NBCOT things

vital signs

1. blood pressure

2. heart rate/pulse

3. respiratory rate

4. oxygenation

5. blood sugar

6. pain

blood pressure

• force of blood pumped through the arteries

• hypertension = HIGH blood pressure

• hypotension = LOW blood pressure

• orthostatic hypotension = sudden drop in blood pressure when person assumes upright position

hypotension symptoms

• dizziness

• lightheadedness

• cold, clammy pale skin

• fainting

• difficulty concentrating

• blurred vision

• fatigue

• fast, shallow breathing

• nausea

• unusual thirst

Hypertension symptoms

• nausea

• headache

• tightness in chest

• dizziness

• fainting

• blurred vision

• fatigue, low exercise endurance

• shortness of breath

• confusion

tachycardia symptoms

• palpitations

• chest pain

• shortness of breath

• lightheadedness or dizziness

• sweating

• weakness or fatigue

bradycardia symptoms

• dizziness

• fatigue

• shortness of breath

• chest pain or a feeling of fluttering or pounding in the chest

• confusion or difficulty concentrating

• fainting

• tiring easily during exercise

• memory problems

• weakness

respiratory rate

• average: 12 to 20 breaths per minute

• breathing in then out = 1 BREATH

hypoglycemia symptoms

• hearth palpitations

• shakiness

• anxiety

• sweating

• tingling sensation around the mouth

• pounding heart, racing pulse

• pale skin/pallor

• trembling

• weakness

• dizziness

• feeling shaky

hypoglycemia if left untreated

• coma

• visual disturbances (ex: double vision, blurred vision)

• seizures (not common)

• loss of consciousness (not common)

hyperglycemia symptoms

• frequent urination

• feeling weak or tired

• blurred vision

• dry mouth

• thirsty

• nausea or vomiting

hyperglycemia if left untreated

ketoacidosis or diabetic coma

different precautions to consider

1. standard

2. weightbearing

3. spinal

4. hip

5. sternal

6. cardiac

7. seizure

standard precautions

• infection control practice to prevent disease transmission

• applies to all patients

• includes

  • hand hygiene

  • PPE

  • cleaning/disinfection

weightbearing

1. non weightbearing

2. touch down (balance) weightbearing

3. partial weightbearing

4. weightbearing as tolerated

5. full weightbearing

spinal precautions

• used to protect spine following injury or surgery

• the BLT

  • Bending (no forward bending past 90)

  • Lifting (no lifting more than 5 to 10 pounds)

  • Twisting (no twisting at waste)

posterior hip precations

• no forward flexion past 90

• no adduction

• no internal rotation

• no crossing legs

anterior hip precautions

• no extension

• no abduction

• no crossing legs

• no external rotation

sternal precautions

• restrict activity following open heart surgery

• the LPRT

  • lifting more than 5 to 10 pounds

  • no pushing/pulling

  • no reaching overhead/back

  • no twisting/bending

what is motor control

ability to regulate and direct movement to accomplish functional tasks, ex: reaching for a coffee mug

focus of motor control FOR

• restoration of voluntary movement

• how the NS regulates the body’s muscles and joints to produce purposeful, coordinated movements

where does movement come from: reflex theory (motor control)

movement happens because something triggers it, ex: touch hot stove —> pull your hand away

where does movement come from: hierarchical theory (motor control)

• maybe movement is controlled from the top down

  • higher brain centers control lower centers

cortex —> brainstem —> spinal cord

motor control approaches

• Rood

• Brunnstrom

• proprioceptive neuromuscular facilitation (PNF)

• neuro-developmental (NDT)

rood frame of reference

• 1 of the 1st sensorimotor approaches to neurorehabilitation

• emphasized the role of sensory input in movement

• linked sensory stimulation to muscle activation

key concepts of rood FOR

• faciliatory: increase muscle tone/activation

• inhibitory: reduce tone/decrease muscle activation

rood: facilitation

used when muscles are

1. weak

2. hypotonic

3. difficult to activate

rood: inhibition

used when muscles are:

1. hypertonic

2. spastic

3. excessively active

rood faciliatory techniques

• quick stretch

• tapping

• vibration

• fast brushing

• vestibular stimulation (fast movement)

rood inhibitory techniques

• neutral warmth

• slow stroking

• light joint compression

• prolonged stretch

• vestibular stimulation (slow movement)

rood’s developmental progression

1. supine withdrawal/flexion

2. rolling

3. prone extension (prone with upper trunk/head extension)

4. neck co-contraction (prone with isolated head extension)

5. prone on elbows

6. quadruped

7. static standing

8. walking

key points for rood FOR

• sensation influences movement

• facilitation = wake up nervous system

• inhibition = calm down nervous system

• stability before mobility

brunnstrom’s FOR

• 1 of the 1st to develop approach to understanding stroke recovery

• focused on understanding motor recovery patterns

• emphasized using synergies and reflexes therapeutically

brunnstrom FOR: synergy

• stereotypical pattern of muscle activation

• instead of moving 1 joint independently, multiple joints move together

brunnstrom’s 7 stages of recovery (don’t need to know for test but possibly for NBCOT)

1. flaccidity: no voluntary movement

2. synergy: synergy can be elicited reflexively

3. begin voluntary movement

4. spasticity begins to decrease

5. further decreased tone increased ability to perform more complex movement patterns independent of synergy pattern

6. tone nearly normal with ability to do complex combinations

7. normal speed and coordination of motor function

key points of brunnstrom

• synergies viewed as normal part of recovery

• recovery after a stoke often follows predictable stages

• progression from flaccidity to isolated and coordinated voluntary movement

PNF FOR

• underlying philosophy that all humans have untapped existing potential

• functional movements occurs in patterns not isolated muscles

• use of sensory input and functional movement patterns help the body to move more effectively

what does PNF mean

• proprioceptive: input from muscles, tendons, and joints

• neuromuscular: interaction between the nervous system and muscles

• facilitation: making movement easier or more effective

PNF concept

• resistance: using optimal resistance to improve muscle contraction

• stretch: putting the target muscle in the optimal lengthening position for facilitating muscle contractions

• irradiation: spreading of response of nerve impulses of stimulus

• traction or approximation: elongation of compression of limbs and trunk to facilitate motion or stability

• body positioning/mechanics: correct positioning and alignment of both the client and practitioner

PNF movement patterns

1. multi joint movements

2. diagonal motions

3. rotational components

PNF: UE patterns, D1 flexion

• starts: arm down by your side, palm facing backward, fingers extended

• action move arm diagonally up and across your body. The shoulder flexes, adducts and externally rotates. Forearm supinates, the wrist and fingers flex

PNF: UE patterns, D1 extension

• starts: arm flexed and adducted near your opposite shoulder

• action: move the arm diagonally down and out to your side. The shoulder extends, abducts, and internally rotates. Forearm pronates, wrist and finger extend

PNF: UE patterns, D2 flexion

• starts: arm is across the body, resting near the opposite hip. shoulder is extended, adducted, and internally rotated with the wrist and fingers flexed (closed hand)

• action: arm moves diagonally up and away from the body. As the arm elevates, the shoulder rotates outwards externally and abducts while the wrist and fingers extend (open hand)

PNF: UE patterns, D2 extension

• starts: the arm is flexed, abduction overhead on ipsilateral side

• action: the arm moves diagonally down and across toward the opposite hip. As it moves the shoulder internally rotates and adducts, while the wrist and fingers into a fist

key PNF techniques

• rhythmic initiation: teaching movement through repetition

• hold relax: isometric contraction followed by a stretch

• contract relax: isotonic contraction followed by a stretch

PNF key points

• uses proprioceptive input to improve movement

• movement occurs in functional diagonal patterns

• irradiation means stronger muscles can help weaker muscles

neurodevelopmental treatment (NDT)

• focused on reducing abnormal movement patterns and promoting more normal movement

• abnormal movement patterns interfere with functional movement and can be improved through guided more normal experiences

NDT concepts

• muscle tone: resistance a muscle provides to passive stretch (hypertonia and hypotonia)

• postural stability: ability to maintain alignment, balance and adjust to movement demands (proximal stability leads to distal mobility)

• abnormal movement patterns: flexor synergies, extensor synergies, compensatory movements (facilitation and inhibition)

key points of control in NDT

• proximal points

  • scapula

  • pelvis

  • trunk

• distal points

  • hands

  • feets

handling in NDT

therapeutic use of touch to

• guide movement

• improve alignment

• facilitate postural control

• increase movement awareness

weight shifting in NDT

• controlled transfer of body weight in various directions supports

  • balance

  • postural control

  • functional mobility

  • reaching

key points of NDT

• focuses on improving movement quality

• postural control is foundation of movement

• tone influences function

• handling and key points of control are central concepts

what is motor learning

a set of processes associated with practice or experience leading to relatively permanent changes in the capacity for skilled movement

what did early approaches to motor learning focus on

• reflexes

• hierarchical nervous system control

• facilitation of normal movement

• inhibition of abnormal movement

motor control vs motor learning

• motor control: therapist helps movement happen through facilitation, handling, and positioning

• motor learning: client learns movement through practice, feedback, problem solving, and repetition

dynamic systems theory

• movement emerges from interactions among

  • person

  • task

  • environment

• no single system controls movement

neuroplasticity

• nervous system’s ability to reorganize itself

• neural connections change based on

  • use

  • practice

  • experience

principle of neuroplasticity

• use it or lose it

• use it and improve it

• specificity

• repetition matters

• intensity matters

• salience matters

occupation based neuroplasticity

strongest learning occurs when activities are

1. meaningful

2. purposeful

3. repetitive

4. challenging

5. goal directed

stages of motor learning

• cognitive stage

• associative stage

• autonomous stage

motor learning: cognitive stage

• learning what to do

• frequent mistakes

• heavy attention required

• high therapist feedback

cognitive stage therapist role

provide

• clear instructions

• demonstrations

• frequent feedback

• simple explanations

• breaks tasks into smaller steps

uses

• visual cues

• verbal cues

• physical guidance

motor learning: associative stage

• improved consistency

• fewer errors

• refinement of movement

• begins recognizing mistakes

• needs fewer reminders

associative stage therapist role

focus on

• refinement

• efficiency

• consistency

decrease:

• physical assistance

• verbal cueing

encourage

• self evaluation

• problem solving

motor learning: autonomous stage

• automatic performance

• minimal conscious attention

• adaptation to environment

• skill is more automatic

• focus can shift to other tasks

autonomous stage therapist role

focus on

• generalization

• real world application

• adaptability

create challenges

• dual task situations

• community environments

• distracting environments

key concepts of motor learning

• task specific training

• practice conditions

• feedback

• knowledge of results

• knowledge of performance

• error based learning

task specific training

• practice the exact task that needs improvement

• learn the skill by doing the skill

• focuses on real life occupations

• encourages transfer to everyday situations

  • ex: dressing practice to improve dressing or bed mobility practice to improve transfers

block practice

• repetition of the same task over and over with low variability

• useful during early skill acquisition

• advantages:

  • builds confidence

  • useful for beginners

  • reduces cognitive demands

• ex: practicing sit to stand 20 times before moving to another activity

random practice

• different tasks practiced in varying order with high variability

• requires greater problem solving

• benefits:

  • improves retention

  • enhances transfer of learning

  • promotes adaptability

• ex: sit to stand, bed mobility, wheelchair transfers

massed practice

feedback

• information provided about performance

• helps learners modify movement

• can come from:

  • therapist

  • environment

  • the learner’s own sensory system

• goal: promote independence in movement control

knowledge of results

• feedback about the outcome

• focuses on whether the goal was achieves

• answers the question “did i accomplish the task?”

• ex: you successfully stood up without assistance or you completed the transfer in 20 seconds

knowledge of performance

• feedback about movement quality

• focuses on how the task was performed

• answers the question: how did i perform the movement

• ex: you shifted your weight forward before standing or your reach was smoother this time

error based learning

• learning occurs through mistakes and corrections

• encourages problem solving

• promotes active participation

• therapist allows safe errors when appropriate because errors are opportunities for learning

strengths of motor learning

• evidence based

• occupation centered

• promotes independence

• supports neuroplasticity

• encourages generalization

limitations of motor learning

• requires active participation

• may be difficult with severe cognitive deficits

• learning can be slow

• requires sufficient practice opportunities

• less appropriate for very early recovery when movement is extremely limited

key takeaways of motor learning

• focuses on skill acquisition through practice

• neuroplasticity is driven by meaningful repetition

• errors are part of learning

• practice should be task specific and occupation based

• therapist becomes coach rather than movement facilitator

• successful occupational performance is ultimate goal

three component model of vision

1. visual integrity

2. visual efficiency

3. visual information processing

are vision and cognition related?

very

role of OT in vision

• perform vision screens: make referrals when needed, complete in depth visual perception eval when needed

• create treatment plans: goal is to address functional deficits impacted by visual impairments (compensatory strategies, adapt/modify environment, or remediation)

visual acuity

• sharpness of vision

• impairment results in difficulty seeing clearly, known as low vision which can be caused glaucoma, cataracts, diabetic retinopathy, or ARMD, refractive errors

behaviors indicating visual dysfunction

• squinting

• closing 1 eye

• skipping letters or lines

• using finger as a guide

visual pursuits

• ability of eyes to move smoothly

• behaviors indicating dysfunction:

  • loss of fixation on target

  • jumpy quality of eye movement

  • unable to move eyes to meet target

  • nystagmus (shaking of eyes)

vision saccades

• rapid eye movements between 2 points of fixation

• can be caused by neurological impairments like TBI, CVA, and alzheimer’s

• can be caused by developmental disabilities like ADHD, ASD, and intellectual disability

behaviors indicating saccades

• under/overshooting a target

• jumpy quality of movement

• loss of fixations on target

• head movement

• excessive blinking, eyes watering, squinting

binocular vision skills

• requires eyes to work together as a team

  • if they aren’t fixating on object/target at same place, brain will receive 2 images and perceive it as double

• behaviors that indicate dysfunction

  • tilting head

  • excessive blinking

  • decreased depth perception

  • closing one eye to see clearly

functional tasks impacted by visual impairments

• ADLs: bathing, dressing, toileting, grooming

• IADLs: medication management, meal preparation, finance management

• reading

• writing

• navigating environment

• driving

glaucoma

loss of peripheral vision

cataracts

blurred vision, lack of visual acuity

Macular degeneration

loss of central vision

diabetic retinopathy

described as having floaters

common causes of low vision

• cataracts

• glaucoma

• ARMD

• diabetic retinopathy

characteristics of low vision

• impaired visual acuity

• limited field of vision

• difficulty with everyday tasks

• cannot be corrected with glasses, contacts, or surgery

• not total blindness

ot interventions for vision deficits

• remedation:

  • ocular exercises

  • visual tracking and scanning activities

• adaptation

  • low vision devices

  • environmental modifications

• compensatory

  • scanning techniques

  • visual and verbal cues

• education

  • safety

  • technology training

visual perceptual skills

• visual attention

• sequential memory

• visual discrimination

• form constancy

• visual memory

• figure ground

• spatial relationships

• visual closure

visual attention

ability to focus on important visual information and filter out unimportant background information

visual discrimination

ability to recognize and differentiate between similar objects based on shape, size, color, etcs

visual memory

ability to remember or recall visual information

spatial relations

the way objects are positioned and arranged in space

sequential memory

ability to remember items or events in a specific order