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137 Cards in this Set
- Front
- Back
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BilaterealVestibular hypofunction symptoms are usually worse in |
the dark or when footing is uncertain |
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what symptoms do people with BilaterealVestibular hypo function have? |
Imbalance and visual disturbance "oscillopsia“or the illusion that the environment is movingwhen we move our heads occurring only when the head is moving. |
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BilaterealVestibular hypofunction is most commonly caused by |
ototoxicity, which selectively damagethe vestibular hair cells |
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Patients withBVH typically experience what movement deficits |
gait ataxia, postural instability, and oscillopsia |
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patients with Unilateralvestibular hypo function need what types of interventions |
Gazestability exercises Posturalstability exercises Motionsensitivity exercises Vestibularadaptation exercises |
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patients with Bilateral vestibular hypo function need what types of interventions |
Gaze stability exercises Sequenced eye and head movements Enhanced use of somatosensory cues Progress walking program to many surfaces Daily living training (may take up to 2 years) Pool therapy Tai Chi Assistive devices as needed Vestibular adaptation exercises |
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3 Exercises to improve central programming of eye movements with progression |
1. Hold 2 targets at arm’s length from your head. Look with your eyes first, then turn yourhead toward the target. Progress: increase distance, use body background. 2. Perform exercise 1 inthe vertical direction. 3. Hold one target at arm’s length from your head. Close your eyes and turn your head away fromthe target, attempting to keep your eyes focused on the target. Progress: standing, decrease BOS |
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Interventionfor Central vestibular hypofunction |
Habituationto dizziness Gaitand balance exercises for all systems Educatingthe patient in fall prevention Compensationactivities to assist in gaze stability |
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Central hypofunction resolves as slowly as _______, if at all, and is often incomplete. |
6 months |
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Patients with a lesion at the level of the vestibular nuclei, will recover in a manner similar to those with |
UVH. |
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eliminating visual dependence requires the somatosensory system to be _____ |
confused/challenged or they will use it |
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activities to eliminate visual dependence |
juggle while standing on board moving head while walking |
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Whyis the trunk important in movement? |
Initiation of trunk musculature iscritical in preparation for weight shifting in standing, and for walkingactivities |
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Their EMG study demonstrated that _____ activity “drive trunk movement during locomotion”, and that control allows forfree pelvic movement required to allow for stepping. |
erecter spinae |
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what is the cupula |
sensoryreceptor at the base of the canal. |
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Themost common and empirically proven treatment for posterior canal BPPV. |
Canalith repositioning procedure(Epleymaneuver) |
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describe Eplys maneuver |
Head extended 20-30 turned to affected Turn head to unaffected Roll body over to unaffected side with head down Sit up |
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The mostreliable way to diagnose horizontal BPPV |
Pagnini-McCluremaneuver |
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Geotropic nystagmus |
Positional nystagmus is right beating upon turning the head to the right andthen left beating when turning the head back to the left side. |
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Apogeotropic nystagmus |
Nystagmusis right beating with turning to the left and left beating with turning to theright. |
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______ nystagmus is less apt to fatigue with repeat positioningthan in cases of ______BPPV |
Horizontal posterior |
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Thereis speculation that apogeotropicdirection-changing nystagmus suggests _____iasis,and geotropicnystagmus suggests _____iasis |
cupulolithiasis canalithiasis |
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HorizontalBPPV Intervention |
Lempertmaneuver |
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what is Limpert Barbeque maneuver |
Thepatient's head is positioned with theaffected ear down Back to midline 90 to unaffected side Roll onto elbows with head flexion Come up on hands and knees and then feet |
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____lateralerector spinae areactive with stride |
Contra |
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during loading on the leg, the TFL has the most activity in ____ side translation |
right |
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Why does the addition of a bar decrease leg anticipatory postural set and increase arm postural stability |
Because postural sets depend on the amountof anticipated amount of muscle activitynecessary. |
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Postural activation patterns can bedivided into 2 parts |
preparatory phase compensatory phase |
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Postural muscles are activated inresponse to the direction of the reach. What is the rule? |
contralateral side of the direction of reach |
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When subjects were asked to pull on ahandle in front of them what muscles were activated first |
1.Gastrocnemius-soleus 2.Hamstrings 3.Trunk extensors |
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When subjects were asked to pull on a handle in front of them what postural muscles were activated after the biceps moves the handle? |
1.Gastrocnemius-soleus 2.Hamstrings 3.Trunk extensors |
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what is Central set |
a state of the nervous system that isinfluenced or determined by the context of the task |
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what anterior muscles are activated prior to you reaching forward |
Upper, middle, and lower transversus abdominis Internal oblique |
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what posterior muscles are activated prior to you reaching forward |
lumbar multifidi act as stabilizers of the lumbar spine |
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with a MMT of the back extensors, a person with strong back but weak hip extensors will _____ |
Hyperextend the spine however cannot lift the trunk all the way off the table. |
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If a person with strong back but weak hip extensors was to try to lift leg from supine position, they would ________ |
hyperextend spine pulling hip to flexion but cannot lift leg |
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with a MMT of the back extensors, a person with strong hip extensors but weak back extensors will ________ |
the pelvis tilts posteriorly and the lumbar spine flexes passively but does not lift off the table |
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When a person with strong lateral trunk flexors and weak abductors tries to laterally lift from table, what happens? |
The ipsilateral iliac crest is elevated and ribs are approximated. The shoulder is not easily raised from the table |
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When a person with strong lateral trunk flexors and weak abductors tries to abduct hip while laying on contralateral side, what happens? |
Pelvis elevates (action ofthe lateral trunk muscles). The hipjoint does not abduct. |
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When a person with strong hip abductors and weak lateral trunk flexors tries to lift body off table, what happens? |
Cannot lift body but tries to by abducting the thigh (drops). The rib cage is does not approximate the pelvis |
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When a person with strong hip abductors and weak lateral trunk flexors tries to lift leg while on contralateral side, what happens? |
Theleg can be lifted, however not raised normally off the table, because theweight of the leg makes the pelvis drop. |
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Holding the feet of a person doing atrunk curl allows that person to use their |
hip flexors instead of their abdominals |
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what muscles does the trunk curl work? |
Rectus abdominis Internal abdominal obliques Portions of the external abdominalobliques |
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why would it matter if you straightened or bent the legs when performing a trunk curl? |
If hip flexors are tight, straight legs causes the patient to startthe exercise from an anterior pelvic tilt, stressing the lower back. |
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During the hip flexor portion of a sit up, what muscle is activated when the knees are bent? |
the iliopsoas |
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During the hip flexor portion of a sit up, what muscle is activated when the knees are straight? |
All the hip flexors can help, with theiliopsoas finishing the activity. |
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When doing a sit up with knees extendedthe arc of movement of hip flexion is |
0 – 80 degrees |
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When doing a sit up with the knees flexedthe arc of movement of hip flexion is |
50 – 120 degrees |
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Whatdoes a sit up look like if the abs are weak? |
Theperson must use hip flexors and have support at the feet. The hip flexors tilt the pelvis forwardand hyperextend the low back |
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what muscles do we use with the leg lowering test |
external obliques and the hip flexors (causing anterior tilt if the abs are weak) |
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When there is weakness in the rectusand the external obliques, the trunkis _______ as the hip flexors pull the pelvis into ananterior pelvic tilt on the leg lowering test. |
hyperextended |
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Explain what the 60second tall kneeling test is and what muscles it is testing |
Assesseseccentric strength of the iliopsoas and rectus femoris Subjectsassume a position of tall kneeling with the trunk aligned directly over thethighs and the arms folded across the chest. Subjectslean back until the angle between the lower leg and thigh is 70° |
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explain the rolling of adults |
Begins with an upper extremity reach pattern, combined with leg pushoff opposite the side of the roll. Whilethe arms continue to lift and reach, the leg opposite the side to which you areturning continues to use a push strategy as it pushes down and over. |
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_______ is a major component in rolling |
Trunk rotation |
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4 phase of sit to stand |
quiet sitting weight shift buttocks lift extension phase |
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what muscles are activated eccentrically most during sit to stand |
erector spine gluteus maximus |
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along with momentum, what muscles are most active concentrically in the buttocks lift phase |
gluteus maximus and hamstrings at thehip the quadriceps at the knee theplantarflexors at the ankle |
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what are the 3 steps of "Stance" phase of stair stepping |
Weight acceptance
Pull-up Forward continuance |
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what muscles are active during pull-up of the stance phase of stairs |
soleus quads hip extensors |
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During forward continuance, the ______ generates ______ force to propel the body forward and up forthe other foot to land. |
gastroc-soleus complex plantar flexion |
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The greatest instability in stairclimbing comes during |
transition from one foot to the other |
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what muscles are active during swing phase of stairs for foot clearance |
Hip – Hip flexors are active to pull the toe up Knee – during the first portion the hamstrings are active to flex the knee. The rectus then takes over to slow thisactivity and assist with hip flexion! Ankle – Tibialisanterior is most active – to pull the toe up |
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The tibias anterior may cause supination as it pulls the tow up for clearance. What muscle counters that? |
Peroneals |
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3 parts of stance phase of DESCENDING stairs |
Weight acceptance Forward continuance Controlled lowering |
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what muscle is active eccentrically during descending stairs- weight acceptance part |
gastroc-soleus |
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what muscle activates prior to the foot contact inorder to cushion the landing during descending stairs- weight acceptance part |
gastroc-soleus |
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what muscles are active concentrically during descending stairs- weight acceptance part |
rectus femoris, and vastis lateral is at the knee |
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Forward continuance of descending stairs– This phase is caused by |
momentum |
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Controlled lowering of descending stairs is lowering ofthe body over the foot and is controlled by |
eccentric activity of the quadriceps andsoleus muscle (because the knee is flexed). |
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Swingphase in descent is due to activation initially by the ________. Bymid-swing the knee, hip, and ankle move into _______ to prepare the foot toland. |
hip flexor muscles extension |
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We contact the stair on the lateralborder of the foot due to supination activity from the |
Tibialis anterior and pre-contraction of the gastroc-soleusto prepare the foot to land |
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Visual-Receptive components - the anterior visual pathway includesthe structures of the eye including |
The cornea, lens, retina, optic nerve, and optic chiasm to the lateral geniculate of thethalamus |
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Visual Reception Skills include |
Ability to receive, detect, orient, and locate visual stimuli |
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what is accommodation of the eyes |
the ability to change the focus of the eye to look at objects at various distances |
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what is Binocular vision |
The ability to fuse two images (one for each eye) into one image |
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what is Ocular Motility/tracking/visual scanning |
the ability to move the eye efficiently for fixation, saccades, and pursuits |
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what is the Visual Perception Component |
Interpretation of the sensory stimulifrom the receptors What our vision tell us about our body inrelationship to our objects What our vision tell us about how tointeract with the environment. |
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what is the perceptual skill of Figureground mean |
differentiating foreground from background |
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what is the perceptual skill of Form constancy mean |
objects are recognized as the same despite size, location or position. |
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what is the perceptual skill of Topographicalorientation mean? |
knowing ones location in a larger space |
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what is the perceptual skill of Spatial Attention mean? |
attention to stimulus in the visual environment |
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when do babies follow moving objects by moving head to eyes |
8-12 weeks |
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when do babies move eyes independent of head necessaryfor tracking and using eyes together |
2-4 months |
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when do babies coordinated eye movements; eyes should nolonger cross |
4-5 months |
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Asymmetrical Tonic Neck Reflex |
Focuses the eyes on the hand and baby brings hand to mouth |
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3 different mechanisms control ourability to manipulate objects: |
1. Objects in close peripheryrequiring primarily eye w/little head movement 2. Objects in further peripheryrequiring combined eye and head movement 3. Objects in far periphery requiringeye-head and trunk movement. |
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Aperson w/sensory and visual loss can demonstrate decent reach w/ a simple,familiar or non-repetitive task thanks to the |
centralmotor program However,they will have difficulty with complex movements w/multiple joints orw/repetition because they can not accurately “update the program.” |
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Intrinsicproperties of AnticipatoryShaping of Hand |
Object size, shape and texture. |
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Extrinsic properties of Anticipatory Shaping of Hand |
Object’s orientation, distance from the body andlocation in respect to the body. |
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definition and types of power grasps |
Power grasps: Fingerand thumb pads are directed towards the palm Hook(suitcase handle) Spherical(ball) Cylindrical(bottle) |
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definition and types of precision grasps |
Precision grasps: Forcesare directed between thumb to fingers Lateral(key) Tripod(pencil) Tip(pick up penny) |
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4Phases of Grasp-Lift Tasks |
One:contact w/ fingers to object Two:grip and load force starting to increase Three:load force has overcome object weight and the object is moving Four:decrease in grip/load force after the object has been released |
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Infants are visually _______ toreachuntil 4-5 months which is why they are not accurate with reach |
visually triggered |
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By 4-5 months, they are visually_______ toreach and accuracy begins to improve. |
guided |
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Researchdemonstrates variationsin accuracy, use of visual feedback and speed abilities for children until movementsstabilize around age |
9 |
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Five Stacking blocks milestones from 1-2 years |
1 Yr: what basic things do/how objects fittogether 13-15mos: 2 blocks 18 mos: 3 blocks 21 mos: 5 blocks 23-24mos: 6 blocks |
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Reach decreases in velocity w/ time, butwhy? |
1. Sensory changes: detection of target 2. Central processing: making a decision (contributes largely) 3. Motor changes: getting to the target 4. Arousal/motivational: is there a target? |
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Reaching forward involves what muscles |
Back extensors Rotator cuffs Coraco Long head of Biceps Ant delt Triceps Pronators Wristextensors FDP, FPol |
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Reaching to the side involves what muscles |
Back extensors Supraspinatus Ant delt Serrates ant Lower traps Wrist extensors FDP, FPol |
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Grasping a ball involves (hand and fingers only) |
Wrist extensors MP joints extensors Fingerjoints: AppPoll,FDS, FDP |
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Grasping a bead involves (hand and fingers only) |
Wrist extensors MP joints extensors Finger joints: AppPoll, FDS, FDP |
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what do grasping a ball and a bead use same mm |
different motor learning |
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The _______ cortex encodesthe GOALS for movement such as the intended hand formation, and orientation tothe object. |
Posterior parietal Informationis then sent to the pre-motor and primary motor cortex. |
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__________ pathways connecting the red nucleus and reticular nuclei controlthe more proximal movements. Activityin the primary motor cortex and the _______ tract control the fine motor aspects. |
Midbrain and brain stem pathways Cortico-spinal |
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how come children with CP have trouble with coordination |
CP affects brain stem |
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phases of grasp and lift |
1. Contactbetween the fingers and the object to be lifted. 2. Contactbetween the fingers and the object to be lifted. 3. The load force has overcome the weight ofthe object and it starts to move 4. There is a decrease in the grip and loadforce shortly after the object makes contact with the new supporting surface |
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How does the CNS determine the correct parameters for grip and load force? |
Previous experience during the task to choose correct gripparameters (cerebellar neurons) Ifthere is a mismatch, Paciniancorpuscles easily detect that an objecthas started to move earlier than expected. Visualand other cues are important in determining the choice ofgrip parameters. |
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Studies demonstrate that people withcerebellar disorders are unable to ______, whereaspeople with cerebral disorders (stroke) can predict the loads appropriately,even though they cannot accurately provide _______ |
anticipate and respond to loads the strength to actually lift the load |
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Although reach and grasp planning andexecution are carried out independently, they must be coordinated by the |
cerebellum |
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why can you write similarly with your hands and your feet |
}Becausethe brain storesmotor programs in terms of “motor equivalence” |
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3 stepsto execute movement processing: |
◦Stimulus identification ◦Response selection ◦Response programming Practice changes these to a one step process |
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what is Fitt's law |
Predicts thatthe time required to rapidly move to a target area is a function of thedistance to the target and the size of the target Describes simplemotor response of thehuman hand, failing to account for accelerationprovided by external devices |
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distanceprogramming theory |
Peopleperceive the distance to be covered. Theythen activate a particular set of agonists to propel the arm the properdistance to the target. At aparticular point, they turn off the agonist muscles and activate the antagonistmuscles at the joint. |
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locationprogramming theory |
TheNS programs the relative balance of tensions of twoopposing agonist and antagonist muscle sets. Every location in space corresponds to afamily of stiffness relations between opposing muscles. The NS chooses the easiest way |
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Short singlejoint movements are too short to takeadvantage of visual feedback in the homing-in phase. Slower movements may involve _______ programming |
location |
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Classifyobjects into 4 broad categories |
Thoseyou poke Thoseyou pinch Thoseyou clench Thoseyou hold in your palm |
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ATN reflex |
Involvesextension in the limbs on the “face side” and flexion of the “occipital side”during head turns. |
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STN Reflex |
Involves flexion of the uppersand extension of the lowers when the head is flexed, and the opposite when thehead is extended |
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Tonic Labyrinthine Reflex |
Neckextension in supine causes severe extension of the trunk and legs, with flexionof the arms and fingers Neckflexion in prone causes less severe flexion of the trunk, legs, and arms. |
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Hierarchical Theory |
Control of movement is organizedhierarchically from: 1. Lowestlevels in the spinal cord (primitiveand stretch reflexes) 2. Intermediate levels in the brain stem (righting, tonic reflexes) 3. Highest levels in the cortex (Protectivereactions, equilibrium reactions, voluntary control) |
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Limitations to Hierarchical Theory |
We demonstrate many examples ofbottom up motor control Motor development actually beginswith many examples of purposeful movement. Evenhigher levels of the CNS like the cortex do not have enough neurons to controleach joint and each muscle to perform motor tasks. |
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what is motor programming theory |
Motor programs can operate separatelyfrom sensory input, but are strengthenedby sensory input. Motorprograms “store rules” for generating movements, so thatpeople do not have to activate individual muscles, but groups |
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Limitations of motor programming theory |
Motor programs - mediated by acentral pattern generator cannot be the sole determinant of movement |
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How can we be successful inintervention for people whose motor programs have been impaired? |
If the CNS insult has NOTinvolved the central pattern generator then the intact CPG CAN be used toguide the activity using uninvolved muscles, joints, etc. |
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Ifthe CNS insult HAS involved the central pattern generator therapists must teachpatients to ________ via functional activity |
re-learn the correct rules for action. |
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what is systems theory |
Combination of hierarchicalcontrol using synergy patterns- basically “motor programs” for activities like locomotion, posture, andrespiration. |
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Dynamical Systems Theory |
Sees motor behavior as “emergingfrom the dynamic cooperation of the many subsystems in a task-specific context” |
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Ecological Theory |
Focused on the importance of perceptionof the environment in influencing motor action. Individuals need to activelyexplore their environments. |
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Affordances |
an environmental property |
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what is the Systems model |
This approach emphasizes thatmovement occurs from an interaction between the individual,the task,and the environment. |
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Where ARE the motor programs for gait? |
SpinalPattern generators allow gait at the spinal cord level, with no input from thebrain |
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What addstiming of the step cycle and task specific modulation (stepping higher orlonger) |
cerebellum |
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what does the basal ganglia do for gait |
posturaltone and dynamic stability |
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What does the brain add for gait? |
1. Vision – Thus adding the ability to perceive and act(“perception/action”) pathways. 2. Orientation to novel situations 3. Spatial orientation. |
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How do we initiate gait? |
Reduction of activity in the gastroc/soleus. Activation of the tibiasanterior GRFV moves toward the stance leg, whilethe swing hip, knee, and ankle dorsi-flexorsbecome active The trunk and other core muscles mustactivate in order to provide stability for standing and gait activities. |
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CARSprinciple for goals |
Challenging Attainable Realistic Specific |
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Each goal should involve: |
Skills – walking fast enough to make itto the bathroom. Behaviors – walking with an appropriateheel strike every step Context – In the patient’s own home. |
