356 Exam 1

two general approaches for Rehab

compensatory and remedial

ICF vs OTPF

OTPF is model off of the ICF

occupations vs activities

impairments vs body functions

environmental and personal factors vs contexts

ICF blends which 2 models of health

medial and social model

motor control

ability to regulate mvmt

CNS PNS, m, joints, sensory input, cognition

the nature of movement is the interaction of

task, environment, person

motor control

planning, initiating, organizing, coordinating, and learning mvmt

motor execution

muscle contraction

stroke in relation to motor control and motor execution

stroke is initially a motor control issue which then may lead to motor execution issue

motor learning

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

plateaus after stroke

when much is going on in the brain but little can be observed

performance vs learning

• performance is short term capabilities as a result of instruction

• learning is long term pontentiaion or depression

how is motor learning tested and measured

• retention tests

• reduction in errors

• increased automaticity

3 stages of motor learning

1. cognitive

2. associative

3. autonomous

cognitive stage of motor learning

• task is new

• conscious attention is needed

• feedback is very important

associateive stage of motor learning

• longer stage

• feedback is monitored internally

• performance becomes consistent

autonomous stage of motor learning

• automatic

• feedback is not important

• improvements are slow but can continue for years

what is the most important factor in motor relearning

the amount of practice

how can we ensure pts are practicing normal movement

movement outside of therapy time using

mirror

unaffected side

videos

movements of the pelvis

ant/post til

r/l lateral tilt

r/l rotation

movements of the spine

flexion/extension

r/l lateral flexion

r/l rotation

what happens to the ribcage when the spine is anteriorly flexed

flared posteriorly

each rib is connected to

2 vertebrae

compressed ribs

ribs together actively

collapsed ribs

ribs together passively

expanded ribs

ribs apart actively

flared ribs

ribs apart passively

shoulder girdle =

scapula and clavicle

shoulder complex =

scapula + clavicle + humerus

spine of scapula

root of spine of scapula

how to palpate for root of spine of scapula

Root is around T3, so palpate C7 which is most prominent and go 3 down

normal resting position of scapula

• slight upward rotation

• inferior angle slightly farther from spine than root

• GF angled up slightly

scapula movements

elevation/depression

pro/retraction

acromioclavicular joint

distal

more mobile

sternoclavicular joint

proximal less mobile

what is the only bony attachment of scapula to rest of thorax

sternoclavicular joitn

movements of clavicle

elevation/depression

anterior/posteiror rotation

3 sensory components of balance

1. vision

2. somatosensation (tactile and proprioceptive)

3. vestibular

motor system involvement for postural control

adequate strength and time of muscle contractions

sustained force

motor components of balance

• strength

• timing

• mobility

• m strength

lack of postural control can lead to

limited capacity to respond to variable conditions in environment

dysfunction of limb control

decreased dissociation of the trunk

primary motor impairments directly attributable to brain lesion

• spasticity

• hypertonicity

• ataxia

• paralysis

  • sensory loss

positive motor signs

(involuntary increase/extra)

spasticity

hypertonicity

negative motor signs

(insufficiency/too low)

paralysis

sensory loss

secondary motor impairments

• preventable; develop over time due to inactivity and immobility

• PROM

• dimished flexibility betwen body segments

maladaptive movement strategies

develop as a response to move within the constraints of the primary and secondary motor impairments

neuromotor intervention often begins with

addressing postural control and balance in sitting and standing

• safety

• proximal stability before distal mobility

interventions to improve postural control and balance

• achieve optimal alignment (stay there)

• develop kinesthetic awareness (get there)

• engage in functional tasks (live there)

optimal pelvic alignment for sitting

neutral to slight anterior pelvic tilt

no lateral pelvic tilt or rotation

optimal spinal alignment for sitting

neutral to slight extension

spinal extensors

spinal extension for proper sitting requires co-contraction of

spinal flexors (abs)

spinal extensors (erector spinae)

optimal shoulder alignment for sitting

symmetrical and slightly anterior to hips

scapula in neutral

optimal hip and knee alignment for sitting

flex to about 90°

no rotation or abd/add of hips

optimal foot alignment for sitting

ankles to 90°

with no inversion or eversion

flat on floor

handling

using out hands/body on the pt body during therapy

why is handling important

pt often lack intrinsic feedback to guide movement

many intervention approaches use handling or physical guidance

handling can also be PROM

facilitation

to enable, increase, encourage, promote, make possible any desired response, movement or otherwise

inhibition

to decrease, prevent any undesired response, movement or otherwise

mobilization/stretching

to increase the length of a soft tissue when it is impeding ROM and/or function

facilitation guidelines

purposeful handling

align first

encourage participation

fade assistance

mobilization guidelines

respect biomechanics

slow rhythmic movement

avoid pain

integrate into tasks

problem solving sequence #1

ask pt for the movement (directly or indirectly)

facilitate the movement (hands off or on)

take them through the movement passively

stretch or mobilize to achieve movement

proximal points of contact

on the m moving the part or on the moving part itsefl

distal point of contact

not on the m moving the part or on the moving part itself

problem solving sequence #2

isometric- no movement hold

eccentric- muscle lengthens controlled

concentric- shortening against resistance

lack of sensation can lead to

learned non use

overall slower motor recovery

parasthesia

tingling, prickling, or electrical sensation

hyperalgesia

increased pain

dyesthesia

unpleasant sensation

allodynia

pain in response to a stimulus that is not typically painful

hyperesthesia

heightened sensitivity to tactile stimuli

what a supplies the thalamus

posterior cerebral artery and posterior communicating artery

what a supplies that anterior parietal lobe

middle cerebral artery

appropriate intervention for diminished or lost protective sensation

compensation to prevent injury

appropriate intervention for hypersensitivity

desensitiziation

appropriate intervention for absent or impaired sensation but expect some sensory abilities to return

passive sensory training

appropriate intervention for some sensation and movement and potential for better sensation or better interpretation of sensory input

active sensory training/ sensory reeducation

sensory substitution

if one sensory system is impaired, use another

continuous low pressure intervention

frequent position changes, wheelchair cushions etc

concentrated high pressure interventions

knife safety, check splint straps, care with AFOs, UE posititioning in wheelchair

excessive heat or cold interventions

insulated coffee mugs, oven mitts, shower safety, appropriate cold weather gear etc.

repetitive mechanical stress interventions

avoid repetitive motions and excess friction

what is the basis of desensitization

habituation- progressive stimulation will allow progressive tolerance

desensitization techniques

exposure to stimuli in a hierarchial fashion

with whom do you use sensory training

for persons with conditions involving either PNS or CNS sensory impairments

goals of sensory training

to maintain or restore the cortical representation of the body in the somatosensory cortex and regain sensation in body

passive sensory training

• requires no attention from the client

• repeated stimulation to denervated body part, typically through electrical stimulation

active training/ sensory reeducation

repeated stimulation to denervated body part

client is active in process: attention, learning, repeated practice, and use of alternative senses to enhance learning

task-specific sensory training

should occur concurrently with motor learning

begin early on!

what