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when have you broken out of synergy?
as soon as you have a single movement that's not in synergy
rowing technique - what's it for, how to do it
- Brunnstrom exercise
- bilat: pt sits facing PT. PT holds pt's hands and moves limbs btwn flexion and extension synergy. Have pt resist on uninv side
- unilat: move OOS pushing forward and pulling back at various angles or places like pt's chin w/wo resistance as needed
seated. put yr arm uner hers and grasp her thumb. Do multiple quick stretches of the extensors. It looks like you're rapidly petting the dorsum of her hand using just a little pressure. This can help reduce tone in the flexors. Keep swatting til you feel this relaxation. Then ask pt to press up against you with superlight feather touch
- its an associated reaction
- if pt's arm is raised to 90 degrees flexion this promotes finger ext. if IR --> ext on ulnar side. if ER (so thumb's up) --> ext on radial side
beware, this pos is OOS. If too much effort is put into doing this the effort will make the pt flex into a fist
this can be done w the PT holding up the arm so it's passive
in assessing the UE of someone w hemiplegia, what kinds of mvmnts to assess first? and real basic, what do you ask for
ext, bc flexion often dominates ext, so if you make the pt flex it'll be harder to get ext.
ask for 1 movement at a time! You can't know what's going on with a movement or muscle until you ask it to move indep
LE flex syergy
- hip: flex (strong, first component, dominant), ER, abd
- knee: flex
- ankle: dorsiflex
- foot: inverted
- toes: dorsiflexed (extended - yes, in the flex synergy)
LE ext synergy
- hip: extended - strong; adducted - moderate; IR
- knee: ext
- ankle: PF
- foot: inverted
- toes: plantarflexed w possible Hallux ext
rigidity goes w __part of brain__ involvement, and in a strok it'smore __tract__ involvement, so in hemiplegia you're seeing ___
- basal ganglia
- pyramidal tract
resting posture = synergy?
NO! it's the underlying tone support that makes for resting posture
asymetrical/reciprocal reactions in the LE
resist a mvment on the unaffected leg and the affected leg will do the opposite -- this is the opp of what happens in the UE, and it's good bc in gait we do opp in each leg -- this is good for flex and ext, not abd/add
- abd in one leg --> abd in other
- add in one leg --> add in other
- can do lying down- moving good leg against resistance
- can do standing - side stepping
an example of how to do asymmetrical LE associated reactions
supine, pillow under involved knee, have pt flex good knee against resistance while pressing down down the pillow (quad set)
could also do DF in the good leg instead of knee flexion
or do a quad set in good leg while asking pt to DF "push your foot up into my hand" on the affected side
Marie Foix Reflex
this inhibits extensor tone in high tone pts
PT plntarflexes and inverts the big toe/whole top/toe area of foot
slowly and steadily stretch to end of range for a kinda noxious stim --> reducing ext tone will allow flexion
useful for a pt w such high tone that it's hard to get into WC
how to trigger ankle eversion
sit w leg dangling of table and do bilat IR against resistance. pt will lead w eversion, esp if you are tapping and giving verbal clues
also, Raimiste for abd can trigger eversion
also, quick stretch and tapping involved side is ok
eversion is tough bc it's not in either LE symmetry
3 possible causes for genu recuratum
- biomechanical secondary to plantarflexion - this puts a posterior moment on the tibia --> more ext
- weakness in quads
- impaired proprioception
an advantae of isometric contractions
gives plenty of timeto recuit MUs
brigding skills are good why?
- bed mobility
- bed pans
- scootching side to side and up and down bed
PT may have to sit on the affected foot to stop it from lifting to flex synergy or shooting out into ext, initially
2 techniques for working on knee flexion
- heel slides
- try to roll the WC w the affected leg
where to stand when guarding a CVA pt
- on weak sid
- if using a guard belt, hold it w flexed elbow, arm in supination
- put yr knee in front of pt's knee if you fear buckling
- can help the leg thru on swing w a gentle kick
- step forward and back, unloading/loading the stance step
- sidestepping - practice wt shift and single steps
- braiding aka grape vine, crossing in front then back
Fugl-Meyer Measurement of Phyiscal Performance is for what?
it is a stroke-specific, performance-based impairment index. It is designed to assess motor functioning, balance, sensation and joint function in patients with post-stroke hemiplegia
5 areas looked at on the Fugl Meyer
top possible score, top score for each area
highest score: 226 pts, means you're fit
- Part 1: PROM, looking at rom and pain level. max 100 pts - 66 UE, 34 LE
- Part 2: sensation - light touch and proprioception - max 24 pts
- Part 3: UE reflexes, synergy, combining synergy, OOS
- Part 4: LE refexe, synergy, combining synergy, OOS
- Part 5: balance, static and unperturbed - sitting/standing w/wo support (this part of the test is questioned for validity)
limitations of Fugl-Meyer
- interrater reliability is debatable - moderate say some, strong say others
- the test is a better discriminator in early staes
the Fugl-Meyer is based on what theory?
Brunnstrom theories of motor recovery -- it gives points for synergies and reflexes where other theories wouldn't support that
whn was Fugl-Meyer Measurement of Physical Performance created?
items are scored 0, 1, or 2 points
what is the Barthel Index?
The originl version consists of 10 items that measure a person's daily functioning, specifically the activities of daily living and mobility. The items include feeding, moving from wheelchair to bed and return, grooming, transferring to and from a toilet, bathing, walking on level surface, going up and down stairs, dressing, continence of bowels and bladder.
later versions have fewer items or diff scoring (0-3 pts instead of 0, 5, 10, or 15 per item)
good things about the Barthel Index
- generic - it's good for diff populations
- short - easy to complete
high score on a Barthel Index means...?
annoying thing about a BI?
- means pt's doing well, independant
- annoying - each one is scored differently
when was the original Barthel index made?