Neurological Rehabilitation: Specific Considerations

coordination is

the ability to execute smooth, accurate, controlled movements

coordination requires

-speed
-direction
-rhythm
-distance
-strength

to have coordination, you must be able to __________ and __________ easily

revers; stop

coordination is ____________________

learned with repetition

coordination tests

-"Finger to Nose Test"
-"Alternating Pronation/Supination"
-"Foot Tapping"
-"Heel to Shin"
-"Catching or Throwing"

muscle tone terms

-hypertonicity
-spasticity
-rigidity
-'normal'
-hypotonia
-flaccidity
-clonus

ROM tests to check tone

-Degree of resistance
-Length of resistance

how to test for clonus

quick stretch to muscle

0 muscle tone

'normal'

1 muscle tone

catch and release or minimal resistance at end of movement

1+ muscle tone

catch and release followed by minimal resistance through remainder of ROM

2 muscle tone

resistance throughout full movement, but extremity still moved easily

3 muscle tone

passive movement difficult

4 muscle tone

rigid in flexion or extension

spastic posture in the upper extremity

flexed, pronated, clenched

spastic posture in the lower extremity

flexed hip, adducted thighs, knee extension or flexion, striatal toe, equinovarious foot

upper extremity flexion synergy pattern

-Scapular elevation/retraction
-Shoulder abduction/ER
-Elbow flexion
-Forearm supination
-Wrist & finger flexion

lower extremity flexion synergy pattern

-Hip flexion, abduction, ER
-Knee flexion
-Ankle dorsiflexion, inversion
-Toe dorsiflexion

upper extremity extension synergy pattern

-Scapular protraction
-Shoulder adduction/IR
-Elbow extension
-Forearm pronation
-Wrist & finger flexion

lower extremity extension synergy pattern

-Hip extension, adduction, IR
-Knee extension
-Ankle plantarflexion, inversion
-Toe plantarflexion

dysarthria

struggle with articulation (lack of muscle control)

agraphia

difficulty writing

sensory aphasia

-Inability to understand spoken language; aka receptive

motor aphasia (Broca's)

-Comprehension intact
-Effortful speech

global aphasia

-Combination of sensory and motor aphasia
-Inability to speak and comprehend language

neurological conditions

-Hemiplegia (one side)
-Monoplegia (one limb)
-Diplegia (legs)
-Paraplegia (legs)
-Quadriplegia (4-limbs)

acute considerations with spinal shock

Do not mistake spinal shock resolution with increased potential of recovery

acute considerations with heterotopic ossification

formation of bone outside the skeletal system
-avoid vigorous stretching

as a general rule, change positioning every ______________

2 hours

functional training with spinal cord injuries

-Sitting tolerance/balance, Bed mobility, Transfers, W/C skills, Ambulation
-ROM & Strength

respiratory management with spinal cord injuries

Assisted coughing, Incentive spirometers, positioning

pressure relief techniques with spinal cord injuries

Push up, Leaning side-to-side, Leaning forward

muscle substitution (SCI)

distal fixation

angular momentum (SCI)

rolling over; transfers

head-hips relationship (SCI)

-Head goes one way, hips go the opposite way
-Combined with momentum

osteoporosis affects majority of individuals with ________________

spinal cord injuries

cardiovascular disease is the leading cause of mortality after __________________ for people with spinal cord injuries

one year

wheelchair propulsion strategies

Long smooth strokes - low impact loads
- Ergonomic Rim

stroke considerations with the shoulder

-Should not be passively moved beyond 90 degrees of flexion and abduction
-Don't lift under arm or pull arm
-Position shoulder in protracted position
-Support: sling, tray, pillows, etc.

stroke considerations with management of tone

weight bearing can help controlled contraction

RIPE

repetitions, intensity, promise, error (systemic grading)

treatment approaches with strokes

-mental imagery
-electrical stimulation
-sensory stimulation
-mirror therapy
-Graded Repetitive Arm Supplementary Program (GRASP)
-Constraint Induced Movement Therapy (CIMT)

cerebral palsy

-abnormal muscle tone
-poor selective motor control
-persistent influence of primitive reflex
-lack of variability of movement choices
-poor postural control
-poor coordination
-muscle contractures (esp 2 joint muscles)
-restricted joint ROM
-muscle weakness
-poor aerobic endurance
-hip dislocation

Gross Motor Function Classification System (GMFCS)

5 levels, for children with cerebral palsy

Level I GMFCS

walks without limitations

level II GMFCS

walks with limitations

level III GMFCS

walks with handheld mobility device

level IV GMFCS

Some self initiated mobility - may used powered mobility

level V GMFCS

transported in a manual wheelchair

Manual Abilities Classification System (MACS)

scale from I to V for how children with cerebral palsy use their hands

I (MACS)

handles objects easily and successfully

II (MACS)

Handles most objects but with somewhat reduced quality and/or speed of achievement

III (MACS)

Handles objects with difficulty; needs help to prepare or
modify activities

IV (MACS)

Handles a limited selection of easily managed objects in
adapted situations

V (MACS)

Does not handle objects and has severely limited ability to
perform even simple actions

hip displacement / dysplasia

-Common in CP
-Not always symptomatic; can become symptomatic
-Early detection critical, routine hip surveillance
-Stretches, Casting/Splinting, Surgery (dependent on severity)
-Functional implications (gait, perineal hygiene)

when managing spasticity, start:

proximally, work slowly, work into positions outside muscle synergy

considerations with carrying and handling techniques

-Encourage symmetry
-Encourage active movement

play based learning could help a child with

-Balance
-Turn-taking
-Core Strength
-Lower Extremity Strength
-Fine Motor Skills

different approaches to neurorehabilition

-bobath
-NDTA
-motor learning
-PNF
-CIMT

bobath

task specific muscle activation

NDTA

neurodevelopmental treatment association

PNF

proprioceptive neuromuscular facilitation

CIMT

Constraint-induced Movement Therapy

treatment points to remember

-developmental sequence
-functional norms
-activities must be graded
-rehab team approach is vital
-knowledge of condition combined with therapeutic exercise

volitional control may _____________ tone

increase

when working with a patient who has neurological conditions most important things (summary)

-understand condition
-recognize symptoms and what they mean
-understand goals of treatment
-listen and see with your hands
-repetiton is vital to success