174 Neuro: Selected Neurotherapeutic Techniques

Front 1

What is PNF diagonal D1 flexion for UE?

Back 1

start: GH IR, ext, and ABD (throwing apple away)

end: GH ER, flexion and ADD (biting apple)

D1 ext is opposite

Named after ENDING position

Front 2

What is PNF diagonal D2 flexion for UE?

Back 2

start: GH ADD, IR, ext (Drawing sword from belt)

end: GH ABD, ER, flex (raising sword)

Named after ENDING position

Front 3

What is PNF diagonal D1 flexion for LE?

Back 3

start: hip ABD, IR, ext

End: hip ADD, ER, and Flexion (Piriformis stretch position)

D1 ext is opposite

Named after ENDING position

Front 4

What is PNF diagonal D2 flexion for LE?

Back 4

start: hip ADD, ext, ER

end: hip ABD, flexion, IR (W-sit position)

Named after ENDING position

Front 5

What are head and trunk diagonal patterns used for?

Back 5

to enhance breathing

and movement patterns (e.g. mobility)

Front 6

What are PNF patterns incorporating trunk and neck movements?

Back 6

Chop (D1 into ext)

Reverse chop (D1 into flex)

Lifts (D2 into flex)

Reverse lifts (D2 into ext)

-supine lower trunk flexion with rotation to right or left and knees flexing for rolling and bed mobility

-LE D1 flexion helps rolling in any direction

Front 7

What is PNF chop and reverse chop?

Back 7

Chop = (Bilat. asymmetrical UE ext with trunk and neck flexion and rotation) = D1 ext with lead arm and assist arm grabs on dorsal side of wrist (use if rolling toward lead arm's side) (pg. 31 in small O'sullivan book/neuro book)

Reverse chop = Bilat asymmetrical UE flexion with neck ext and rotation = opposite of chop D1 extension (use if moving/rolling to side opp to side performing the diagonal)

CHOP = D1

Front 8

What is PNF lifts and reverse lifts?

Back 8

Lift = (Bilat. asymmetrical UE flexion with neck ext and rotation) = D2 Flexion with lead arm and support arm grabs ventral side of wrist

Reverse Lift = Bilat asymmetrical UE ext with neck flexion and rot = opposite of lift = D2 ext

LIFT = D2

Front 9

What are agonist reversals (AR)?

Back 9

-slow isotonic shortening contraction through the range followed by eccentric lengthening contraction of the same mm groups (ex: bridging & other anti-gravity movements)

Indications

1. weak postural muscles

2. inability to eccentrically control body weight during movement transitions (e.g. sitting down)

Front 10

what is PNF approximation?

Back 10

joint compression

indications:

-used to facilitate extensor/stabilizing muscle contraction and stability

-to stimulate afferent nerve endings

Front 11

what is PNF contract-relax (CR) and indications?

Back 11

-isotonic movement in rotation to range limitation followed by isometric hold of the antagonist (range limiting muscles) and then isotonic contraction of antagonist against resistance then relaxation and active movement into the new range of the agonist pattern

Indications: limited range of motion caused by muscle tightness or spasticity

Front 12

what is PNF Hold-Relax (HR)?

Back 12

Isometric contraction of antagonist against resistance followed by voluntary relaxation and passive movement into the newly gained range of the agonist

indications: limited ROM due to muscle tightness, spasm or pain

Front 13

What is PNF repeated contractions (RC)?

Back 13

Repeated isotonic contractions induced by quick stretches and enhanced by resistance performed through the range or part of range at a point of weakness

indications: weakness, incoordination, muscle imbalances and lack of endurance

Front 14

What are PNF rhythmic initiations (RI)

Back 14

voluntary relaxation followed by passive movement through increasing ROM, followed by active assisted contractions progressing to resisted isotonic contractions

Indications: spasticity, rigidity, hypertonicity, inability to initiate movement (apraxia), motor learning deficits, communication deficits (aphasia)

ex:

1. "relax, let me move you"

2. progress to "now, help me move you.

3. then progress to light resistance "Now, push up."

4. at end ask pt to move indep

Front 15

What are PNF Rhythmic stabilizations (RS)?

Back 15

Simultaneous isometric contractions of both agonist and antagonists patterns performed without relaxation using careful grading of resistance

-co-contraction of opposing mm groups

Indications

1. instability in weight-bearing and holding

2. poor anti-gravity control

3. weakness

4. ataxia

5. limited ROM caused by mm tightness

6. Painful muscle splinting

Front 16

What is PNF slow reversal?

Back 16

aka Dynamic Reversals

alternating isotonic contractions of agonist then antagonist patterns using careful grading of resistance and optimal facilitation

Slow Reversal Hold (SRH) = isometric hold added to end of range at a point of weakness

Indications:

1. inability to reverse directions,

2. muscle weakness or imbalance

3. incoordination

4. lack of endurance

Front 17

What are PNF stabilizing reversals?

Back 17

alternating isotonic contractions of first agonists and antagonists against resistance allowing only very limited movement.

-technique progressses to stabilizing holds (alternating isometrics)

command = Don't let me push you

Indications:

1. impaired strength

2. impaired stability and balance

3. impaired coordination

Front 18

What is PNF traction?

Back 18

separation of joint surfaces

Indications:

facilitates flexor muscles

mobilizing patterns (e.g. stretch of joint capsule and other mob indications)

Front 19

What are facilitation techniques?

Back 19

1. repetitive brushing. facilitates tactile receptors and movement responses

2. quick icing for muscles

3. quick stretch or tapping of agonist tendon or muscle belly

4. High-frequency vibration 50-3000 Hz to agonist

*Facilitation techniques to antagonist inhibit agonist via reciprocal inhibition

Front 20

what are inhibition techniques?

Back 20

1. prolonged icing inhibits muscle

2. neutral warmth. relaxation by wrapping in towels or blankets to decr postural tone

3. prolonged stretch. muscle tone decreased

4. low freq vibration (5-50 Hz)

5. Pressure on tendons (firm and constant)

Front 21

What vestibular stimulation techniques can be used for inhibition?

Back 21

slow rocking, rolling on ball

inhibits postural tone

Front 22

What vestibular stimulation technique facilitates tone?

Back 22

fast spinning

facilitates postural tone

promotes head righting

Front 23

What can prone over large ball promote?

Back 23

vestibular stimulation

-can activate postural extensors of neck, trunk and proximal joints

-soothing effect for sympathetic responses

Front 24

What principles are advocated by NDT,Bobath?

Back 24

1. Motor learning (relearning) occurs through repetition and experience in the environment

2. inhibition of unwanted activity precedes practice of normal motor patterns

3. Guided movements or assisted movements only when needed. (usu early in rehab process)

4. Normalization of postural tone

-inhibit reflexes

-increase tone if hypotonic

-decrease tone if hypertonic

5. normalization of sensory/perceptual experiences

6. resumption of functional activities that are meaningful, goal oriented

7. validity of NDT has been questioned

Front 25

what is a motorPROGRAM?

Back 25

a set of prestructured muscle commands that, when initiated, results in the production of a coordinated movement sequence

Front 26

what is a motor PLAN?

Back 26

overall strategy for movement

-action sequence requiring coordination of a number of motor programs

Front 27

What is feedforward?

Back 27

sending of afferent signals in advance of movement to ready the system

-anticipatory responses in postural activity

Front 28

What is feedback?

Back 28

afferent info sent by various sensory receptors to motor control centers to shape ongoing movement or allow for adaptation of motor responses

Types of Feedback:

1. Intrinsic: sensory information normally acquired during performance of a task

2. Augmented: externally presented feedback that is added to that normally acquired during task performance

3. KR (knowledge of results): augmented feedback about the outcome of a mvmt

4. KP (knowledge of performance): augmented feedback about the nature of the movement produced

Front 29

What is motor skill acquisition?

Back 29

behavior is organized to achieve a goal-directed task

Front 30

what is motor learning?

Back 30

the change in the ability to perform a skill

-the result of practice or experience

Front 31

what are measures of motor learning?

Back 31

1. Performance (of the skill or task)

2. Retention

3. Generalizability

4. Resistance to contextual changes

Front 32

what is retention?

Back 32

the ability to demo the skill after a period of no practice

Front 33

what is generalizability?

Back 33

ability to apply what has been learned to other similar tasks

Front 34

what is resistance to contextual changes?

Back 34

ability to apply what has been learned to other environmental contexts

Front 35

what are the components of motor learning?

Back 35

1. feedback

2. practice

3. transfer

Front 36

what are the stages of motor learning?

Back 36

1. cognitive

2. associative

3. autonomous

Front 37

what is the cognitive stage of motor learning?

Back 37

develop an overall understanding of the skill through trial and error practice

Front 38

what is the associative stage of motor learning?

Back 38

refinement of the motor strategy is achieved through continued practice

-concentrate on how to do the movement rather than on what to do

Front 39

what is the autonomous stage of motor learning?

Back 39

after considerable practice the motor performance becomes largely automatic