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131 Cards in this Set
- Front
- Back
- 3rd side (hint)
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what are 5 UMN signs
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- increased tone - increased reflexes - clonus - abnormal synergies - positive Babinski |
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in which rigidity are the arms posture in flexion and the legs postured in extension
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decorticate |
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the Babinski test is negative if
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all the toes flex in response to stroking along the lateral sole of the foot |
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what is the UE flexion synergy described by Brunnstrom
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- elbow, wrist, fingers flexed |
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what are the strongest components of the LE extensor synergy described by brunnstrom
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- knee extension - plantarflexion |
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are abnormal synergies less evident when a person is at rest or when they are actively engaged in a task
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less evident at rest |
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primitive reflexes which are present at birth or shortly after generally ( DO or DO NOT) persist into adulthood
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DO NOT
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you should observe the position of the extremities in response to head movement to check for the presence of
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- ATNR - STNR |
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In ATNR the extremities on the face side are ________ and the extremities on the skull side are ________
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skull side- flexed |
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if ATNR persists the child will experience difficulty with
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rolling
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patients with MS often have increased extensor tone in their trunk and extremities. Sitting may be a better treatment position for them than supine based on
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the bodys response to tonic labyrinthine |
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righting reactions, equilibrium reactions, and protective reactions are ( learned or not learned ) behaviors
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not learned
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what is the heads normal response to tilting the body side to side in space
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tilt to align with the horizon
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in response to a shift in the center of gravity to the right, what does the trunk do and what does the extremities do? State whether it is the R or L extremities performing this action
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- trunk side bends to the left - left extremities abduct |
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neck on body righting and body on body righting reactions are important for
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rolling activities
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what can improve with CVA rehab
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- equilibrium and protective reactions - UE/LE function |
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controlled mobility is the term used to describe
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weight shifting within a posture |
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what are athetoid movements described as |
slow involuntary, writhing, twisting, worm like |
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describe the tonicity and state what is demonstrated with movement and gait in a people with cerebellar disorders
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- generally hypotonic - ataxia with movement and gait |
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a patient with decerebrate posturing will benefit from positioning in what positions and why are theses positions beneficial
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- bc they reduce the influence of the tonic labyrinthine reaction |
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which reactions persist into adulthood
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righting and equilibrium |
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what strategy is used to maintain balance when we experience a small shift in our center of gravity
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ankle strategy |
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bright colors, noxious odors, and loud brisk verbal commands tend to do what to our nervous systems |
facilitate or stimulate it |
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list the seven things which can be used to facilitate the nervous system |
2. fast swinging 3. light touch 4. tapping 5. vibration 6. quick stretch 7. traction |
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what does approximation or weight bearing facilitate and what does this cause to happen? |
- facilitates muscle activity - causes co contraction aroung WB joints |
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what can approximation or weight bearing cause reduction of
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- Reduction of tone in muscles with increased tone |
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what are the 5 techniques that can be used to inhibit the nervous system
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2. neutral warmth 3. head down activities over a ball 4. deep pressure on tendons 5. prolonged stretch |
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what is considered the systems model for treatment of neurological injuries
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interaction between the individual, the task, and the environment |
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the hip strategy is used to |
maintain balance when there is a large shift in the center of gravity but the base of support is maintained |
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when is training more likely to carry over to an actual task |
if the practice resembles the task |
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practice, practice, and more practice is essential for |
recovery of motor skill learning and recovery |
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what has been shown to be a safe and effective task oriented training activity on a motorized treadmill that allows the patient to regain walking ability
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locomotor training using body weight support from an overhead harness |
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locomotor training with an overhead harness is progressed by
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- decreasing amount of body weight supported and increasing speed from very low to functional speeds for community ambulation |
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what is the functional speed required for community ambulation
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2.8 mph |
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give an example of extrinsic feedback to improve performance of a task |
- auditory input such as a metronome |
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impairments that affect a patients ability to problem solve, concentrate, or store and retrieve memory can make learning a new motor skill difficult. these impairments are termed
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cognitive impairments
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sensory info provides the necessary feedback for determination of (3)
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- error detection during movement - movement outcomes to shape further learning |
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what are the sources that can be used to monitor movement? what does this include?
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- visual, vestibular, proprioceptive, tactile inputs |
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what does closed loop feedback allow for
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error detection and correction as the movement takes place |
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what is used to refer to a patients orientation to person place and time
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A & O x 3 |
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asking a person " which is larger two feet or a yard) is a way to asses their
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cognitive status |
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A&O x 3 refers to |
a persons orientation to person, place, and time |
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you know your patient is in the flaccid stage of recovery if
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reflexes and voluntary movement are absent |
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clonus, and indication of UMN lesion, is positive if there is a __________ when the examiner rapidly ________ the ankle
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- a cyclical tonic resistance - dorsiflexes |
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in pusher syndrome what does the patient do that results in instability and falls? what does training emphasize ? |
- uses stronger extremity to push body over to weaker side - vertical orientation and active movement shifts to the strong side |
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difficulty planning and executing movements that cannot be accounted for by any other reason is see in patients with
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apraxia |
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head down activities are contraindicated if you patient has
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increased intracranial pressure |
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sensory systems critical for postural control include |
vision, vestibular, and somatosensory |
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what is feed forward processing also known as
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- anticipatory postural control - predictive central set - proactive state |
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what is feed forward processing
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- sensory info sent ahead to prepare for the movement to follow |
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it is advisable to practice in a closed environment before progressing to an open environment when
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learning new motor skills |
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an assistive device is usually recommended for balance when |
more than one sensory system is impaired |
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list the directions in which protective reactions develop from fist to last |
1st: in a forward direction 2nd: sideways 3rd: backward |
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cognitive dysfunction can include: ( list 4 of the 7 ) |
- disorientation - poor attention span - loss of memory - poor judgment - poor safety awareness - inability to reason - inability to control emotional responses |
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the Glasgow coma scale is used to asses the patients
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level of arousal |
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what tests the patients limits of stability
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functional reach |
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the Romberg test is positive if
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the patient has significant increases in postural sway with eyes closed and arms crossed |
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what does a positive Romberg test indicate |
proprioceptive or vestibular impairment |
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the lower the score on the berg balance scale, the more likely is the
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patients fall risk |
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it is indicated a patient is independent in an activity if they get a FIM score of
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7 |
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the six minute walk test is a reliable measurement of |
functional ambulation |
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what are indicators of impaired coordination
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dysmetria, dysdiadochokinesia, and inability to preform heel shin test
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what challenges a persons ability to pay attention to the task
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dual task activities |
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what are appropriate progressions to challenge your patients motor control that are important for patients to experience in a controlled environment since these situations are sure to arise upon discharge
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- adding dual task activities - removing sensory systems the person is reliant on - changing environment from closed to open |
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between a patient with a Glasgow coma scale of 9 and another patient with a Glasgow coma scale of 15, who has more severe brain injury
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the patient with a Glasgow coma scale of 9 has more severe brain injury
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a patient with impaired motor control will have deficits in _____ and ______ of their movement. Difficulty selecting and ________ their muscles and poor _________ of the response
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- sequencing - timing |
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as an infant looks up what do the UEs and LEs do and why does this occur
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- UEs extend - LEs flex - result of STNR |
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which reactions are normal for an adult and which are abnormal for them to demonstrate
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normal- righting and equilibrium reactions abnormal- primitive reflexes and tonic reactions |
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weight shifting within a posture causes what to happen at the trunk? on which side is this occurring? is this desirable or undesirable?
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- on the same side - desirable effect |
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motor learning takes place in a predictable sequence. Whats the sequence
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cognitive, associative, then autonomous |
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in which phase of motor learning does learning take place primarily with verbal and visual feedback and trial and error
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the cognitive phase of motor learning |
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what is characteristic of the autonomous phase of motor learning (3)
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coordination ability to perform skill at high level regardless of environment |
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in which phase of motor learning is the patient focusing on " how to do" the movement
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associative |
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what is the term, open environment, used to describe
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a changing unpredictable environment
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what are important parts of NDT (2) which occur prior to the patient engaging in functional activities
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- inhibition of tone with handling skills - reflex inhibiting postures |
one has to do with inhibition of tone and the other with inhibition of reflexes |
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care is taken to avoid contact over the muscle bellies when handling during which approach ( NDT or PNF)
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NDT
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in PNF what is used to facilitate and guide the desired movement
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manual contact over the muscle bellies |
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In the NDT approach patients are encourage to transfer to which side? Why is this encouraged?
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- involved side - increases awareness of involved side and increases weight shifting to involved extremity |
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in NDT the trunk , head, scapula, and pelvis are the
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proximal key points of control |
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rhythmical rocking, prolonged stretch, neutral warmth and head down position can be used to
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inhibit tone |
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1.aquatic therapy may be beneficial for someone with_______ deficits. 2. why might aquatic therapy be beneficial for this group of people |
1. balance deficits 2. bc they have more time to react to balance challenges in water |
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definition of limit of stability
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max angle from vertical that can be tolerated w/o loss of balance or changing base of support |
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what two things do patients with neurological impairments typically have reduction in and what do they usually have an increase in
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- increased postural sway |
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guidance, verbal feed back, and demonstration are helpful in which phase of learning a motor skill
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cognitive phase |
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list the 4 things that can be used to asses balance
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- tinetti - TUG - dynamic gait index |
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NDT goals which should be addressed in treatment include : 1. increase ______ and ____ to involved side 2. _______ orientation 3. Improved ______ 4. decreased _________ |
1. weigh bearing and shifting 2. midline orientation 3. inc. balance 4. dec. spasticity |
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activities performed with both hands and cross the midline are useful to improve _______? and are especially useful in a patient with ________
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- improve midline orientation - pt with unilateral neglect |
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to prevent shoulder pain in a flaccid shoulder, which approach DISCOURAGES the use of a sling and prom through full range using pulleys
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NDT approach discourages use of sling and PROM through full range with pulleys |
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In the NDT approach patients are frequently positioned on which side ( inv. or non inv.) and why is this done |
- involved - to promote scap protraction and weight bearing |
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what is an associated reaction
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an increase in abnormal synergy which occurs with straining, coughing, yelling, or sneezing in CVA patients
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impairments in any of the following: proprio, cognition, attention, arousal, sensation, flexibility, strength, tone, synergies, primitive reflex patterns, balance, and coordination can affect a persons......
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motor control
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a patient that has balance loss while walking and turning their head side to side probable has some of what type of involvement
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vestibular involvement
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ability to type a paper from a copy while having a conversation shows you have probably reached_____________
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the autonomous phase of typing
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prone on elbows position has a ____ COG and a ______ BOS that quadruped
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- larger BOS |
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if the goal is to improve postural control in the neck and back which 3 positions would be better than which 2 positions
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- pone on elbows, quadruped, and sitting would be better than - hooklying and bridging |
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if the goal of exercise is to strengthen hip extensors in preparation for gait, activities which could be used are (3)
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- sit to stand - bridging - kneel sit to kneeling |
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alternating isometrics and rhythmic stabilization are _____ techniques that use ______ to promote ________
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- use isometric contractions - promote stability in a posture |
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which PNF technique in not isometric
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slow reversal |
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is rhythmic rotation is done ______ to inhibit tone
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passively |
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the traditional approach to neuro rehab focuses of ________ whereas the system model focuses on _________
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- compensation for deficits - recovery of function |
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motor control is the second to second ,min to min, ________ so that movements are performed with _______ and ____
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- quality and efficiency |
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_____________ depends on the individuals ability to perform a task in the enviro that they need to do it in
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the movement that emerges
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elements that are recommended to promote neural recovery include (3)
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- afferent input - task specific activity |
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a task can be classified as (4)
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- stability - controlled mobility - skill |
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if a patient attempts to maintain static standing on an unstable platform, which one of the 4 classifications of a task are they working on |
stability |
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if a pt tries to lean toward targets on the balance biodex, which one of the 4 classifications of a task are they working on
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controlled mobility
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when learning something new, it is important to establish a _______ from the start bc every subsequent event that is similar in nature will be compared to it.
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good trace memory
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which test is used to test a patients limit of stability in standing
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functional reach test |
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speed bumps on the side of the road that let you know you are not in your right lane and need to correct are an example of
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sensory feedback from the environment - this example is audio and tactile sensory feedback |
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feed forward is AKA
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anticipatory postural control |
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how does feed forward improve motor performance
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by activating muscles before the movement takes place |
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what is the idea behind contextual interface
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- ie SLS on foam will improve SLS on a level surface |
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what is the strategy that is utilized when there is a narrow base of support
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the hip strategy |
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what is an activity that is directed at improving the hip strategy
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walking on balance bean or tape line on floor |
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which is more beneficial to prepare a pt for novel situations that they might encounter: random practice or blocked practice
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- random practice will be more beneficial |
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what is defined as the process that brings about a permanent change in performance as a result of practice and experience
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motor learning |
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using a weighted vest on an ataxic patient with proprioceptive deficits may improve their movements by causing ________ and_______
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increased approximation and joint receptor activity ( afferent input)
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research has demonstrated that strategies to reduce spasticity should address _____ and ______
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weakness and adaptive shortening of mm
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what is a clinical example of reducing spasticity while addressing weakness and adaptive shortening of mm
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e-stim to wrist/finger extensors in a patient with fisted hand from flexion synergy
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what is a task specific way to apply estim to the quads if the goal is to improve knee control during gait
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applying estim to quads while pt stands in standing frame
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what are some advantages of unweighted treadmill
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- repetition - normal gait speed |
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what type of practice is preferable if ur patient has low: endurance, motivation, attention or if the task itself is complex
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distributed practice |
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what is the term for: augmented feedback about the nature or quality of the movement pattern produced |
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what is particularly helpful for tracking tasks that rely heavily on visual and kinesthetic feedback
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knowledge of performance
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augmented feedback is AKA
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extrinsic feedback |
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augmented feedback about the end result or overall outcome of movement is termed
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knowledge of results |
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what is useful for tasks like transfers, where analysis of an attempt leads to the pt and PT to make adjustments to improve subsequent attempts |
knowledge of results
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which test is used to test anticipatory postural control and reactive postural control
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mini best test
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which test is done by checking the pts ability to come from sitting to standing, rise to their toes and stand on one leg
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the mini best test for anticipatory postural control
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which test is done by seeing how well a pt recovers from a balance loss forward, backward, and to the side.
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the mini best test for reactive postural control
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how many steps should it take for the pt to recover when performing the mini best test for reactive postural control
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1 step to recover |
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