UMN interventions

document resting alignment, time to hold midline, assistance needed to maintain midline

how to document midline functioning

cueing, visual input (mirror, external ques), reach across midline, weight shift equipment, handling

how to help facilitate static and dynamic midline functioning

constraint induced movement therapy

CIMT (or CIT)

1. correct alignment and postural symmetry

2. assisting difficult movement patterns

3. block undesirable movements

handling techniques

tapping/vibrating, light touch, compression, visual input, quick ice, manual resistance, weight baring, joint approximation

facilitation techniques

prolonged stretch deep pressure, rotation, prolonged ice, neutral warmth, weight baring, joint approximation

inhibition techniques

weight baring, joint approximation

what two techniques can be for both facilitation and inhibition

increase motor recruitment

when to use facilitation techniques

when we want to decrease motor recruitment, ex. spasticity

when to use inhibition techniques

static, dynamic, eccentric, concentric

framework order for progressing patients with flaccidity

WB approximation to facilitate motor recruitment (sit arm extend, sitting with forearm WB, prone elbows, quadruped, lean wall)

static UE positioning to promote functional movement

sitting, standing, bridging, kneeling, quadruped

static UE positioning to promote functional movement

modified plantar grade, great way to WB without full postural demands

add reaching w/ affected maintaing weight baring and intact arm doing reach, trunk dissociation, bed mobility over stable,

Dynamic examples

left

if your right side is effected, which way should you scoot to work on dynamics?

step off with left, lower with right

how to eccentrically control a step down with R leg

lower body on WB extended arm, lower on flexed elbow/shoulder, sitting, reach down to floor, lower items from shelf

eccentric UE activities

stand to sit, step down, lower from bridge, slow lunge

eccentric LE activities

bimanual tasks

using both hands to do a task

carry an object, arm swing, ball dribble/throw, grocery cart

how to incorporate arm while working on LE (walking especially)

STAGE 6, when a patient starts to make fractionated movements out of synergy

when to start cardinal plane, fractionated exercises?

OUT of synergy movements

what are out goals during stages 4-5

putting on jacket, reaching with elbow straight, pronation and supination with elbow at 90 or progressive shoulder flexion with elbow at 0

UE out of synergy movements

bridging, sliding leg forward hip flexed and knee extended, bending knee while hip stays neutral, ankle dorsiflexion while LE neutral

LE out of synergy movements