Handling/Facilitation

What term describes the application of hands-on/manual techniques to facilitate/inhibit movement?

handling

What term describes handling that makes movement easier, or allows an increased capacity to initiate a movement response?

facilitation

What term describes handling that decreases neuronal activity and synaptic output leading to decreased capacity to initiate a movement response?

inhibition

If a person is sitting with slumped posture, give an example of a faciliatory contact and an inhibitory contact that could aid in upright posture.

F: posterior should girdle, PSIS

I: anterior shoulder girdle

What is the main goal of handling?

patient to be active and create motion

Manual contact should always be ____

purposeful

What is the ideal manual contact? (What parts of hands)

through palm of hand with lumbrical grip

Manual contact over the muscle belly facilitates ____ of the muscle

contraction

What type of manual contact facilitates movement about a joint?

bony prominences

When should heavy touch be used?

activation of contractions for force production

When should light touch be used?

faciliating active movement, guiding patient in aspects of movement they can't control independently

True/false: in handling/facilitation we passively lift/push/pull

false

The longer the contact, the _ the muscle recruitment or __ the active movement you facilitate

greater, larger

Facilitation towards a support surface results in _ facilitation

stabilizing

stabilizing facilitation is consistent with joint ____ for co-contraction

approximation

Facilitation away from a supporting surface in movement facilitation is consistent with joint ___.

distraction

What are the inputs to the primary motor cortex?

sensory cortex, premotor areas, cerebellum

What tract does the motor cortex send motor commands through?

corticospinal tract

In an contraction, tension remains constant while muscle length changes

istonic

true/false: isotonic contractions can be concentric or eccentric

true

Why is resistance applied in an isotonic contraction?

so motion can be smooth and coordinated

In an ___ contraction, agonist and antagonist forces are equal

isometric

In posture, _ of muscles leads to stability. This is an ____ contraction.

co-contraction, isometric

Isometric contractions create the needed for isotonic contractions to create _

stability, mobility

As the arm moves on a stable scapula, what type of contraction maintains the stability of the scapula and what type of contraction allows the arm to move (generally)?

scapula: isometric for stability

arm: isotonic for smooth mobility

What term describes the distraction of joint surfaces?

traction

Traction occurs normally and promotes ___

movement

In an unstable joint, does traction facilitate movement?

no

What term describes the compression of aligned joint surfaces?

approximation

Approximation promotes _, muscle co-contraction through weight bearing

stability

What type of manual joint force is contraindicated with weight bearing precautions?

approximation

What somatosensory organs/systems are involved in manual contact/facilitation?

joint receptors, muscle spindles, GTOs, touch/pressure receptors

Therapeutic handling and facilitation influences movement

quality

Facilitation supports motor learning with sensory cues to weak movement patterns and _ excessive ones

reinforce, inhibit

What are the basic tenants of neurodevelopmental treatment?

begin early

build simple towards functional

use manual handling to establish normal patterns

create normal and inhibit abnormal movements

focus on posture/stability and weight shifts

Under neurodevelopmental treatment, what is the focus on?

posture/stability and weight shifts

Under neurodevelopmental treatment, what are the key points of control?

bony prominences

Is approximation or distraction useful when working with a patient with flaccid paralysis?

approximation

Proprioceptive Neuromuscular Facilitation focuses on _ what a patient __ do

reinforcing, can

Irradiation is the of the response to the stimulus to _.

overflow, synergists

What term describes why a PT may resist submaximal dorsiflexion to enhance quadriceps contraction?

irradiation

Reciprocal Inhibition is the contraction of the ____ muscle resulting in a concurrent inhibition of the __ muscle.

agonist, antagonist

What term describes why contraction of the middle and lower traps causes concurrent inhibition of pec major/minor?

Reciprocal Inhibition

Autogenic Inhibition is when the _ is inhibited during agonist contraction

agonist

What are the basic tenants of Proprioceptive Neuromuscular Facilitation (PNF)?

manual contacts over a muscle with graded resistance

coordination of verbal cuing and manual facilitation

use of diagonal component of muscle action

Under Proprioceptive Neuromuscular Facilitation, what should be coordinated with manual facilitation?

verbal cueing

Under Proprioceptive Neuromuscular Facilitation, what direction of muscle action/movement is of focus?

diagonal

Proprioceptive Neuromuscular Facilitation patterns are named for the ____ at the ____ pivot joint

action, proximal

Why should the trunk always be considered in Proprioceptive Neuromuscular Facilitation?

extremity function dependent on trunk, stability is needed for mobility

What functional activities are associated with UE D1 and D2 PNF movements?

D1: grab and buckle seatbelt

D2: pulling sword from scabbard (super functional ik)

Describe the two start/end motions associated with the D1 UE PNF movement.

Start: shoulder extension/abduction/IR, scapular depression, forearm pronation, wrist ulnar extension, fingers ulnar extension, thumb extension/palmar abduction

End: shoulder flexion/adduction/ER, scapular anterior elevation, forearm supination, wrist/fingers radial flexion, thumb flexion/adduction

Describe the two start/end motions associated with the D2 UE PNF movement.

Start: shoulder extension/adduction/IR, scapular depression, forearm pronation, wrist/fingers ulnar flexion, thumb flexion/opposition

End: Shoulder flexion/abduction/ER, scapular posterior elevation, forearm supination, wrist/fingers radial extension, thumb extension/abduction

Describe the two start/end motions associated with the D1 LE PNF movement.

Hip Flexion/adduction/ER, ankle DF, foot inversion, toe extension

Hip extension/abduction/IR, ankle PF, eversion, toe flexion

Describe the two start/end motions associated with the D2 LE PNF movement.

hip flexion/abduction/IR, ankle DF, eversion, toe extension

hip extension/adduction/ER, ankle PF, inversion, toe flexion

How can PNF patterns be challenged?

change action at intermediate joints

change position of patient

change conditions (speed, surface, resistance)

change complexity

What type of inhibition is exemplified by having a patient contract their biceps then relax as the PT extends their elbow?

autogenic

What type of inhibition is exemplified by having a patient contract their biceps then relax as the PT flexes their elbow?

reciprocal inhibition

Why may whole-part-whole practice be used in movement/facilitation of movement?

if there is a specific portion of the movement that is abnormal

What is important to consider when determining the direction of movement?

orientation of muscle alignment from origin to insertion

cardinal plane/rotational components

isolated muscle vs mass movement

When evaluating a patient's functional limitations, what are the 2 broad inabilities that lead to movement dysfunction?

inability to stabilize or maintain posture

inability to move or control movement

Describe the (general, 4 step) evaluation and treatment sequence for movement facilitation.

ask the patient to move (guard and safe)

facilitate movement in variety of ways

increase ROM if needed

repeat and challenge movement (build toward complex functional tasks)

What type of treatment approach is aimed at the affected muscles, extremity, or body region?

direct

What type of treatment approach is aimed at the unaffected body region to facilitate improvement in the affected region?

indirect

What type of treatment approach uses strategies/devices to compensate for impairments?

compensatory

What are 4 major components to consider when using verbal cues?

use brief/clear/concise patient friendly terms

positive feedback

modulate volume

timing

Volume of verbal cues should be _ for stronger contractions and ____ for stability/relaxation

louder, softer

What does coordination of head movement with activity enable?

visual feedback

increasing trunk participation

helps with head-hips relationship

What are the 4 main (potential goals) of manual contacts?

passive movement, active assist, active control, strengthening

The magnitude of the response is related to the ___ provided by the PT

resistance