intro neuro eval g

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intro neuro eval g
2012-10-08 20:02:41
intro neuro eval

intro neuro eval g
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  1. NDT was dev by who? When?
    Bobath 1950s-70s
  2. 5 categories of changes after a strke
    • motor
    • sensory
    • visual
    • pereptual (agnosia, apraxia, body image problems, etc)
    • language disorders (aphasia)
  3. 3 key players inNDT today
    • Lois Bly
    • Judith Bierman
    • Reggi Boehme
  4. Bobath's original assumptions - 3 things required for vol function
    • 1- normal postural tone of moderate intensity (high enough to resist gravity, low eough to give way to movement)
    • 2 - normal recprocal interacion of muscles --including fixation of prox muscles to allow distal mobility, LE asymmetrical flex/ext to allow gait, graded control of ag/antagonists
    • 3 - righting and equilibrium responses
  5. diff btwn righting and equilibrium responses
    • righting = getting eyes to horiz plane
    • equilib = reactions to keep you stable when center of gravity is displaced
  6. protective extension
    • sticking out a limb to stop you from falling
    • used when equilib reactions fail
  7. Bobath  3 stages and goals for each one
    • flacidity -- get tone
    • spasticity -- inhibit tone and get functional movements
    • relative recovery -- get diversity of controlled movement
  8. 4 ways NDT interacts w models of mtorcontrol (hierarchica,dynamic sytems theory, generalized motor program thery, neuronal group selection theory)
    • NDT should be ...
    • function oriented
    • task specific -- using practice, repetition, PT feedback, knowledge of results, knowlded of performance
    • fostering economical, functional synergies as movement options
    • problem-solving by pts
  9. associated reactions
    • tonic postural reactios in muscles deprived of voluntary control - sort of like a reflex, but more like overlow - flexing one arm helps flex the other, or TNR influencing mvmnt
    • can be slow to develop but then last longer than the initial stim
  10. nromal poural reflex mechanism = central postural control system ... what is it
    • anti-gravity, dynamic control of postural adjusments/postural sets -- this is prior to movement, and postural reactions -- during and after movement 
    • it's part of normal motor dev
  11. 10 pt summary of Bobath/NDT
    • 1. postural control and movement coordination are the big problems
    • 2. these can be improved by directly addressing the problems in task-specific contexts
    • 3. these issues affect the pt's body and place in life and society
    • 4. the framework for the theory is based in a working knowledge of typical adaptive motor dev and how it changes across the lifespan
    • 5. NDTers change mvmnt strategies to improve qol for pts
    • 6. sensory is involved both for feedback and for feedforward (informing pt on where/how to move)
    • 7. pt needs to actively partcipate while PT heps thru manual guidance
    • 8. NDTers use mvmnt analysis to id missing or atypical elements that link functional limitations to system impairments
    • 10. goal - to optimize function
  12. shunting
    changing state of a distal muscle by stimming prox - can inhibit excitatory outflow to the spastic muscles and simultaneously facil ACTIVE mvmnt in highly integrated, complex mvmnts... make shoulder relax before fingers can extend
  13. primary goals of Bobath (basic stuff)
    • inhibit poor, non-functional patterns of mvement
    • tain more complex, functional patterns posture and movement
    • ensure the pt is being an active learner
  14. a few things to remember under the NDT emphasis
    • secondary impairments can come from disuese or poor use, so pt needs motor training for safe mvmnt
    • on affected side diff limb segments may be at diff stages of recovery - some parts spastic, some flaccid
    • on unaffected side - mayb have motor impairments or movement disorders after a stroke
  15. positioning to counter flexor synergy
    • supine, pillow to elevate affected pelvis and reduce ER
    • put leg in neutral, not IR
  16. positioning to counter ext synergy
    supine, light abd, small pillow under knee