Npte - Interventions For Neuro Disorders

Front 1

PNF: Basic concepts

Back 1

REMEDIATION/FACILITATION TECHNIQUE

Lay down gross motor patterns
Normal movements are spiral and diagonal
Stronger body parts used to stimulate and strengthen weaker parts
Agonist/antagonist balance
Emphasis on correct handling and manual contacts
Short and concise verbal commands
Resistance through pattern
Proprioceptive stimulation

Total patterns of movement and posture are important preparatory patterns for advanced functional skills (e.g. gait)

Front 2

Neurodevelopmental Treatment (NDT) (Bobath): Concepts

Back 2

REMEDIATION/FACILITATION TECHNIQUE

Original BOBATH approach was abased on heirarchical motor control theory (levels of reflex integration within CNS).
Abnormal reflexes, obligatory synergies and spasticity were inhibited; normal postural reflexes (equilibrium, protective extension, higher-level righting) were facilitated. Developmental sequence was followed. These concepts have been modified in favor of more recent theories.

Distributed control/dynamical systems model:
-Focus on activities which promote normal movement patterns and integrate function
-Avoid abnormal/compensatory patterns.
-Motor learning of patterns can be facilitated by appropriate handling techniques (inhibition/initiation techniques), repitition and environmental experience
-Achieve muscle balance
-Active, dynamic treatment
-Emphasize rotation component
-Movement in and out of midline
-Don't follow developmental sequence - may practice out-of-sequence activities as needed by patient

Front 3

Neurodevelopmental Treatment (NDT): Techniques: Guided Movement

Back 3

Guided active/active-assisted movements
Focus on:
- Assistance given ONLY AS NEEDED
- Task understanding, voluntary control
- Low effort: Maximizes performance in presense of tonal disorders
- High effort: Maximal resistance results unwanted activity and is avoided
- Avoidance of substitution movements
- Minimizing verbal instructions/feedback during movement
- Ensuring movement success, avoidance of repeated failures

Front 4

Neurodevelopmental Treatment (NDT): Techniques: Normalization of Postural Tone

Back 4

Efforts made to increase tone (if hypotonic)
Efforts made to decrease tone (if hypertonic)
(e.g. rhythmic rotation/tapping)
Abnormal patterns and reflexes inhibited/prevented
Normalization of sensory/perceptual experiences

Front 5

Neurodevelopmental Treatment (NDT): Techniques: Patterns of movement

Back 5

Resumption of normal functional activities which are:
- Meaningful
- Goal oriented
e.g. rolling, sitting up, standing, walking

Development or retraining of balance reactions (righting, equilibrium, postural/protective)
Selective limb movements (e.g. UL functional tasks)
Integrated movements utilizing both affected and intact body segments.

Front 6

Movement Therapy in Hemiplegia (BRUNNSTROM): Basic Concepts

Back 6

REMEDIATION/FACILITATION TECHNIQUE

Based on work of Signe Brunnstrom
Sensorimotor recovery occurs in a sequential recovery pattern.
Recovery can vary between limbs (typically leg>arm)
Recovery can vary within a limb (shoulder>hand)
Recovery can plateau at any stage
Encourage overflow
Use repitition and positive reinforcement
Strength evalutation focuses on patterns of movement (not single plane)

Careful examination can delineate the stage of recovery and provide accurate description of the pathokinesiology of stroke.
(development of an accurate stroke assessment tool is a major contribution of Brunnstrom).

Front 7

Movement Therapy in Hemiplegia: Techniques: Volitional movement control

Back 7

Volitional control of movement can be facilitated through use of:
- Reflexes: (now considered INAPPROPRIATE)
- Proprioceptive inputs: Resistance, weight bearing, stretch, tapping, manipulations
- Exteroceptive inputs: Rubbing, stroking
- Eye contact, appropriate verbal commands
- Use of sounds side to facilitate hemiside: Transfer effects

Front 8

Movement Therapy in Hemiplegia: Techniques: Progression, resistance, reinforcement

Back 8

Control progressed from small range to large range
Isometric and eccentric to isotonic.
Fatigue, pain, heavy resistance avoided since control decreases
Positive reinforcement and repitition are keys to success and motor learning.

Front 9

Movement Therapy in Hemiplegia: Techniques: Patterns of Movement

Back 9

Training activities focus on the out-of-synergy combinations needed for every day function (hand function, walking, etc.)

Patients with very little recovery and limited movement (stages 1 & 2) first practice movement in synergy (now viewed as INAPPROPRIATE)

Front 10

Sensory Stimulation (ROOD): General Concepts

Back 10

REMEDIATION/FACILITATION TECHNIQUE

Based on theory that all motor output is the result of past and present sensory input.
Treatment based on sensorimotor learning.
Takes autonomic and emotional factors into account.
As soon as response is obtained the stimulus is withdrawn
Exercise seen as a treatment technique only if the response is correct and it provides sensory feedback that enhances learning of the response
Movement is considered autonomic and noncognitive
Homeostasis of all systems is essential

Front 11

Motor Control Strategies: Motor Program

Back 11

Set of prestructured muscle commands
When initiated result in production of coordinated movement sequence (learned task)
Largely uninfluenced by peripheral feedback

Front 12

Motor Control Strategies: Motor Plan

Back 12

Overall strategy for movement (action sequence)
Coordintion of number of motor programs

Front 13

Motor Control Strategies: Feedback

Back 13

Afferent info sent to control centers
- Updates control centers about correctness of movement
- Shapes ongoing movement
- Allows motor responses to be adapted to demands of environment

Front 14

Motor Control Strategies: Feedforward

Back 14

Readies system in advance of movement
Anticipatory responses
Adjusts system for incoming feedback or future movements
e.g. postural adjustments

Front 15

Motor Control Strategies: Motor Skill Aquisition

Back 15

- Behaviour is organized to achieve goal directed task
- Active problem solving/processing is required for the develpoment of a motor program/motor plan
- Motor learning improves retention of skills
- Adaptive to specific environmental demands (regulatory conditions)
Closed environment: Fixed, non-changing
Open environment: Variable, changing

CNS recovery/reorganization is dependant on experience

Front 16

Motor Control: General Concepts

Back 16

Task-Oriented approach
Examination function, strategy, impairment examination

Treatment attempts to resolve impairments, implement compensatory and recovery strategies, retrains using functional activities.
Intervention designed at the level of impairment - tasks broken down into components for practice.
Emphasis on postural control, alignment, movement sequencing
Intervention should create multiple ways to solve a movement disorder

Front 17

Motor Control Strategies: Stages of Motor Learning: Cognitive Stage

Back 17

The Learner:
Develops an understanding of the task
Cognitive mapping
Assess abilities, task demands
Identifies stimuli, contact memory
Selects response, perfroms initial approximations of task
Structures motor program
Modifies initial responses

Front 18

Motor Control Strategies: Stages of Motor Learning: Associated Stage

Back 18

The Learner:
Practices movments
Refines motor program: Spatial/temporal organization
Decreases errors, extraneous movements
Dependence on visual feedback decreases, increases for use of proprioceptive
Cognitive monitoring decreases

Front 19

Motor Control Strategies: Stages of Motor Learning: Autonomous Stage

Back 19

The Learner:
Practices Movements
Continues to refine motor responses, spatial/temporal highly organized
Movements largely error free
Minimal level of cognitive monitoring

Front 20

Task-Related Training Approach: General Concepts

Back 20

Emphasis on FORCING USE OF AFFECTED BODY SEGMENTS USING TASK-RELATED EXPERIENCES AND TRAINING

Patients practice important functional tasks in appropriate environments
Focus is on anticipated environments for ADLs.
Patients practice supervised and independantly.
Therapists:
- Provide assistance throguh guided movement/cueing
- Serve as motor learning coaches, encourage correct performance
- Exercise/activity logs can help organizr the patient's self-monitored practice
- Repetition and extensive practice are required

Promotes use-dependant cortical reorganization
Prevents learned non0use

Front 21

PNF: Chopping

Back 21

Combinaiton of bilateral UL asymmetrical extensor patterns in closed-chain

Front 22

PNF: Developmental sequence

Back 22

Progression of motor skill acquisition.
Mobility - Stability - Controlled Mobility - Skill

Front 23

Sensory stimulation (ROOD): Indications

Back 23

Indications: Patients with absent/disordered motor control
(e.g. difficulty initiating or sustaining movement) who would benefit from augmented feedback.
Most useful in early stages.

Front 24

Sensory stimulation (ROOD): Contraindications

Back 24

Contraindications: Patients who:
- WILL NOT BENEFIT from hands-on approach
- Demonstrate sufficient motor control to perform and refine a motor skill
- Have the ability to self-correct based on intrinsic feedback
(later stages of motor learning)

Front 25

Sensory Stimulation (ROOD): Stimulation response

Back 25

Response to stimulation is dependant on multiple factors:
- Level of intactness of CNS
- Initial central level of CNS arousal
- Type and amount of stimulation
- Specific activity of alpha MN pool

Front 26

Sensory Stimulation (ROOD): Considerations

Back 26

Early use of sensory stim phased out ASAP in favor of active control (avoid dependance on PT)

Spatial summarion (multple techniques)/temporal summation (repeated application of same) may be needed in low-level patients (come/early recovery)

Consider cumulative effects:
- Total environment as well as technique
- Avoid bombardment (CNS may shut down)
- Consider what stimuli yeild desired performance and optimum learning