Normal movement

neurology

Goal of treatment

• people with neurological dysfunction is to teach them to move as normally as possible

• PTA you need to learn normal movement to assist them.

Postural sets

automatic reactions the body makes in preparation for movement

typical posture sitting in wheelchair

• posterior tilt of pelvis

• causes:

  • forward head

  • decreased chest capacity

  • difficulty feeding self

  • drooling

sit to stand

• place feet (// shoulders and greater 90 degrees)

• anterior tilt of pelvis

• scoot forward

• lean forward

• transfer weight of body from buttocks and posterior thighs to feet

stand to sit

• turn your head and upper trunk to see where the chair is

• place feet shoulder width apart and //

• lean forward

• transfer weight from feet to buttocks

• scoot back

• posterior tilt of pelvis

segmental rolling

• progression from log rolling

• upper or lower segment of the trunk moves independently while the other segment is stabilized

• normal rolling not the same for each individual

• weak side = determine normal rolling by rolling on to weak side with strong side

righting reactions

maintain the head in its normal upright position

equilibrium reactions

maintain balance in response to alterations in the body’s center of gravity and/or base of support

protective extension

arms extend to protect the face and head when the body’s center of gravity exceeds its base of support

• occurs when equilibrium reactions are not enough to prevent a falll

Placing

• called drop arm test

• passively lift arm into 90 degrees and let go

normal response the arm will fall a few degrees then the patient will check the movement

normal scapulohumeral rhythm

• shoulder girdle reach 180 = shld flx or aabd the scapula most also move

• every 2 degrees Gh joint = 1 degree of scapular movement

• inferior border of the scapula moves upward and laterally

deep tendon reflexes (DTR)

• tapping tendon with fingertips or a reflex hammer

• grade scale

  • 0 - absent

  • 1+ - decreased response

  • 2+ - normal

  • 3+ - exaggerated response

  • 4+ - clonic

sensation

the appreciation of stimuli through the organs of special sense (eyes, ears, nose), the peripheral cutaneous sensory system (temp, taste, touch) or the internal receptors (muscles, joints)

superficial (light touch)

• ability to appreciate touch with either a fingertip or a cotton swab

• pt indicates by voicing a “yes” when touched

superficial (pressure)

• more firm than touch

  • determines if pt is able to feel feet on the floor

• pain ability to discriminate between sharp and dull

  • use paper clip

proprioception

• position sense

  • awareness of the position of the joints at rest

  • test and verbal response

  • test and nonverbal response

movement sense

• appreciation of movement = kinesthesia

  • awareness of movement of muscle receptors

  • test and response

stereognosis

ability to recognize the form of objects by tough and manipulation

tactile localization

ability to locate the light touch

Double simultaneous sensation (Bilateral)

• ability to perceive two distinct points when both are touched at the same time

• the inability to perceive both points = extinction (pt will only fell uninvolved side)