Motor Behavior Quiz 2 Ch. 4-6

biomechanical approaches to managing hypertonicity focus on

altering muscle length through prolonged stretching

Casts, splints, and orthoses are used to

manage hypertonia, maintain or increase PROM, improve function in patients with neural pathology

Patient positioning is biomechanically used for what

improve muscle length

hierarchy of sensory function

low → high

detection → discrimination → quantification → cortical sensation

detection → single pt stimulus

discrimination → btw 2 stimuli

quantification → organize tactile stimuli according to degree (roughness/wt)

cortical sensation → graphesthesia, stereognosis (recognize car in hand)

UE flexion synergy presentation

scapular retraction & elevation

shoulder abd & ER

elbow flex

forearm sup

finger & wrist flex

LE extensor synergy

hip ext, add & IR

knee ext

ankle PF & inversion

toe PF

Potential lesion locations if explicit learning is impaired

medial temporal lobe areas, sensory association cortex, hippocampus

Potential lesion location if nonassociative learning is impaired

reflex pathways

Potential lesion location if associative learning is impaired

amygdala, cerebellum, deep cerebellar nuclei, premotor cortex

Potential lesion location if procedural learning is impaired

striatum and other motor areas

Diaschisis

transient CNS disorder in which a part of the brain that is structurally intact loses function because of a loss of inputs from an anatomically connected area of the brain that is injured

The sudden functional depression of brain regions distant from the primary site of injury can be due to

a reduction in blood flow and/or metabolism

Early recovery of function following stroke is due to

the resolution of diaschisis

Cerebral edema

space-occupying lesion that can cause an increase in intracranial pressure

Recovery of synaptic effectiveness and nerve conduction is due to

resolution of edema

Long term sensitization results in

Increased number of synaptic connections

Sensitization mechanisms

Prolonged actional potentials that increase the EPSP

Example of habituation

Decreasing sensitization to dizziness during head movements in patients with inner ear disorders

Short-term habituation results in

No structural changes, just a decrease in EPSP amplitude at the synapse

Long-term habituation results in

Decreased number of synaptic connections and active transmitting zones within the existing synaptic connections

hyperkinetic disorders

Athetoid CP, Huntington’s Disease, Hemiballismus

Hypokinetic disorders

Parkinson’s

hyperkinetic disorders characterized by

excessive and involuntary movements and hypotonia

Athetosis/athetoid movement

slow involuntary writhing and twisting movements

Which extremity is affected more with athetosis

upper extremity

Athetosis can also affect

the face, neck, and tongue

Primary cause of athetosis

Athetoid CP

hyperkinetic disorder characteristics

excessive and involuntary movements and hypotonia

Chorea/choreiform movements

involuntary, rapid, irregular, and jerky movement

Primary cause of choreiform movements

Side effect of antiparkinsonian medications

Primary cause of dystonia

Basal ganglia disorders

Dystonia characteristics

co-contraction of agonist and antagonist muscles

What is dystonia initiated/worsened by?

voluntary action

Dystonia is associated with

overflow muscle activation

APTA model of practice

exam → history, review of systems, test & measures, data collection to form diagnosis, prognosis, POC

evaluation → clinical reasoning based on data from exam

prognosis, diagnosis → intervention

plan of care

Principle 1 of neuroplasticity

Use it or lose it

Use it or lose it

Failure to drive specific brain functions can lead to functional degradation

Principle 2 of neuroplasticity

Use it and improve it

Use it and improve it

Training that drives a specific brain function can lead to an enhancement of that function

Principle 3 of neuroplasticity

Specificity

Specificity

The nature of the training experience dictates the nature of the plasticity

Principle 4 of neuroplasticity

Repetition matters

Repetition matters

induction of plasticity requires sufficient repetition

Principle 5 of neuroplasticity

intensity matters

Intensity matters

induction of plasticity requires sufficient training intensity

Principle 6 of neuroplasticity

time matters

Time matters

different forms of plasticity occur at different times during training

Principle 7 of neuroplasticity

salience matters

Salience matters

the training experience must be sufficiently salient to induce plasticity

Principle 8 of neuroplasticity

Age matters

Age matters

training-induced plasticity occurs more readily in younger brains

Principle 9 of neuroplasticity

transference

Transference

plasticity in response to one training experience can enhance the acquisition of similar behaviors

Principle 10 of neuroplasticity

interference

Interference

plasticity in response to one experience can interfere with the acquisition of other behaviors

finger to nose nonequilibrium test of coordination

The shoulder is abducted to 90 degrees with the elbow extended. The patient is asked to bring the tip of the index finger to the tip of the nose.

finger to therapist’s nonequilibrium test of coordination

The patient and therapist sit opposite each other. The therapist’s index finger is held in front of finger of the patient. The patient is asked to touch the tip of the index finger to the therapist’s index finger.

finger to finger nonequilibrium test of coordination

Both shoulders are abducted to 90 degrees with the elbows extended. The patient is asked to bring both hands toward the midline and approximate the index fingers from opposing hands.

Alternate nose to finger nonequilibrium test of coordination

The patient alternately touches the tip of the nose and the tip of the therapist’s finger with the index finger.

Finger opposition non equilibrium test of coordination

The patient touches the tip of the thumb to the tip of each finger in sequence. Speed may be gradually increased.

Mass grasp nonequilibrium test of coordination

An alternation is made between opening and closing fist. Speed may be gradually increased

Pronation/supination nonequilibrium test of coordination

With elbows flexed to 90 degrees and held close to the body, the patient alternately turns the palms up and down. This test also may be performed with shoulders flexed to 90 degrees and elbows extended. Speed may be gradually increased.

Rebound test nonequilibrium test of coordination

The patient is positioned with the elbow flexed. The therapist applies sufficient manual resistance to produce an isometric contraction of biceps. Resistance is suddenly released. Normally, the opposing muscle group with contract and check movement of the limb.

Tapping hand nonequilibirum test of coordination

With the elbow flexed and forearm pronated, the patient is asked to tap the hand on the knee.

Tapping foot nonequilibrium test of coordination

The patient is asked to tap the ball of one foot on the floor without raising the knee; the heel maintains contact with the floor.

Pointing and past pointing nonequilibirum test of coordination

The patient and therapist are opposite each other, either sitting or standing. Both patient and therapist bring shoulders to a horizontal position of 90 degrees of flexion with elbow extended. Index fingers are touching or the patient’s finger may rest lightly on the therapist’s. The patient is asked to full flex the shoulder and then return to the horizontal position such that index fingers will again approximate. Both arms should be tested, either separately or simultaneously. A normal response consists of an accurate return to the starting position.

alternate heel to knee; heel to toe nonequilibrium test of coordination

from a supine position, the patient is asked to touch the knee and big toe alternately with the heel of the opposite extremity

toe to examiner’s finger nonequilibrium test of coordination

from a supine position, the patient is instructed to touch the great toe to the examiner’s finger.

heel on shin nonequilibrium test of coordination

from a supine position, the heel of one foot is slid up and down the shin of the opposite lower extremity

drawing a circle nonequilibrium test of coordination

The patient draws an imaginary circle in the air with either upper or lower extremity.

Fixation or position holding nonequilibrium test of coordination

upper extremity: the patient holds arms horizontally in front.

lower extremity: the patient is asked to hold the knee in an extended position

____________ feedback facilitates learning better than ________ feedback

intermittent; constant