intro neuro eval d

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intro neuro eval d
2012-10-08 08:34:32
intro neuro eval

intro neuro eval d
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  1. 3 basic types of interventions in Brunnstrom method
    • sensory cues
    • associated reactions
    • reflexes
  2. what area of th CNS did Brunnstrom tap into to help pts regain movement? what's her technique called?
    • motor cortex
    • central facilitation technique
  3. Beevor's axiom
    a muscle maybe paralyzed for one movement but not another
  4. UE flexion synergy
    • scapula: elevation (75-100%) retraction (50%)
    • shoulder: abd 90 degrees, ER 90 degrees
    • elbow: full flexion
    • supination: full
    • wrist flexion: 20 degrees
    • finger flexion: full
  5. UE extension synergy
    • scapula: protaction (50%) depression (50%)
    • shoulder: add to midline, IR 60-90 degrees
    • elbow extension: full
    • pronaation: full
    • wrist extension: 20 degrees
    • finger flexion: full
  6. symmetrical tonic neck reflex
    • flex neck: LEs ext, UEs flex
    • ext neck: LEs flex, UEs ext
    • (basically your legs get you away from what you're looking at)
  7. asymmetrical tonic neck reflex
    turn head to one side, and the limbs on that side will extend while te lmbs on the other side flex
  8. tonic labyrinthine reflex
    • if pt is supine this greatly increases extensor tone
    • if prone this nominally increases flexor tone
  9. tonic lumbar reflex
    rotate trunk to one side --> tennis player pose: the UE on that side flexes, as does the contralat LE, while the others ext
  10. relative influences of Brunstrum's reflexes
    • TNR strontest of all, but UE > LE
    • T Lab. R -- UE>LE
    • T Lumb. R LE>UE, but weakest reflex compared to the above
  11. associated reactions in facilitating synergy for UEs
    • flex of one UE -->flex of other
    • ext of one UE -->ext of other
    • start w PT resisting the unaffected side to get overflow into affected side
  12. homolateral limb synkinesis
    what an LE does, the ipsilat UE wants to do too, and vice versa (good w flex/ext)
  13. stages 1 and 7 of Brunnstroms stages of recovery
    • stage 1: no voluntary movement at all. Flacid. No spasticity, reflexes, clonus.
    • stage 7: full normal movement
  14. In Brunnstrom's stages of recovery, when does pt first begin to break out of synery and see a decrease in spasticity?
    stage 4
  15. Brunnstrom's stage 2
    stage 2: weak associated reactions. Spasticity developing. No voluntary movement, but some reflexes or spasticity. No clonus yet
  16. Brunnstrom's stage 3
    stage 3: basic limb synergies, spasticity increased. No isolated OOS movements.
  17. Brunnstrom stage 5
    stage 5: partial indep frm synergy. multiple isolated movements possible
  18. Brunnstrom's stage 6
    stage 6: isolated joint movement, good recovery but still residual problems like impaired speed
  19. seated trunk control exercises
    • (Rood was all about stability before mobility)
    • first - pt has arms cradled - we help pt just stay upright
    • then - work on forward flexion, side flexion, rotatating side to side -- this is for dynamic sitting balance
    • you can hold pt's arms, scap, a portion of hand, whatever is appropriate
  20. ways to make seated trunk control exercises more complex
    • reach arms across body at various angles
    • cross legs
    • move forward to edge of table to reduce contact/support from table
    • sit on  softer cushion or a ball
  21. 4 UE treatment goals for Brunnstrom
    • 1. Attain synergy patterns
    • 2. Increase activation of weak components (don't let disuse lead to weakness!)
    • 3. Attain volitional and selective control (move muscles w/o their synergists)
    • 4. Decrease co-activation (synergies) of muscles

    beware of fatigue - it can act neg on control and increase synergies, so give pts rest as needed
  22. what to do for mild spasticity? for mod to severe spasticity?
    • mild: stretch slowly, strengthen
    • mod-sev: splinting, positioning devices, drugs
  23. a list of UE movements/muscles that are likely to be quite spastic (so you have to stretch these and strengthen their antagonists)
    • scap depressors
    • scap retractors
    • shoulder extensors
    • shoulder adductors
    • shoulder IRs
    • elbow flexors
    • pronators
    • wrist flexors
    • finger flexors
    • pec major - flex, add, IR humerus
  24. LE strong spasticity movements/actions (so stretch these and strengthen their antagonists)
    • hip ext
    • knee ext
    • plantarflex
    • foot inversion (equinovarus)

    the extension spasticity helps w standing but not w gait
  25. 3 popular causes of pain in the CVA pop
    • shoulder mismanagement
    • spasticity
    • not doing prevention (fyi, if having a hard time planning a program, ask yrself what's likely to go wrong over time, and then prevent that)
  26. ways to manage pain
    • slow passive movements
    • prevent traction on GHJ and brachial plexus
    • prevent mishandling of UE, esp shoulder (teach pt's family)
    • maintain full ROM
    • prevent edema
  27. a few ideas on how to prevent edema for CVAs
    • positioning - elevate limb
    • rocking chairs so pt's pumping ankles
    • compression
    • hands in WC should be above heart
  28. general Brunnstrom treatment techniques
    • resistance: to increase tone and volitional/synergistic mvmnt - use tactile clues to recruit muscles
    • effort: increased effort increses muscle tone. Use associated reactions like homolateral limb synchinesis
    • reflexes: TNR TLabR TLumbR
    • eliminate: all the above asap
    • once synergy is present: work to get OOS asap!