Session 5

Question 1

directs, regulates, and organizes tactile, vestibular, or proprioceptive input.

Answer 1

manual contacts

Question 2

parts of the body deemed optimum for directing movement patterns and to facilitate or inhibit postures or movements

Answer 2

key points of control

Question 3

name the 2 proximal key points of control.

Answer 3

• shoulder

- pelvis

Question 4

name the 3 distal key points of control.

Answer 4

• head
• upper extremities (hands)
• lower extremities (feet)

Question 5

describe 4 specific aspects of inhibiting abnormal tone with key points of control.

Answer 5

• head/trunk flexion to decrease shoulder retraction, trunk and limb extensor tone (head/trunk)
• shoulder ER/abduction and elbow extension to decrease UE flexor tone (humerus)
• thumb abduction and extension and forearm supination to decrease wrist/finger flexor tone (thumb)
• hip ER and abduction to decrease LE extensor/adductor tone (hip)

Question 6

avoid exercises that increase ___ ___ and avoid ___ movement patterns.

Answer 6

muscle tone, abnormal

Question 7

what is necessary for good alignment and symmetry of the extremities?

Answer 7

alignment and symmetry of the trunk and pelvis

Question 8

inhibition techniques and postures are used to… (what 3 things)

Answer 8

• decrease abnormal muscle tone during task performance
• restore normal alignment in the trunk
• decrease unwanted movements or associated reactions

Question 9

• facilitating the opposite pattern of the spastic upper limb to lengthen spastic muscles
• critical for training in proper positioning to decrease potential for pain, muscle imbalance, and deformity
• weight bearing to decrease increased muscle tone
• trunk rotation and scapular mobilization (in sitting or supine)

Answer 9

reflex inhibiting postures (AKA out of pattern)

Question 10

reflex inhibiting postures should always move in which direction?

Answer 10

start proximal to distal

Question 11

name the 6 reflex inhibiting postures.

Answer 11

• shoulder protraction
• shoulder abduction (as tolerated)
• external rotation
• elbow and wrist extension
• finger extension and abduction
• thumb abduction

Question 12

name 5 aspects of positioning the hemiplegic limb.

Answer 12

• support
• alignment
• joint preservation
• prevent muscle tightness
• promote limb awareness through weight bearing

Question 13

n/a

Answer 13

n/a

Question 13

used to:

• provide somatosensory input of normal movement
• stimulate muscles to contract
• allow for practice and teach ways to incorporate the involved side into functional tasks.
• weight bearing to increase tone into forearm or extended arm
• activate postural responses through weight bearing or trunk
• facilitate arm movements in supine with “place and hold”
• arm movements in sitting with guided movement practice

Answer 13

facilitation techniques

Question 14

describe proper base of support

Answer 14

• upper trunk extension

- neutral pelvis

Question 15

describe proper shoulder stability and mobility.

Answer 15

• co-contraction of shoulder girdle muscles to support distal UE movement
• reaching with distal use in all directions

Question 16

describe proper wrist stability and mobility.

Answer 16

• maintain the wrist in a neutral or extended position to allow for grasp and prehension patterns.
• approx. 20 to 30 degrees of wrist extension

Question 17

describe proper elbow stability and mobility.

Answer 17

co-contraction of the elbow musculature to support distal UE movement in space during reaching

Question 18

• grip that places an object in contact with the palm and palmar surface of the digits.
• needed to grasp and release large objects.

Answer 18

gross grasp

Question 19

hand position that allows for finger and thumb opposition and manipulation of objects.

Answer 19

prehension patterns

Question 20

thumb opposes one or more fingers (ex: the index and long fingers)

Answer 20

palmar prehension

Question 21

thumb and the radial side of the index and long fingers meet

Answer 21

lateral prehension

Question 21

thumb and the radial side of the index and long fingers meet

Answer 21

lateral prehension

Question 22

name the 2 types of motions involved in PNF.

Answer 22

• rotation

- diagonals

Question 23

synergistic movement or performance involves the motions of rotation and diagonals

Answer 23

PNF

Question 23

synergistic movement or performance involves the motions of rotation and diagonals

Answer 23

PNF

Question 24

the goal of PNF is to facilitate which 2 things?

Answer 24

- proximal stability of the trunk for adequate distal control of limbs. - voluntary motor control and coordinated movement

Question 25

in PNF, movement patterns occur across which planes?

Answer 25

all 3 planes

Question 26

use of ____ is key when using PNF techniques.

Answer 26

proprioception

Question 27

___ ___ ___ (such as repetition, feedback, practice) are also used to enhance movement in PNF.

Answer 27

motor learning principles

Question 28

name 4 goals of PNF.

Answer 28

- acquisition of new motor skills - retention of new motor skills - transfer of learning of new motor skills - increase in strength, control, and endurance

Question 29

therapist engages pt. in which 5 ways during PNF.

Answer 29

- manual contacts - verbal commands - body positioning - body mechanics - visual guidance of movement pattern

Question 30

the therapist is trained in observing which 4 aspects of PNF.

Answer 30

- when to apply these techniques - when to withdraw techniques as pt. gain more motor control and independence - contraindications to use of techniques (significant pain, joint instability, fractures, or medically unstable) - position pt. in optimal or neutral alignment as much as possible

Question 31

muscle spindle is involved with...

Answer 31

- autogenic excitation | - reciprocal inhibition

Question 32

GTO is involved with...

Answer 32

- autogenic inhibition | - facilitating contraction of opposing muscle aka antagonist muscle

Question 33

name the 5 aspects of the D1 Flexion PNF pattern.

Answer 33

- shoulder adduction and external rotation - supination - radial deviation - wrist flexion - finger flexion/adduction

Question 34

name 5 aspects of the D1 extension PNF pattern.

Answer 34

- shoulder abduction and internal rotation - pronation - ulnar deviation - wrist extension - finger extension/abduction

Question 35

name 5 aspects of the D2 flexion PNF pattern.

Answer 35

- shoulder abduction and external rotation - supination - radial deviation - wrist extension - finger extension abduction

Question 36

name 5 aspects of the D2 flexion PNF pattern.

Answer 36

- shoulder abduction and external rotation - supination - radial deviation - wrist extension - finger extension abduction

Question 37

name 5 aspects of the D2 extension PNF pattern.

Answer 37

- shoulder adduction and internal rotation - pronation - ulnar deviation - wrist flexion - finger flexion/adduction

Question 38

name the 4 phases in which movement training occurs (rhythmic initiation).

Answer 38

1. pt. instructed to relax (PROM) 2. movements progressed to active assistive (AAROM) 3. movements are resisted (resistance to AROM) 4. Pt. moves independently (AROM) (can reverse phase 3 and 4 when indicated)

Question 39

when would you start with phase 3 rather than phase 4?

Answer 39

if pt. lacks full AROM and needs to facilitate recruitment of more motor units, then follow up with phase 4.

Question 40

when would you start with phase 4 rather than phase 3?

Answer 40

if pt. has full AROM, followed by phase 3, to work on strengthening of muscle.

Question 41

rhythmic initiation is used for pts. with which 4 conditions?

Answer 41

- hypertonicity - difficulty initiating active or voluntary movement - uncoordinated movement - difficulty with motor planning or apraxia