Neuromuscular Theories of Rehabilitation Flashcards
(25 cards)
Bobath: Neuromusclular Developmental Treatment (NDT)
based on hierarchical model of disfunction
abnormal postural reflex activity/ muscle tone caused by loss of CNS control @ brainstem/spinal cord
recognizes abnormal function of CNS = slowing/cessation of motor development, inhibited righting/equilibrium reactions, automatic movements
**pts should learn to control movement via normal movement patterns that integrate functionality
NDT Postural Control Assupmptions
Can be learned/modified w/ experience
Uses both feedback & feed-forward mechanisms to perform tasks
Initiated from pt’s base of support
Required for skill development
Develops by assuming progressive positions that increase distance b/w CoG and BoS (BoS should also decrease)
NDT Intervention Constructs
Inhibit abnormal patterns w/ simultaneous facilitation of normal patterns
Alter abnormal tone & influence isolated active movement
Use manual contact/handing through key points of control for facilitation/inhibition
Achieve balance b/w muscle groups during interventions
Use developmental sequence, dynamic reflex inhibiting patterns, functional activities w/ varying difficulties
Emphasize rotation
Provide sensation of normal movement by inhibiting abnormal postural reflexes
Tx should be active/dynamic w/emphasis on function
Orient pt to midline control by moving in/out of midline w/dynamic activity
Belief that compensation techniques are unnecessary/should be avoided
Brunnstrom Movement Therapy in Hemiplegia
created/defined “synergy,” encouraged use of synergistic patterns during rehab immediately, then develop combos of patterns outside of syngery
synergies = primitive patterns occurring @ spinal level as result of hierarchical organization of CNS
**research now says synergies are very hard to change, use discouraged in therapy
Brunnstrom’s 7 Stages of Recovery
1: no lateral movement
2: appearance of basic limb synergies, beginning of spasticity
3: synergies performed voluntarily, spasticity increases
4: spasticity begins to decrease, movement patterns not dictated solely by limb synergies
5: further decrease in spasticity w/ independence from synergistic patterns
6: isolated joint movement performed w/ coordination
7: normal motor function restored
Homolateral Synkinesis
flexion pattern of involved UE facilitates flexion in involved LE
Limb Synergies
group of muscles that produce predictable pattern of movement in flex/ext patterns
Raimiste’s Phenomenon
involved LE AB/ADDucts w/applied resistance to uninvolved LE in same direction
Souque’s Phenomenon
raising involved UE above 100˚ w/ elbow ext produces ext and ABduction of fingers
Proprioceptive Neuromuscular Facilitation (PNF)
based on idea that stronger body parts are used to stimulate/strengthen weaker ones
Normal posture= balancing agonist and antagonist muscle groups, development follow normal sequence
places great emphasis on correct manual contacts/handling w/ short verbal commands+resistance through full movement of pattern
should promote response of neuro mechanism through stimulation of proprioceptors
movement follows diagonal/spirals (flex/ext/rotation) directed towards/away from midline
PNF Constructs
pt learns diagonal patterns of movement
must have accurate timing/ specific commands/ correct hand placement
verbal cues must be concise
repetition is important for motor learning
resistance given is greater to develop stability, less to develop mobility
techniques should use isometric/isotonic contractions
Tx objective dictate use of techniques through either full movement/ @points w/in range
used in conjunction w/ developmental sequence to increase balance between agonists/antagonists
implemented to progress pt through stages of motor control
functional patterns used to increase control
should increase strength/relaxation by enhancing overflow from stronger muscles to weaker ones
PNF Pattern: Scapula
D1 Flex: elevation, ABduction, Upward rotation
D1 Ext: ext, ADDuction, downward rotation
D2Flex: elevation, ADduction, upward rotation
D2 Ext: depression, ABduction, down rotation
PNF Pattern: Shoulder
D1 Flex: flex, ADduction, LAT rotation
D1 Ext: ext, ABduction, MED rotation
D2Flex: flex, ABduct, LAT rotation
D2Ext: ext, Adduct, MED rotation
PNF Pattern: Elbow
D1 Flex: flex/ext
D1 Ext: flex/ext
D2 Flex: flex/ext
D2 Ext: flex/ext
PNF Pattern: RadioUlnar
D1 Flex: supination
D1 Ext: pronation
D2 Flex: supination
D2 Ext: pronation
PNF Pattern: Wrist
D1 Flex: flex, RAD deviation
D1 Ext: ext, ULN deviation
D2 Flex: ext, RAD deviation
D2 Ext: flex, ULN deviation
PNF Pattern: Thumb
D1 Flex: ADduct
D1 Ext: ABduct
D2 Flex: extension
D2 Ext: opposition
PNF Pattern: Pelvis
D1 Flex: protraction
D1 Ext: retraction
D2 Flex: elevation
D2 Ext: depression
PNF Pattern: Hip
D1 Flex: flex, ADduct, LAT rotation
D1 Ext: ext, ABduct, MED rotation
D2 Flex: flex, ABduct, MED rotation
D2 Ext: ext, ADduct, LAT rotation
PNF Pattern: Knee
D1 Flex: flex/ext
D1 Ext: flex/ext
D2 Flex: flex/ext
D2 Ext: flex/ext
PNF Pattern: Ankle and Toes
D1 Flex: dorsiflex, inversion
D1 Ext: plantarflex, eversion
D2 Flex: dorsiflex, eversion
D2 Ext: plantarflex, inversion
Rood
introduced use of sensorimotor stim to facilitate/inhibit responses
all motor output is result of both past and present sensory input. Tx based on sensorimotor learning. uses developmental sequence of “key patterns” to enhance motor control. Goal = obtain homeostasis in motor output & activate muscles to perform tasks independent of stimuli
Once response is obtained curing Tx, stimulus should be widthdrawn
Sensory Stimulation Techniques: Facilitation
Approximation Joint compression Icing Light Touch Quick Stretch Resistance Tapping Traction
Sensory Stimulation Techniques: Inhibition
Deep Pressure
Prologued Stretch
Warmth
Prologued Cold
