34. Miscellaneous Topics

Motor Learning

Motor Learning » Stage 1: Cognitive Stage (Beginning/Novice)

• 4 Characteristics

• Gathering Info

• Frequent Errors and Feedback

• Cannot Perform Dual Task

• Large Gains BUT Inconsistent Performance

Motor Learning » Stage 2: Associative Stage (Intermediate/Practice)

• 6 Characteristics

» Putting Actions Together «

• Practice is Critical

• Small Gains BUT Disjointed Performance

• Less Cognitive Effort

• Begin to Learn What Errors They Are Making

• Patient Reflects on Performance

Motor Learning » Stage 3: Autonomus Stage (Advanced/Fine Tuning)

• 5 Characteristics

• Accurate

• Consistent

• Efficient

• Smooth

• Recognize when skills are performed INCORRECTLY

• Motor Learning occurs as a direct result of what?

• WHO is practice important for?

• How often should feedback be given for Novice Learners?

• Practice

• Novice Learners at the Cognitive Phase

• Frequent Feedback

Cognitive Learning Phase:

• What type of practice is BEST for pts in the COGNITIVE learning phase?

  • BUT can begin ___ practice as they progress

• What should the PT allow time for in pts in the Cognitive Learning Phase?

• Blocked Practice

  • Serial Practice

• Process the Practice

Associative Learning Phase:

• ASSOCIATIVE learners are beginning to develop and hone in what?

• What type of practice are ASSOCIATIVE learners?

• What should the PT allow time for in pts in the Associative Learning Phase?

• Internal Reference of Correctness

• Transition from Serial Practice » Random Practice

• Reflect on the Performance

• What is Blocked Practice?

  • Example:

• Repetition and Practice

  • Ex: Practice STS 12x from WC

  • 111222333

• What is Serial Practice?

  • Example:

• Practice sequence in which different skills are performed in a MIXED ORDER but FIXED FORMAT

  • Ex: Practice STS 4x from bed, 4x from WC, 4x from couch

  • 123123123

• What is Random Practice?

  • Example:

• RP:

  • Previously constructed plans be abandoned

  • Processing facilitates learning

• Ex: Random order of transfers

  • 1232123

• Random Practice is BEST for what 2 types of learners?

• Associative Learner » Who has developed a “Reference of Correctness”

• Autonomous Learners » Who are highly skilled/expert

• What is Mental Practice?

• What is Part Task v Whole Task Practice?

• Mental:

  • Having patient review planned movement in their heads PRIOR to completing movement

• Part v Whole:

  • Breaking up the training into portions » practice a portion of the movement

Intrinsic v Extrinsic Feedback:

• Define:

  • Intrinsic Feedback:

  • Extrinsic Feedback:

    • AKA:

    • Rate Given:

• Intrinsic:

  • Patient thinking and performing

    • Kinesthetic, Visual, Cutaneous, Vestibular, Auditory Feedback of the patient

• Extrinsic:

  • External sources that are supplemental to intrinsic feedback

    • AKA: Augmented

    • Rate:

      • Concurrently, Immediately After, or Delayed

• How much feedback should be given as learning progresses for these stages:

  • Cognitive Level:

  • Associative Feedback: (4)

• Cognitive Level:

  • Frequent Feedback

• Associative Feedback:

  • LESS OFTEN is more beneficial

  • DELAYED Feedback is more beneficial than INTERMEDIATE Feedback

  • Blocked » Random once pts has “Internal Reference of Correctness”

  • Given when patient performance falls OUTSIDE of acceptable level OR FADING feedback as pt skill level improves

Scoliosis:

• At what degree of Scoliosis curvature is a brace effective?

• 25-45 degrees

Heart Murmurs:

• Murmur =

• Sounds occurring between S1 and S2 =

• Sounds occurring between S2 and S1 =

Correct: 1

• Murmur = Turbulent blood flow within heart or great vessels

• Sounds occurring between S1 and S2 = Systolic Murmurs

• Sounds occurring between S2 and S1 = Diastolic Murmur

Ankle Sprain Grades:

• Grades 1-3:

Ankle Brachial Index (Ankle SBP / Arm SBP)

• Purpose:

  • To distinguish…

• Compares…

• Uses Doppler at what 2 arteries?

• Compression Therapy is CONTRAINDICATED for what ABI?

• Purpose:

  • To distinguish LE Neurogenic vs Vascular Claudication Pain

• Compares:

  • Ratios of SBP of Arms and Legs

    • L Leg Systolic / Highest Brachial BP

    • R Leg Systolic / Highest Brachial BP

• Doppler:

  • Posterior Tibial Artery

  • Dorsalis Pedis Artery

• Contra:

  • < 0.80 ABI

Myositis Ossificans:

• Widespread ossification of __ __.

• Episodes of _ and _ _ _.

• Tissues can __

• How can Myositis Ossificans occur? (3)

• 3 MC sites

• Tx: (2)

• Connective Tissue

• Eposides of Fever or Soft Tissue Inflammation

• Harden

• How:

  • Often in Early Childhood or after trauma

  • Maybe from massage or STM TOO EARLY in rehab

  • Lack of RICE after injury

• Muscles:

  • Quads

  • Brachialis

  • Deltoid

• Tx:

  • Ice in fully stretched positions

  • STOP MASSAGING AND USING HEAT

Metabolic Equivalent:

• 1 MET =

• Convenient Method for standardizing…

  • Light Intensity:

  • Moderate Intensity:

  • Vigorous Intensity:

• 1 MET = Relative Oxygen Consumption at REST

• Standardizing » Intensity of Activities

  • Light Intensity: 1.6-2.9 METS

  • Moderate Intensity: 3.0-5.9 METS

    • Walk, Run, LE/Arm Cycling (~3.5)

  • Vigorous Intensity: ≥ 6.0 METS

Tethered Dura:

• Define:

• Can Cause:

• Define:

  • Abnormal fixation of the SC/Dura

• Causes:

  • Traction and Neurological Symptoms ESPECIALLY c Movement or Growth

Idiopathic Pulmonary Arterial Hypertension (IPAH):

• Prevalence:

• Describe:

• IPAH can lead to:

• RARE

• Define:

  • Progressive disease where there is abnormally high BP in Pulmonary Artery c no identifiable cause

• Lead to:

  • R Heart Failure

Idiopathic Pulmonary Arterial Hypertension (IPAH):

• Physiology: (4)

• Pulmonary Artery becomes narrowed, thickened, or stiff

• Increase Pulmonary Vascular Resistance (Afterload)

• R Ventricle has to work harder to push blood to lungs

• Overtime » R Ventricle Hypertrophy » R HF

Define:

• Nociplastic Pain:

• Nociceptive Pain:

• Neurogenic Pain:

• Psychogenic Pain:

Correct: 3

• Nociplastic Pain:

  • Associated c symptoms that do not have clear anatomical correlate, is widespread, and/or not consistent

• Nociceptive Pain:

  • Pain resting from stimulation of nociceptors

  • Often with a clear stimulus-respose relationship between movement and symptoms

• Neurogenic Pain:

  • Pain that arises from injury, dysfunction, or disease of the nervous system

• Psychogenic Pain:

  • Pain where psychological factors are the primary cause

T4 Syndrome:

• T4 actually means:

• Describe:

• Presentation: (4)

• T4 = T2-T7

• Describe:

  • Symptom complex especially Upper T/S

  • Unknown Cause

• Presentation:

  • Hand or Hands always affected

  • Glove like distribution of parethesias

  • Dull aching or pressure in or around the head

  • No changes in reflex or myotomes

• CRPS:

  • Common S/S: (4)

  • In final stage, affected limb is…

Correct: 4

CRPS:

• Common S/S:

  • Burning or Aching Pain

  • ANS Dysfunction

  • Edema

  • Movement Disorder

• Affected Limb = Cooler

CVA Terminology:

• Anosognosia:

• Ideational Apraxia:

• Somatoagnosia:

• Right and Left Discrimination Disorder:

• A:

  • Denial or lack of awareness of the presence or severity of one’s paralysis

• IA:

  • Inability to perform a task on motor or on command

• S:

  • Lack of awareness of the body structure and relationship of body parts to oneself or to others

• R and L:

  • Inability to identify R and L sides on one’s own body

Sensory Organization Test (SOT)

On or after third postpartum day

Sit and Lean Forward

Meralgia Paresthetica:

• Define:

• This injury affects sensation where?

• Define:

  • Entrapment or injury to the Lateral Femoral Cutaneous Nerve » Purely Sensory Nerve

• Affects sensation:

  • Lateral Thigh

How to assess difference between:

• Anterior TIBIO-FIBULAR Ligament Sprain:

• Anterior TALO-FIBULAR Ligament Sprain (ATFL):

• Anterior TIBIO-FIBULAR Ligament Sprain:

  • Compression of the Distal Shafts of the Tibia and Fibula (Syndesmosis Injury)

• Anterior TALO-FIBULAR Ligament Sprain (ATFL):

  • Anterior Drawer

NOTE: READ THE FULL NAME OF THE LIGAMENT » DONT ASSUME ATFL

A patient in a persistent vegetative state in a nursing home has developed a Stage 2 ischial pressure injury. The pressure injury has not improved after 4 weeks of standard wound care treatment. The physical therapist should recommend a consultation with:

1. An orthotist to investigate lower extremity bracing.

2. A nutritionist to investigate level of protein.

3. A respiratory therapist to administer oxygen therapy.

4. A surgeon to perform a skin flap.

» WHY?

• Increased __ __ are linked to improved __ __ healing in pts c pressure injuries.

• A nutritionist to investigate level of protein.

  • INCREASED PROTEIN LEVELS » WOUND HEALING

Hemipalegic Posture:

• What position is an IDEAL early standing posture in which to develop UE and LE control?

• This posture helps affected extremities weight bear out of what?

• This position is easily tolerated by what pop?

• Modified Plantigrade

• Synergy patterns

• Elderly pts

HR:

• If a patient has an irregular HR > 100 bpm, what is the most accurate method of measuring HR?

• HR faster than 100 bpm OR slower than 60 bpm should me measured at…

• Auscultate the apical heart for at least 60 sec

• > 100 OR < 60

  • Measured at the FULL MINUTE

    • Could miss the irregular heart beat if done at 15 or 30 second intervals

What is the MAXIMUM current density that should be used to initiate iontophoresis when the current amplitude is 10 milliamperes and the conductive surface area is 20 cm²? 

1. 0.2 milliamperes/cm²

2. 0.5 milliamperes/cm²

3. 5 milliamperes/cm²

4. 20 milliamperes/cm²

2. To calculate current density, the current amplitude is divided by conductive surface area; therefore, 10/20 = 0.5.

A 4-year-old child has maxillary hypoplasia, an elongated mid face, and a short, upturned nose. The child has a short attention span and poor growth. Which of the following interventions would be MOST appropriate for the child? 

1. Gait training with a rolling walker

2. Sensory desensitization activities

3. Activities to inhibit spasticity

4. Dynamic balance activities

»

• What condition does this child have?

• What are 4 main characteristics/impairments associated with this condition?

4. Dynamic balance activities

»

• Fetal Alcohol Syndrome

• 4:

  • Fine Motor Dysfunction

  • Visuomotor Deficits

  • Balance Problems

  • Weak Grasp

Postural Control:

• What is the difference between… tested?

  • Reactive Postural Control:

  • Anticipatory Postural Control:

• Reactive Postural Control:

  • Providing an unexpected EXTERNAL PERTURBATION OR CHANGE to test ability to maintain/recover balance

• Anticipatory Postural Control:

  • Assesses ability to COUNTERACT a PREDICTED OR ANTICIPATED postural disturbance

    • Ex: Catching a Ball

Creep:

• Creep is a permanent deformation of tissue through the application of…

• Use of a dynamic splint will allow the application of such a load induce WHAT with minimal tissue damage and inflammation?

• Low magnitude load over a long period of time

• Rapid changes over an extended period of time

When selecting exercises for a patient who has diabetes mellitus, the patient's insulin injection site is important to consider because insulin has which of the following characteristics?

1. Longer duration of action if large muscle masses are involved in the exercise

2. Slower absorption if the injection site is in the exercised extremity

3. Faster delivery into the bloodstream if the injection site is in the exercised extremity

4. Faster degradation due to metabolic by-products in the exercised extremity

1. Faster delivery into the BLOODSTREAM if the injection site is in the exercised extremity

• Cogwheel Resistance to Passive Manipulations =

• Clasp Knife Phenomenon =

• Cogwheel Resistance to Passive Manipulations =

  • Lesions of the Basal Ganglia

• Clasp Knife Phenomenon =

  • Injury to Descending Motor Pathways from Cortex or Brainstem

Which of the following symptom indicates that the patient has a decompensated heart failure?

A. Presence of S2 heart sound

B. Gradual decrease in weight of the patient

C. Presence of indentations when pressure is applied to pretibial area

D. Increased appetite

»

• What is this indicative of?

C. Presence of indentations when pressure is applied to pretibial area

• Peripheral Edema

» Answer:

• Uncompensated:

  • Forefoot VARUS =

  • Forefoot VALGUS =

• Compensated:

  • Forefoot VARUS =

  • Forefoot VALGUS =

» A

• Uncompensated:

  • Forefoot VARUS = Neutral Heel + BIG Toe Up

  • Forefoot VALGUS = Neutral Heel + LITTLE Toe Up

• Compensated:

  • Forefoot VARUS = Neutral Forefoot + Calcaneal EVERSION

  • Forefoot VALGUS = Natural Forefoot + Calcaneal INVERSION

Define:

• Spatial Relations Disorder:

  • Inability to…

    • AKA:

• Figure Ground Discrimination:

  • Inability to…

• Form Discrimination:

  • Inability to…

  • People is likely to confuse…

• Anosognosia:

• Spatial Relations

  • Inability to perceive the relationship of one object in space to another object, or to oneself.

    • AKA: Spatial Disorientation

• Figure-Ground Discrimination:

  • Inability to visually distinguish a figure from the background in which it is embedded

• Form Discrimination

  • Inability to perceive or attend to subtle differences in form and shape. The patient is likely to confuse objects of similar shape or not to recognize an object placed in an unusual position.

• Anosognosia:

  • Lack of awareness, or denial, of a paretic extremity as belonging to the person, or a lack of insight concerning, or denial of, paralysis and disability.