Ther Ex Quiz 2

Front 1

Review The general definition of PNF. (What does “PNF” stand for??? P…. N….F…)

Back 1

Proprioceptive neuromuscular facilitation is an approach to therapeutic exercise that combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor response and improve neuromuscular control and function. (Moving away from straight plane movements into functional diagonal patterns (multiplanar movements),Includes facilitation and inhibition)

Front 2

Who Developed PNF?

Back 2

Developed during the 1940/s and1950’s by Kabat, Knott, and Voss.

Front 3

What Are some clinical applications?

Back 3

· Increasing ROM

· Develop muscular strength

· Develop muscular endurance

· Promote mobility

· Promote stability

· Promote neuromuscular control and coordinated movements

· PNF techniques are useful throughout the continuum of rehabilitation.

Front 4

Can it only be used with neurological impairments?

Back 4

-Used not only in neurorehabilitation, but PNF techniques are applicable for patients with musculoskeletal conditions that result in altered neuromuscular control of extremities, neck and trunk. (Also used in ortho-musculoskeletal)

Front 5

What Is autogenic inhibition?

Back 5

– Inhibitory signal from GTOs override excitatory impulses – from muscle spindles – causing gradual relaxation (includes hold relax & contract relax)

Front 6

Reciprocal Inhibition?

Back 6

– Contraction of agonist muscle elicits relaxation of antagonist (while stretching the hamstring with SLR & hipflex contraction to inhibit hamstring)

Front 7

Stretch reflex?

Back 7

– Sudden stretch of muscle spindle causes agonist to contract and antagonist to relax (the biceps catch)

Front 8

D1- Flex/ UE

Back 8

Shoulder.................Flexion- ADD- ER

Scapula Elevation...ABD- Upward rotation

Elbow Flex or Ext....it depends

Forearm .................Supination

Wrist .......................Flex,Radial deviation

Fingers/Thumb.......Flex - ADD

Front 9

D1- Ext/ UE

Back 9

Shoulder ....Ext-ABD-IR

Scapula.... Depression-ADD- Downward rotation

Elbow ........it depends

Forearm ....Pronation

Wrist...........Ext.,Ulnar deviation

Fingers/Thumb..Ext. - ABD

Front 10

D2- Flex/ UE

Back 10

Shoulder.....Flex-ABD- ER

Scapula.......Elevation- ABD- Upward rotation

Elbow..........it depends

Forearm......Supination

Wrist............Ext- Radial deviation

Fingers/Thumb....Extension,

Front 11

D2- Ext/ UE

Back 11

Shoulder....Ext-ADD - IR

Scapula.....Depression-ADD- Downward rotation

Elbow......it depends

Forearm...Pronation

Wrist.......Flex-Ulnar deviation`

Fingers/Thumb.....Flexion,ADD

Front 12

D1 - Flex/LE

Back 12

Hip.........Flex-ABD-IR

Knee..it depends

Ankle...DF– EV

Toes....Ext

Front 13

D1 - Ext /LE

Back 13

Hip.....Ext-ABD-IR

Knee....it depends

Ankle....PF,EV

Toes.....Flex

Front 14

D2 - Flex /LE

Back 14

Hip...Flex-ABD-IR

Knee...it depends

Ankle...DF– EV

Toes...Ext

Front 15

D2 - Ext /LE

Back 15

Hip...Ext-ADD-ER

Knee...it depends

Ankle...PF-Inv

Toes...Flex

Front 16

Remember muscle groups contract simultaneously

Back 16

- Multiple muscle groups contract simultaneously.

Front 17

Remember the patterns move on the diagonal, what is your position when working with these patterns?

Back 17

Body position of the therapist plays an important role – must be “on the diagonal”

Front 18

Cana stronger muscle influence a weaker muscle? What do we call that?

Back 18

· Timing for emphasis – maximum contraction that is used to promote overflow of a strong contraction to weaker muscles

Front 19

How do we “name” the pattern? What joint?

Back 19

-Pattern ID by Joint Position at end ROM

-Patterns ID by motions at Proximal Pivot Points

A pattern is named by the position of the shoulder or hip when the diagonal pattern has been completed!

Front 20

Flaccidity

Back 20

Absence of tone

Front 21

Hypotonicity

Back 21

decrease in tone

Front 22

Hypertonicity

Back 22

Increased tone

Front 23

When do you use a quick stretch?

Does it facilitate motion or inhibit?

Back 23

Facilitation Quick stretch (on Hypotonicity, to bi’s and tri’s, hamstring, DF,)

a. Mechanism– activates muscle spindles – sensitive to velocity and length changes. Response is a stretch reflex – facilitates the agonist muscle to contract.

b. Position– apply in the lengthened range

Front 24

What are other Facilitation techniques?

Back 24

1. Resistance

2. Joint Approximation

3. Joint traction

Front 25

What is tracking resistance?

Back 25

i. Part of PNF resistance, (the hardestpart in PNF is hand placement and resistance)

Front 26

What are the main components of learning theories?

Back 26

Whole learning, Pure Part, Progressive/Sequential learning, Whole to Partto Whole learning

Front 27

Whole Learning

Back 27

practicinga behavior or task in its entirety.

Front 28

Pure-Part Learning

Back 28

Use For complex activities where the components parts are discrete motor programs (piece of the puzzle, in the end all components need to come together in order for motor learning to occur.

Front 29

Progressive/Sequential-Part learning

Back 29

–teaches intermediate skills and serial task that require many steps that must be performed in a specific sequence in order to be successful.

a. The Learning always begins with the same initial step (step 1,2,3,4)

b. Must-have task analysis

Front 30

Whole To Part to Whole learning

Back 30

1. Most frequently used method in the clinic

a. First The pt. performs the whole task

b. PT/PTA breaks down the task into separate components and

c. rebuilds the program.

d. Task Analysis – Done by the PT initially. (However!)We are always looking at tasks!!

i. Looking For missing components

ii. Looking For impairments

1. Impairmenttraining

Front 31

Be able to describe the three stages of motor learning

Back 31

(cognitive, associative, autonomous)

Front 32

Cognitive/Acquisition of a Motor Skill

Back 32

1. (what to do)

a. The patient is learning a new skill or relearning an old one as a whole activity.

b. Practice is key!!

c. Self Correction is also important

d. Environment for practice needs to be consistent

e. Typeof practice = mass practice (generally)

Front 33

Associative Stage/Refinement

Back 33

1. (how to do)

a. The patient can perform the program within specific environment constraints

i. Show decreased error during the activity

ii. Apply less effort (mental and physical)

iii. Environment is generally consistent

Front 34

Autonomous Stage/Retention

Back 34

1. (how to succeed)

a. The patient can perform the program in a variety of different environments

i. At this point practice is random

ii. Truelearning has occurred!! (goals have been achieved)

Front 35

What are Practice theories? When would you use them?

Back 35

Mass Practice,

Intermittent/Scheduled,

Random Practice.

Front 36

Mass Practice

Back 36

1. used to learn or relearn a skill that's essential for ADLS.

a. Initially practice task as a whole – then break it down

b. To achieve motor learning, the entire pattern/motor program must be practiced frequently enough for the CNS to learn the pattern as a whole.

c. It is the opportunity to practice a motor pattern or functional movement with few interruptions.

(Must learn to do correctly before progressing to different practice modes and more complicated tasks)

Once The motor program is established within the CNS, the individual will no longer need to mass practice unless the external environment changes.

If The individual stops performing a task, learning can deteriorate (we will need to prioritize to touch on all parts of and the whole treatment)

Front 37

Intermittent/Scheduled Practice

Back 37

1. The motor program is available to the pts.CNS, but impairment errors occur and practice is still needed to ensure long-term motor memory.

a. Generally proceeds from more frequent to less frequent intervention from the PT/PTA.

Front 38

Random Practice

Back 38

1. practice done independently without a scheduled frequency of practice.

a. Ultimately the responsibility of the pt. =Home program

b. The activity is becoming part of one’s daily–living life skill.

c. Follow-up visits may occur

Front 39

Whatare the 2 different ways you can give feedback?

Back 39

Intrinsic Feedback

Extrinsic Feedback

Front 40

Intrinsic Feedback

Back 40

1. based upon sensory response inherent to the pts. body as part of the desired movement

a. If deficits exist there should be specific activities that either allow the patient to regain accurate sensory awareness or substitute another sensory system.

b. Lack of appropriate intrinsic feedback or compensatory input systems will lead to error failure in achieving functional independence .

Front 41

Extrinsic Feedback

Back 41

1. based upon an outside source providing feedback.

a. A pt. still ultimately needs to self correct(inherent feedback) to achieve independence.

i. Knowledge of performance – uses a sensory system

ii. Knowledge of results – informs the patient as to whether the task is accomplished or how close the movement comes to accomplishing the task

Front 42

Schedules of External Feedback

Back 42

i. Summed feedback

ii. Faded feedback – Most effective

iii. Bandwidth feedback –(feedback applied in intervals or at crucial moments)

Front 43

Dependent upon sensory input

Back 43

· When there is sensory loss, feedback mechanisms are lost or inconsistent (due to disease or trauma)

· Compensation thru alternative sensory systems is indicated (extrinsic feedback)

Front 44

Exteroceptor techniques –

Back 44

Facilitation

Manual contacts (must be in the right spot,and correct pressure, with both hands)

a. Mechanism –activates tactile receptors

b. Position - firm deep pressure of the hands in contact with the body;

c. Example – PNF techniques – diagonal patterns; cueing for postural awareness

2. Inhibition

Neutral Warmth -

a. Mechanism – Retention of body heat;activates tactile and thermoreceptors; generalized inhibition of tone

b. Position – comfort; often used with other inhibitory techniques

c. Example – wrapping body or body parts; towel wraps; hot packs

Front 45

Vestibular Techniques

Back 45

1. Facilitation

a. Fast Rocking – activates otolith organs – facilitates muscletone (postural tone)

i. Example- therapy ball; scooter board

2. Inhibition

a. Slow, maintained Rocking - Activatesprimarily otolith organs- inhibition or dampening of tone and motor output;passive, manually assisted or active motions; repetitive

Front 46

Canyou define the four stages of motor control?

Back 46

1. Mobility (comes first)

2. Stability

3. Controlled Mobility

4. Skill (coordinated, voluntary, skillful, purposeful)

Front 47

Rigidity

Back 47

Severe hypertonicity that results in an inability to move the extremity passively or actively, and with limitations in all directions

Front 48

Spasticity

Back 48

1. abnormal velocity dependent muscle tone – the faster the limb is moved the more resistant. (muscle spindles???-generally hypertonic)

a. Resistance Increases with amplitude of lengthening the muscle

Front 49

How can we assess tone?

Back 49

Assessment of Tone - Use very slow/passive motion. The PT/PTA feels for resistance – or lack of resistance to movement.

Front 50

Dowe have any tools that we use to define tone? What are/is those/that called?

Back 50

Modified Ashworth Scale: Table 4-1, p. 44.

0 = No increase in muscle tone

1 = Slight increase in muscle tone

1+ = Slight increase in muscle tone,manifested by a “catch” followed by

Minimal resistance throughout the remainder of the ROM

2 = More marked increase in muscle tone through most of the ROM but

Affected part easily moved

3 = considerable increase in muscle tone; passive movement difficult

4 = Affected parts rigid in flexion and extension

Front 51

What can we do with “guided movements”?

Back 51

* Substitute
* Stabilize
* Constrain
* Guide
* Allows the sensation of movement

Front 52

Synergistic Patterns

Flexion

Extension

UE

Scapular adduction & elevation Shoulder ER & abduction Elbow flexion Forearm supination Wrist Flexion Scapular abduction Shoulder IR & adduction Elbow extension Forearm pronation Wrist extension

LE

Hip abduction, flexion, & ER Knee flexion Ankle dorsiflexion Hip adduction, extension & IR Knee extension Ankle plantar flexion

Back 52

Synergistic Patterns

Flexion

Extension

UE

Scapular adduction & elevation Shoulder ER & abduction Elbow flexion Forearm supination Wrist Flexion Scapular abduction Shoulder IR & adduction Elbow extension Forearm pronation Wrist extension

LE

Hip abduction, flexion, & ER Knee flexion Ankle dorsiflexion Hip adduction, extension & IR Knee extension Ankle plantar flexion