oth 603/606- wk 3

Pedr (ch.8, table 8.1), Pedr (ch 32 & 33), Pedr (pg. 245-265), Gabai (ch 4)

independent

client completely independent. task completed safely

modified independent

independent but require additional items to complete

supervised

requires supervision to safely complete. verbal que may be required

contact guard/standby assistance

hands on contact necessary or must be within arm’s length

minimum assistance

up to 25% assistance, physical or verbal

moderate assistance

up to 50% assitance, physical or verbal

maximal assistance

up to 75% assistance, physical or verbal

dependent

more than 75% assistance

motor program

procedure or spatiotemporal order of muscle activation needed for smooth and accurate motor performance

3 principal motor regions located in frontal lobe…

primary motor area, supplementary motor area, premotor area

2 principal sensory regions located in parietal lobe…

primary somatosensory cortex and posterior parietal cortex

posterior parietal cortex integrates and translates….

sensory info so that the ensuing movements are directed appropriately in extrapersonal space

basic units of motor control

reflexes

in hierarchical model motor control…

CNS thought have specific organizational structure and motor development and function depend on that structure

Rood approach

use of sensory input to evoke a motor response and the use of developmental postures to promote changes in muscle tone. sensory stimulation applied to muscles and joints to elicit a specific motor response

emphasis on Brunnstrom approach

facilitating progress of individual by promotion of movement, from reflexive to volitional

stage 1 brunnstrom recovery

flaccidity present and no move of limbs can be initiated= arm. flaccidity= hand

stage 2 brunnstrom recovery

basic limb synergies or some of their components may appear as associated reactions or minimal voluntary movement responses may be present, spasticity begins to develop= arm. little or no active finger flexion= hand

stage 3 brunnstrom recovery

patient gives voluntary control of movement synergies although ROM of all synergy components does not necessarily deveop= arm function. mass grasp, use of hok grasp but no release, no voluntary finger extension, possible reflex extension of digits= hand function

stage 4 brunnstrom recovery

some movment combination that don’t follow synergies are mastered and spasticity begins decline= arm function. lateral prehension, release by thumb movement, semi voluntary finger extension of digits, variable range= hand function

stage 5 brunnstrom recovery

more difficulty movement combination are possible as basic limb synergies lose their dominance over motor acts= arm function. palmar prehension, possibly cylindrical and spherical grasp, awkwardy performed and with limited functional use, voluntary mass extension of digits, variable range= hand function

stage 6 brunsstrom recovery

spasticity disappears and individual joint movements become possible= arm function. all prehensile types under control, skills improving, full range voluntary extension of digits, individual finger movements present, less accurate than on opposute site= hand function

encompassed in PNF are mass..

movement patterns that are spiral and diagonal and resemble movement seen in functional activities

11 principle of PNF

1. all humans have potentials that have not been fully developed

2. normal motor development processeds in a cervicocaudal and proximodistal direction

3. early motor behavior is dominated by reflex activity. mature motor behavior is supported or reinforced by postural reflexes

4. early motor behavior characterized by spontaneous movement, which oscillates between extremes of flexion and extension

5. goal directed behavior constructed with reversing movements

6. developing motor behavior is expressed in an orderly sequence of total patterns of movement and posture

7. growth of motor behavior has cyclic trends, as evidenced by shifts between flexor and extensor dominance

8. normal motor development has an orderly sequence but lacks a step by step quality

9. improvement in motor ability dependent on motor learning

10. frequency of stimulated and repetitive activity used to promote and retain motor learning and to develop strength and endurance

11. goal directed activities couped with techniques of facilitation are used to hasten learning of total patterns of walking and self care activities

PNF uses the concepts of

part task practice whole task practice

PNF assessment follow a sequence from proximal to distal

1. vital related function are considered

2. head and neck region observed: dominance of tone (flexor or extensor), alignment (midline or shift to one side), stability and mobility (more or less needed)

3. upper trunk, lower trunk, and lower extremities

head, neck, and trunk patterns in PNF referred to as

• flexion with rotation to right or left

• extension with rotation to right or left

upper and lower extremities described according to 3 movement components of shoulder and hip

1. flexion and extension

2. abduction and adduction

3. external and internal rotation

unilateral patterns of PNF

1. UE D1 and D2 flexion

2. UE D1 and D2 extension

3. LE D1 and D2 flexion

4. LE D1 and D2 extension

symmetric patterns, bilateral

paired extremities perform similar movements at the same time

asymmetric patterns

paired extremities perform movements toward one side of body at same time which facilitates trunk rotation

reciprocal patterns

paired extremities move in opposite directions simultaneously either in same diagonal or in combined diagonals

interaction of UE and LE results in

1. ipsilateral patterns with extremities of same side moving in same direction at same time

2. contralateral patterns with extremities of opposite sides moving in same direction at same time

3. diagonal reciprocal patterns with contralateral extremities moving in same direction at same time while opposite contralateral extremities move in opposite direction

in PNF developmental postures also called

total patterns of movement and posture

pressure from therapist touch used as…

facilitating mechanism and serves as sensory cue to help client understand direction anticipated movement

traction

facilitates joint receptors by creating separation of joint surfaces

approximation

facilitates joint receptors by compressing joint surfaces. promotes stability and postural control and is used for pushing motion

maximal resistance

stronger muscles and patterns reinforce weaker components

repeated contractions

technique based on assumption that repetition of an activity is necessary for motor learning and helps develop strength, ROM, and endurance

contract-relax

targeted muscles for lengthening are contracted by client against resistance for short period of time. following, stretch gently applied to lengthen targeted muscle

rhythmic initiation

involves voluntary relaxation, passive movement of extremity by therapist, and repeated isotonic contractions of agonistic pattern

slow reversal

isotonic contraction of antagonist followed by isotonic contraction of agonist. slow reversal hold is same sequence with isometric contraction at the end of the range

stabilizing reversals

alternating isotonic contractions opposed by enough resistance to prevent motion

rhythmic stabilization

increased stability by eliciting simultaneous isometric contractions of antagonistic muscle groups

hold relax

performed in same sequence as contract relax but involves isometric contraction of antagonis followed by relaxation and then active movement into agonistic pattern

slow reversal hold relax

begins with isotonic contraction followed by isometric contraction, relaxation of antagonistic pattern and then active movement of agonistic pattern

rhythmic rotation effectivve in…

decreasing spasticity and increasing ROM

NDT practice model divided into 4 sections

1. info gathering

2. examination

3. evaluation

4. intervention

NDT approach is now widely described as…

problem solving method for restoring movement and participation for individuals with UMN lesion, specifically cerebral palsy and hemiplegia

key philosophical tenet and emphasis associated with NDT

focus on whole person in intervention planning and implementation as a key element at every stage of evaluation and intervention process. emphasis on addressing and improving client’s participation in functional activities by addressing specific impairments in client’s posture and movement as well as individual body system movements

philosophical tenet NDT, active carryover

importance of active carryover and transition of therapeutic functional activities into daily life condition and situations

NDT and handling

central tent is that handling is a natural method to help others learn the optimal or necessary postures and movement for specific functional activities. what separates from other approaches is that therapeutic handling is beneficial to clients with neuromuscular and neuromotor disorders

evaluation using NDT practice model, things to looks at

1. client’s ability to maintain postural alignment required for occupation

2. “normal” or typical motor performance skills required for tasks or activities that will be addressed

3. client’s alignment and movement while performing basic motor skills necessary in everyday activity

4. underlying impairment that are contributing to movement dysfunction

5. must also assess environmental factors and the task demands that may influence the selection of posture and movement sequences

intervention preparation, NDT practice model might include

1. therapist careful analysis of the movement components required for the task of occupational goal

2. promote active participation on the part of the client as well as attention to the client’s starting alignment for activity

3. mobilization to give the client access to the ROM required for the task

clinicians using an NDT approach include the UE in…

weight bearing as part of the base of support to assist with postural control and to promote sensory input and isometric and eccentric control in limb

dynamic systems theory

views motor behavior as a dynamic interaction between client factors, context, and the occupations that must be performed to enact the client’s roles. based on a heterarchical model in which each component is viewed as being critical in a dynamic interaction to support the client’s ability to engage in occupation

hierarchical model

viewed higher centers in the CNS as having control over the subordinate lower centers

task oriented approach

to motor recovery is based on dynamic systems principle in which occupational performance and motor recovery are achieved by a dynamic interaction of the person, the environment, and the occupations that the person is performing

CIMT

forced use. designed to promote functional use of a hemiparetic UE and has been credited with speeding up the cortical map reorganization process. based on the principles of dynamic systems theory and task oriented approach the the acquisition of motor control

learned nonuses

individual neglects to use affected or more involved extremity because of the extreme difficulty coordinating movement after the onset of stroke, brain injury, or other neurologic condition

shaping

procedures are behavioral techniques that approach a desired motor outcome in small, successive increments

possible criteria for using CIMT

1. first time stroke that occurred more than a year earlier

2. not currently receiving any therapeutic intervention

3. score of 44 or higher on BBS

4. ability to move affected arm in 45 shoulder flexion/abduct, 90 elbow flex/extend, 20 wrist extend, and 10 extend at metacarpal phalanges/interphalanges

5. no significant cognitive impairment

6. no preexisting comorbid conditions

7. limited spasticity

8. ability identify individual to help them

feedback

sensory experiences intrinsic to client and external info provided by environment, which includes verbal comments

action observation

observation of actions performed by others activate the same internal representations of actions

praxis and movement skills

refer to movement related function and include strength, coordination, dexterity, psychomotor, and neuromuscular factors

G-code

four digit code that addresses a particular facet of function. functional areas include mobility, self-care, cognition, and swallowing

modifier

classifies the ability of the client to participate in a particular activity through the use of 2 letter abbreviation which corresponds to a level of impairment noted to complete an activity

a widely used G-code assessment is____

AM-PAC, which is an outcome instrument that measures function in 3 domains: basic mobility, daily activities, and applied cognitive skills