Rehab Exam 1 Review Flashcards
(64 cards)
1
Q
Motor Control
A
- Study dealing with the understanding of the neural, physical and behavioral aspects of movement
- Everything related to movement
- How brain talks to rest of the body
2
Q
Motor Skill
A
- Purposeful and functionally based movement learned through interaction and exploration of the environment
3
Q
Motor Plan
A
- Idea or plan for purposeful movemtn
- Brain creates plan of action over time
- Take in sensory input, create motor output
- Concept –> brain, neuron, neurotransmitter –> movement
4
Q
Motor Program
A
- Set of commands that results in production of coordinated movement
- Possible contributions: synergistic component parts, force, direction, timing, duration, extent of movement
5
Q
Motor Memory
A
- Recall (perform) the motor programs without thought, as if muscles remembers
6
Q
4 components of motor memory
A
- Initial movement conditions
- Sensory: how movement felt, looked, sounded
- Specific movement parameters (ex: force needed to generate movement)
- Outcome of movement
7
Q
Neuroplasticity
A
- Ability of brain to create and repair itself
- Ability of CNS to respond to intrinsic/extrinsic stimuli by reorganizing structure, function, connections
8
Q
When neuroplasticity occurs
A
- During development
- Response to environment
- Support of learning (learningd new tasks)
- Response to disease/damage/injury
- Relationship to therapy
9
Q
Adaptive Neuroplasticity
A
- Good, positive change; re-routing occurs (creates new routes in brain)
10
Q
Mal-adaptive Neuroplasticity
A
- Does not generate new routes; allows compensation/changes vs. doing task properly
11
Q
Motor Learning
A
- CNS integrates sensory and motor info to produce a motor action and relatively permanent changes in capability for skilled behavior
- “Perfect practice makes perfect”
- “Not perfect” practice can lead to mal-adaptive neuroplasticity
12
Q
PTA “Must-Do” requirements for Motor Learning
A
- Determine if SKILL is IMPORTANT to the patient, DESIRABLE, REALISTIC to learn
- DEMONSTRATE task exactly as it should be done
- RELATE skill to a skill that pt is FAMILIAR with; pt can use PAST EXPERIENCE as subroutines
- Give CLEAR and CONCISE verbal instructions and VS; Allow TRIAL and ERROR
13
Q
Feedback
A
- Response-produced info received during or after a movement used to monitor output for corrective actions
- Intrinsic (inherent) - as natural part of movement (visual, proprioception)
- Extrinsic (augmented) - info received from outer influences (verbal/tactile cues, visual, biofeedback)
- Concurrent - occurs during movement
- Terminal - occurs after movement
14
Q
Feedforward
A
- Sending signals in advance of movement to ready sensorimotor system
15
Q
Dynamical Systems Control Theory
A
- CNS organized around specific task demands
- Larger areas of CNS may be needed for complex tasks
- Higher CNS levels may not be used for simple or discrete tasks
16
Q
Hierarchial Control Theory
A
- CNS organized from top-down
- Areas shape and determine motor plans
- High: organize sensory motor, decision making (association cortex, basal ganglia)
- Middle: define specific motor programs, initiate commands (sensorimotor cortex, cerebellum, basal ganglia, brainstem)
- Lower: execute movement (spinal cord)
- Higher levels needed for initial skill acquisition
- As motor learning develops, only lower levels activated for motor programming
17
Q
Stages of Mobility
A
- Mobility (Transitional mobility)
- Stability (Static postural control)
- Controlled Mobility (Dynamic postural control)
- Skill
- Develop levels in order, but work on simultaneously
18
Q
Mobility
A
- Ability to move from one position to another
- Ability to initiate movement through a functional ROM
19
Q
Stability
A
- Ability to maintain a position/posture through co-contraction and tonic holding around a joint with COM over BOS with body NOT in motion
- Ex: Unsupported sitting in midline or (alternating) isometric contractions
20
Q
Controlled Mobility
A
- Ability to move within a WB position or rotate around a long axis
- Ability to maintain postural stability and orientation with COM over BOS while parts are in motion
- Move COM away from BOS and back
21
Q
Static-dynamic controlled mobility
A
- Maintain posture while moving one or more limbs
22
Q
Skill
A
- Ability to CONSISTENTLY perform functional tasks and manipulate environment with normal postural reflex mechanisms and balance reactions
- Consistently doing activities in UNCONTROLLED environment
23
Q
Categories of Cognitive Deficits
A
- Focal: Only one or a few deficits
- Profuse/multifocal or global: Deficits across many areas of cog function
24
Q
5 levels of Consciousness
A
- Consciousness
- Lethargy
- Obtundation
- Stupor
- Coma
25
Consciousness
- State of alertness and awareness of surroundings
26
Lethargy
- Slow motor processing
- Drowsy - opens eyes and responds briefly
- Easily falls asleep; impaired focus
- Requires constant stimulation
- Speak loudly, ask simple questions
27
Obtundation
- Dulled or blunted sensitivity
- Difficult to arouse, slow responses
- When aroused, appears confused; demonstrates little interest or awareness
- Longer period of time than lethargy
- Little awareness of environment
28
Stupor
- Semi-consciousness
- Lacks responsiveness
- Requires strong (often painful) stimulus to arouse
29
Coma
- Unconsciousness; unable to arouse
- Eyes open
- No sleep-wake cycle
- No response to painful stimuli
- Generally time-limited
30
2 levels of Coma
- Minimally conscious (vegetative) state: Return of irregular sleep/wake cycles; Normalization of vegetative functions (respiration, digestion, BP); aroused, unaware of environment; nopurposeful or cog responsiveness
- Persistent vegetative state: Vegetative state for 1 year or more
31
Orientation
- The who, what, where and when
- Time, place, person, circumstance
- A+O x 3: orient to time, place, person
- A+O x 4: includes circumstance
32
Selective attention
- Screen and process relevant info while screening out irrelevant info
- Can function in busy environment; focus on select conversation
33
Sustained attention
- Length of time pt maintains attention
34
Alternating attention
- Switching attention between two different tasks
| - Add 2 numbers, then subtract 2 numbers
35
Divided attention (dual task)
- Performing two tasks simultaneously (walk and talk)
36
Receptive Aphasia
- Wernicke's Aphasia (fluent aphasia)
- Can talk, but does not understand
- Left-sided - CVA, TBI
37
Expressive Apashia
- Broca's Aphasia (non-fluent aphasia)
- Difficulty talking, but understands
- Left-sided - usually not TBI
38
Global Aphasia
- Receptive + Expressive Aphasia
39
3 elements of Memory
- Acquisition or Learning (registration)
- Storage or retention (retention)
- Retrieval or recall (recall)
- Concept similar to card catalog (store info to be able to recall)
40
Short-term memory
- Capability to remember day-to-day events, learn new material and retrieve after minutes, hours or days
41
Long-term memory
- Recall facts or events such as birth dates or anniversaries
42
Memory impairments
- Amnesia: Memory deficit (Those with no long-term memory)
- Anterograde (post-traumatic) amnesia: Inability to learn new info
- Retrograde Amnesia: Inability to remember previously learned info that they knew prior to the insult to the brain
43
Developmental Postures
- POE (Prone on elbows)
- Quadruped
- Bridging
- Sitting
- Kneeling and half-kneeling
- Modified plantargrade
- Standing
44
Decorticate Posturing
- Abnormal flexor pattern
- UE in flexion (elbow, wrist and fingers flexed with shoulder adduction)
- LE in extension (extension, IR, plantar flexion)
- Pretty severe brain damage
45
Decerebrate Posturing
- Abnormal extensor pattern
- UE in extension (elbow extended, forearm pronated, wrist and fingers flexed, shoulder abduction)
- LE in extension (extension, IR, plantar flexion)
46
Rood (Neuromuscular facilitation/inhibition)
- Sensory stimuli to achieve motor output through facilitation (creation) or inhibition (decrease) of movement responses
- All motor output is the result of past or present sensory input; takes into account autonomic nervous system, emotional factors, motor ability
- Goals of treatment: Homeostasis in motor output; activate muscles - response to stimulus, perform task independently of stimulus
- Once desired response is achieved, stimulus is withdrawn
47
Facilitation techniques
- Approximation
- Joint compression
- Icing
- Light touch
- Quick stretch
- Resistance
- Tapping
- Vibration
- Brushing
48
Inhibition techniques
- Deep pressure
- Prolonged pressure
- Prolonged stretch
- Warmth (ex: inhibit muscle spasm)
- Prolonged cold
- Carotid reflex
- Traction (Grade 1 or 2 distraction)
49
NDT (Neurodevelopmental Treatment)
- Function-induced recovery
- Inhibit bad postures (abnormal movement), facilitate normal movement
- Promote normal movement patterns that integrate function
- Abnormal movement patterns (compensations) are not tolerated
- Key points of control: Shoulder, Pelvis, Hand, Foot
50
NDT (5 basic components of movement)
- Trunk control and movement (Estabish trunk stability to superimpose head and limb control)
- Head control on trunk (Head aligns on stable trunk)
- Midline orientation (Pt learns where midline is and begins moving away from and toward midline)
- Movement over BOS (Move trunk over BOS, prep for standing)
- Limb function on trunk (Allows for contact with environment, trunk stability = better limb function)
51
Brunnstrom (Movement Therapy in Hemiplegia)
- Synergy is primitive patterns that occur at the SC as a result of CNS hierarchial organization
- Uses synergy to restore function
- Reinforcing synergies are difficult to change later
- Focus on pattern of movement
- Initial limb synergies encouraged as necessary milestone for recovery
- Encourage overflow to recruit active movement
- Use of repetition of task and positive reinforcement
52
Brunnstrom (7 stages of recovery)
- Stg 1: No volitional movement of limbs can be elicited
- Stg 2: Appearance of basic limb synergies as associated reactions; beginning of spasticity
- Stg 3: Voluntary control of movement synergies, although not full range; spasticity increases, may be severe
- Stg 4: Spasticity decreases; movement combos that don't follow paths of synergy are mastered
- Stg 5: Further decrease in spasticity; independence from limb synergy
- Stg 6: Disappearance of spasticity; isolated jt movement with coordination
- Stg 7: Normal motor function restored
- Pt may experience plateau at any stage of recovery, preventing full recovery
53
Modified Ashworth Scale
```
0 = No increase in muscle tone
1 = Slight increase in muscle tone; catch-and-release, or min resistance at end of ROM when affected part moved in flexion/extension
1+ = Slight increase in muscle tone; catch, or min resistance throughout remainder (less than half) of ROM
2 = More marked increase in muscle tone throughout most of ROM, but affected part easily moved
3 = Considerable increase in muscle tone, passive movement difficult
4 = Affected part(s) rigid in flexion/extension
```
54
PNF (Proprioceptive Neuromuscular Facilitation)
- Synergistic movement patterns are components of normal movement
- Emphasizes diagonal patterns with rotation (incorporate flexion, extension, rotation that are directed toward or away from midline)
- Originally developed for neurological conditions
- True PNF has more specific hand placements
- Stronger parts of body are utilized to stimulate and strengthen the weaker parts
55
PNF (Intervention principles)
- Technique must have accurate timing, specific commands and correct hand placement
- Short and concise verbal commands
- Repetition in motor learning
- Isometric and isotonic muscle contractions
- Implemented to progress a pt through stages of motor control
56
PNF Techniques (Mobility)
- Increase ROM: CR, HR, JD, RR, RS
| - Initiate Movement: HR Active Movement, JD, RC, RI, RR
57
PNF Techniques (Stability)
- AI, RS, SR SR Hold
58
PNF Techniques (Controlled Mobility)
- AR, SR, SR Hold
59
PNF Techniques (Skill)
- Distal Functional Movement: NT, SR, SR Hold
| - Proximal Dynamic Stability: AR, RP
60
PNF Techniques (Strength)
- AI, RC, RP, TE
61
Motor Control Theory
- Task-oriented approach
- MC = ability to produce, regulate and alter mechanisms that produce movement and control posture
- Observation of functional performance, analysis of strategies used to accomplish tasks; assessment of impairments
- Design and implement effective recovery and compensatory strategies
- Retrain using functional activities
Evaluation determines degree of impairment, intervention designed at level of impairment
- Tasks broken down into components of the task for practice
62
CIMT (Constraint induced movement therapy)
- Restrain uninvolved extremity; forces use of involved extermity
- Most research focuses on UE because gait is natural CIMT
- Concentrated time frame (intense - multiple hours); repetitive practice; task- specific (practice of multiple tasks
63
Functional, Task-oriented training
- Combined with motor control and motor learning, task-oriented training is leading approach to intervention
- Enhances recovery and re-acquire skill
- Functional task - focused on functional tasks; Motor control - Based on level of impairments
- PTA acts as "coach" and implements feedback with skill: Initial movements assisted or guided, active movements are overall goal
64
Kleim Article (10 principles of neuroplasticity)
- Use it or lose it (failure to drive specific brain functions = degradation)
- Use it and improve it (training that drives specific brain function = enhancement)
- Specificity (Nature of training experience dictates nature of plasticity)
- Repetition matters (Plasticity requires sufficient repetition)
- Intensity matters (Plasticity requires sufficient training intensity)
- Time matters (Different forms of plasticity occur at different times during training)
- Salience matters (Plasticity requires sufficient salience)
- Age matters (Training plasticity occurs more readily in younger brains)
- Transference (Plasticity in response to one training experience can enhance acquisition of similar behaviors)
- Interference (Plasticity in response to one training experience can interfere with acquisition of other behaviors)
