NM II Unit I: Intro to general interventions

what are the three domains of activity or function

physical

psychological

social

what is deductive reasoning

when an individual uses theories or concepts to guide intervention choice

what is inductive reasoning

using real world experience to guide decisions

what is functional competence in neuro PT

consistent and efficient success within a movement pattern

what should be considered when determining the model of motor behavior in neuro PT

it should be meaningful to the pt

what has shown to prime a pt for motor learning

aerobic activity

how does aerobic activity impact motor learning

Brain derived neurotrophic factor is produced which is shown to facilitate motor learning and neuroplasticity

what is the optimal walking intensity for pts post stroke

vigorous (>60% HRR)

what is the optimal dosing of aerobic exercise post stroke

3-7 days/wk

20-60 min

RPE 12-16

40-80% HR max

what is the optimal dosing for strengthening post stroke

2-3 days/wk

50-80% 1 RM

what is the optimal dose for aerobic exercise for pts with MS

2-5 x/wk

10-40 min

RPE 11-15

40-0% HR max

what is the optimal dosing for strength exercise for pts with MS

2-3 x/wk

8-15 reps

what is the optimal dose for aerobic exercise with PD

3-5 x/wk

20-60 min

RPE 13

60-80% HR max

what is the optimal dose for strengthening exercise with PD

2-3 x/wk

40-80% 1RM

what is motor learning

a set of processes associated with practice or experience leading to relatively permanent changes in the capability for responding

what is the cognitive stage of motor learning

the stage where the learner develops an understanding of the task

what is the associative stage of motor learning

the stage where the learner is practicing and refining the task performance with decreasing errors and cognitive monitoring

what is the autonomous stage of motor learning

the stage where the learner is continuing to refine the task performance, errors are minimal, and cognitive monitoring is minimal

what is motor performance

a more transient response to exercise where the pt may make immediate small that don't last over time

what are the three components of movement

environment

individual

task

what is gentiles taxonomy

a framework that shows how the environment, task, or individual can be manipulated to make tasks easier or harder

it gets more difficult moving down and to the right

what should be done in the motor plan of tasks (3)

include the pt

ask questions for the pt to try to fix the problem

make suggestions and let the pt choose

what is augmented intervention

provided extrinsic feedback such as hands on cues, verbal cues, knowledge of performance/results

what are the three ways interventions can be progressed or regressed

motor learning (practice/feedback)

movement/task characteristics

other

how can motor learning be progressed or regressed (3)

practice and feedback patterns are manipulated

environmental manipulations

manipulation f the whole task or part task

how can the movement/task characteristics be manipulated

changing the speed

what are other considerations to progress/regress an exercise

assistance

what are rehabilitative/recovery based techniques

utilizing activity based strategies, motor learning, and neuroplasticity to improve function and return to as close to baseline as possible

what is the impairment specific intervention strategy

identifying and correcting impairments to improve function

what are some interventions that may be used for impairment based strategies

strengthening exercises

stretching

HEP

etc

what are augmented interventions

interventions that include guided movement and general neuromuscular facilitation and other handling techniques like auditory or visual cueing

what is compensatory intervention

resumption of a function that is typically resigned to using the less involved segment to make the task easier

what is substitution

using an alternate strategy to complete a task that normally did not need compensation for

what is an example of substitution

brushing hair with non dominant side rather than hemiparetic side

what is adaptation in compensatory intervention

modifying the environment to complete the activity

what is neurofacilitation

retraining motor control through techniques designed to facilitate and/or inhibit different movement patterns

what is the Rood focus on neurofacilitation

sensory motor integration for stability and mobility

what is the Ayres focus of neurofacilitation

sensory integrations concepts

what is the Brunnstrom focus of neurofacilitation

synergistic imbalances within aspects of muscle tone

what is the neurodevelopmental theory

a hierarchical approach to promote recovery of movement by inhibiting abnormal movement strategies and facilitate the proper way to move

what is proprioceptive neuromuscular facilitation

resisting spiral movement patterns in an attempt to facilitate more function and return

what are ask oriented training approaches

utilizing functional activity as the basis for any intervention

what are the 4 categories of Roods neurofacilitation

mobility

stability

controlled mobility

skill

what is skill

the distal aspects of the limbs are free in open chain and able to produce coordinated movement within a stable base

what was the Ayres hypothesis for neurofacilitation

sensory integration is the basis for all learning and functional tasks

what are examples of proprioceptive interventions

lifting, moving, carrying objects

joint compression

weighted vests

what are oral motor sensations

having the pt chew on different textured items

what can whole body vibration be helpful in reducing

tone

what are the Brunnstrom stages of motor recovery

1- flaccidity

2- increasing spasticity

3- maximal spasticity

stage

4- decreasing spasticity

5- minimal spasticity

6- normal voluntary movement

what interventions are used in general neurodevelopmental treatment (NDT)

goal driven intervention to maximize alignment and recovery of function

what is essential for NDT

a thorough postural assessment to identify missing components of movement

what is done after deviations are found in NDT

a hands on approach to decrease abnormal movement strategies and promote normal strategies

what are handling procedures

procedures that work to facilitate grading of muscle activity

what are the indications for handling procedures (5)

muscular imbalance

poor grading of muscle activity

motor fatigue

initiation deficits

timing and sequence deficits

what are the key points of control handling techniques

head and neck

upper trunk

lower trunk

UE

LE

what is the purpose of manual contacts used in handling techniques

they are used to activate the system rather than provide assistance

how long should manual cues be used

as short as possible

how should general handling techniques be progressed

starting with light touch progressing to deeper pressure

what grip is used for handling techniques

open hand lumbrical grip

avoiding distal IP flexion using a scooping motion instead

what are the benefits of NDT (2)

decreased tone post stroke

improved ADL function post stroke

what does NDT not improve (2)

shoulder sublux and pain

gait

where should the plumbline be laterally in a posture screen

through the external auditory meatus and acromion

behind the hip

in front of the knee

in front of the ankle

what should be done before performing neurofacilitation techniques (3)

have the pt try on their own first

ask the pt

try verbal cues first

how should lumbar facilitation be performed

Bilateral: use wide fingers and match the oblique muscles of the erector spinae above the PSIS

scoop the hands up and inward

Side: wide fingers placed on lower back with thumb pointed to pt head

where should the front hand be positioned in lumbar facilitation

in a V shape with the thumb and index fingers separating to open the chest

how is thoracic facilitation performed to fix a flexed posture

anterior: both hands obliquely in the mid back that push down and in

side: Single hand on midback pushing down and in

what should be done if facilitation does not improve posture

mobilize the restricted area by moving into the desired position and holding to stretch the joints and tissue

where does PNF handling occur

on bony landmarks

what is the PNF procedure (6)

proper and clear manual contacts

proper PT position and mechanics

appropriate resistance

proper verbal commands

visual stimulus if needed or to incorporate other body segments

timing the verbal command and resistance

what is traction in PNF

the therapist elongates the segment away from the axis of motion of the joint which is said to improve muscular activity

what is approximation in PNF

compression of the joint to assist in promoting stability

why is resistance used in PNF

to facilitate increased effort from the targeted muscle group

why is stretch included in PNF

muscle spindle are facilitated causing a contraction of the agonist muscle

what is the theory of irradiation

the response to resistance spreads to other adjacent and agonist muscles

what is the theory of successive induction

resistance in one direction will strengthen the opposite direction

what is reciprocal inhibition

the agonist muscle contracts and the antagonist muscle relaxes

when is rhythmic initiation used

for pts who have difficulty initiating movement or controlling speed, direction, or quality of movement

also builds strength

what is used at the beginning of every PNF activity

rhythmic initiation because it assists the pt in actually learning the movements

what is the process of rhythmic initiation

the therapist passively moves the pts body part through the ROM and gradually asks the pt to help for active assisted ROM

the pt can then take over active control

then resistance is added

what is repeated quick stretch

repetitive use of the quick stretch reflex to initiate a movement and then reinforcing the strength of the contraction though the ROM

what is repeated quick stretch used to improve

initiation

muscle strength

what is combination of isotonic used for

build strength

improve coordination

what is combination of isotonics

using concentric and eccentric activations having the pt perform a concentric contraction first then hold in an isomeric position then slowly return to starting position for an eccentric activation

what is rhythmic stabilization (stabilizing reversals) used for

to reinforce stability

what is rhythmic stabilization (stabilizing reversals)

the pt is asked to hold a position and not allow the therapist to move them while they resist at different aspects of the body segments

what is reversal of antagonist (dynamic reversals) used to do

improve coordination and strength

what is reversal of antagonist (dynamic reversals)

have the pt perform a concentric motion in one diagonal and a concentric motion in the opposite diagonal without pause

what are contract relax and hold relax techniques used to do

improve ROM

what is contract and hold relax

the pt contracts the muscle that is restricted then relaxes as the therapist pushes into more ROM

when is hold relax used as opposed to contract relax

hold relax is used of the pt has pain and it is more efficient for them to hold rather than to actively contract against resistance

what is the motor retraining program

pts require practice in order to reduce abnormal movement patterns

what interventions are used in the motor relearning program

repetition and task practice using approximation, weight bearing, and discouraged compensatory strategy

what occurs in the motor relearning program once abnormal patterns are recognized

they are practiced in a normalized movement pattern with feedback (visual, verbal, or environmental)

once a movement is practiced in the correct movement pattern what occurs next

the task is transferred to various environments to maximize carry over

what is constraint induced movement therapy

behavior training created to address the aspects of learned non use post stroke

what is learned non use

when an impaired extremity is unsuccessful within carrying out a task so the pt uses the less involved extremity to complete the task

how is constrain induced movement therapy done

a mitt is used to partially restrain the less involved extremity to force the more involved extremity to be used

what is the dosing of constraint induced movement therapy

it should be used for 90% of waking hours, 6 hrs a day for 10-14 consecutive days

what is a transfer package

a log that is used to monitor the restraint time and the activities that are performed in order to transfer the activities that are performed into the clinic

what is completed before starting constraint induced movement therapy

a behavior contract to indicate full agreement with the program