pt prev 2

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shmvii
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pt prev 2
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2012-05-16 17:48:08
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  1. Brunnstrom's technique's name
    • Central Facilitation Techniques
    • focuses on motor unit recruitment
  2. Rood's technique's name
    techniques based on cutaneous stim
  3. parts of CNS used in reflexes
    spinal cord, brainstem, midbrain
  4. equilibrium reactions are leicited thru what stim?
    vestibul and neck muscle proprioceptive stim
  5. basic unit of motor control in one word
    reflexes
  6. def of reflex
    a sterotyped (invol) motor response elicited by a defined, specific sensory stim

    early motor behavior is dominated by reflex activity


    they then become integrated dn are thought to form the basis for volitional movement
  7. damage to CNS affects reflexes how?
    screws them up -- results in re-emergence of and inability to control te reflexes
  8. fyi, motor control is hierarchigally arranged, with the higher and middle levels of cns controlling lower


    So, a neurologic insult will lead to...?
    a release of lower-level centers from higher-level inhibitory control, leading to sterotypical postures, primitive movemnt patterns, and predominant reflex activity

    also, loss of supraspinal control fo gamma motor neruons will chang how it's biased and lead to hypertonicity
  9. assymetrical tonic neck reflex (ATNR)
    • primitive relfex found in newborns:
    • put a baby supine, point its head to the R, and the R UE and LE will extend while the left flex
  10. Tonic Labyrinthine Reflex
    in newborns

    • tilting the head back while supine causes:
    • the back to stiffen and arch backwards,
    • legs straighten and stiffen,
    • toes point,
    • arms bend at elbows and wrist
  11. tonic labyrinthine reflex if presnt beyond newborn stage is called...?
    abnormal extension pattern or extensor tone
  12. symmetrical tonic neck reflex
    • enables infant to "creep" - push around on stomach
    • assists in dev of visual tracking

    shoulders extend over hands, flexion in hips (looks like crawling in the pic)
  13. tonic labyrinthine reflex, assymetrical tonic neck reflex, and symmetrical tonic neck reflex are all...?
    brainstem reflexes
  14. three midbrain reactions
    body on head righting, parachut, labyrinthine righting
  15. body on head righting (a midbrain reaction)
    if the head rolls one way, the body follows suit

    this preps the kid to transition between supine, sidelying and prone
  16. parachute (midbrain reaction)
    a protctive extension of upper extremities and neck, and hand opening if you're falling down head first
  17. labyrintine righting (a midbrain reaction)
    "upright position of the head; orients head in space; maintains face verticle"
  18. Bobath approach hypothesis (hierarchical model)
    a neurologic insult will lead to a release of teh lower-level centers from higher-level center inhibitory control, resulting in sterotypical postures, primitive movemnet patterns, and predominant reflex activity
  19. Bobath approach - name?
    neuro-developmental treatment
  20. contemporary bobath concept utilizes..?
    a problem solving approach to the individual's clinical presentation and personal goals, with treatment focused on remediation and guiding the indevidual towards efficient movemnt strategies for task performance
  21. reflexes in the Bobath NDT approach
    No! NDT doesn't use reflexes as a precursor for volitional movement
  22. 4 principles of bobath/ndt
    • 1 - normalize muscle tone
    • 2 - inhibit primitive reflexes
    • 3 - facilitate normal postural reactions
    • 4 - treatment should be developmental using a cephalocaudal approach
  23. Bobath/NDT techniques
    weight bearing over affected limb (lean on weak arm/leg)

    utilize positions that allow use of affected limbs

    avoid sensory input that affect muscle tone
  24. Bobath approach / NDT ... main and secondary problems?
    main: abnormal coordination of movemnt patterns and abnormal postural tonus
  25. secondary: muslce strength and activity
  26. handling, "Key Points of Control" (bobath/ndt)
    KPCs are parts of the body where PT can most effectively control and change patterns of posture and movement of other parts of body

    proximal KPCs: spine, sternum, shoulder/scapula, pelvis/hip

    distal KPCs: jaw, elbow, wrist, knee, base of thumb, ankle, big toe

    head can be prox or distal
  27. central facilitation techniques
    don't rely on peripheral mechanisms, but instead rely on motor recruitment techniques to facilitate synergistic muscles
  28. who recognized the sterotyped patterns of recover following CVAs and developed a 7 stage model of motor recovery?
    Brunnstrom!
  29. Brunnstom noticed that after a CVA an individual goes thru...?
    'evolution in reverse,' with motion becoming primitve, reflexive, and automatic

    considered changes in tone and reflexes as normal parts of recovery
  30. 4 Brunnstrom strategies in therapy
    • 1 - facilitate pt's progress thru the 7 recovery phases (can stop prgressing at any phase)
    • 2 - use postural and attitudinal refelxes to increase and decrease muscle tone
    • 3 - stim of skin over muscle produces contraction
    • 4 - resistance facilitates contraction
  31. Brunnstrom's 7 stages of recovery, super simplified
    • 1 - brand new CVA, flacid, no movement at all
    • 2 - synergies, vol movement, and spasticity begin to dev
    • 3 - progress from stage 2, spasticity is at its peak
    • 4 - spasticity and hypertonicity start to decline, primitive reflexes are gone
    • 5 - getting better...
    • 6 - individual joint movemnts are possible, specificisty of joint motion returns, cooridintation approaching normal...
    • 7 - aok
  32. the rundown on basic limb synergies
    muscles are neurophysiologically linked and can't act or perform all their functions on their own.... if one muscle in a synergy is activated, each muscle in that synergy responds.... soooo - pts can't perform isolated movements when bound by these synergies
  33. typical hemiplegic LE posture
    pelvis
    hip
    knee
    ankle
    toes
    • pelvis - posteriorly elevated, retracted
    • hip - IR, add, ext (like lats do!)
    • knee - extended
    • ankle - PF, inverted, sup
    • toes - flexed
  34. LE flexion synergy
    • hip: flex, abd, ER
    • knee: flex
    • ankle: DF
    • toes: ext

    so - everything goes up and out
  35. LE extension synergy
    • hip: ext, add, IR
    • knee: ext
    • ankle: PF
    • toe: flex

    same as the typical hemiplegic LE posture
  36. UE ext synergy
    • shoulder: protracted, IR
    • arm add in front of body
    • elbow: ext
    • forearm: pronation

    like you're reaching to grab something in front of you on the contralat side
  37. UE flex synergy
    • shoulder: retract and/or elev, ER, abd to 90 degrees
    • elbow; flexion to acute angle
    • forearm: sup


    elbow up, now touch your shoulder
  38. typical hemiplegic UE postrure
    • head: lat flex toward affected side (maybe helps w/balance?)
    • scap; depressed and retracted
    • shoulder: add, IR
    • elbow: flex
    • forearm; pronated
    • wrist; flex, ulnar dev
    • fingers: flex

    hand curled down below contralat boob
  39. Brunnstrom, what to do when no motion exists:
    • facilitate movement using:
    • reflexes,
    • associated reactions,
    • proprioceptive facilitation,
    • exteroceptive facilitation

    this is all to develop muscle tension in preparation for voluntary movement
  40. Brunnstrom, how resistance stims movement vs how tactile stime does
    resistance (proprioceptive stim)- promotes a spread of impulses to produce a patterned response

    tactile stim - facilitates only the muscle related to the stimmed area
  41. Raimiste's phenomenon
    The involved lower extremity will abduct/adduct with applied resistance to the uninvolved lower extremity in the same direction.
  42. homolateral limb synkinesis
    flexing hip and knee may help bend ipsilat elbow
  43. limitation of sensorimotor approach
    doesn't actively engage the pt's motivation or volition in performance of a motor activity

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