Neurophysiologic frame of reference is ulitized for persons with ________.

*Sensorimotor control occurs at a developmental sequence and normalization of tone and muscular responses are achieved via sensory stimulation to elicit desired movement patterns.

Examples: inhibition/facilitory techniques such as icing, stroking, tapping, etc.

1. Supine withdrawal (to gain trunk stability and flexion responses)

2. Rollover (elicits lateral trunk responses for those dominated by tonic reflexes)

3. Prone extension (isometric contraction of extensors and ABDs)

4. Neck cocontraction (develops head control)

5. Prone on elbows (inhibit tonic neck reflexes and provides trunk and proximal limb stability)

6. Quadruped (develop limb and trunk cocontraction patterns)

7. Standing (static --> active weight shifting)

8. Walking (then integrated into functional activities)

List principles from an NDT approach/intervention methods.

*Handling techniques

*Techniques to normalize postural tone, limb tone and movement patterns (prerequisite to normal movt)

*Weightbear and weight shifting in all directions

*Bilateral integration

*Equillibrium and righting reactions

List some intervention methods of PNF.

-Diagonal patterns or mass movt patterns are utilized during functional activities.

-All patterns cross midline and encourage rotary components to movt.

-Flexion or extension is the major component.

-For each body segment 2 pairs of diagonals exist.

Perform D1 Flexion and D1 Extension.

-Heavy/light joint compression

-Manual pressure

-Neutral warmth

-Vibration

-Vestibular stimulation

-Tapping

-Quick stretch

Applies to tx of hemiplegia and uses motor patterns available to the pt; goal is to progress through stages of recovery toward more normal and complex movt patterns.

-Pt should be aided to gain control of limb and that selected sensory stimuli can help initiate and gain control of movt.

In the Brunnstrom approach, hemiplegia is either _____ or _____ synergy pattern.

What do these 2 consist of?

Flexor OR Extensor

Flexor synergy: scapular ADD and elevation, should ABD and Ext Rot, elbow flexion, supination, wrist flexion and finger flexion.

*Spasticity greaest in elbow flexion and least in shldr ABD and ext rot.

Extensory synergy: scapular ABD and depression, shoulder ADD and int rot, elbow ext, pronation and wrist and finger flexion or ext.

*Shldr ADD and int rot more hypertonic.

-Bed positioning

-Bed mobility

-Balance and trunk control

-"pain free" shoulder ROM (pendulum or codman's exercises)

1. Flaccidity or no voluntary motion.

2. Developing synergies.

3. Voluntary movt begins within synergy pathways.

4. Initial movt to deviate from synergy.

5. Independent from basic synergy.

6. Isolated, near normal movt with minimal spasticity.

Brunnstrom approach: Recovery follows an ontogenic process (3):

1. Proximal to distal.

2. Flexion before extension.

3. Reflex movt before controlled/volitional movt.

*Emphasis based on person's ability to overcome movt dominated by flexor/extensor synergies.

Motor learning requires a multisensory approach, which includes:

Provide examples.

Auditory, visual and tactile systems that are all used to achieve the desired response.

Examples: verbal commands (brief and clear), soft tone of voice (encourage smooth movt), verbal mediation (pt says aloud the steps of activity to enhance learning), visual stimuli, tactile input, practice.

Dysmetria: undershooting over overshooting of a target.

Dyssynergia: a breakdown of movt resulting in joints being moved seperately to reach a desired target.

Cogwheel rigidity: alternative contraction/relaxation of muscles being stretched.

Leadpipe rigidity: consistent contraction throughout range.

Athetosis: inadequate timing, force and accuracy of movt in the trunk/limbs and are worm-like.

Dystonia: an involuntary sustained distorted movt or posture involving contraction of groups of muscles.

Chorea: consists of involuntary movts of face and extremities which are spasmodic and of short duration.

Hemiballismus: a unilateral chorea characterized by violent, forceful movts of the proximal muscles.

1. Allow person's arm to dangle freely.

2. Palpate the space underneath acromion process with your index finger.

3. Compare to the intact side and document the width of space in terms of finger breadths.

Utilizing postural interventions to increase swallowing efficiency during meals:

a. Chin tuck

b. Head tilt

c. Head turn

Orthoses may be used with neuromuscular dysfunction to meet the following goals:

-Prevent/correct/control deformity or spasticity by aligning joints and providing prolonged stretch to muscles.

-Position hand in functional position to promote engagement in activities.

-Provide proximal support and promote distal mobility.

a. Bobath finger spreader (ABD splint): positions digits and thumb in ABD to reduce tone.

b. Rood cone: cone-shaped splint to reduce flexor spasticity in the hand.

c. Orthokinetic splints: utilizes tactile input (via elastic bandages) to facilitate and/or inhibit appropriate muscle groups.

d. Spasticity reduction splint: places the spastic distal extremity on submaximal stretch to reduce spasticity.

a. Overhead suspension sling: incorporates an arm support for those with proximal weakness with MMT in the 1/5 to 3/5 range (also MD, ALS, etc.)

b. Balanced forearm orthoses: mobile arm support allows a patient with weak proximal muscles to utilize available control of the trunk and shoulder to engage in functl activities.

c. Shoulder slings: utilized to support a flaccid arm after neurologic insult for short and controlled periods of time (may be detrimental in terms of soft tissue contractures and pain syndromes).

a. Cock-up splint: supports the wrist in 10-20 degrees of extension to prevent contracture and allows digits to function.

b. Resting hand splint: utilized for persons who need to have their wrist, thumb and digits supported in a functional posiion for a prolonged period of time.

c. Opponens splint: designed to support the thumb in a position of ABD and opposition, utilized during functl activities to compensate for weakness patterns.

Ideational apraxia: a breakdown in the knowledge of what is to be done or how to perform it.

Motor apraxia/ideomotor apraxia: loss of access to kinesthetic memory so purposeful movt cant be achieved because of ineffective motor planning.

Somatagnosia: a body scheme disorder that results in diminished awareness of body structure and a failure to recognize body parts as one's own.

General intervention strategies for body neglect:

Bilateral activities, guide affected side through the activity, increase sensory stimulation to the affected side.

ROM for Shoulder Horizontal ABD and ADD.

Shoulder Horizontal ABD: 0-40 degrees

Shoulder Horizontal ADD: 0-130 degrees

Goniometer: axis, stationary and moveable arms.

Record starting position and ending position

(ex: 0-150)

Grip strength is assessed by using the ______, which requires _____ trials on each hand.

If the person has arthritis, what would you use instead?

Dynamometer, 3 trials

Vigorometer or Sphygmomanometer cuff

Pinch strength is measured by using the ______ with _____ trials. Describe the position of the UE for testing and name the 3 types of pinches assessed.

Pinchmeter, 3 trials

Position: shldr ADD to side, elbow flexed at 90 and forearm in neutral.

MMT grades 0-5, name and briefly describe each.

0: ZERO; no muscle contraction seen or felt.

1: TRACE; contraction felt no motion.

2-: POOR MINUS(P-); Incomplete ROM gravity eliminted plane.

2: POOR(P); Complete ROM gravity eliminated plane.

2+: POOR+(P+); Incomplete ROM (<50%) against gravity, complete ROM gravity elim with slight resist.

3-: FAIR-; Incomplete ROM against gravity (>50%).

3: FAIR; Complete ROM against gravity.

3+: FAIR+; Complete ROM slight resist.

4: GOOD; Complete ROM mod resist.

5: NORMAL; Complete ROM max resist.

When sensory testing, always test the ________ first. How are the following tested for sensation?

Spinal cord injuries

Peripheral nerve injuries

Neurological disorders

Univolved side

SCI: tested proximal to distal.

PNI: tested distal to proximal and assess for peripheral nerve involvement.

ND: assess for dermatone pattern.

-Light touch: touch with cotton swab person responds yes if touched.

-Localization: touch with cotton swab person responds yes if touched an points to area touched.

-Pain: touch with paper clip, person responds sharp or dull.

-Temperature sensation: test cubes or thermal kit, person responds hot or cold.

-Stereognosis, proprioception (pt dupicates movt)

-Kinesthesia: therapist moves part pt responds up or down.

Isometric: contraction without movement; contraindicated for those with hypertension and cardiovascular problems. (Lifting object from a desk, walking, running)

Isotonic: eccentric = lengthening; concentric = shortening. (Pushing palms of hands together, resistance)

When administering a contrast bath, the warm water should be ____ and the cold water should be _____. It should be ___ to ___ in duration. Describe the process.

Warm water temp: 104-110, Cold water temp: 50-64.

15-30 mins in duration. 

Process: begin in warm water (10mins), then to cold (1min) then warm (4mins) and end in warm water.

For severe edema end in cold.

-Infection

-Grafts/wounds

-Vascular damage

-Unstable fractures

-CHF

-ROM.

-Massage (circles and friction)

-Scar pad with compression

-Splinting (prevent contractures)

-Edema control (elevation, cold packs, compression garments,etc)

1. Proximal transverse arch

2. Distal transverse arch

3. Longitudinal arch

Name functional and safe splinting positons for the:

Wrist

MCPs

IPs

Thumb

Functional position:       Safe position:

 Wrist: 20-30 ext             Wrist: 0-20 ext

 MCPs: 45 flex                 MCPs: 70-90 flex

 IPs: 20-30 flex                IPs: ext

 Thumb: ABD                   Thumb: ABD and ext

Splints common for:

Brachial Plexus Injury

Radial Nerve Palsy

SCI (c6-c7)

Carpal Tunnel Syndrome

DeQuervains

CMC Arthritis

Brachial Plexus Injury: flail arm splint.

Radial nerve palsy: dynamic wrist, finger, thumb ext splint.

SCI (c6-c7): tendonesis split.

Carpal tunnel syndrome: wrist splint 0-15 in ext.

DeQuervains: thumb splint, includes wrist and IP joint free.

CMC Arthritis: hand based thumb splint.

Splints common for:

Ulnar drift

Swan neck

Boutonniere

Arthritis

Ulnar drift: ulnar drift splint.

Swan neck: silver rings or buttonhole splint.

Boutonniere: silver rings or dynamic PIP ext splint.

Arthritis: funct splint or safe splint (depends on stage).

Splints common for:

Flaccidity

Spasticity

Muscle weakness

Burns

Flaccidity: resting splint.

Spasticity: spasticity splint or cone splint.

Muscle weakness: balanced forearm orthoses (bfo), deltoid sling/suspension sling - mounds to w/c and person must haveshould or trunk movt.

Burns: airplane splint.

Physical Agent Modalities (PAMS)

Paraffin baths

Hot/cold packs

Fluidotherapy

Whirlpool

Ultrasound

Electrical stim

-Relieves pain.

-Increases ROM.

-Assists with would healing.

-Relieves pain and decreases inflammation.

-Controls edema.

-Decreases abnormal tone.

-Facilitates muscle tone.

-Relieves pain.

-Stimulates and strengthens muscles.

-Stimulates denerved muscle.

List benefits of ultrasound:

List a benefit of contrast baths:

-Relieves pain and decreases inflammation.

-Increases ROM and decreases adhesions.

-Reduces edema.

List general contraindications for PAMS:

-Cancer

-Pacemaker

-Pregnancy

-Cognitive impairment

-Sensory impairment

-Vascular impairment