Ther Ex II Q5 PNF/Stroke/Tone/TBI

• Contract Relax
• Hold Relax
• Hold Relax w/ movement
• Joint Distraction
• Rhythmic Initialization
• Rhythmic Rotation
• Repeated contractions

• Compression
• Alternating Isometrics
• Rhythmic Stabalization (when used with AI)

• Normal timing (distal to proximal sequence)
• Timing for emphasis (to strengthen any weak component of a motor pattern)
• Resisted Progression (resistance of prox components during gait)

• Right-sided hemiplegia
• Aphasia
• Slow cautious style of behavior
• short term memory loss

• Left-sided hemiplegia
• difficulty w/ spacial & perceptual abilities (dysmetria)
• Judgement difficulties (impulsive & dangerous)
• Visual Issues
• Left sided neglect
• short term memory loss

• Reflexes & balance
• Difficulty standing
• nausea
• dizziness

• BP
• HR
• RR
• Swallowing
• Hearing
• Aphasia

• Involuntary Emotional Expression Disorder
• laughing or crying outbursts

• "fluent aphasia"
• Can understand but, has issues speaking
• spontaneous speech present but, auditory is comprimised
• calling a knife a gleeble

Difficulty forming complete sentences & rules of grammar

• can barely speak
• Cannot understand speech
• unable to read or write

Rupture of a vessel that leads to bleeding within the brain

Aneurysm produced in small cerebral blood vessels caused by atherosclerosis

sacular aneurysm in large blood vessels that causes bleeding into the subarachnoid space

• Arterial Venous Malformation
• A tangle of blood vessels redirects oxygen rich blood to the veins instead of to the brain tissues, causing the brain to be deprives of oxygen

• Hypertension
• Heart Disease
• Diabetes
• TIA

• Face
• Arm
• Speech
• Time

Events which occur after stroke

Accumulation of fluids after ischemic stroke which peak in 3-4 days

• 1 of the 2 bifurcations of the common carotid
• run up neck to head
• supplies the brain
• divides to form anterior cerebral artery & Middle cerebral artery
• Receives blood from circle of Willis

• Runs paralell to carotid
• Supplies blood to the Circle of Willis

Surgical removal of atherosclerotic material

• Tonic Labyrinthe Reflex
• Tilting head backward causes:
• Leg extension
• Back extension or arching
• Flexion of UE

• Asymmetrical Tonic Neck Reflex
• When a person turns their head to one side the arm and leg of that side extend

When a stimulus is applied to the bottom of a foot the hip, knees, elbows and wrist flex while the foot dorsiflexes

Stepping on a nail

• 1-Flacidity
• 2-Spacticity begins to develop, synergies begin to appear, minimal voluntary facilitation
• 3-Spasticity increases up to severe, voluntary facilitation occurs, synergies increase
• 4-Spacticity begins to decline, some non-synergistic movements can be accomplished
• 5-More difficult non-synergistic limb movements are learned, synergies lose their dominance
• 6-Individual joint movements occur, spasticity disppears
• 7-Full recovery

• inability to recognize an object
• inability to recognize a nose

• Stimulus to sensory (somatic) receptor
• Afferent fibers carry signal to dorsal horn
• interneurons integrate information
• Efferent fibers carry signal to skeletal muscles
• Skeletal muscle react

Senses muscle length and speed of length change

• Eye Opening
• Motor Response
• Verbal Response
• (1 is the lowest for each component)

• Coma
• Stupor
• Obtunded
• Lethargy
• Conscious

Unable to create new memories

Unable to remember from the time of injury until recent recall is re-established

Unable to recall memories prior to accident

• 1 - No Response
• 2 - Generalized Response
• 3 - Localized Response
• 4 - Confused Agitated
• 5 - Confused Inappropriate
• 6 - Confused Appropriate
• 7 - Automatic Appropriate
• 8 - Purposeful Appropriate

• Form of rigidity that occurs from injury to brainstem
• UE & LE - Extensor Synergy

• Type of rigidity that occurs from an injury above the brainstem
• UE - Flexion
• LE - Extension

Cerebral Lesion

Cerebellar Lesion

• Common Carotid
• -Internal Carotid
• --Anterior Cerebral Artery
• --Middle Cerebral Artery
• --Circle of Willis
• -Vertebral Artery
• --Posterior Cerebral Artery
• --Posterior Portion of the circle of willis

• Aphasia
• Dysphagia
• UE>LE

• Mental impairments
• Urinary incontinence
• Apraxia
• Bradykinesia

• Hemianopsia (1/2 visual field)
• Pusher Syndrome
• Thalamic Pain Syndrome

• Ataxia
• Locked-in Syndrome

early reflexes & relearning motor control via reflex patterns

• Sensory input is required for normalization of tone and evocation of desired muscular responses.
• Sensory motor control is developmentally based.
• Movement is purposeful, engagement in activities is required to produce a normal response.
• Repetition of movement is necessary for learning.

• Supine withdrawal
• Segmental rolling
• Pivot prone (prone extension)
• Neck co-contraction
• Supporting self on elbows
• All fours movement patterns
• Standing
• Walking

• 0+no response (flaccidity)
• 1+decreased response (hypotonicity)
• 2+normal response
• 3+exaggerated response
• 4+sustained response (severe hypertonia)

• 0+absent
• 1+tone change; slight and transient with no movement of extremity
• 2+Visible movement of extremities
• 3+exaggerated, full movement of extremities
• 4+Obligatory and sustained movement, lasting for more than 30 seconds