answer 36

- Stability => Mobility => Manipulate

Question 37

# Intro to NDT Augmented Interventions What is the difference between Facilitation and Inhibition?

Answer 37

Facilitation: to make easier Inhibition: to prevent or hinder movement

Question 38

# Intro to NDT Augmented Interventions What are the Goals of NDT Treatment?

Answer 38

- Works in the framework of stability to mobility - Optimal Alignment for functional tasks - WB of extremities to maintain alignment - Use of both sides of body to create normal sensorimotor experience - Active participation - Repetition and Practice *Overall goal is to utilize hands to facilitate normal movement and inhibit abnormal movement*

Question 39

With NDT, where should you start?

Answer 39

Create proximal stability and then add distal mobility - **Always start at the Lower Trunk**

Question 40

# Augmented Interventions PNF What is PNF Technique?

Answer 40

This is utilized during movement in order to enhance movement facilitation

Question 41

# Augmented Interventions PNF What is PNF Pattern?

Answer 41

A movement in one plane of motion that a joint/extremity is taken or resisted through

Question 42

# Augmented Interventions PNF What PNF Diagnal?

Answer 42

A movement in two planes of motion that a joint/extremity is taken or resisted through

Question 43

# Augmented Interventions PNF What is Irradiation?

Answer 43

Transfer of activaion from agonist to another agonist ## Footnote If an individual is to perform a supine to sit, activation of the trunk flexors may predispose activation of the hip flexors

Question 44

# Augmented Interventions PNF What is Successive Induction?

Answer 44

Transfer of activation from agonist to antagonist ## Footnote Ex. if we strengthen the biceps during elbow flexion that this path would be carried over to the antagonist direction and would in turn strengthen/activate the tricep during elbow extension

Question 45

# PNF Techniques WHat does Rhythmic Initiation promote?

Answer 45

Promotes new movement, re-establishes directions | PNF techniques almost always start with this technique ## Footnote This technique may be revisited if an individual has trouble with a pattern or feels fatigued

Question 46

# PNF Techniques What does Combination of Isotonics promote?

Answer 46

Promotes movement control ## Footnote This can be delivered in either strengthening or neuromuscular reeducation types

Question 47

# PFN Techniques What does Rhythmic Stabilization/Stabilizing Reversals promote?

Answer 47

Promotes stability ## Footnote The goal is for the patient to remain stable in response to an outside stimulus

Question 48

# PNF Technique What does Dynamic Reversals promote?

Answer 48

Promotes coordination of movement ## Footnote This requires more than 1 plane of movement to be conducted

Question 49

# PNF Techniques What does Repeated Quick Stretch promote?

Answer 49

- Strengthen within the movement - Reaffirms correct pattern/diagonal ## Footnote This is used to provide proprioceptive cueing to increase the resistance of a movement, can also be used to redirect patients to the correct pattern or diagonal

Question 50

# PNF Technique What does Hold/Contract Relax promote?

Answer 50

Promotes increased passive ROM

Question 51

# PNF Patterns What are the different Scapular and Pelvic Patterns?

Answer 51

- Anterior Elevation - Posterior Depression - Anterior Depression - Posterior Elevation ## Footnote These are all in one place of motion

Question 52

# PNF Patterns What are the different UE and LE patterns?

Answer 52

- D1 Flexion and Extension - D2 Flexion and Extension

Question 53

# PFN Patterns What are the different Trunk Patterns?

Answer 53

- Lift - Chop

Question 54

# PFN Diagonals What are the different Scapular and Pelvic Diagonals?

Answer 54

- Anterior Elevation and Posterior Depression - Anterior Depression and Posterior Elevation ## Footnote Its both parts of a pattern

Question 55

Which PNF "Techniques" would only warrant a pattern?

Answer 55

- Combination of Isotonics - Hold/Relax

Question 56

Which PFN "Techniques" would only warrant a Diagonal?

Answer 56

- Dynamic Reversals

Question 57

# Augmented Interventions PNF What are PNF Barriers?

Answer 57

- Cognition - Strength - Assistance Level - Subluxation (for joint traction) - Behavior

Question 58

What are the 3 Principles of Neuroplasticity that are imprortant for Neuro patients?

Answer 58