Movement Science Exam I
What are the 4 requirements to do a FCA?
Must be trained professional Requires client participation Needs full effort and cooperation Pain doesn't "lead" the test
The government plays a major role in setting standards in the workplace and limits the amount an employee can sue medical professionals. How does the imply to you?
Must carry malpractice insurance, especially since you have doctorate degree. Check and see if your first job offers this
List the 6 reasons an employer is affected during a worker's compensation scanario.
Must pay employee Must retrain a replacement Must pay for training and more cost Increased paperwork concern with permanent disability Must make "reasonable" accomendations
Is a safe functional max dictated by pain? When should you stop the test?
No it's not. Let them power through until they stop especially if they maintain proper body mechanics. If they have unsafe compensations, then stop the test. Document this
What model is the ICF based upon?
Biopsychosocial Model
What are the 3 main purposes of a functional capacity evaluation/assessment?
Determine presence/degree of disability Improve job role performance by identification of functional decrements Improve the likelihood of safe return to the job
What are the 6 progression tips for balance rehabilitation?
Don't need to start with full WB Should have adequate strength, flexibility and ROM Should have adequate static balance before going to dynamic Should have DSL (double leg stance) before SLS May add pertubations Progress sets/reps over time
Execution
How do they do it? Amplitude, size, direction, speed
Transfer
How well training transfers to a new task or new environment • Depends on the similarity between task and environment Provides a way to measure Motor Learning (have patient perform movement without instructions/cuing)
What are the 5 financial burdens of someone on worker's comp?
Injured Receiving less $ Check not on time Bills are still due Finances can caused increased household stress
Abnormal movement = abnormal stress = __________________
Injury
What are the 3 factors of a movement analysis?
Knowledge of health conditions, task requirements and the individual Develop hypothesis and underlying impairments Test hypotheses
What kind of extrinsic feedback is defined as, "related to the nature or quality of the movement pattern"?
Knowledge of performance
Which augmented feedback is most commonly used.
Knowledge of performance
What kind of extrinsic feedback is defined as, "terminal feedback about the end result or overall outcome of the movement"?
Knowledge of results
How does the propriception system translate sensory information to the sensory nervous system?
LE proprioceptors, such as messiener corpuscles, GTO and muscle spindes. sense of touch at sole of feet
A functional capacity assessment looks at what 4 things?
Looks at abilities vs. disabilities Looks at whole body, not parts Considers what is safe level performance Must determine safe functional maximum effort
What are the 4 reasons to use Charles sherrington's law of irradiation?
Reinforcement to strengthen Properly apply resistance to make stronger Response will increase as stimuli increase in duration and intensity Can occur in any direction across any body segment
Describe a personality type as the game player
Sx provide opportunity for a game Tend to be male and opportunistic See Sx as way out of slums Extravagant goal setting Impuslive and don't care of reinjury Tend to be irresponsible but pretend to be responsible Sx may be appropriate but rare
Advocacy
advocate for patients/clients as individuals and population
Delayed
after a brief time delay
Terminal
after the movement
Personal Factors
age and life-cycle stage, occupation, economic situation, lifestyle, personality and self-concept
factors that influence neural plasticity
age, characteristics of lesion, effect of experience, effect of training
The APTA's pt and client management model is
an iterative process that focuses on the needs of the individual. It is comprised of 6 elements: examination, evaluation, diagnosis, prognosis, intervention, and outcomes.
What is an example of fixed-support strategy
ankle strategy, hip strategy
Feedforward motor control
anticipatory, takes advantage of previous experiences
Exercising in the heat
arterial blood diverts to the skin to transport metabolic heat for cooling, but that means the blood can not deliver its oxygen to active muscles
constant v. variable
constant: practice same thing same way. improve motor performance variable: performing tasks with variations in environment, speed, difficulty. improve motor learning
Systems Theory
control is distributed across neural subsystems. movement emerges from interaction between individual, task, and environment
Hypothesis-orientated practice..
involves hypothesizing impairments based on movement analysis.
feedback motor control
involves input from sensory systems, compared to a reference signal
Stability movement
tasks that requires a non-moving BOS
Individual Constraints:
• Motor/action systems-neuromuscular and biomechanical systems • Sensory/perceptual-systems-peripheral sensory mechanisms and higher-level processing • Cognitive systems- attention, problem solving, motivation and emotional aspects that underline intent.
Walking on an uneven surface is what type of task? A. Open stability B. Closed Mobility C. Open mobility
C. Open mobility
Aspects of the environment that shape the movement itself are know as what? A. Open environment B. Non-Regulatory constrains C. Regulatory constrains
C. Regulatory constrains
While working on jump training, you ask your patient to "land softly" which is an example of what kind of feedback? A. Intrinsic B. Internal focused C. external focused
C. external focused
What kind of exercises should we start with to help restore balance?
CKC activity, doesn't even need to be weight bearning
What is impaired balance?
COG cannot be maintained over BOS. Proprioception is useful
What is semi-dynamic balance?
COG fixed BOS on unstable surface Transfers COG over fixed BOS on stable surface
What is static balance?
COG over fixed BOS on stable surface
What is dynamic balance?
COG over moving BOS usually on stable surface
Describe low intensity
Cardiovascular Perspective low- 40-54% MHR mod- 55- 69% MHR Perfection Perspective low- perfect practice
Systems review
Cardiovascular/pulmonary: HR, rhythm, RR, BP, Edema Integumentary: skin temp, color, texture, integrity, scar formation, wound, incision Musculoskeletal: symmetry, gross ROM and strength, height and weight. Neuromuscular: overall assessment of gross coordinated movement (balance, gait, transfers, transitions) and motor function (motor control, motor learning). Communication ability, affect, cognition, language, learning style - ability to make needs known, consciousness, orientation (person, place, time situation), expected emotional/behavioral responses, learning preferences
Reflex Theory
Charles Sherrington (late 1800s-early 1900s): complex behavior explained through combined action of individual reflexes chained together
Reflex Theory
Charles Sherrington (late 1800s-early 1900s): sensory receptors in the skin and muscles elicited movement through the combined action of individual reflexes chained together
What are the 3 characteristics of using verbal cues when incorporating PNF?
Clear, concise and well-timed Enhances strength of muscle contraction and synergistic movement Improves motor learning
Task Variations
Closed environment vs Open environment
Extrinsic feedback should only be given frequently in what stage of motor learning?
Cognitive (in order to develop a reference of correctness)
What are the three stages of Fitts and Posner?
Cognitive --> Assosiative --> Autonomous
In what stage of motor learning does the performer develop a "reference of correctness"
Cognitive stage
Performance is usually variable in what stage of motor learning?
Cognitive stage
Fitts and Posner Three stage model
Cognitive stage Associative stage Autonomous stage
Stages of Motor Learning
Cognitive, Associated, Autonomous
Diagnosis Process:
Collection of data, analysis and interpretation to working hypotheses, organization of data and classification into categories
Which PNF techniques help with increasing strength?
Combination of isotonics Dynamic reversals Rhythmic stabilizing Stabilizing reversals Quick stretch at beginning and through ROM
Which PNF techniques help with increasing coordination and control?
Combination of isotonics Rhythmic initiation Dynamic reversals Stabilizing reversals Rhythmic stabilization Quick stretch from beginning of ROM
Which PNF techniques help with increasing stability?
Combination of isotonics Stabilizing reversals rhythmic stabilization
How is the combination of isotonics PNF pattern applied?
Combined concentric, eccentric and isometric contraction of 1 group of muscle without relaxation. Begin where pt has most strength or best coordination "Slowly let me win" is commanded
Indirect Mechanism of Recovery
Completely different neural circuit takes over function. Compensation
Approximation and traction are part of the guiding principles for appropriately using PNF. What are the 3 characteristics we use for approximation?
Compression of joints Applied manually or with gravity Ensure all joints are aligned
Evidence-based practice
Conscientious, explicit and judicious use of current best evidence in making decisions about the pt care, combine knowledge of literature with clinical expertise
What 2 things should a rehabilitation consultant consider during a patient compensation scenario?
Consider: Employee's perspective of rehabilitation consultant Insurance companies don't make $, if they spend $
What are the 5 various feedback schedules based on timing and amount of extrinsic feedback?
Constant Delayed Summary Faded Bandwidth
What 2 types of practice schedule help with motor performance?
Constant and Blocked
Clinical Prediction Rules:
Contain predictive factors, identify subgroupings of pts who are likely to benefit from a particular approach. Patellofemoral pain syndrome and lumbopelvic manipulation, LBP and stabilization exercises, neck pain and thoracic spine manipulation, caveat: limited evidence
What PNF technique is characterized by, "resisted isotonic contraction of the restricting muscles followed by relaxation and active movement into new range"
Contract-Relax
What is balance controlled by in the body?
Coordinated muscles in kinetic chain
Patient History- Interview
Current Conditions Activities/Participation Living Arrangement/Social History Clinical Tests
What PNF LE pattern uses PF and eversion at the ankle?
D1 LE extension patter
What PNF pattern incorporates scapular elevation, shoulder flexion, add, er, forearm supination, wrist flexion, finger and thumb flexion?
D1 UE flexion pattern
What is the bilateral asymmetrical reciprocal pattern to D2 extension?
D1 flexion
What is the D1 and D2 flexion patterns at the hip?
D1: Flexion/ADD/ER D2: Flexion/ABD/IR
The UE PNF patterns of flexion incorporate what motion at the scapula?
D1: anterior elevation D2: posterior elevatoin
What is the D1 and D2 extension pattern at the hip?
D1: extension/Abd/IR D2: extension/Add/ER
What are the flexion PNF patterns at the toes?
D1: extension/medial deviation D2: extension/lateral deviation
What is the extension PNF pattern at the toes?
D1: flexion/lateral deviation D2: flexion/medial deviation
The UE PNF patterns of extension incorporate what motion at the scapula?
D1: posterior depression D2: anterior depression
What PNF LE pattern uses DF and eversion at the ankle?
D2 LE flexion pattern
Integumentary Potential Impairments
Decreased mobility secondary to poor skin integrity, wounds, restrictions, and adhesions.
What extrinsic feedback schedule is defined as, "brief time delay"?
Delayed feedback
Patient History- Intake Forms
Demographics Medications Medical/Surgical History Clinical Tests
What kind of training strategies would you use for a patient in the cognitive stage of motor learning?
Demonstrations Verbal instruction Manual guidance Mental practice Extrinsic feedback
Motor Control Theory
Describes and explains how the nervous system produces coordinated movement during motor skill performance in a variety of environments
What is symptom magnification?
Describes objective inconsistency in the test Describes behavior
Work hardening must have a psychological component to it via behavioral modification. What is this designed to achieve?
Designed to achieve the goals associated with those needs/impairments
What is the 3rd part of the motor control framework?
Develop plan of care to address movement dysfunction
Briefly describe someone in the cognitive stage of learning
Developing an overall understanding of task Performance is variable Trail and error process needs to occur Vision is primary driver of learning
Diagnosis
Diagnosis: labels that identify the impact of a condition on function at the level of the system (especially the movement system) and at the level of the whole person. Example: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation • APTA is currently working on Movement System Diagnoses
Which of the following is true regarding aerobic exercise?
Diastolic blood pressure remains relatively unchanged with increased workload
Time matters
Different forms of plasticity occurs at different times during training
Cortical remapping
Different part of body takes over region of brain that was previously occupied by injured body part
Recovery of Function after Neural Injury
Direct (restorative) Indirect (compensatory)
Direct (restorative)
Direct (restorative)- resolution of temporary changes and recovery of the injured neural tissue itself • Includes nearby neural tissue taking over identical neural functions- leads to restitution of function
Recovery
Direct Mechanism Indirect Mechanism
Where should the therapist be positioned during PNF?
Directly in line with desired motion
Task Attributes
Discrete vs Continuous Closed vs Open Stability vs Mobility Manipulation vs Non-manipulation Tasks
What is the difference between a discrete skill and a continuous skill?
Discrete: has a definite beginning. (kicking a soccer ball or sit --> stand) Continuous: No definite beginning or end. (walking or riding bike
ACL Tear Disease, Injury, Abnormality? Impairment in Component Elements? Movement Impairments? Disability?
Disease, Injury, Abnormality • ACL Tear Impairment in Component Elements • Musculoskeletal System Impairments Movement Impairments • Inability to run and cut due to instability Disability • Inability to play football
Spinal Cord Injury Disease, Injury, Abnormality? Impairment in Component Elements? Movement Impairments? Disability?
Disease, Injury, Abnormality • Spinal Cord Injury Impairment in Component Elements • Nervous System Impairments Movement Impairments • Max assist with sit to stand Disability • Inability to care for self
Does the proximal or distal component begin the UE PNF pattern?
Distal component (hand/wrist --> elbow --> shoulder)
What kind of practice condition is defined as," having more rest time than practice time or equal amount"
Distributed practice
Hypothermia
Drop in core temperature Factors: water immersion, low body fat, older age, hypoglycemia, alcohol
When would it not be a good idea to initiate balance rehabilitatoin?
During acute phase when healing, adequate ROM and strength are not there
When is massed practice best used?
During discrete task performance
What is kinesthesia?
Dynamic position sense
What is defined as, "the ability for the body to maintain postural stability while parts of the body are in motion"?
Dynamic postural control
Primary impairment is MOVEMENT FAULT
Dynamic potential impairments
What are the 3 different techniques of reversal of antagonists?
Dynamic reversals Stabilizing reversals Rhythmic stabilization
Which PNF techniques help with increasing ROM?
Dynamic reversals Stabilizing reversals Rhythmic stabilization Contract-Relax Hold-relax Quick stretch
What is balance?
Dynamic, integrative process involving neurological pathways and musculoskeletal response
Statics
Effects of forces at rest and equilibrium Ex: Gravity
Muscle coordination relies on what kind of information?
Efferent information
Setting the scapula is an important part of scapular PNF, since it needs to be in a neutral position to move freely and efficiently. What should you do if the scapular deviated during anterior elevation-posterior depression?
Elevate the shoulder complex
Approximation and traction are part of the guiding principles for appropriately using PNF. What are the 3 characteristics we use for traction?
Elongation of joint Traction force applied through arc of motion Facilitate muscle response
Radiation
Emission of electromagnetic heat waves Heat moves from high heat to low heat
Timing for emphasis is one of the PNF techniques we learned. Describe the 5 properties of this technique
Emphasize 1 component of pattern Use resistance to enhance a more localized contraction Emphasize a particular component within the pattern Strengthen weaker component through irradiation and reinforcement Strong muscles are resisted isometrically while motion is allowed in weaker muscles
Who is the 2nd most affected person in a worker's compensation scanario?
Employer
What 3 things occur due to industrial medicine before a patient is sent back to work?
Evaluation Treatment Evaluation
Task oriented approach to examination
Evaluation of Functional Activities; Description of strategies used to complete functional skills; Quantification of the underlying sensory, motor and cognitive impairments that constrain performance of functional activities
What are some special programs that help industrial medicine with prevention?
Evaluation: Pre-employment screenings Job site analysis or task analysis Education: Body mechanics (back schools) *teach people how to lift and sit Prevention of overuse syndrome
What are the components of evaluation of under the concept of industrial medicine?
Evaluation: Job analysis (site/task) Functional assessment (whole body view of person) Treatment --> Second Evaluation: Exit functional assessment Special programs
Bony Structural Variations Potential Impairments
Ex: Hip Antetorsion / Retrotorsion
Steps of PCM
Examination, evaluation, diagnosis, prognosis, intervention, outcome
What part of the task analysis can be defined as the, "Period when body segments are undergoing movement"?
Execution
Quick stretch is one of the guiding principles of PNF. What does this help facilitate?
Existing contractions through increased motor unit recruitment. Initiates dynamic movements
What is the main components of the D1 UE extension pattern?
Extension/ABD/Ir
What are the two contextual factors?
External : Environmental Factors Internal: Personal Factors
Would you rely on extrinsic or intrinsic feedback for a patient in the cognitive stage of motor learning?
Extrinsic
Think about the flow of industrial medicine starting with a FCE
FCE
Heat syncope
Factors: standing erect for long periods of time, decreased BP, Stopping long bouts of upright exercise Treatment: recline supine, fluid replacement, cooling
Which type of feedback schedule is most likely used in clinical practice?
Faded feedback schedule
Use it or lose it
Failure to drive specific brain function can lead to functional degradation
True or false: if a nerve cell body dies, it can still regenerate?
False, BUT if the injury is to an axon or at synaptic level (mostly PNS) it can regenerate
Dynamics Potential Impairments
Faulty arthrokinematic and/or osteokinematic motion(s)
Models of Human Movement
Faulty movement can be the driver of pathology (kinesiopathological model) OR Pathology can lead to faulty movement (pathokinesiologic model) Regardless, a good Movement Analysis is key!
What is a summary feedback schedule?
Feedback given for a group of trials
Blocked feedback
Feedback is provided on a segment of the motor skill
Internal Focus
Focus on the body itself • Push your knees apart as you land • Straighten your knee as your heel contacts the ground • Squeeze your glutes as you bridge up
What is the precision grip, grasp pattern
Forces are directed between thumb and fingers Used for holding a pen or manipulating objects relative to the hand
Frost bite
Freezing and injury of tissue Treatment: move to warm place, handle area gently, rewarm gently, medical care
Cold stress
Frost Bite Cold air inhalation Hypothermia
What is defined as a, "A detailed examination and evaluation that objectively measures the patient's current level of function, primarily within the context of the demands of competitive employment"?
Functional capacity assessment/evaluation
How would a surgeon limit and control movement for spine stabilization? What would a physical therapist do?
Fusion followed by spine brace PT would provide muscular support. Bracing or taping. Proprioception training
What is the purpose of a movement analysis?
Gather information to develop a hypothesis about what might be going on in the body function/structure level
WHat is defined as, "distal components mobile while proximal muscles/joints remain dynamically stable"?
General skill
What is ability?
Genetically predetermined characteristics that might interact with in social context to affect movement performance ie) attitude, body type, cultural background fitness level...
What is a preparatory verbal cue used for?
Get patient ready for movement by describing or demonstrating movement (Used in cognitive stage of motor learning)
Dehydration
Greater than 2% bodyweight loss during exercise is bad Effects: decreased performance, plasma volume and skin blood flow
Propriceptive neuromuscluar facilitation was developed by Dr. Herman Kabat and Maragaret Knott. What is PNF?
Hands on treatment to facilitate movement patterns
What are the components of the Biopsychosocial Model?
Health Condition ICF Domains- Body Functions and Structures, Activity, Participation Contextual Factors- Environmental and Personal
What is part of the ICF model?
Health conditions, body function & structure, impairment of body function, activity limitations, participation restrictions
Circulatory system during cold stress
Heat conservation Peripheral vessels constrict Blood shunted to deep body cavities Hormonal changes: stimulation of non-shivering thermogenesis, food break down for creating heat
Heat illness
Heat cramps Syncope Heat exhaustion Heat stroke
What is COM and BOS in standing ?
High COM small BOS
What type of practice is more beneficial?
High intensity causes more errors and patient will gain more cognitive strategies that will transfer to real world
What is the LE D1 PNF extension pattern?
Hip: Ext/ABD/IR Foot/ankle: PF, eversion Toe: Flexion, lateral deviation
What is the LE D2 PNF extension pattern?
Hip: Ext/Add/ER Foot/ankle: PF, inversion Toe: flexion, medial deviation
What is the LE D2 PNF flexion pattern?
Hip: Flex, ABD, IR Foot/ankle: DF, eversion Toe: extension, lateral deviation
Movement is the product of the interaction among the
INDIVIDUAL, the TASK, and the ENVIRONMENT
Diagnostic Category
Identifies and describes patterns or clusters of findings, purpose of label is to guide the PT in developing prognosis, POC and interventions, should describe the impact of the health condition on the HMS, indicates the primary dysfunction to be addressed in the selection of interventions and development of POC
Proprioceptive neuromuscular facilitation is a manual therapy treatment to facilitate movement patterns. What are the 4 characteristics of PNF, according to our VOPP?
Identifies mass movement patterns Developed techniques to use with patterns Stretch is effective facilitation mechanism Evolved to integrate principles of motor learning
What is the goal of the PNF technique, contract-relax?
Improve ROM
Indirect (compensatory)
Indirect (compensatory)- completely different neural circuits enable the recovery of impaired function • Includes function-enabling and function-disabling plasticity
Global muscles only provide what kind of stability to the spine?
Indirect stability
Contributions to Movement Control
Individual Constraints: Environmental Constrains:
What are examples of Personal Factors?
Individual's Unique traits Age, Gender, Coping Styles, Education, Profession, Past and Current Experience
Repetition
Induction of plasticity requires sufficient repetition
Intensity
Induction plasticity requires sufficient training intensity
What is the branch of medicine concerned with the maintenance of health and prevent and treatment of diseases in the workplace?
Industrial medicine or occupational medicine
What is the pressure biofeedback cuff and how is this used to help with training the lumbar spine stabilizers?
Inflate cuff to 70 mmHg Patient in prone with cup underneath abdomen and in between ASIS Have patient perform abdominal drawing in Pressure should decrease about 6-8 mmHg of pressure
What are 5 reasons we use the FCE?
Information for rating disability Identify ways to modify the workplace Identify levels of "return to work" Identify symptom magnifiers Develop a rehab plan, modified to the worker
Irradiation uses facilitation and inhibition. Which term is used to cause relaxation of weaker synergistic muscles?
Inhibition
Pulmonary System Potential Impairments
Insufficient Oxygen delivery/supply needed for movement
Direct Mechanism of Recovery
Intact neurons take on identical function of dead neurons. Restorative
What muscles increase the intrabdominal pressure to increase stabilization on the spine?
Internal oblique Transverse abdominis
What are the principles muscles involved with the pelvic anterior elevation PNF pattern?
Internal obliques External obliques
Evaluation
Interpret response to tests and measures, integrate data with information collected in history, determine diagnosis, determine prognosis, develop POC
What kind of feedback is defined as, " information you receive from your own sensory systems"?
Intrinsic feedback
Participation:
Involvement in a life situation
What are the primary muscles used with a pelvic posterior elevation PNF pattern?
Ipsilateral QL Ipsilateral Latissimus dorsi Ililocostalis lumborum Longissiumus thoracic
The abdominal co-contraction is a skill, what substitutions would you look for to make sure this is done properly?
Isolate Avoid global activation Visual inspection Palpation Pressure biofeedback unit Verbal and tactile cues
A stability dysfunction can be broken down into what 2 categories?
Isolated- isolated muscle weakness or ligamentous/joint laxity Complex/multiple systems- stability issue with motor control
Task Analysis- Things to consider
It is important to examine tasks under conditions comparable to those in which the individual typically functions!
Why did companies start using functional capacity measurements to fix worker compensation costs?
It reduces WC claims and can get people back to work. This increased interest from the companies
Joint Integrity/ Mobility Potential Impairments
Joint surface or capsule impairments Joint Hyper/ Hypomobility
Kinesiopathologic Model
Key Principles: • The idea that imprecise, abnormal or excessive movement can cause specific anatomical or physiological conditions (movement can create pathology) • Empirical bases: Repetitive movements and sustained postures can positively or negatively influence bodily tissues
An appropriate FCA requires what setting?
Large area Usually 4-6 hours over 2 days. Day 2: check for reliability and repeat test Trained PT/OT for consistency (follows script, use of professional judgement)
What is the attachments of the internal oblique?
Lateral inguinal ligament, iliac crest, and thoracolumbar fascia to the 4 lower ribs and linea alba
What are the principle muscles involved with posterior scapula depression?
Latissimus dorsi Rhomboids Serratus anterior (lower)
Describe upper trunk anterior diagonal roll
Leads with abdominals, obliques, and neck muscles. Upper trunk initiates followed by passive lower trunk. Segmental "Throwing opposite shoulder across body to opposite hip, lower trunk follows"
Describe mass flexion roll
Leads with abs and hip flexors, lower and upper trunk initiate Non-segmental "Ab crunch with upper and lower trunk, falls to side"
How would you test agility and protective mechanisms of a neutral spine?
Look at ability to receive proprioceptive feedback and response with a change of direction
impairment
Loss of integrity of body functions or structures
Conduction
Loss or gain of heat by direct contact of body to another surface
Why is spine stabilization training important?
Low back pain is very prevelent in America. (85% will suffer) This leads to lack of productivity in the workplace
Which muscles are usually effected effected with lumbar spine pain?
Lumbar multifidus Transvere abdominis Internal oblique
Which 3 muscles are crucial in providing lumbar spine stabilization which provide direct segmental stability to the spine?
Lumbar multifidus Transverse abdominis Internal oblique
Specific manual contact is very important for PNF. What grip should be used for all techniques and what function does a specific manual contact provide?
Lumbrical grip will: Enhance muscle contraction Enhance kinesthetic awareness
Evaporation
Major physiological defense against overheating Evaporation of sweat to steam Humidity is very important factor
What term commonly used with worker compensation patients, is actually a psychological diagnosis that describes motivation, and therefore should not be used?
Malingerer
The lumbar multifidus is the deepest posterior spinal muscle and attaches where?
Mamillary process of lumbar vertebrae to spinal vertebrae 2-4 segments up
Manipulation vs. non-manipulation (task constraints)
Manipulation = with UE. (standing + holding something) Non-Manipulation = without UE (just sitting)
Manipulation vs Non-manipulation Tasks
Manipulation involves movement of the upper extremities
Skill is the highest level of motor control, that includes what 2 functions?
Manipulation of the environment Exploration of the environment
Describe the 4 factors of professional and personal balance that may affect the psychological factors of someone who is away from work in workers compensation
Many identify from profession (males especially) Characteristic of good return to work program incorporates a psychological component Involves OT's, social workers, psychologist Employee may feel out of control
What kind of practice condition is defined as," having more practice time than rest time"?
Massed practice
Spacing
Massed- rest time less than practice time Distributed-practice time equal to or less than rest time
Where does the Plumb line (line of gravity) fall in standing? [NPTE question too]
Mastoid: midline between mastoid processes Shoulder joints: just in front Hip joints: just in front Knees: just in front Ankles: just in front
Define spine stabilization
Method for limiting or controlling spine movement
What muscle position puts the greatest muscle tension on a muscle?
Midrange
Task constraints
Mobility Postural control UE function Classifications: 1. discrete v. continuous: defined ending to the movement (sit to stand) v. no definite end point (walking) 2. open v. closed environment: Performer must adapt to an ever changing environment v. predictable fixed environments 3. stability v. mobility: activities with moving v. non-moving base of support 4. manipulation v. non-manipulation: a task that involves movement of the upper extremities
What is sitting COM, BOS, and plumb (gravity) line
Moderate BOS, moderate height COM and line falls through joint axis of spine
Fitt's Law
Movement time increases linearly with task difficulty
70% of the stabilizing effect on the spine, comes from what muscle?
Multifidus
Describe the 7 progression for a spine stabilization program
NWB --> WB Nonfunctional --> functions Simple movement --> complex No external load --> external load Low speed --> high speed Local --> global Proprioception
Patient position is one of the guiding principles of PNF. What is the optimal alignment for patient postion?
Neutral
An injured ____________ is defined as the "position or range of movement defined by the patient's symptoms, pathology and current MS restrictions"
Neutral spine
We cannot train spine stabilization muscles until we have what?
Neutral spine
Is pain a reason to stop the FCA?
No
What things should you look for while training to train a co-contraction of the local spine stabilization muscles?
No rib/shoulder/pelvis movement Make sure they don't have a sucking in under rib cage No depression of rib cage No lateral flairing of waist
What must be performed before a FCA?
Normal PT evaluation so you know physical limitations
Why is back schools an ineffective intervention for spine stabilization?
Not generalized or specific to problem the patient may have
What are the three Stages in Berstein's model?
Novice --> Intermediate --> Expert
What is the most stable spine position and asymptomatic position for the task at hand?
Nuetral spine
Visual information
Object perceived Temporal lobe: what Parietal lobe: where
What are regulatory features of the environment?
Objects/People- size, weight, shape, location Support Surface: slippery, carpet, etc Movement: Predictable/ Unpredictable
phase 4 of grasp and lift task
Occurs at the end of the lifting task when there is a decrease in the grip and load force after the object makes contact with the table.
Neural regeneration
Occurs primarily in the PNS
phase 2 of grasp and lift task
Once contact has been established, the second phase begins with the grip force and the load force (load on the fingers) increasing.
Bandwidth
Only if performance falls outside of predetermined error range
Describe the characteristics of how someone in worker's comp gets paid
Only receive a % of salary and check "rarely come in on time"
What is the Kinesiologic Model?
Optimal functioning and interaction of body systems is needed to maintain good msk health
What does appropriate resistance help facilitate when incorporating PNF?
Optimal resistance facilitates muscle contraction
The 3rd part of the motor control framework is to develop a plan of care to address movement dysfunction. What 4 things should be included to accomplish this goal?
Optimize movement and minimize functional problems Specify goals Identify specific interventions Seek evidence
Environment Factors
Outside of the individual. Associated with physical, social, attitudinal environment in which people conduct their lives.
environmental factors
Outside the individual: physical, social, attitudinal environment; architectural characteristics;climate terrain
What are the 4 different types of rhythmic initiation?
PROM: "relax let me move you" AAROM: "Now, help me move you" AROM: "Now, move on your own" Resisted: "Now, push up"
Interventions:
PT selects, prescribes, and implements interventions based on examination data, evaluation, diagnosis, prognosis, goals.
When developing an exercise regimen what 3 things dictate the program?
PT/OT exam Evaluation Goal setting
Which of the following is an impairment associated with the subacute phase of healing?
Pain at the end of available ROM
Strategies
Part/Whole- component parts practiced prior to whole task Mental Practice- task is imagined or visualized
Participation (involvement in life situations)
Participation Restrictions
What are the 12 guiding principles of PNF?
Patient position Therapist position Manual contact Verbal cues/commands Patterns of movement Timing Appropriate resistance Approximation Traction Visual input Irradiation and reinforcement Quick stretch
Describe the following as it relates to Scapular anterior elevation and it's PNF pattern: Patient position PT position Start Manual contacts Movement Verbal cues
Patient position: Side lying, head and spine in neutral PT position: Behind pt, facing head in line with diagonal Start: Posterior Depression Manual contacts: Superior/anterior aspect of shoulder Movement: Scapular moves up and forward toward nose, inferior angle rotates away from spine, resistance down and back Verbal cues: "Pull your shoulder up and forward"
Describe the following as it relates to Pelvic anterior elevation and it's PNF pattern: Patient position PT position Start Manual contacts Movement Verbal cues
Patient position: Side lying, hips flexed to 80-90 with head and spine in neutral PT position: Behind pt, facing head in line with diagonal Start: Posterior diagnol Manual contacts: 1. Fingers on anterior iliac creast 2. Lateral border of hands on the iliac crest Movement: Pelvis moves up and forward; inferior angle rotates away from spine. Resistance is down and forward Verbal cues: "pull pelvis up"
Describe the following as it relates to Pelvis posterior elevation and it's PNF pattern: Patient position PT position Start Manual contacts Movement Verbal cues
Patient position: Side lying; hips flexed to 70 degrees, head and spine in neutral PT position: Behind pt near head, facing pelvis in line with diagonal Start: Anterior depression Manual contacts: Heel of hand on posterior superior ilium. Other hand on top Movement: Pelvis moves up and back. Resistance is down and forward Verbal cues: "Push pelvis up and back"
Describe the following characteristics of UE d1 flexion: Patient position PT position Manual contacts Movement Verbal cues
Patient position: Supine with arm in ext/abd/ir PT position: Standing facing feet and swivel to end of pts head Manual contacts: palmar surface of pts hand with fingers on ulnar side. Wrap other hand underneath forearm Movement: shoulder flexion, add,ER, wrist flexion, radial deviation Cues: Pull across
Describe the following characteristics of UE d2 extension: Patient position PT position Manual contacts Movement Verbal cues
Patient position: Supine with arm in flex/abd/er PT position: stand at shoulder's, face feet, hips in line with diagonal manual contacts: palmar suface of pt's hand and anterior aspect of humerus Movement: Shoulder ext/add/ir forearm pronation wrist flexion/UD thumb flexion/abd/opposition Verbal cues: "squeeze my hand, pull down and across
Visual input is one of the guiding principles of PNF. Why is visual input important?
Patient should watch movement and give themselves feedback Can enhance and guide movement Use mirror to help with visual trunk alignment and scapular patterns
Cognitive stage
Patient trying to understand the task, performance is variable, trial and error, movement guided by vision, large improvements Training: extrinsic cues
The following functional activities would be most improved by what PNF pattern? Going down on stairs Initial contact Loading response
Pelvic anterior depression
Functional activites such as the following use what kind of PNF pattern?: Terminal stance activities Jumping Walking stairs Making high steps
Pelvic posterior depression
Walking backward and preparing to kick a ball use what kind of pelvic PNF pattern?
Pelvic posterior elevation
What is the actions of the internal oblique muscles?
Pelvis fixed: 1 internal oblique side bends and rotates to same side Thorax fixed: 1 internal oblique side bends and rotates to opposite side 2 internal obliques will flex and stabilize the spine
What are the 4 main problems of a worker's compensation issue?
People begin pointing fingers at each other Employee blames unsafe workplace No groundwork for communication Increased likelihood of lawsuit
The following describe what kind of personality type: Not gender specific Presents with increased assistive device Likes pt role to diminishes other roles No real goal, rather survival Life is survived, not enjoyed tend to fall in middle of test for unknown reasons Sx will be fictions
Perceptual/Identified patient
Frequent extrinsic feedback could improve motor (learning or performance)?
Performance
Underlying assumptions of task oriented approach
Performance is controlled by the integration of individual systems individuals learn by attempting to solve problems actively
Briefly describe a patient in the associative stage of motor learning
Performer is refining the strategy for the task Coordination and efficiency improves and becomes more consistent Proprioceptive cues are more important than visual cues
What are the 2 contextual factors of the ICF model?
Personal and Environmental
Which of the following can be used to assess your patient's readiness for exercise?
Physical Activity Readiness Questionnaire
Describe the role of the Physical Therapist in the Human Movement System.
Physical therapist practice and the human movement system Human movement is a complex behavior within a specific context. - PT provides a unique perspective on purposeful, precise, and efficient movement across the lifespan. - PT examine and evaluate the movement system to provide customized, integrated POC - PT maximize an individual's ability to engage with and respond to environment using movement-related interventions to optimize function and performance - Integrate knowledge of the HMS and its component elements - Evaluate, diagnose movement dysfunction - Identify physical impairments across various body systems - Design an intervention program to address underlying impairments as well as movement dysfunction itself
What is a Physical Therapist?
Physical therapists (PTs) are health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives.
What are examples of Environmental Factors?
Physical, Social and attitudinal Environment in which people live and conduct their lives. Social Attitudes, Support and Relationships, Services Technology, Legal, Terrain.. etc
Interference
Plasticity in response to one experience can interfere with the acquisition of other behaviors
Transference
Plasticity in response to one training experience can enhance the acquisition of similar behaviors
What is the 3 ways to test alignment of a neutral spine?
Plumb line Palpation Vertical compression
Someone who is not injured would have their nuetral spine as defined by what?
Position in which a vertical force exerted through the spine allows equal weigh transference to WB surfaces
Define the neutral spine
Position or range of movement defined by patients signs and symptoms/pathology and MS restrictions. Neutral spine is individualized for each patient
Denervation Supersensitivity
Post synaptic neurons are more sensitive to presynaptic impulses
What is the muscle type fibers of the 3 main stabilization muscles? (TA, IO, Multifidus)
Postural/tonic muscles Type 1, slow twitch that are good at endurance Isometrics are ideal
What are the 6 factors affecting balance?
Posture Disease Drugs Deconditioned state Disuse, injury or surgery Fatigue
constant practice
Practice of a given task under a uniform condition
What part of the task analysis can be defined as the, "Period of time when movement is organized"?
Preparation
Verbal cues are another guiding principle for PNF. What are the 3 different types of verbal cues?
Preparatory verbal cues Action verbal cues Corrective verbal cues
What are some McKenzie extension exercise?
Pressing up on elbows prone Standing extension
Participation Restriction:
Problems an individual may experience with involvement in life situations as measured by social standards
Prognosis
Prognosis: the predicted optimal level of improvement in function and the amount of time needed to reach that level Example: The patient will return to prior level of function of playing on school competitive soccer team within 8 weeks.
What is the goal of the PNF technique, Rhythmic initation?
Promote learning of new movement Improve intra and intermuscular coordination Promote relaxation, independent movement
What is the center of performance and function for balance rehabilitation?
Proprioception
What has the function to promote functional movement through facilitation, inhibition, strengthening and relaxation of muscle groups
Proprioceptive neuromusclar facilitation
What is a corrective verbal cue used for?
Provide feedback to patient to guide and modify movement in patients
What is the purpose of development of functional movement screens?
Provides normative data Monitors movement factors influencing performance and injury To detect movement problems Provide a functional baseline
Timing is important for movement, as it uses we use a sequence for smooth movement. What are the 3 keys for muscle timing during PNF?
Proximal stability for distal mobility Normal timing in trunk-proximal to distal Normal timing in extremities- distal to proximal
What is Malingering?
Psychological diagnosis, therefore do not use. Describe motivation
What are the 4 principles of clinical/functional exercise
Purpose Posture Position Pattern
Intervention
Purposeful and skilled interaction of the therapist with the patient. • Patient or client instruction (used with every patient and client) • Airway clearance techniques • Assistive technology • Biophysical agents • Functional training in self-care and domestic, work, community, social, and civic life • Integumentary repair and protection techniques • Manual therapy techniques • Motor function training • Therapeutic exercise
What are some functional activities of UE D2 extension?
Putting on seat belt Tucking in shirt
Personal Factors
Race, gender, family background, education, profession, past experience, fitness, etc..
Factors in heat loss
Radiation Conduction Convection Evaporation
What kind of practice condition is defined as," variety of tasks performed in random order"?
Random practice
What are some functional activities for D2 flexion?
Reaching for seat belt Reaching for overhead light Reaching into cabinet
Collateral Sprouting
Reactive Synaptogenesis. Surrounding neurons generate synapses with the neuron that was previously connected with the damaged neuron
Resistance can help relaxation of antagonist muscles via what concept?
Reciprocal inhibition
Unmasking of Silent Synapses
Recruitment of previously silent synapses
Nervous System Base
Recruitment, timing, order, magnitude of motor unit activation Sensation and Perception Cognition Neural Mobility/ Neurodynamics
Which of the following statements is true for reflex theory of motor control?
Reflex theory does not adequately explain movement that occurs in the absence of a sensory stimulus.
What are the 5 Motor control theories?
Reflex, Hierarchical, Motor Program, Dynamical Actions/Systems, Ecological
What 2 things should we train to help with balance, in regards to the neurmuscular system?
Reflexes and reaction times
Reflex Theory and what does it cover?
Reflexes are basis of all movement where by sensory stimulus leads to a new movement. Reflex Chaining: sensory activation of one reflex triggers sensory activation of another reflex Covers: Nervous in Body Structure component
Environment
Regulatory features: specify aspects of the environment that shape the movement itself. the movement must be conformed to these features .i.e. size of cup being picked up, type of surface we walk on Non-regulatory features: may affect performance but movement does not have to conform to these features i.e. distractions
Who represents the insurance company in an insurance compensation dilemma?
Rehabilitation consultant: Interpreter from the medical community PT advocate Determines # of MD visits and whether they pay for second opinion
Dynamics
Relationship between motion (kinematics) and the forces producing motion (kinetics)
anticipatory balance
Relies on feedforward control, activating muscles in advance
Take home message on Walking down stairs Example
Repetitive faulty movement (knee valgus descending stairs) Underlying impairment: weak gluteus medius/max leading to dynamic knee valgus The dynamic knee valgus over time leads to patellofemoral pain syndrome Because of the pain, the patient is unable to go hiking with friends The patellofemoral pain didn't cause the knee valgus! Instead, the dynamic knee valgus likely caused the patellofemoral pain.
When is the Transverse abdominus activated first?
Research shows TA fires first with expected and unexpected loading of the spine
What is a dynamic reversal to help with PNF?
Resistance of active motion changing from agonist to antagonist without pause. Pull up then push down "Push, push, push.. pull, pull pull"
How would you preform autogenic inhibition during a contract-relax PNF technique?
Resisted contraction of antagonist muscle group, which is limiting motion. High tension will cause a muscle to relax
Goal setting when developing an exercise regimen should focus on what?
Restoring functional homeostasis
Secondary Impairment
Result of preexisting impairments
Outcomes:
Results of implementing the POC, functional outcomes (meaningful, practice and sustainable), measuring outcomes.
How would you test whether you are improving a patients motor learning or performance?
Retention tests
What are the principle muscles involved with scapular anterior depression?
Rhomboids Serratus anterior Pec major/minor
Which 3 PNF techniques help with Learning a motion?
Rhythmic initiation Combination of Isotonics Quick stretch at beginning and throughout motion
Which PNF techniques help with changing rate of motion?
Rhythmic initiation Dynamic reversals Quick stretch at beginning and throughout motion
What are the 7 different types of PNF techniques?
Rhythmic initiation Reversal of antagonists Repeated quick stretch Combination of isotonics Timing for emphasis Contract-relax Hold-relax
Which PNF techniques help with relaxation?
Rhythmic initiation Rhythmic stabilization Hold-relax
Which 2 PNF techniques help with initiating motion?
Rhythmic initiation quick stretch at beginning of ROM
Between stabilizing reversals and rhythmic stabilization, which one would you use to improve ROM and help with pain?
Rhythmic stabilization
Which PNF techniques help with decreasing pain?
Rhythmic stabilization Stabilizing reversals Hold-relax
What PNF technique is characterized by, alternating isometric contractions of antagonist patterns against resistance focusing on co-contraction?
Rhythmic stabilization. Intent is to stay still
What are the components of the motor movement systems in postural control
Righting reactions, protective reactions, equilibrium reactions
What is the functional activities that D2 LE extension helps with?
Rolling supine to sidelying
Cardiovascular drift during prolonged exercise
SV gradually decreases HR gradually increases Maintenance of Q Mechanism: Core temp increases-->blood volume is redistributed to the skin-->SV decreases due to decreased VR-->HR increases to maintain temperature of body (continue to pump blood to peripheral vasculature)
How would you document a FCA if the person stops the test due to pain?
Say test is self limited due to pain
What are the 2 types of asymetrical trunk pattern?
Scapular AD-pelvic AE: Massed flexion Scapular AE-pelvic PD: massed extension
What is a symmetrical reciprocal PNF pattern?
Scapular AE with pelvic PD: trunk elongation with rotation Scapular PD-pelvic AE: trunk shorting with rotation
What is the following PNF pattern: Scapula moves up and forward toward nose, inferior angle rotates away from spine. Resistance is down and back
Scapular anterior elevation
Reflex theory
Sherrington Complex behavior explained through combined action of individual reflexes Limitations: requires outside influence or stimulus, relies on sensory input, doesn't explain fast movements, varying response based on context, novel movements Clinical implications: reflexes should be tested, can help predict motor function
What muscle position produces the weakest contractile force?
Shortened range
What are the implications of spine stabilization?
Should be performed by Physical therapists Everyone needs it since it effects 85% of people It is proven to be effective
What is the main components of the D1 flexion UE pattern?
Shoulder flexion/ABD/ER
How can drugs affect balance?
Side effects such as vasodilation and alcohol
Scapular PNF patterns are usually performed in what position?
Sidelying
What is defined as, "applies skill to specific adult movement patterns"?
Specific skill
PNF Patterns involving the pelvis influence what other body structures?
Spine and bilateral LE
List the 7 reasons for spine stabilization listed in our Unit 7 powerpoint
Spine is vulnerable Protection of articular surfaces Prevent reinjury Facilitate healing Decrease pain Prevent injury Improve performance
What 3 things should you look at to determine if a patients movement pattern is safe?
Spine position BOS Symmetry of movement
A fracture that is caused by a twisting or torsional force is called?
Spiral
Charles sherrington's had a reflex theory using the law of irradiation. What is irradiation?
Spread of the response to simulation
Open environment
Stability (non-moving BOS): Sitting/standing on moving surface Mobility (moving BOS): Walking on uneven or moving surface
Closed environment
Stability (non-moving BOS): Sitting/standing on non-moving surface Mobility (moving BOS): Walking on non-moving surface
Stability vs mobility (task constraints)
Stability = non moving BOS Moving = moving BOS
What technique is characterized by alternating isometric contractions with stabilizing hold to agonist to antagonist, opposed by enough resistance to prevent motion?
Stabilizing reversals
Stabilizing reversals and rhythmic stabilization both use alternating isometric contractions. What is the difference between the two?
Stabilizing reversals: Intention to move Dynamic commands Muscle activity from agonist to antagonist Improves stability, strength, balance and coordination Rhythmic stabilization: No intention to move Static commands Agonist and antagonist contract together Improves ROM, strength, stability, balance and pain
What are some functional activities of LE D1 extension?
Stance phase of gait Descending stairs
List the order of progression for balance training for the following: State of balance Body Weight BOS Vision Surface Counter balance Shoes External stimuli Dual task
Static > Semi-dynamic > dynamic Body weight: Sit > stand > weight shifts BOS: Bilateral > unilateral Vision: Eyes open > eyes closed Surface: Stable firm surface > Unstable soft surface Counter balance: extremities for counterbalance Shoes: ON-vs-Off External physical stimuli: manual vs. self Dual task: Addition of cognitive task
Define stability?
Static postural control during sitting or standing
What are the classifications of Postural Control?
Static, Dynamic
Primary impairment is POSTURAL FAULT
Statics potential impairments
What are 4 important steps to consider when making an exercise progression program?
Stay within the healing constraints of the tissue Be aware of what stresses are being imposed on the tissues Have a criteria for progression Must perform the exercise safely, correctly and effectively before adding or changing variables to make it more difficult
What 3 factors of someone's identity can change if they are on worker's compensation?
Staying at home No longer primary bread winner Can't pay bills *Pressure to get better and get a job
What are some functional activities of LE D2 flexion?
Steeping into shower Sitting to sidelying
Why would "Williams" flexion exercises be a good idea for spine rehabilitation?
Stenosis Bad idea for disc herniation
Which step confirms or rejects Hypothesis?
Step 16 Evaluation
Essential characteristics of sit to stand
Sufficient Joint torque Stability/postural control Ability to modify You're going from one BOS to another
What is the Hierarchical Theory and what does it cover
Suggests that motor control emerges from the reflexes that subjugated by higher levels of the CNS Top Down Organization structure- High- cortex, intermediate- brainstem, low= spinal cord normal movement cant occur unless the higher centers of the CNS regain control of lower centers Covers: Nervous and activity components
What extrinsic feedback schedule is defined as, "after a set number of trails"?
Summary feedback
take home message about forward neck lean?! example
Sustained faulty posture possibly due to poor kinesthetic awareness Led to impairments of weak deep neck flexors and hypomobile OA posterior glide Movement fault: lack of cervical OA flexion Now patient has neck pain with cervicogenic headaches and can no longer work a full day at the computer
What phase of gait would a pelvic anterior elevation PNF pattern help with?
Swing phase of gait
Why should you care about posture while performing spine stabilization exercises?
Talked about in class
An individuals motor functions relies on the interaction between what 3 factors?
Task Individual Environment
What kind of extrinsic feedback is defined as, "given at end of task performance"?
Terminal feedback
What part of the task analysis can be defined as the, "Instant when movement stops"? (note outcome of movement)
Termination
What is the romber test?
Test for postural equilibrium, with feet together, eyes closed and hands at side (Qualitative and subjective)
What is the vestibulo-spinal reflex?
Test of postural movement and vestibular nerve Test postural stability and equilibrium
What is the vestibulo-ocular reflex response?
Test of vestibular nerve Maintain a stable point of visual fixation during head movement
Motor Programming
The CNS produces central motor patterns activated by sensory or central processes. Limitations: cannot be sole determinant of action, two identical commands may produce different movements based on variables Clinical implications: moves beyond reflex explanation for disordered motor control, retraining movements are important to functional task
International Classification of Functioning, Disability, and Health (ICF)
The World Health Organization's ICF framework: • Provides a conceptual framework for examining effect of a health condition on individual (bio-psycho-social model) • Provides a common language for communicating information to clinicians and non-clinicians.
What does postural control involve?
The ability to maintain stability in an upright posture by keeping the COM over/within the BOS through the integration of sensorimotor systems
Define transitional mobility
The ability to move from one position to another independently and safely
Preparation
The interval between an external or internal stimulus to move and the initiation of the movement (reaction time). What does the individual do to prepare to perform the task? • Reaction time to initiate movement • Preparatory activities that took place before initiation of the movement task. Considerations: What processes must occur (if any) before movement for a task is initiated. Can the individual perform these processes?
Specificity
The nature of training experience dictates the nature of the plasticity
What are 3 ways that a patient tries to gain control after being in a worker's compensation program?
The symptoms they tell you they have. People actually listen when they have Sx May lead to Symptom magnification behavior
What is Self Organization?
The system will seek the most efficient movement strategy
Tests and Measures
The tests and measures performed as part of an initial examination should be only those that are necessary to: 1. Confirm or reject a hypothesis about the factors that contribute to making the individual's current level of function less than optimal 2. Support the physical therapist's clinical judgments about the diagnosis, prognosis, and plan of care.
Salience Matters
The training experience must be sufficiently important to induce plasticity
Initial Conditions
This is the "snapshot" at the beginning before more movement occurs • Initial state of the performer—posture (position of arms/legs/trunk), affective • Initial state of the environment—physical, psychological, and social • Can include surfaces (texture, height, etc), lighting, shoe wear, restrictive clothing, background noise, distractions, additional people in room, etc.. • Considerations: What are the initial conditions required for the successful completion of the task?
Dysfunctional movement is a result of a breakdown of what systems?
Tissue extensibility/mobility Joint mobility (intrartircular) Stability dysfunction
Define assessment (table 17-1)
To examine something; to judge or evaluate it; to calculate a value based on various factors
What is an action verbal cue used for?
To guide patient through movement. (Used in associative stage of motor learning). Time is important
What is it termed when we elongate a joint via an arc motion to facilitate a muscle response?
Traction
Using the SAID principle. How should you train the tonic muscles for posture?
Train with long duration, low load exercises
Age
Training induced plasticity occurs more readily in younger brains
Use it and improve it
Training that drives a specific brain function can lead to an enhancement of that function
Convection
Transfer of heat to moving air and water molecules
Vision Statement for PT Profession
Transforming society by optimizing movement to improve the human experience
APTA's Vision for PT Practice (2013):
Transforming society by optimizing movement to improve the human experience.
When there is an expected and unexpected loading of the spine, what is the 1st muscle activated?
Transverse abdominus
What is the deepest abdominal muscle and where does it attach?
Transverse abdominus Attaches at lateral inguinal ligament, iliac crest, thoracolumbar fascia, and lower ribs to Linea alba and interal oblique and pectin pubis
What are the 2 principle muscles involved with posterior elevation?
Trapezius Levator scapulae
Describe the interaction between industrial medicine, workers comp and functional capacity of assessment/evaluations may be related
Trauma to injured worker --> Treatment to acute care hospital or rehab clinic --> Returned to work, but may have been hurt once returning to work. NOW! When worker is injured they go from acute care --> rehab --> industrial medicine --> They deem if the patient can return to work, before they go back and get injured again.
Heat exhaustion
Treatment: oral or IV fluids, cooling
True or False: If damage is severe and nerve cells die, the brain can re-organize itself so other areas can take over?
True Areas adjust function, location, and activity
A bilateral UE pattern places greater demand on what part of the body?
Trunk
What is the "CHOP" bilateral UE pattern movment?
Trunk rotation with flexion
Describe hypothesis-oriented clinical practice.
Type of practice that generates hypothesis. Making an educated guess about potential abnormal movements. Determine appropriate tests and measures to rule in/out.
The following describes what UE pattern?: Scapular anterior depression Shoulder Ext/add/ir forearm pronation Wrist flexion/finger/thumb flexion
UE D2 extension
The following describes what UE PNF pattern?: Scapular posterior elevation Shoulder, Flex/abd/er Forearm supination Wrist/finger/thumb extension
UE D2 flexion pattern
The following characterizes what PNF pattern?: Scapular posterior depression Shoulder Ext, ABD, IR Forearm pronation Wrist/finger/thumb extension
UE patterns D1 extension
The interview:
Understand pt and chief complaints. Explore questions (open/ended). Enablement perspective (identify participation and roles). Disablement perspective (analysis from underlying disease or pathology).
What should the reps be for a strength assessment during a FCA?
Use 5 RM Hold position for given time TImed lifts
What kind of training strategies would you use to for someone in the autonomous stage of motor learning?
Use a variety of environmental situations Modify feedback and practice schedules
What should be incorporated into balance rehab?
Use closed-kinetic chain exercises Train neural system Make intervention functional
What is the balance error scoring system?
Use firm surface and foam surface and test with various different components. Higher error score = poorer balance
Factors influencing neural plasticity
Use it or lose it Use it and improve it Specificity Repetition Intensity Time Salience Age Transference Interference
How would you move the shoulder into a posterior elevated position during the scapular PNF pattern if it was deviating?
Use lateral border of hand, compress and upwardly rotate scapula to allow superior angle to move toward the spinous process of cervical vertebrae
What is work hardening?
Using the patients workplace in therapy and making sure therapy is meeting demands they must encounter at workplace
Describe the problems a physician will create in a worker's compensation scenario
Utilized "medical model" Meds then sit at home for 1-2 weeks Problem: MD communicates with employee/employer with medical terminology, creating confusion
What 2 types of practice schedule help with motor learning?
Variable and Random
What kind of practice condition is defined as," practice with variations in task;better for learning"?
Variable practice
What does sitting postural control require
Various combinations of head, trunk, LE, and UE movement to maintain balance during functional activities Static Dynamic- APA, RPA
extrinsic feedback
Verbal, tactile and visual cues Knowledge of performance Knowledge of results
What system registers the orientation and movement of the head?
Vestibular
Sensory information relies from feedback on what 3 systems? What is the main system used for sensory organization?
Vestibular, Visual, Somatosensory Healthy adults relay mainly on somatosensory information
How does the vestibular system translate sensory information to the sensory nervous system?
Via semicircular canals and otoliths
What kind of training strategies would you use, for a patient in the associative stage of motor learning?
Video self-assessments Less motor cues Changes in feedback and practice schedules to refine movements
What sensory system mainly guides a patient in the cognitive stage of motor learning?
Vision
Task Analysis - Outcomes
What is the problem with completing the task? Where along the movement continuum does the problem interfere with function? What are the underlying determinants of the problem? How do we intervene?
Many patients with low back pain have been coached to complain of pain during what assessment?
When they are put on their back
What is the only reasons to use a quick stretch.
When tying to use a dynamic muscle activity/movements
Treatment of symptom magnifiers is controlled by what?
Work hardening
power grip
a fistlike grip in which the fingers and thumbs wrap around an object in opposite directions
Concepts that would contribute to a conceptual framework for clinical practice would include:
a model of function and disability.
What is the function in sitting test (FIST)
a more comprehensive sitting test including static, dynamic and reactive sitting
precision grip
a precise grip in which the tips of the fingers and thumbs come together, enabling fine manipulation
Selection and control of movement
a. CNS organization b. Use of sensory information c. task parameters d. environment
Recovery
achieving function through original processes
Unmasking of silent synapses
activation of unused pathways and neurons
Outcomes
actual results of implementing the plan of care that indicate the impact on functioning
How should the head and neck be positioned in static sitting position
aligned with torso, neutral (no forward head or excessive extension)
Compensation
alternative behavioral strategies are adopted to complete task
Practice principles
amount and type ensure patient practices correct movements involve patient in goal setting identify appropriate practice conditions
massed practice conditions
amount of practice time in a trial> amount of rest between trials
distributed practice conditions
amount of rest between trials> amount of time for a trial
Theory
an explanation using an integrated set of principles that organizes observations and predicts behaviors or events
Body structures
anatomical parts of the body
Regulatory environmental factors to movement control
aspects of the environment that shape the movement itself. Movement must conform to regulatory features ex: size of a cup to grab
How much fluid should be replaced per pound of body heat lost?
at least 1 pint
cognitive systems individuals factors to movement control
attention, problem solving, motivation, and emotional aspects that underline intent
The ICF model is a...
biopsychosocial model where environmental and personal factors are integrated with the concept of functioning and disability.
Blocked v. random
blocked: practice repeatedly for a block of trials. improved motor performance random: random order, improve motor learning
What parts of the nervous system are plastic?
brain & spinal cord
delayed EF
brief time delay allowed
Mission Statement
building a community that advances the progression of PT to improve the health of society
Limitations of Motor Programming Theory
cannot be sole determinant of action, 2 identical commands may produce different movements based on variables present
evidence-based practice
clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences
Motor Programming Theory
control is activated either by sensory stimulus OR central processing
systems theories (late 1900s, Woollacott & Shumway-Cook)
control is distributed across neural subsystems & movement emerges from interactions between individual, task, & environment
Systems Theory
control is distributed across neural subsystems, movement emerges from individual and environment, interaction between cognitive , perception and environment
Identity
define and promote the movement system as the foundation for optimizing movement to improve heath of society. Movement system - integration of body systems that generate & main movement at all levels of bodily function. PT will evaluate and management an individual's movement system across the lifespan. Movement system is core of PT practice, education, & research.
best feedback for motor learning
delayed terminal bandwidth variable summed
What is the trunk impairment scale outcome measure
designed for patients with hemiplegia due to stroke.
Activity limitations (ICF model)
difficulties an individual may have in executing activities
What are Activity Limitations?
difficulties an individual may have in executing activities
High humidity ______________ the body's ability to use evaporation for heat loss.
diminishes
Restorative recovery of neurological function after brain injury
direct mechanisms
task constraint classifications
discrete vs continuous, open vs closed, stability vs mobility, manipulation vs nonmanipulation
Health Condition
disease, trauma, etc.
Practice conditions
distribution, variability, closed v. open environment, part task v. whole task
what are impairments of the trunk impairment scale outcome measure
does not evaluate functional sitting activities
Activity
execution of a task or action by the individual
Heat stroke
exertion heat stroke: wet, pale skin Non-exertional heat stroke: dry, hot, flushed skin Treatment: whole body cooling with cold water and ice emersion
environmental factors
external to the individual that facilitate or hinder impact of features of the physical, social, and attitudinal world
summary EF
feedback after a set # of trials
knowledge of performance (KP)
feedback related to the movement pattern used to achieve the movement outcome
Knowledge of performance
feedback relating to the movement pattern used to achieve the goal
Feedforward vs feedback control of movement
feedforward: anticipatory, takes advantage of previous experience to predict feedback: involves input from sensory systems, compared to a reference signal (desired state)
how should the hips and thigh be positioned in static sitting position
femurs slightly abducted
power grip grasp pattern
finger and thumb pads are directed toward the palm to transmit the force to an object ex: grabbing a mug
What is the motion at the thumb for UE flexion and extension patterns?
flexion: flexion/adduction/opposition extension: extension/abduction
Enablement model
focus on an individual's participation and roles (self-care, social, occupational, and recreational activities). Exploring skills and resources that are required for fulfilling roles in different environments.
precision grip grasp pattern
forces are directed between the thumb and fingers ex: picking up m&ms
Summed feedback
given after a set number of trials
constant feedback
given after every trial
Terminal feedback
given at end of task
terminal extrinsic feedback
given at end of task performance
concurrent extrinsic feedback
given during task performance
immediate EF
given immediately after movement
immediate feedback
given immediately after performance
Motor Control Theory
group of abstract ideas about the control of movement
cardiac output
heart rate x stroke volume
how should the UEs be positioned in static sitting position
in line with torso, shoulders relaxed
Feedback
includes all sensory information that is available as the results of a movement that a person has produced
cardiovascular drift
increase in heart rate but decrease in stroke volume so that CO can remain the same
Fitt's Law
increase in movement precision+increase in movement distance= decreased movement time (increased movement efficiency)
compensatory recovery of neurological function after brain injury
indirect mechanisms
What is external imagery?
individual views from the perspective of the observer
What is augmented feedback?
info provided to the learner from an external source to supplement movement
faded feedback
initially provides feedback after every trial then decreasing
neural regeneration
injured axons begin sprouting or regenerating
Task oriented approach to examination
integrates ICF to to examine at level of bodies & functions, activities, & participation
What is Participation?
involvement in a life situation
changes in BP during dynamic aerobic exercise
linear increase in systolic BP w/ increased workload, diastolic BP relatively unchanged
peripheral input on HR
mechanoreceptors and chemoreceptors are stimulated to monitor the state of active muscle
The Individual generates movement to
meet the demands of a Task being performed within a specific Environment
Motor/action systems individual factors to movement control
neuromuscular and biomechanical systems
blocked practice
one task performed repeatedly
blocked practice conditions
one task practiced repeatedly for a block of trials before moving on to another task=improved motor performance
What kind of environment would be more beneficial during advanced learning?
open, provides greater variability
Hierarchical Theory
organization control that is top down
Preparation
positioning for the activity, analyzing the activity
variable practice
practice of a given task under differing conditions
distributed practice
practice time is equal to or less than rest time
part v. whole
practicing whole task v. part of task
what is the Ottawa sitting scale
provides a relatively comprehensive evaluation of seated postural control
Discrete movement
recognizable beginning and end
continuous task
repetitive task w/out a clear beginning or end (walking, running)
Open movement
requires adapting movement strategies to a constantly changing and often unpredictable environment
According to the Physical Stress Theory, which of the following is NOT a tissue response to physical stress?
resistance
Initiation
rest to movement, speed, smoothness, delay
Which of the following is a continuous movement task?
running
Impairment
significant deviation or loss in body function or structure
Impairment (ICF model)
significant deviation or loss in body function or structure
Functional movements require what?
skill
what is an example of change-in-support strategy
stepping strategy, grasping
mental practice
task is imagined or visualized
Open movement tasks are best described as:
tasks that require the performer to adapt his or her behavior.
mobility movement
tasks that requires a moving BOS
Motor Control is:
the ability to regulate or direct the mechanisms essential to movement
According to Kleim and Jones (2008), principle 10, interference, refers to:
the possibility of plasticity within a given neural circuitry impeding the induction of new plasticity within the same or other circuitry
collateral sprouting
the process by which axons of some healthy neurons adjacent to damaged cells grow new branches
What is Balance
the state of an object when the force acting upon it is zero
What are you looking for in the sagittal, frontal, and transverse view of the hip in sitting?
tilt, obliquity, rotation
what are skills?
traits or abilities learned for a specific motor task ie) HR control, Manuel dexterity, interfinger coordination...
When are random schedules used?
typically not introduced until learner understands the components of the task (later)
best practice for motor learning
variable random
random practice
variety of tasks ordered randomly
processing of visual info
visual input->temporal lobe (what) & parietal lobe (where)-> plan created (feedforward)-> cerebellum & basal ganglia (modify & refine)-> motor cortex (generate movement)-> cerebellum (feedback for error detection)
Which of the following is an example of an activity, according to the ICF framework?
walk to the mailbox
Conceptual Frameworks for Clinical Practice
• APTA's patient-oriented management process • ICF model of function and disability (ICF guidelines & 18steps) • Hypothesis-oriented clinical practice • Task oriented approach to examination
Clinical Implications
• Assessing MOVEMENT leads to investigation of underlying impairments • WE DON'T TREAT THE PATHOLOGY! • We treat impairments and re-train movement to optimize function!
APTA's patient-oriented management process
• Basic terms: outlines what and when is done with a patient/client and in what order
Other variables
• Blocked- one source of feedback (ie same segment each trial) • Variable- multiple sources of feedback (ie different segments on successive trials)
Systems Review-When to Refer?
• Cardiovascular/pulmonary system: • Integumentary system: • Musculoskeletal system: • Neuromuscular system: • Communication ability, affect, cognition, language, and learning style • Discharge from PT?
Systems Review
• Cardiovascular/pulmonary system: • Integumentary system: • Musculoskeletal system: • Neuromuscular system: • Communication ability, affect, cognition, language, and learning style:
Scheduling (when)
• Concurrent- during the movement • Terminal- after the movement • Delayed- after a brief time delay • Immediate- immediately after the movement
Intensity (how often)
• Constant- every trial • Summed- after a set of trials • Faded- initially every trial, then less often • Bandwidth- feedback only when there is an error
What do Physical Therapists Do?
• Diagnose and manage -- movement dysfunction and enhance physical and functional abilities. • Restore, maintain, and promote -- not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health. • Prevent -- the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
Does the task have a beginning/end?
• Discrete • Continuous • Serial
Discrete vs Continuous
• Discrete- have a recognizable beginning and end • Continuous- the end point of the task is not an inherent characteristic to the task but is decided arbitrarily by the performer
Patient/Client History
• How do we obtain patient history? • What does it include?
Cognitive
• Learner develops an understanding of the task • "What to do" decision
Associated
• Learner refines movement with less errors and more temporal and spacial organization • "How to do" decision
Collateral Sprouting (reactive synaptogenesis)
• Neighboring normal axons sprout to innervate synaptic sites that were previously activated by the injured axons
Physical Therapist Practice and the Movement System (APTA)
• Physical therapists provide a unique perspective on purposeful, precise, and efficient movement across the lifespan based upon the synthesis of their distinctive knowledge of the movement system and expertise in mobility and locomotion. • Physical therapists examine and evaluate the movement system (including diagnosis and prognosis) to provide a customized and integrated plan of care to achieve the individual's goal-directed outcomes. • Physical therapists maximize an individual's ability to engage with and respond to his or her environment using movement-related interventions to optimize functional capacity and performance.
Referral/Consultation
• Refer an individual to another provider and conclude care, or not develop a plan of care • Refer an individual to another provider and continue the plan of care at the same time • Receive an individual referred from another provider who chooses not to continue treating the individual • Receive an individual from another provider who continues to treat the individual
Environmental Constrains:
• Regulatory- aspects of the environment that shape the movement itself. Movement must conform to regulatory features. • Non-regulatory- may affect performance, but movement does not have to conform
Motor Control
• Shumway-Cook and Woollacott describe an integrated motor-control theory that reflects key elements of previous theories. • Movement- product of the interaction among the INDIVIDUAL, the TASK, and the ENVIRONMENT. • Movement is thought to be generated by an individual to meet the demands of a specific task performed within a specific environment.
Stability vs Mobility
• Stability task- Nonmoving base of support •Mobility- Moving base of support
Knowledge of Results
• Terminal feedback about the outcome of the movement • You jumped 2 inches further • You lost your balance 3 times • You improved your time by 6 seconds
What is The Human Movement System?
• The movement system is the integration of body systems that generate and maintain movement at all levels of bodily function. • Human movement is a complex behavior within a specific context, and is influenced by social, environmental, and personal factors
Closed vs Open
•Open Movement Task- requires performer to adapt movement strategies to constantly changing/unpredictable environment • Closed Movement Task- movement performed in relatively fixed/predictable environments
What is the main components of the UE D2 extension pattern?
(Ext/Add/IR)
What are some benefits of Motor Program Theory
- Helps identify abnormal movement -helps pt relearn correct rules of action -do not just reeducate muscles in isolation, retrain movements for functional task ex) Central Pattern Generators
What is the Expert stage of Bernstein's model?
- Learner continues to release and reorganize degrees of freedom -exploits additional passive forces -movement is faster and more forceful
Hierarchical Theory (mid 1900s)
- control of movement occurs from the top down - in a healthy org, motor control system is a bureaucracy in which each level must take orders from the level just above it, and ultimately the highest level of the CNS controls what movement occurs
• Serial-
- discrete movements performed sequentially
What is the initial Stage of Gentiles motor learning model?
- getting the idea of the movement - establish relevant and non relevant stimuli -establish most appropriate pattern (involves coordination)
Consumer-centricity
- patient/center values and goals are central to all efforts
What is simplification part practice?
- reducing the difficulty of different parts or skill as a whole ie.) lowering the speed, weight
What is the Later (fixation) stage?
-Closed skill requirement -learner develops capability to of doing what is needed regardless of situation (adapting) - skills refined and retained
Feedback schedule
-Concurrent -Terminal -Immediate -Delayed -Summary -Faded -Bandwidth
What is a serial task
-Discrete actions linked together -order is important, longer movement time, practice in parts -Some prepared in advance, others adjusted during the task ie) dancing, gynastics, playing a piano
What are limitations of the Hierarchical Theory?
-Doesn't explain dominance of reflexes -Everyones' developmental patterns are different -Patient is a passive participation in intervention
When is distributed practice best used?
-During continuous task performance. -fatigue masks learning -less fatigue, results in better performance
What are limitations of Motor Program Theory
-How MP are created is unknown -Not enough space to store all -Doesn't explain nervous/musculoskeletal & environmental variables -Cannot account for new movements
What is the dynamical Actions/System Theory?
-Inclusive of all components of the movement system interacting together -movement is purposeful/ activity oriented
Intrinsic feedback in motor learning
-Information received by the learner as a result of performing the task -Information is received from tactile, vestibular, and visual systems during and after the task
What are the two stages in Gentiles motor learning model?
-Initial stage -Later Stage -Fixation (closed environment) -Later Stage - Diversification (open environment)
What are the limitations of the dynamical action/systems theory?
-Lack of focus and abstract -person, task, and environment have equal roles -presumes that the relationship b/w physical systems & environment determines behavior
What is the intermediate stage of Bernstein's model?
-Learner begins to reinstate/release degrees of freedom -dynamics become more apparent to the learner -more fluidity of movement
What are the benefits/ clinical applications?
-Movement is an emergent property from interaction of multiple elements - interaction b/w internal and external environment -Understand and dynamic functions of the body
What are the 4 key principles of the dynamical actions/system theory?
-Self-Organization -Attractor States -Phase Transitions -Control Parameters
what is a closed environment?
-Stable and predictable. -Allows learner to control the situation. -No fear of environmental change
What is the Ecological Theory?
-Stresses the interaction b/w the individual and the environment -Perception focuses on detecting info from the environment that will support actions needed to achieve a goal
Effects of dehydration
-decreased exercise performance -decreased plasma volume->decreased SV-> increased HR-> decreased Q->decreased BP-> increased circulatory strain -decreased skin blood flow=hyperthermia -altered metabolic & CNS functions
When should you use constant practice?
-during initial stages of learning -serial and continuous tasks- due to the nature of the task more constant practice maybe required
What is the autonomous stage of Fitts and Posner?
-expert after months to years -performance is automatic -minimal improvement
cold stress
-facilitates heat conservation: peripheral vessels constrict=blood shunts to deep body cavities -hormones that stimulate heat production: epi, norepinephrine, thyroxin
heat load
-facilitates heat loss: peripheral vessels dilate= blood redistributed from core and muscles to periphery and skin -hormones that conserve water & electrolytes: aldosterone & vasopressin (ADH)
subacute stage of healing (10-17 days, can last 6 weeks)
-fibroblastic activity, collagen formation, granulation tissue -myofibroblastic activity starts= scar contracts & closes by day 8 on skin/mm & 3-6 weeks on tendon/ligament -healing is fragile, thin, unorganized -pain @ end range of movement -AROM, isometrics
What is the cognitive stage Fitts and Posner?
-focus on what needs to be done -lots of errors -rapid improvement
what is a discrete task?
-has distinct beginning and end (clearly defined) -short duration -movement prepared in advance ie) shooting a bow, STS, picking a glass
What is Motor Learning?
-includes a set of internal processes -produces an acquired capability for movement -occurs as a direct result of instruction, practice, and experience -not directly observable, inferred -produces relatively permanent changes
How to practice depends on what?
-individual's goal -abilities of the the individual -type of task -environment
exercise in cold environments
-individuals w/CVD have an increased risk of mortality -shoveling snow: isometric component w/reliance on UE -walking in snow= increased energy & myocardial oxygen demands -swimming in cold water= may not be able to recognize angina s/s
Acute stage of healing (4-6 days)
-inflammatory: cellular, vascular, chemical responses -48 hrs: vascular changes=clot formation & fibroblastic activity -protect tissue, joint mob I & II, PROM
what is knowledge of performance?
-information about the pattern of movement -kinematic feedback- speed, velocity -kinetic or EMG feedback -quality of movement
What is part practice?
-involves high complexity tasks (many parts) -low organization (independence of parts)
What is whole practice?
-involves low complexity (few parts) -high organization (highly related parts)
What is fractionization of part practice?
-involves practicing separate components of the whole skill; typically with asymmetric limb coordination
What is the associative stage of Fitts and Posner?
-learner find most effective ways -able to identify/correct errors -refining skills -improvements is more gradual
chronic stage of healing (after 21 days)
-maturation of tissue->improved orientation & tensile strength -no swelling -return to function
what are limitations of the multidirectional functional reach test
-measures only a single construct and not comprehensive for sitting function -clinically challenging for reliable test administration
What is the Later (Diversification) Stage?
-open skill requirement -larger repertoire of motor patterns -more options for movement success is required -skills markedly altered
What is a blocked schedule?
-practicing one skill before practicing the next -trials are performed sequentially without interruption (early)
AIMS For ICF
-provide scientific basis for the consequences of health conditions -establish a common language -permit comparisons of data across countries, health care disciplines, services, time
what is a continuous task
-repetitive & rhythmic, beginning or end arbitrary or set by the environment -longer time span, determined by goal or person -ongoing movement adjusted during task ie)walking, running, cycling
What is segmentations of part practice?
-separating skill into parts, practicing parts so that after 1 part is practiced, it is practiced with the next part
What is the novice stage of Bernstein's model?
-simplify the movement 'problem' by reducing (freezing out) degrees of freedom
Motor control
-the nature of movement and how movement is controlled -ability to regulate or control the mechanisms essential to movement -interaction of individual, task constraints and environment
What is an open environment?
-unpredictable, ever-changing -requires individuals to adjust to spatial and/or temporal qualities
What is knowledge of results?
-usually verbal -can be visual or auditory -provided by instructor or clinician External info given about outcomes of task or their ability to achieve the goal
What is a random schedule?
-various skills practiced in unsystematic way -trials are never performed more than once in order (later)
Dosage for exercises during healing
-vascular: 31+ reps w/o fatigue -coordination/endurance: 25-30 reps w/fatigue -strength/endurance: 15-20 reps w/fatigue -strength: 1-12 reps w/fatigue
risk for heat injuries in continuous activity/comps
-very high risk: >28*C (82*F)=postpone comp -high risk: 23-28*C (73-82*F)= heat-sensitive individuals shouldn't compete -moderate risk: 18-23*C (65-73*F) -low risk: <18*C (65*F)
2 ways to regulate heat
1) afferent thermal receptors in skin 2) changes in blood temp (fine-tuning)
What are the 4 elements of the movement system ?
1) base elements: muscular and skeletal systems 2) modular element: nervous system 3) supper elements: cardiac, pulm, endocrine, etc 4) biomechanics: statics/dynamics
parts of the individual
1) cognitive: attention, planning, problem solving, motivation, & emotional aspects 2) motor/action: neuromuscular & biomechanics 3) sensory/perception: info regarding state of body & environment
5 responses to physical stress
1) decreased stress tolerance, atrophy 2) maintenance 3) increased stress tolerance, hypertrophy 4) injury 5) death
What are the 5 rolling strategies?
1) half bridge: 2) flexion adduction roll 3) upper trunk anterior diagonal 4) mass flexion 5) log roll
2 Important Requirements for Successful Grasp
1) hand must be adapted to the size, shape, & use of object 2) finger movements must be timed so that they close around the object at the appropriate moment
6 phases of bone remodeling
1) inactive 2) activation 3) resorption 4) reversal 5) formation 6) mineralization
4 phases of grasp and lift
1) list starts w/ contact between fingers & object 2) once contact has been established, grip force occurs & load force is on fingers 3) load force overcomes weight of object & it starts to move 4) occurs @ end of task, a decrease in grip/load force after the object makes contact w/table
grades of tissue injury
1) mild pain, swelling, tenderness, pain w/stress 2) moderate pain, must stop activity, stress/palpation= pain, torn fiber, increased joint mobility 3) near or complete avulsion, stress is painless, marked instability
Parts of the task
1) mobility 2) postural control 3) upper extremity function
parts of the environment
1) regulatory 2) non-regulatory
4 phases of grip and lift tasks
1) starts with contact between fingers and object 2) load on fingers increasing - increased grip force 3) load force overcomes weight of object, object moves 4) end of task, decrease in grip and load force "object gets placed on table"
3 contributors to the nature of movement
1) task 2) individual 3) environment
How do you progress a task based on Gentiles Taxonomy?
1)Body Stable, no manipulation 2)Body Stable, manipulation 3)Body Transport, no manipulation 4)Body Transport, manipulation
Elements of Neuroscience of Postural Control include?
1)Spinal Cord- sensory Pathways 2)Brain Stem- Vestibular Nuclei 3)Cerebellum- Spinocerebellar Tract, Vesibulocerebellum Tract 4)Basal Ganglia 5)Cerebral Cortex
How do you progress an environment based on Gentiles Taxonomy?
1)Stationary, No intertrial Variability 2)Stationary, Intertrial Variability 3)In-motion, no intertrial Variability 4)In-motion, intertrial Variability
What are the phases of sit to stand and their features/muscles?
1)Weight shift - LTIAWS, erector spinae active, stable 2)Lift off - unstable, vertical and horizontal motion, hip and knee extensors 3)Extension - hip/knee extension, vertical goal, COM within BOS 4)Stabilization - period following complete extension Side note: UEs are not part of normal STS
MENTI QUIZ
1-10
What 2 things can help prevent and inversion ankle injury (anterior talo-fibular ligament)?
1. Avoid excess inverion/pf stress 2. Overcome inversion torque with reactive, strong time critical motor strategies
Fitts and Posner 3 stage model of motor learning
1. Cognitive Stage: develop an overall understanding of the task 2. Associative Stage: now refining the strategy for the task--improving coordination & efficiency 3. Autonomous Stage: movement is refined->automatic performance of the movement
Task oriented approach to examination
1. Guides Examination 2. Integrates with the ICF 3. Observation of movements and description of strategies used to accomplish a functional task 4. Uses tests and measures
Three Models of the Human Movement System
1. Kinesiologic Model 2. Pathokinesiologic Model 3. Kinesiopathologic Mode
Five conceptual framework components
1. Model of practice 2. Model of function and disability 3. Hypothesis oriented clinical practice 4. Principles of motor control and motor learning 5. Evidence based clinical practice
What are the 3 steps to perform a contract-relax stretching technique?
1. Pt actively moves limb in pattern to end range 2. Followed by strong resisted contraction of the antagonists 5-8 sec 3. Voluntary relaxation and active movement into new range of agnoist pattern
What are the 3 steps of a hold-relax PNF technique?
1. Pt actively moves limb in pattern to end range 2. Followed by strong resisted isometric contraction of antagonists (5-8 sec) 3. Voluntary relaxation and passive movement into the new range of agnoist patterns
Theories of motor control
1. Reflex Theory 2. Hierarchial Theory 3. Motor Programming theories 4. Systems Theory
When considering the eyes of the employee what are the 2 different perspectives of someone in worker's compensation?
1. Some want to get back to work as soon as possible 2. Issues of secondary gain
Plan of Care
1. Specify the goals 2. Predicted level of optimal improvement 3. Specific interventions to be used 4. Proposed duration and frequency of the interventions that are required to reach the goals and outcomes
Consider Task vs Environment:
1. Stationary individual in a stationary environment 2. Moving individual in a stationary environment 3. Stationary individual in a moving environment 4. Moving individual in a moving environment
Collaboration
1. demonstrate value of collaboration: health care providers, consumers, community organizations, other disciplines. Interprofessional education. Interprofessional research.
Components of patient/client management model
1. examination 2. eval 3. dx/prognosis 4. intervention 5. outcomes
Task Analysis Steps
1. initial conditions 2. preparation 3. initiation 4. execution 5. termination
axonal regrowth rate is?
1mm per day 1 inch per month 12 inches per year PNS > CNS *Schwann Cells*
In the Stanley Paris 18 step extremity examination, where is Task Analysis??
2.Initial Observation 16.Movement Analysis
What are the three motor learning theories?
3- stage Model: Fits and Posner 3- stage model: Bernstein 2- Stage Model: Gentile
How long should your documentation be supenable for?
5 years Documentation must be objective
narrow limits of body temp
5*C increase (9*F) & 10*C decrease (18*F)
Normal adult resting heart rate
50-80 bpm
9 Categories of intervention
9 categories: patient instruction, airway clearance, assistive technology, biophysical agents, functional training, integumentary repair/protection, manual therapy, motor function training, therapeutic exercise. Effective interventions result in the reduction/elimination of body function or structure impairments activity limitation and/or participation restrictions. Evidence-based.
how should the knees and ankles be positioned in static sitting position
90 degrees
What is rhythmic initiation?
A PNF technique that uses rhythmic motion of body through the desired range starting with PROM and going to active resisted movement
Osteoporosis
A condition in which the body's bones become weak and break easily.
Task Analysis:
A detailed observational analysis of the patient's total body movement patterns during task performance "...task analysis is one of the skills that defines the physical therapist, and therefore synthesizes many of the skills taught throughout the physical therapy curriculum"
Theories of Motor Control
A group of abstract ideas about the control of movement • Reflex Theory • Hierarchical Theory • Motor Programming Theory • Systems Theory • Ecological Theory
Wet Bulb Globe Temperature (WBGT)
A measure of the heat stress in direct sunlight, which takes into account: temperature, humidity, wind speed, sun angle and cloud cover (solar radiation). This differs from the heat index, which takes into consideration temperature and humidity and is calculated for shady areas. WBGT = 0.7NWB + 0.2GT + 0.1DB NWB = Natural Wet-Bulb Temperature DB = Dry-Bulb (air) Temperature GT = Globe Thermometer Temperature
Define testing (table 17-1)
A series of questions, problems, or practical tasks to gauge knowledge, experience, or ability; measurement with no interpretation needed
Conceptual frameworks provide..
A structure to oranize clincial practice and context to interpret clinicial information. Numerous decision making frameworks exit to guide PTs.
Define a screening
A system for selecting suitable people; to protect somebody from something unpleasant or dangerous
What is the term of the ability to regulate or direct the mechanisms essential to movement? A. Motor Control B. Motor Learning C. Modulation
A. Motor Control
What technique do we use to train the specific spine stabilization muscles via co-contraction?
Abdominal drawing in technique
neural plasticity
Ability of the brain to change their experience, both structurally and chemically--happens all the time
What is mental practice?
Acquisition or performance preparation
Describe an exercise progression for shoulder rehabilitation after surgery
Active/passive ROM Isometric strengthening Elevation of arm after surgery Elevation of arm with weights Motor control of shoulder with plyoballs or body blade Weight machines Free weights Sports activites
Activities (functional tasks)
Activity Limitations
Health conditions
Acute or chronic diseases, disorders, injuries, or circumstances that have an impact on the individual's level of function. Medial Diagnosis.
Neural Mobility/ Neurodynamics Potential Impairments
Adverse neurodynamics, decreased mobility, adhesions, hypersensitivity, pain, muscle atrophy, sensory loss, etc.
Contextual Factors
Affect all 3 domains of human function Environmental Factors Personal Factors
Sensory organization relies on what kind of information?
Afferent information
Summary
After a set number of trials
Hypothesis-orientated algorithm for clinicians II HOAC II
Algorithm for planning and evaluating that facilities use of science in practice, describes a series of steps involved in making informed clinical decisions, incorporates elements of the APTA's Guide to PT practice, Hypothesis-oriented approach of creating problem lists and hypotheses as to why the problems exit, monitor intervention effects and altering the POC Hypothesis=orientated algorithm part 1
What are the things to asses for in a neutral spine?
Alignment Strength and balance Agility and protective mechanisms
What is the purpose of a bilateral UE pattern?
Allow use of irradiation from patient's strong UE to facilitate weaker muscles
Statics Potential Impairments
Alterations/Impairments in alignment, muscle activation, joint/soft tissue stress, bone remodeling
Endocrine/Metabolic Potential Impairments
Altered homeostasis and production of necessary hormones. Impaired energy consumption and replenishment
Recruitment, timing, order, magnitude of motor unit activation Potential Impairments
Altered motor unit activity. Coordination, timing, symmetry impairments
Stabilizing reversal and rhythmic stabilization how what characteristic in common?
Alternating isometric contractions
What structure is most frequently injured in the body, leading to body impairments?
Ankle injury
Scapular PNF patterns occur in 2 diagonals, what are these 2 patterns?
Anterior elevation-posterior depression Posterior elevation-anterior depression
What is the main function of the 3 main stabilization muscles? (TA, IO, Multifidus)
Anti-gravity postural support
Explain the two domains of dynamic postural control
Anticipatory Postural Adjustment (APA)- expected and/or self-initiated (reaching, throwing, lifting) Reactive Postural Adjustment (RPA) - unexpected from external forces (moving surfaces, catching unfamiliar objects)
What is it termed when we compress a joint while making sure all joints are aligned?
Approximation
What is Base of Support
Area enclosed within all points of body contact with supporting surface. ex. sitting- created ischial tuber-sixties and posterior thighs
Primary types of impairments
Arise directly from health condition
Primary Impairments
Arises directly from health condition
What is the difference between an assessment and a evaluation?
Assessment: Collecting objective information Evaluation: When you bring your clinical decision making and try to figure out what your objective findings mean
What are some good exercises for semi-dynamic balance training? (As seen in our PP)
Assisted squat on medicine ball Single leg nose to toes touch/squat Lunges Single leg UE resistance exercises Rotations or Catches on unstable surface
If someone is refining the strategy for a task, is becoming more consistent in the task and is improving coordination and efficiency, what stage of motor learning are they in?
Associative stage
Proprioceptive cues are more important than visual cues in what stage of motor learning?
Associative stage
What is the best PNF pattern to help with supine to prone activites?
Asymmetrical patterns
The scoring system for functional movement screen is on a 0-3 point scale. Describe what a score of 0 would be
At any time during testing the athlete has pain anywhere in the body; test only considers pain
What stage of motor learning would a patient be in if, the movement is refined, they can accomplish the task in a variety of settings and are able to complete additional tasks during the movement?
Autonomous stage
Which ICF domain would difficulty swimming fall under? A. impairment B. Activity limitation C. participation restriction
B. Activity limitation
The process of obtaining data necessary to form a diagnosis, prognosis, and plan of can is call what? A. Evaluation B. Examination C. Subjective History
B. Examination
Your patient is able to demonstrate proper squatting mechanics 2 months after you last saw the patient. This is an example of what? A. Motor Performance B. Motor Learning C. Practice
B. Motor Learning
Which system is the modulator of movement? A. MS system B. Nervous System C. biomechanical system
B. Nervous System
Normal initiation of sit to stand is what? A. anterior translation of the tibia B. anterior translation of the trunk C. hip and knee extension
B. anterior translation of the trunk
What are non-regulatory features of the environment?
Background noise or distractions
A neutral spine is a position in which an individual can best maintain what?
Balance and agility
To restore balance we need to consider what 4 things?
Balance is a skill Balance is functional Integrated, coordinated, efficient, multidirectional movement Proprioception
What are some current hi-tech balance assessments, reabhilition technologies?
Balance master Balance master with force plate Equitest Biodex stability system Proprio reactive balance system
What is the ability to maintain center of gravity over base of support?
Balance of postural equilibrium
What extrinsic feedback schedule is defined as, "given only if performance falls outside a predetermined error range"?
Bandwidth feedback
What are the 3 personality types of a symptom magnification syndrome?
Based on reported objective behavior... Personality types: Refugee Game players Perpetual/identified patient
What is the 5 pieces of history leading to spine rehabilitation?
Bed rest Williams flexion exercise McKenzie extension exercise Back schools Spine stabilization exerces
How did companies begin to control the outcomes, costs and claims of worker's compensation?
Began to have evidence. Used functional capacity evaluations to measure a patient's level of function with in the context of the individual's work environment
Disablement model
Begin analysis from the underlying disease or pathology. Impact and functional consequences of acute or chronic conditions that compromise performance and an individual's ability to meet necessary, customary, expected, and desired societal functions and roles.
phase 3 of grasp and lift task
Begins when the load force overcomes the weight of the object and it starts to move.
Hypothalamus
Body's thermostat Initiates autonomic response to temperature change
What is occupational medicine? AKA, Industrial medicine
Branch of medicine concerned with the maintenance of health and prevention and treatment of diseases and accidental injuries in workplace
What verbal cues would help to facilitate a co-contraction of the muscles that are primary spine stabilizers?
Bring belly button toward spine Suck in to put on on pants
Scapular PNF pattern influence what other structures?
C-spine, t-spine and bilateral UE
What are the movement systems for postural control
Biomechanical, Sensory, Motor
Heat cramps
Factors: Muscle fatigue, water and sodium loss Treatment: rest, fluid replacement, sodium replacement
What is the main thing to look for in a FCA?
Look at what the patient CAN do. not what they CAN NOT do
What is a functional capacity assessment/evaluation?
A detailed examination and evaluation that objectively measures the patient's current level of function, primarily within the context of the demands of competitive employment
What is limits of stability?
Ability to maintain COG over BOS
What factors influence a person's ability to learn a skilled motor act?
Ability/Attribute and skills
What is the pathokinesiologic model?
Abnormal movement is caused by an underlying condition
What are the 6 physiological reasons to stop the FCA?
Abnormal: HR, angina Skin color Sweating Muscle shaking SOB *****Substitution. or unsafe compensations
The repeated quick stretch is elicited from (agonist/antagonist) muscles under tension of contraction
Agonist
To properly use a quick stretch, or stretch reflex, how should all synergistic muscles in the pattern be positioned?
All muscles should be elongated
How is a combination of isometrics often used?
Antigravity activities and assumption of postures
Case Report- Using the ICF Model
Apply the ICF to the following patient • Make a list of probable impairments • What functional activities are likely affected? • What is this patient's participation restrictions? • What are potential contextual factors (personal and environmental) that impact this case?
What is the historically main intervention for spine rehabilitation?
Best rest (which isn't really a good idea)
What is the "CHOP" bilateral UE pattern?
Bilateral asymmetrical UE extension with neck flexion
What is the "LIFT" bilateral UE pattern
Bilateral asymmetrical UE flexion with neck extension
What kind of practice condition is defined as," 1 task is practiced repeatedly"
Blocked practice
Practice order
Blocked- one task performed repeatedly Random-variety of tasks ordered randomly
ICF Model
Body Functions: why can't they do activities? Activities: what functional things are limiting them from participating in activities? Participation: what does the patient want to do?
SUPPORT BASE
Cardiovascular System Pulmonary System Endocrine/Metabolic Integumentary
Describe high intensity
Cardiovascular perspective High- >70% MHR Perfection Perspective High- imperfect practice
What are the principle muscles involved with a pelvis anterior depression?
Contralateral QL Iliocostalis lumborum Longissimus thoracis
What are the primary muscles involved with a pelvic posterior depression PNF pattern?
Contralateral internal oblique Contralateral external oblique
What kind of environment would be more beneficial during early learning?
Closed, requires fewer demands on info processing systems
What is the difference between a closed and open motor skill?
Closed: performed in a stable, non-changing environment Open: task performed in a changing enviornment
How do we train the specific muscles local muscles that stabilize the spine? (TA, IO, Multifidus)
Co-contraction , using the abdominal drawing in technique
What are the 3 main stages of motor learning?
Cognitive Associative Autonomous
What part of the body provides proximal stability for distal mobility?
Core
What is core training for spine rehabilitation?
Core = lumbo-pelvic hip complex where all movement is centered
What is the action of the transverse abdominus?
Compression, support and protection of spine
What is the "movement System"?
Comprises of the anatomical structures and physiological functions that interact to move the body or its component parts
What kind of extrinsic feedback is defined as, "given during task performance"?
Concurrent feedback
Balance depends on what 6 things?
Configuration of BOS (wide vs. small) COG alignment over BOS Speed of postural movement Ability to maintain a position Ability to voluntarily move Ability to react to perturbations
What extrinsic feedback schedule is defined as, "given after every trial"?
Constant feedback
What kind of practice condition is defined as," Practicing the same way every time"
Constant practice
Variability
Constant- skills practiced in constant conditions Variable- skills practiced in various conditions
What is the bilateral symmetrical reciprocal pattern to D2 flexion?
D2 extension
What is the bilateral asymmetrical pattern to D1 flexion?
D2 flexion
What are contraindications of the quick stretch PNF?
Don't apply in presence of joint instability, pain or injured muscle
A Task Oriented Approach to Examination
Designed to place the patient's performance of functional tasks at the forefront of the examination process • Observe the patient perform a task • Analyze strategies used to perform the task • Hypothesize about the impairments that may be constraining the patient's movement
What are the 3 ways to maintain balance/postural equilibrium?
Detect body position/movement Relay info back to CNS for reorganization Approriate MS response
External Focus
Focus beyond the body • Push the floor apart as you land • Reach out as you step • Lift upwards towards the ceiling
Why would a doctor handling a worker's compensation scenario create a problem for you, the therapist?
Don't get to therapy until 2-6 weeks Deconditioning is occurring, attitude is decreased, as patient is sitting at home on medication
5 components of task analysis (in order)
Initial conditions Preparation Initiation Execution Termination You guys know the components already
Which PNF techniques help with increasing enduracnce?
Dynamic reversals Stabilizing reversals Rhythmic stabilization Quick stretch beginning and throughout ROM
What is the difference between dynamic and semi-dynamic exercises?
Dynamic: Both floor and COG move Semi-dynamic: Either COG moves or area your standing on moves, while the other remains static
What are the two most often used motor control theories?
Dynamical Actions/Systems Theory Ecological
PNF was developed for a patient to reach there highest level of function. What are the 5 key components of PNF?
Emphasize functional outcomes Manual technique to facilitate and enhance coordinated muscle activity Use synergistic movement patterns Use developmental postures and transitions Inclusion of motor learning principles
What part of the task analysis can be defined as the, "Instant when displacement of body segment begins"?
Initiation
A contract-relax technique is usually performed at what range in the motion?
End range
Radiation
Energy that is radiated or transmitted in the form of rays or waves or particles.
Radiation
Energy that is radiated or transmitted in the form of rays or waves or particles. -depends on temp gradient
Why should the therapist use their body and be directly in line with motion during PNF?
Enhance control of therapist Reduces fatigue Protects against injury
What is the goal of a repeated quick stretch?
Enhance initiation of motion and motor learning, increase strength, endurance, improve intra/intermuscular coordination, ROM, reduce fatigue and guide desired motion
What are the indications of patient position when applying proprioceptive neuromusclar facilitation?
Enhance muscle contraction and maximize postural stability
Open task
Environment changes from one trial to the next, must adapt movement strategy (soccer)
closed task
Environment is stable, which offers predictability to the movement (sitting at desk)
Clinical Implication- Internal vs External Focused Feedback
External Focused Feedback • Improves movement effectiveness (accuracy, consistency, balance) • Improves movement efficiency (muscular activity, force production) • This is true across various tasks, skill levels, and age groups • Paying too much attention to elements of the task (internal focus) may reduce performance and learning
Think about the flow from industrial medicine and how does work hardening address our goals
FCE/A --> Work hardening --> FCE/A
Circulatory system during heat load
Facilitates heat loss Dilates peripheral vessels Blood is redistributed to skin Hormonal changes: conserve water to prevent dehydration
Irradiation uses facilitation and inhibition. Which term is used to describe the contraction of weaker muscles?
Facilitation
What are functional activities that D1 flexion can help with?
Feeding Dressing Brushing teeth
Thermoregulation
Fine balance between adding and removing heat
Somatosensory
Fine regulation and control during reaching and grasping Joint receptors, muscle spindles and mechanoreceptors control of grip forces
What is the power grip, grasp pattern? Give three examples
Finger and thumb pads are directed towards palm Hook grasp: holding a suitcase Spherical grasp: holding a baseball Cylindrical grasp: holding a bottle
What is the D2 UE pattern?
Flexion-ABD-ER and Extension-ADD-IR
What is the D1 UE pattern?
Flexion-ADD-ER and Extension-ABD-IR
What is the D1 UE flexion pattern?
Flexion/Add/ER
What happens at the forearm during UE PNF flexion or extension patterns?
Flexion: Supination Extension: Pronation
What is the flexion and extension PNF patterns at the wrist?
Flexion: flexion/radial deviation Extension: extension/ulnar deviation
What are 4 ways a FCA can analyze strength?
Floor to waist lift Wt Carry (50 ft) Short distance carry OVerhead lift (Level of AC to overhead) *Find out if they can do it unresistant first
How does the visual system translate sensory information to the sensory nervous system?
Focal and peripheral vision to vestibular nuclei
What is the LE D1 PNF flexion pattern?
Hip: Flexion/add/ER Foot ankle: DF, inversion Toe: Extension/medial deviation
Three components of examination
History Systems review Tests and measures Important first test and measure is task analysis
Examination includes:
History, interview, systems review, tests and measures.
What PNF technique uses a resisted isometric contraction of the antagonistic muscles followed by relaxation?
Hold-Relax
Which PNF technique is best used to improve patients ROM, especially in pts with pain?
Hold-Relax
Clinical Applications of Hierarchical Theory?
Identify and prevent primitive reflexes, inhibit undesirable reflexes, normalize tone, facilitate normal patterns Ex. Infant Developmental Sequence, Stages of Motor control
How can disuse affect balance?
If you don't train balance you can loose ability
Cardiovascular System Potential Impairments
Impaired Oxygen consumption, distribution and/or utilization needed for movement
What is defined as a isolated movement limitations or abnormalities that can be measured by clinical means?
Impairment (Quantitiy and Quality)
Health condition: Spinal Cord Injury Impairment? Activity Limitation? Participation?
Impairment: Paralysis of the lower extremities Activity Limitation: Incapable of stepping up to get into a bus Participation: Lack of accommodations in public transportation leads to no participation in religious activities
Body Functions & Body Structure
Impairments
Impairments in Component Elements
Impairments can be caused by faulty movement or there can be underlying impairments that have led to the faulty movement which in turn leads to pathology
Cognition Potential Impairments
Impairments in attention, planning, problem solving, motivation, emotion, etc
Sensation and Perception Potential Impairments
Impairments in proprioception, kinesthesia, peripheral and higher-level processing
Why is proprioception and agility important for our spine stabilization interventions?
Important for us to be able to respond to stimuli with a quick change of direction, before injury occurs
Kinesio-pathologic Model
Imprecise, abnormal, excessive repetitive movements or sustained postures Impairments in Component Elements Movement Impairments Disease, Injury, Abnormality Functional Limitations and Disability
Walking down the stairs Example Imprecise, abnormal, excessive repetitive movements or sustained postures? Impairments in Component Elements? Movement Impairments? Disease, Injury, Abnormality? Functional Limitations and Disability?
Imprecise, abnormal, excessive repetitive movements or sustained postures • Dynamic Knee Valgus while descending stairs Impairments in Component Elements • Musculoskeletal System Impairments; Neuro System Impairments Movement Impairments • Needs upper extremity support to descend stairs because of pain; Dynamic knee valgus Disease, Injury, Abnormality • Patellofemoral Pain Functional Limitations and Disability • Inability to go hiking with friends
Forward Lean on Cervical Spine Imprecise, abnormal, excessive repetitive movements or sustained postures? Impairments in Component Elements? Movement Impairments? Disease, Injury, Abnormality? Functional Limitations and Disability?
Imprecise, abnormal, excessive repetitive movements or sustained postures • Poor sitting posture with forward head position Impairments in Component Elements • Musculoskeletal System Impairment; Nervous System Impairment Movement Impairments • Decreased upper cervical flexion AROM Disease, Injury, Abnormality • Neck pain with headaches Functional Limitations and Disability • Difficulty working due to pain
What is the goal of a hold-relax PNF technique?
Improve ROM especially in pts with pain
What are the goals of the PNF, to use a combination of isotonics?
Improve active motor control/learning, coordination, AROM, strength, eccentric control of movement
Why is dynamic reversal used?
Improve intra- and intermuscular coordination, AROM, strength, endurance and decrease muscle tone
High frequency feedback
Improved motor performance but delayed motor learning, Patient internalizes ideal movement
What is the goal of the timing for emphasis technique?
Improves strength and coordination
Which of the following is an example of a restriction in the participation domain of the ICF framework for a woman following a traumatic brain injury?
Inability to shower without assistance
What are some tests to check if a patient is faking a symptom?
In sitting, extend knee and PF foot Then in supine do a SLR. See if patient reports pain with one degree of hip flexion and not the other. This would consider the patient a symptom magnifier
Feedback
Includes all sensory information that is available as the result of a movement that a person has produced
Execution
Includes description of the movement towards the specific task goal; explanation of (a) what occurs at BUE, BLE, head, trunk during the task, and (b) the speed, smoothness, direction of movement. • Describe the overall sequence of movements used to execute the movement task: what occurs at the head/trunk/UE/LE? • Describe the quality of movement (speed, smoothness, amplitude, direction) Considerations: Compare performance to normal movement kinematics.
What is the main stabilization effect of the internal oblique?
Increase in intraabdominal pressure in the thorax that increases stabilization on the spine
Why do we start with CKC activities to help train balance?
Increased load to jiont stimulates mechanoreceptors Encourages functional muscle co-contractions
Why is protecting the articular surfaces important in the spine?
Increased movement will lead to instability and increased stress on articular surfaces
Take Home about Task Analysis
Initial Conditions • Starting posture • Environment Preparation • Response time Initiation • First thing to move • Speed/timing Execution • Movement description Termination • Final posture • Smoothness • Timing
Temporal sequence- 5 Stages of task performance
Initial Conditions Preparation Initiation Execution Termination
What part of the task analysis can be defined as the, "individual's system and environmental conditions"?
Initial conditions
What are the 5 components of a task analysis?
Initial conditions Preparation Initiation Execution Termination
Task Analysis
Initial conditions Preparation Initiation Execution Termination
Patho-kinesiologic Model
Key Principles: • The study of abnormal movement that is caused by an underlying pathologic condition. • How pathology affects movement. • Move beyond consideration of just pathoanatomical or pathophysiological conditions Disease, Injury, Abnormality Impairment in Component Elements Movement Impairments Disability
What are some "Williams" flexion exercises
Knees to chest Curl up Bend down, toe touch
Forms of Terminal Feedback
Knowledge of Results Knowledge of Performance
Describe the log roll
Leads with bilateral hip flexors, isom abs, upper and lower trunk move together Non-Segmental "How we all left Sarah's after table nachos"
Describe a flexion adduction roll
Leads with hip flexors and adductors, lower trunk imitated, upper trunk follows passively Segmental "Picks knees up, drops knees over"
Describe a half bridge roll
Leads with hip flexors, lower trunk initiating, upper trunk follows passively. Segmental "Half bridge position, push leg up and throws leg over"
Less extrinsic feedback may slow performance initially but may lead to improved motor (performance or learning)
Learning
what is the primary function of the hippocampus ?
Learning and memory
What are some examples of specific functional performance tests?
Leg press Step up or step down test Tuck jump assessment On leg balance test
The neutral spine is individualized for specific patients, it depends on what factors?
Length tension No pain
Muscle Length Potential Impairments
Lengthened Muscles Weakness Short and/or Stiff Muscles Decreased mobility
What muscle position produces an optimal stretch for muscle spindles?
Lengthened range
What are the 3 principles muscles involved in anterior elevation of the scapula?
Levator scapulae Rhomboids Serratus anterior
Motor Performance vs Motor Learning
Level of attention Cognitive-high Associative-medium Autonomous-low
phase 1 of grasp and lift tasks
Lift starts with contact between the fingers and the object to be lifted
Vital sign changes with aerobic exercise
Linear increase in systolic blood pressure with increased workload Linear increase in HR with workload BP=Q*TPR RR increases linearly with with increase in workload
Specific functional performance tests should have what 4 qualities?
Match function Be objective Be reliable Be sensitive to change
A safe functional maximum effort is not dictated by pain. What does this test look for?
May be safe and still have disconfert. Go until pt loses proper body mechanics Test may be self limiting SFM =@ least 100% max effot FCA - each station = max effot
Heat gain comes from
Metabolism Eating Hormones Postural changes Environment
Constant and Blocked practice schedules are more ideal to promote motor learning or motor performance?
Motor performance
Individual
Motor/action: Neuromuscular and biomechanical systems Sensory/perception: higher level processing, state of the body and the environment Cognitive: attention, planning, problem solving, motivation
Setting the scapula is an important part of scapular PNF, since it needs to be in a neutral position to move freely and efficiently. What should you do if the scapular deviated during posterior elevation-anterior depression?
Move shoulder into posterior elevated position using lateral border of hand
How can we progress to dynamic balance rehabilitation?
Move to faster speed Use higher force Uncontrolled progression Activity/sport specific
Tests and measures:
Movement analysis - hypothesis generation Specific tests and measure - clinical decision making to confirm or reject a hypothesis. Outcome measures - functional outcome measures - assess extent of impairments, activity limitations, and participation restrictions.
What is the kinesiopathic model?
Movement can create pathology (in the name)
What is fixed inter-trial variability for regulatory features?
Movement is stable and does not require much if any monitering
The scoring for the selective functional movement assessment includes 4 different labels of outcome of pattern performance. Describe what dysfunctional non painful movement is indicative of
Movement that is limited or restricted in some way because of lack of mobility, stability, or symmetry and is performed without pain or increased symptoms
The scoring for the selective functional movement assessment includes 4 different labels of outcome of pattern performance. Describe what dysfunctional painful movement is indicative of
Movement that is limited or restricted in some way because of lack of mobility, stability, or symmetry, reproduces or increases symptoms; or brings on secondary symptoms
What is Fitts' Law?
Movement time increases with task difficulty Reaching for a button is harder than a book. Farther = longer too. Think aiming, cursors, pegs in holes "Whenever arm movement precision is increased or movement distance increased, movement time becomes longer." -Fitts' Law
What are Limitations of the Reflex Theory?
Movement without sensory input -sensory blocked off still had accurate results Doesn't account for fast movements -ie. typing It only impacts the nervous system level and relies upon intact sensory system in order to work
Functional movements should be broken down into fundamental sub-movements. What are submovements?
Multi-segmental functional movements -simple and distinguished -more specific to the problem -represents a level of motor control/developmental patterns need for the development of skill
Acute unilateral back pain is usually due to atrophy of what muscle?
Multifidus. Multifidus not working correctly may be working problem which is a problem sine it stabilizes 70% of the spine
Muscle Strength/Performance Potential Impairments
Muscle Atrophy Muscle Strain Neuromodulation Decreased force production, muscle endurance and power
Muscular and Skeletal Systems Base
Muscle Strength/Performance Muscle Length Joint Integrity/ Mobility Bony Structural Variations
Hypothesized underlying impairments
Muscle/Strength performance potential impairments Recruitment, timing, order, magnitude of motor unit activation potential impairments Sensation and perception potential impairments
What are some contraindications of the stretch reflex, or quick stretch?
Muscles/tendons or bones are injured
Work hardening addresses issues in the FCA through the contents of work. What are the 6 factors this can address?
Muscular Endurance Strength Attendance Increased ROM CV endurance Client becomes in control??again of documentation and progress
What is the position in which an individual is most asymptomatic and position in which an individual can produce the greatest amount of force through their extemities?
Neutral spine
How does posture affect balance?
Neutral spine can maintain optimal alignment for strength and coordination
long-term potentiation (LTP) is when:
New and strengthened synapses are created; silent synapses turned into active ones Happens primarily in hippocampus and cortex
What are the clinical applications of Reflex Theory
No longer used to explain voluntary movement, still used in PT - PNF, NDT..
What are the 2 types of movement patterns used in PNF?
Normal functional movement Synergistic patterns (Basis for PNF)
Kinesiologic Model
Normal, optimal functioning Key Principle: • Optimal functioning and interaction of body systems is needed to maintain good musculoskeletal health and allow proper movement Variety in Joint Movements and Postures Precise Movements Good Musculoskeletal Health
Why may a person in workers compensation lead to symptom magnification behavior?
Only way they can gain control over a situation
The task analysis would go under what component of the Motor Control Framework?
Observation and Description of movement
What are the 3 components of the Motor Control Framework?
Observation and Description of movement Movement analysis Plan of care to address movement dysfunction
Hierarchial Theory
Organization of control is from top down (CNS to PNS) Limitation: what about reflexes Clinical implications: may explain abnormal reflexive activity
Hierarchial Theory
Organization of control is from top down (CNS to PNS). Each successively higher level exerts control over level below it
Describe the following characteristics of UE d1 extension: Patient position PT position Manual contacts Movement Verbal cues
Patient position: Supine with arm in flexion/add/er PT position: Face pt's head, hips in line with diagnol Manual contacts: Dorsal surface of pts hand with fingers on ulnar side and thumb on radial side. Wrap around humerus on extensor side Movement: Shoulder ext/abd/ir elbow ext/pronation wrist ulnar deviation/thumb abd Verbal cue: "Open your hand and push down and out"
Describe the following as it relates to Scapular posterior elevation and it's PNF pattern: Patient position PT position Start Manual contacts Movement Verbal cues
Patient position: Side lying, head and spine in neutral PT position: Behind pt near head, facing pelvis in line with diagonal Start: Anterior depression Manual contacts: Heel of hand on superior/posterior aspect of acromion and spine of scapula Movement: Scapula moves up and back. Resistance is down and forward Verbal cues: "Pull shoulder up and back"
Describe the following as it relates to Scapular posterior depression and it's PNF pattern: Patient position PT position Start Manual contacts Movement Verbal cues
Patient position: Side lying, head and spine in neutral PT position: Behind pt, facing head in line with diagonal Start: Anterior elevation Manual contacts: Inferior angle/medial border of scapula and posterior humerus Movement: Scapula moves down and back, inferior angle rotates toward spine. Resistance is up and forward Verbal cues: "Push shoulder down and back"
Describe the following as it relates to Pelvis Anterior depression and it's PNF pattern: Patient position PT position Start Manual contacts Movement Verbal cues
Patient position: Side-lying, hips flexed 70 degrees with head and spine in neutral PT position: Behind pt near head, facing pelvis in line with diagonol Start: Posterior elevation Manual contacts: Lateral border of hand on GT, with other hand for reinforcement Movement: Pelvis moves down and forward Verbal cues: "Pull down and forward"
Describe the following as it relates to Pelvic posterior depression and it's PNF pattern: Patient position PT position Start Manual contacts Movement Verbal cues
Patient position: Side-lying, hips flexed 80-90 degrees, head and spine in neutral PT position: Behind pt, facing head in line with diagonal Start: Anterior elevation Manual contacts: Base of hands on ischial tuberosity using lumbrical grip Movement: Pelvis moves down and back. Resistance is up and forward Verbal cues: "Sit into my hand. Push down and back"
Describe the following as it relates to Scapular anterior depression and it's PNF pattern: Patient position PT position Start Manual contacts Movement Verbal cues
Patient position: Sidelying, head and spine in neutral PT position: Behind pt near head, facing pelvis in line with diagnol Start: Posterior elevation Manual contacts: 1. Axillary border of scapula and lateral border of pec major/inferrior border of coracoid process. 2. Distal humerus Movement: Scapula moves down and forward toward opposite hip Verbal cues: "Pull your shoulder down toward your belly button"
Describe the following characteristics of LE d1 flexion: Patient position PT position Manual contacts Movement Verbal cues
Patient position: Supine with LE in D1 ext PT position: stand at pt feet facing head, hips at diagonal Manual contact: Therapist same hand contacts dorsum of foot, proximal hand on VMO area Movement: hip flex/add/er knee flex ankle DF/inversion toe ext/medial deviation
Describe the following characteristics of LE d1 extension: Patient position PT position Manual contacts Movement Verbal cues
Patient position: Supine with LE in D1 flexion PT position: stand at ankles, facing head Manual contacts: Therapist on plantar foot with proximal hand on lateral extensors Movement: Hip extension/abd/Ir knee ext ankle pf/eversion toe: flexion/lateral deviation Verbal cue: "Push down and out"
Describe the following characteristics of LE d2 flexion: Patient position PT position Manual contacts Movement Verbal cues
Patient position: Supine with LE in D2 extension PT position: stand at hip facing foot Manual contact: On distal/lateral portion of foot Proximal hand on lateral extensors Movement: Hip flex/abd/ir knee flexion ankle: df/eversion Toe: extension/lateral deviation
Describe the following characteristics of LE d2 extension: Patient position PT position Manual contacts Movement Verbal cues
Patient position: Supine with LE in D2 flexion PT position: Standing at hip facing foot Manual contact: Therapist has hand on plantar surface of foot wraps hand around distal thigh Movement: Hip ext/add/ER knee ext ankle PF, inversion toes: flexion/medial deviation Verbal cues: "toes down, pull in"
Describe the following characteristics of UE d2 flexion: Patient position PT position Manual contacts Movement Verbal cues
Patient position: Supine with arm ext/add/ir PT position: stand facing pt feet, hips on diagonal Manual contacts: On pts dorsal surface of hand and on posterior lateral humerus to remain supinated Movement: Shoulder flex/abd/er wrist extension/radial deviation thumb ext Verbal cue: "Open your hand and push out"
What 2 things should we consider when looking at someone's functional capacity at returning a person back to there job.
Person's ability to perform a job Job's impact on or requirement of the person
The following activities use what PNF scapular pattern?
Rolling forward Reaching forward Throwing a ball in sporting activites Reaching down
Think of some functional activities that use a pelvic anterior elevation PNF pattern
Rolling forward Swing phase of gait
What is the "LIFT" bilateral UE pattern used for functionally?
Rolling- sidelying to supine
What is the "CHOP" bilateral UE pattern used for functionally?
Rolling- supine to sidelying/prone supine to sit
What are some assessments for balance?
Romberg Balance error scoring system
What are the planes of movement used during synergistic exercises as incorporated with PMF?
Rotational and diagonal to mirror normal movement
Motor Program Theory
Rules for action are represented in the highest level: abstract motor program Lower levels of Hierarchy contain specific info to effect muscles for action "Every movement is directed by a specific motor program and learning new movement"
What is a serial skill?
Series of discrete actions strung together. (i.e getting dressed)
According to table 17-1 in our text, we should know the difference between a screening, testing and assessment. What is the meaning of these 3 terms?
Screening- To create grouping and classification; to check for potential risk Testing- To gauge ability Assessment- to estimate inability
Reaching up in front of body, rolling foward and gait related terminal stance, uses what kind of scapular movement?
Scapular anterior elevatoin
What kind of PNF pattern do the following activities use? Trunk extension Rolling backward Using crutches while walking Pushing up with a straight trunk
Scapular posterior depression
What PNF patterns is used during the following functional activites: Moving backward Reaching out before throwing Donning a shirt
Scapular posterior elevation
Feedback Schedule
Scheduling (when) Intensity (how often) Other variables
What is the key to joint homestasis?
Sensorimotor system proprioception
What 2 things changes/move in response to head motion or position of cilia to send a neural stimulus?
Semicircular canals Otoliths- crystals
Resultant or underlying impairments:
Sensation and perception potential impairments Muscle Length potential impairments Joint Integrity/ mobility potential impairments
Vital sign changes with anaerobic exercise
Significant change to diastolic and systolic BP due to muscle pushing on arteries (increasing TPR) during contraction Heart rate increases linearly as the body attempts to restore blood flow RR increases alinearly to buffer lactic acid build up due to metabolic byproducts of training
What is the abdominal drawing in technique?
Simultaneous contraction of Multiifidus, Internal oblique and TA. In and up contraction toward nava, and look for hallowing of lower lumbar wall
What are some functional activities of UE D1 extension?
Sit to stand Scooting forward Sit to sidelying
What positions would you use to use the abdominal drawing in technique to facilitate a co-contraction and train specific muscles?
Start with Prone, quadruped and progress to supine then functional positions
18 Steps of the Extremity Examination Which step(s) generates hypothesis?
Step 1: pain assessment, Step 2: Initial Observation, Step 3: History
Briefly describe/summarize the step up/down: weight shift, muscles, etc..
Step up: LTILWS to stance leg, flexes hip and knee of dynamic leg placing it on step. Slight forward and lateral WS to step leg, quads and glutes activate Step down: WS again towards support limb, dynamic limb steps down. Eccentric contraction of hip and knee extensors to lower body down. Forward WS onto dynamic leg. Reciprocal gait pattern
18 Steps of the Extremity Examination Which steps test the hypotheses?
Steps 4-15: objective tests and measures
What are 3 cardinal signs of symptom magnifiers?
Sx are not effected by anything Activities do not control Sx (everything is externally controlled) Things don't add up.. Objective findings don't match Sx
What do FCA tests look for?
Strength- how much can a person lift without accommodation Coordination and Balance Body mechanism Behavior during test
What is "Locking in", which is used during a timing for emphasis PNF?
Strong muscles are resisted isometrically while motion is allowed in weaker muscles
Framework provides
Structure to organize clinical practice, context to interpret clinical information
Define motor learning
Study of and acquisition or modification of a skilled action, leading to permanent changes in the capacity for producing a specific movement
What are some functional activities for the LE D1 flexion pattern?
Swing phase of gait Ascending stairs
What are the 4 types of bilateral UE patterns?
Symmetrical Asymmetrical Bilateral symmetrical reciprocal Bilateral asymmetrical reciprocal
Inconsistent symptoms during a FCA, is a common indication of what?
Symptom magnification
If another larger, global muscle is activated before the transverse abdominus, how could this lead to lower back pain?
TA is no longer recruited first, which results loss of stability in the spine
Why should you use 2 tests to simulate Sx reconstruction during a FCA?
TO test for faking
Motor Control Theory
The ability to regulate or direct mechanisms essential to movement.
Motor Control
The ability to regulate or direct the mechanisms essential to movement
Postural Control
The act of maintaining, achieving or restoring a state of balance or stability during any posture or functional activity
Outcomes
The actual results of implementing the plan of care that indicate the impact on functioning • Performance-based outcome measures • Self-reported measures
Conduction
The direct transfer of heat from one substance to another substance that it is touching. -depends on temp gradient -25x > from H2O than from air
What is the 4 roles of the physical therapist in a worker's compensation scenario?
The musculoskeletal/occupational expert Communication skills at multiple levels Pt advocate Hands-on with pts and establish rapport/trust
The scoring system for functional movement screen is on a 0-3 point scale. Describe what a score of 2 would be
The person is able to complete the movement but must compensate in some way to complete the task
The scoring system for functional movement screen is on a 0-3 point scale. Describe what a score of 1 would be
The person is unable to complete the movement pattern or is unable to assume the position to perform the movement
The scoring system for functional movement screen is on a 0-3 point scale. Describe what a score of 3 would be
The person performs the movement correctly, without compensation
Evaluation
The process of making clinical judgements based on data gathered during the examination • Interpret the individual's response to tests and measures • Integrate the test and measure data with other information collected during the history • Determine a diagnosis, prognosis, and plan of care • Potential for referral
Examination
The process of obtaining a history, performing relevant systems reviews, and selecting and administering specific tests and measures
Examination
The process of obtaining data necessary to form a diagnosis, prognosis and plan of care • History • Systems review • Tests and measures
What type of person would the following be described as: Typically female, with no future orientation If Sx are maintained they get out of unresolved conflict pt feels they are indispensable No career, rather job hop Martyr Pt responds with a "yes.. but"
The refugee
Motor Learning
The study of the acquisition and/or modification of skilled action
Convection
The transfer of thermal energy by the circulation or movement of a liquid or gas -air movement is slow=skin is warmed -air movement is fast=skin is cooled
Termination
The transition from movement to rest This is the "snapshot" at the end once movement has stopped. Include a description of the state of the performer (posture) and the environment. • What is the ending position? Alignment/posture? • Describe the environment. • Describe elements of stability, timing and accuracy. Considerations: How is the movement normally terminated? Consider stability, timing, accuracy
Initiation
The transition from rest to movement; the time when movement begins; description of where and/or movement begins; include weight shift if applicable • Note where and how the movement is initiated • Note all qualitative descriptors of initiation - speed, direction, etc Considerations: the requirements for overcoming the resting stat e to initiate movement (timing, direction, smoothness). Can the individual perform these actions? Does the movement begin with a weight shift?
Manual contact or hand placements are used to guide movement during PNF. Why is this very important?
Therapist must provide accurate sensory input to skin and pressure receptors, so patient can react appropriately to movement commands
SCI led to impairments in the nervous system
These impairments led to faulty movement SEE slide 127 ABOVE or unit4pg17 pdf
ACL tear led to impairments in the musculoskeletal system:
These impairments led to faulty movement (abnormal gait, inability to run/cut) SEE pg 19 of unit4 pdf
Describe the role of an attorney in a worker's compensation scanario
They try to win for their side Ask the therapist for documentation
What is the frequency and duration at which we should traint the 3 main stabilization muscles? (TA, IO, Multifidus)
Think endurance: Low load, long duration 1-25% of max contraction, is all that you need
What is internal imagery?
individual images being inside his/her body and experiences sensations which would be expected in the actual situation
What factors should you consider when understanding the difference in individuals when structuring your plan of care?
Unique impairments, activity limitations and participation restrictions Difference in learning styles Different psycho social factors
Personal Factors
Unique to the individual, race, gender, family background, coping styles.
The scoring for the selective functional movement assessment includes 4 different labels of outcome of pattern performance. Describe what functional non painful movement is indicative of
Unlimited, unrestricted movement that is performed without pain or increased symptoms
The scoring for the selective functional movement assessment includes 4 different labels of outcome of pattern performance. Describe what functional painful movement is indicative of
Unlimited, unrestricted movement the reproduces or increases symptoms or brings on secondary symptoms
Unmasking
Unmasking of silent or unused neural pathways
What are the 5 best practice tips to use a FCE according to "Nelson and June"?
Understand the purpose of FCE- compare functional capacity to demands of job Timing- in middle of continuum of care Outside factors- employers, payers, psycho social, family Documentation- thorough and objective communication- regular to align expectations with everyone to promote positivity
What is the action of the lumbar multifidus muscle?
Unilateral: Trunk flexion, sidebending and rotation to opposite side Bilateral: Stabilize vertebral column and lumbar extension
How would you elevate the shoulder complex during the scapular PNF pattern if it was deviating?
Use lateral border of your hand to downward rotate and retract the scapula back to neutral
Define muscular fusion
Use of co-contraction of deep abdominals to hold spine in neutral
How can diabetes affect balance?
Vision changes Sensation changes via neuropathy Neurological changes
What system measures the perception of the orientation of the head/eyes and self-motion to the environment?
Visual
What are the components of the sensory movement systems in postural control
Visual, Somatosensory, Vestibular
What functional activities can a symmetrical reciprocal PNF pattern be used for?
Walking, rolling, pushing something away, reaching overhead, dissociation of upper and lower trunk
Cold air inhalation
Water loss causes dry mouth and burning sensation, can cause brochoconstriction
long-term depression (LTD) is when:
Weakened synapses occur due to active synapses turning into silent ones Also happens primarily in the hippocampus and cortex
What are 3 ways to stimulate mechanoreceptors?
Weight-bearing Oscillations Isometrics
when issues arise
What came first, the pathology or the faulty movement pattern?
Patient History- Patient Goals
What do you hope to get out of physical therapy?
What are the components of treatment under the concept of industrial medicine?
Work hardening- patient goes through rehab, that is specific to there job. Resulted in formation of pain centers
Describe the 3 key pieces of history that lead to industrial medicine
Workers compensation Early, workers compensation cost was growing at same rate as medical costs Later, workers comp costs and claims increase more than medical costs
model of function and disability
World Health Organization's (WHO) International Classification of Functioning, Disability, & Health (ICF) model intended to help one visualize components of the current understanding of the implications and consequences of disease or disability for the ability of an individual to function in any or all domains
ICF Model
World Health organizations framework that provides conceptual framework for examinig effect of a health condition
Why is core strength very important to help with balance
You must have proximal stability before distal mobility. Base strength before extremity strength
What is an appropriate feedback schedule for a patient entering the autonomous stage of motor learning? X. concurrent constant feedback Y. Terminal constant feedback Z. bandwidth
Z. bandwidth
Motor Programming Theory
a central motor pattern may be activated by sensory stimuli or central processes
What are control parameters?
a component of the system that changes the behaivor ie) changing the speed of a stroke patient walking on a treadmill, using a harness
heat stroke
a condition marked by fever and often by unconsciousness, caused by failure of the body's temperature-regulating mechanism when exposed to excessively high temperatures.
Frostbite
a condition that results when body tissues become frozen, generally affecting exposed skin (nose, ears, cheeks, wrists, hands, feet) -superficial (partial full-thickness skin freezing) or deep (muscle, tendon, bone freezing) -treatment: move to warm place, handle area gently, re-warm by soaking in warm water, hospitalization
task analysis
a detailed observational analysis of the patients total body movement patterns during task performance
Intrinsic feedback
available through the individuals sensory system Somatosensory, vestibular, auditory may vary based on the presence of impairments
blood pressure
cardiac output x peripheral resistance
Knowledge of Results (KR)
category of augmented feedback that gives information about the outcome of an attempt to perform a skill
cortical influence on HR
central command provides the greates control over the HR. produces an anticipatory HR. Brain --> hypothalamus --> medulla --> SA node
Motor Programming Theories
central pattern generator (neural circuits for generating movement); or "rules" for generating movements
short-term neural plasticity
changes in efficiency or strength of synaptic connections
major signs and symptoms suggestive of cardiovascular, pulmonary, or metabolic disease
chest pain SOB dizzy orthopnea ankle edema palpitations intermitten claudication known heart murmur fatigue
In which stage of soft tissue healing is it safe to restore your patient to full, normal function?
chronic
indirect/compensatory neuroplasticity
completely different neural circuits enable the recovery of impaired function
Reflex Theory
complex behavior explained through individual reflexes chained together
Part-whole practice
component parts practiced prior to whole task
Human Movement System:
comprises the anatomic structures and physiologic functions that interact to move the body or its component parts. Endocrine, nervous, cardiovascular, pulmonary, integumentary, musculoskeletal.
Best feedback for motor performance
concurrent constant immediate blocked
heat exhaustion
condition resulting from exposure to heat and excessive loss of fluid through sweating
heat exhaustion
condition resulting from exposure to heat and excessive loss of fluid through sweating causing severe hyperthermia (core temp >40*C) with marked CNS disturbances & multiple organ system failure -generally dry, hot, flushed skin -life-threatening emergency -treatment: immediate whole body cooling w/cold ice/water immersion
Which of the following involves heat transfer from direct contact?
conduction
best practice for motor performance
constant blocked
heat cramps
cramps/spasms usually in large abdominal or limb muscles. factors: Muscle fatigue, water & sodium loss in sweat
Innovation
creative and proactive solutions to enhance delivery of services. Delivery models, practice patterns, education, research, patient-centered procedures, technology.
frost bite
damage to tissues as the result of exposure to cold, frozen body parts
Indications for stopping exercise
decrease SBP > 10 mmHG Increase SBP > 250 mmHG, DBP > 115 mmHG failure of HR to increase SOB poor perfusion sever fatigue angine-like symptoms ST or QRS changes arrythmias
intracellular neural plasticity
denervation supersensitivity, unmasking of silent or unused neural pathways, neural regeneration, collateral sprouting
what are the limitations for Ottawa sitting scale
lack of validity studies
Limitations of Hierarchical Theory
doesn't explain normal reflexive behavior
limitations of reflex theory
doesnt explain: how people can produce movements spontaneously, wihtout any change in sensory input, how diff responses can result from the same stim
Hypothermia
drop in core temperature. shivering, numbness, weakness, pale skin, unconsciousness
Concurrent
during the movement
continuous movement
end point is arbitrary e.g. walking or running
Exercise and Stroke Volume
enhanced cardiac filling in diastole followed by a more forceful systolic contraction
Initial conditions
environment: i.e. what is patient wearing, lighting etc.
Quality
establish and adopt best practice standards in: examination, diagnosis/classification, intervention, outcome measurement. Highest standards of teaching and learning. Researchers collaborate with practitioners to expand evidence.
What is the gross motor function measure (GMFM -88 & GMFM-66)
evaluates change in gross motor function in children w/cerebral palsy, describes a child's current level of motor function, and determine treatment goals
clinical practice
evolves in parallel w/ scientific theory, as clinicians assimilate changes in scientific theory & apply them to practice
BP responses during heavy resistance exercise
extreme increase in SBP & DBP w/ extreme mechanical compression of arterial vasculature
When locating a target, what's the order of trunk, head, and eye movement
eyes move, then head, then trunk *Feedforward and feedback control*
heat syncope
fainting that occurs when the body attempts to cool itself by dilating the blood vessels
Heat Syncope
fainting that occurs when the body attempts to cool itself by dilating the blood vessels, caused by standing erect for long periods, cessation of strenuous prolonged/upright exercise, decreased BP, or inadequate blood flow to the brain -treatment: recline supine w/feet elevated, fluid replacement, cooling
What is a continuous feedback schedules?
feedback after every trial
faded EF
feedback given less frequently w/ongoing practice
bandwidth feedback
feedback given only when there is an error
Variable Feedback
feedback is provided on multiple segments of the skill
What is a bandwidth feedback schedule?
feedback only given if errors > than certain level
delayed feedback
feedback provided several seconds or more following movement completion
concurrent feedback
feedback received during the performance of a skill
Knowledge of performance
feedback related to the movement pattern used to achieve goal
What is a faded feedback schedule?
higher frequency of feedback early in acquisition phase and less feedback in later stages
Faded
given less frequently
bandwidth EF
given only if performance fails outside of a predetermined error range
Conceptual Framework for Clinical Practice
guide clinicians through a comprehensive process of patient management, communicating with other health professionals, and facilitating educational processes.
Composite Impairment
have multiple underlying causes; arises from both primary and secondary impairments
Which of the following is a life threatening emergency?
heat stroke
Evaporation
heat transfer from H2O that vaporizes from skin to air (& respiratory tract) -skin receptors & hypothalamus (via autonomic pathways) stimulate sweat glands to release sweat to skin-> heat is transferred from skin to sweat-> sweat evaporates from liquid on skin to gas in air=transfers large amount of body heat to environment (occurs when ambient temp>skin temp, or cannot lose heat by radiation & conduction)
Evaporation
heat transfer from water that vaporizes from skin to air
denervation supersensitivity
heightened sensitivity to a neurotransmitter after the destruction of an incoming axon
What is high organization vs low organization?
high organization is dependent on what proceeds the part
Where does neurogenesis occur?
hippocampus (adults), also developing brain
Ecological Theory
how actions are geared to the environment
Ecological Theory-
how actions are geared to the environment
nonpharmacological hypertension therapy
hypotensive recovery response where there is pooling of blood in organs and lower limbs which reduces the blood pressure post exercise
Thermostat for the body
hypothalamus: central coordinating center
what is the Alberta infant motor scale (AIMS)
identifies infant and toddlers with gross motor delay and to evaluate gross motor skill maturation over time
8 guiding principles
identity, quality, collaboration, value, innovation, consumer-centricity, access/equity, advocacy
Immediate
immediately after the movement
Activity Limitation
impaired execution of a task or action by an individual
effects of frequent EF
improved motor performance, slow motor learning
According to Shumway-Cook and Woollacott, movement emerges from an:
interaction between the individual, the task, and the environment.
Impairment of body structure examples
joint swelling, muscle spasm, scarring, wound amputation
Diagnosis
labels that identify the impact of a condition on function at the level of the system and the level of the whole person
Autonomous stage of motor learning
learner continues to refine movement, high level of special and temporal organization and movement is relatively error free
Cognitive Stage of Motor Learning
learner develops an understanding of the task
Associative Stage of Motor Learning
learner refines the movement with less errors and more temporal and spacial organization
What are limitations of Ecological Theory?
less emphasis on the nervous system
what are the limitations of the Alberta infant motor scale (AIMS)
limited to infants
what are the limitations of FIST
limited to sitting
changes in HR during dynamic aerobic exercise
linear increase in HR w/ increased workload
Sensory
location of object, modification during completion of task
Conduction
loss or gain of heat by direct contact of body to another surface
Massed v. distributed
massed: practice time is greater than rest period, decreased motor performance but increased motor learning distributed: practice less than or equal to rest. increased motor performance, decreased learning
Limits of stability
maximum distance a person can intentionally move without losing balance (cone)
non-regulatory environmental factors to movement control
may affect performance, but movement does not have to conform ex: loud noises
what is the multidirectional functional reach test
measurement of self initiated self-initiated perturbation
In a cold environment, clothing should be carefully chosen to:
minimize sweating
Task constraints on movement
mobility, postural control, UE function
Participation Restriction
restriction of involvement in a life situation
cortical remapping
modification in the cortical representation of the body occurring in the brain
what is changing inter-trial variability for regulatory features?
movement diversifies and requires ongoing monitoring
Systems Theory-
movement is the result of the dynamic interaction between the perception, cognition, and action systems
Autonomous stage
movement refined, patient independent, can perform in any environment, more automatic Training: variety of environmental situations, modified feed back and practice
Termination
movement to rest
Feedback should change as patient
moves into a new stage of motor learning!
What is phase transition
moving from a stable to unstable state and back to stable
heat cramps
muscle spasms that result from a loss of large amounts of salt and water through perspiration, or muscle fatigue -treatment: rest, fluid/sodium replacement
After injury, plasticity in the form of compensatory recovery is characterized by:
nearby neural tissue taking over the neural functions of the original damaged tissue
Principle 1 "use it or lose it," suggested by Kleim and Jones (2008), refers to:
neural circuits not actively engaged in task performance for an extended period of time begin to degrade
After brain injury the intercellular response where injured axons begin sprouting is known as:
neural regeneration
How should the pelvis be positioned in static sitting position
neutral pelvic tilt, pelvis level,
• Continuous-
no recognizable beginning or end
Activity Limitation:
occurs when an individual has difficulty executing or is unable to perform tasks, actions, or ADLs
Impairment of body function
pain, reduced sensation, decreased ROM, decreased strength/power/endurance, impaired balance/coordination, poor posture, decreased aerobic capacity.
motor performance vs motor learning
performance: temporary change in motor behavior observed during practice learning: relatively permanent change that isn't directly observable, inferred & assessed via: retention test, transfer of learning, generalizability
Closed movement
performed in relative fixed or predictable environments
sensory/perceptual individual factors to movement control
peripheral sensory mechanisms and higher level processing
What is physical practice?
physical performance of the skill
Body Functions
physiological functions of the body
variable practice conditions
practicing a task w/ variations in task performance that may include changes to environment, speed, or difficulty/complexity=better for motor learning
What is constant practice?
practicing the same task in the same conditions ie) closed environment
constant practice conditions
practicing the same task the same way each time= better for motor performance
What is variable practice?
practicing the same task while varying parameters of the task (gentiles taxonomy)
Prognosis
predicted optimal level of improvement in function and amount of time needed to reach that level
Prognosis:
prediction of a patient's optimal level of function expected as a result of PT, determining an accurate prognosis is challenging, many factors influence prognosis: complexity, severity, acuity, chronicity, and expected course of health condition, impairments, activity limitations, participation restrictions, general health, comorbidities, previous functioning or disability, living environment, motivation, safety issues, extent of support, health literacy.
What are participation restrictions?
problems an individual may experience in involvement in life situations
participation restriction
problems an individual may experience in involvement in life situations
Evaluation
process of making clinical judgements based on data gathered during the examination. Can help determine potential for referral
cardiovascular drift
prolonged aerobic exercise in the heat (@ same intensity)= gradual decrease in SV, gradual increase in HR, & maintenance of Q
sensory systems during upper extremity function
provides information about the task such as where the object is located in order to anticipate the requirements of the task
intervention
purposeful and skilled interaction of the therapist with the patient
Recovery of Function
reacquisition of movement skills lost through injury
recovery of function
reacquisition of movement skills lost through injury
After brain injury the intercellular response where healthy neurons near the damaged neurons sprout new connections to neurons previously innervated by damaged neurons is known as:
reactive synaptogenesis
• Discrete-
recognizable beginning and end
discrete task
recognizable beginning and end (sit to stand)
Access/Equity
recognize and work to ameliorate health inequities and disparities
Associative stage
refining strategy for task, more consistent, proprioceptive cues, slower progress Training: video, changes to feedback necessary for refinement of movement
Environmental constraints
regulatory: shapes movement (ex. Stairs, size, shape, weight, type) non-regulatory: affects, but doesn't shape movement. (Ex. Background noise, distractions)
Learning
relatively permanent change
direct/restorative neuroplasticity
resolution of temporary changes and recovery of injured neural tissue itself
massed practice
rest is less than practice
Composite types of impairments
result of multiple underlying causes, arises form primary and secondary impairments. Ex: balance
Secondary types of impairments
result of preexisting impairments
4 systems for sensory input
sensory visual information somatosensory motorsystems
Extrinsic feedback:
sensory cues that are not normally received during the movement Examples: • Verbal cues • Visual cues (mirror, video) • Tactile cues • Auditory cues
extrinsic feedback in motor learning
sensory cues that are not normally received during the movement. external cues.
Intrinsic feedback:
sensory cues that come to the individual as a normal result of the movement. • Examples: visual, vestibular, proprioceptive and sensory signals.
What is the center of Pressure
single location where the gravitational line through the COM would strike supporting surface
What is Center of Mass
single point at which all the mass lies
effects of less EF
slow performance initially but may lead to improved motor learning on retention tests
Low frequency feedback
slows motor performance but improves motor learning
An environmental factor that can influence the effect of a health condition on functioning would be:
socioeconomic status.
Frank-Starling Law of the Heart
the more the heart fills with blood during diastole, the greater the force of contraction during systole
Long term Neural plasticity
structural changes in the organization and number of connections among neurons
Motor Learning
study of acquisition or modification of movement in normal subjects
Motor Learning
study of the acquisition and modification of skilled action
History
systemic gathering of past and present data. Demographics, social history, employment and work history, growth and development, living habits, family history, medical history, current complaints, functional status, medications, other clinical tests. Gathered from individual, family, etc.
most comprehensive theory currently
systems theories
anaerobic exercise and BP
systolic and diastolic increase
Aerobic exercise and BP
systolic increases, diastolic stays the same
motor performance
temporary change in motor behavior is observed during practice
Performance
temporary change in motor behavior observed during practice session
Motor performance v. motor learning
temporary v. permanent change
Knowledge of results
terminal feedback about the outcome of the movement
knowledge of results
terminal feedback about the outcome of the movement
Hypothesis oriented practice
tests assumptions about the nature and cause of problems via the 18-step extremity exam
A clinical implication of systems theory would be:
that examination and interventions should focus on the interacting impairments among multiple systems.
neural plasticity
the ability of the brain to change in response to experience
reactive balance
the ability to compensate and recover from unexpected perturbations (tripping, getting bumped)
steady state balance
the ability to maintain COM relative to BOS in fairly predictable and no changing conditions (walking)
Motor Control
the ability to regulate or direct the mechanisms essential to movement
What is massed practice?
the amount of time the learner is engaging in practice is higher than the time devoted to rest.
What is distributed practice?
the amount of time the learner is resting between practice attempts is equal to or greater than the amount of time the learner is engaged in activity
Relative Humidity (RH)
the amount of water vapor present in air expressed as a percentage of the amount needed for saturation at the same temperature. -most important factor of evaporation -high RH=evaporative heat transfer from skin to air is greatly diminished
In the APTA's model of practice prognosis refers to:
the anticipated goals and outcomes, and the expected duration and frequency of interventions.
Wind Chill Temperature Index
the effect of wind and temperature on a person's body which can lead to increased heat loss from the body and a lowering of body T° -running into wind=increased effect -running w/tailwind=decreased effect
What is Activity?
the execution of a task or action by an individual
Value
the heath outcomes achieved per dollar spent. Services with best value will be: safe, effective, timely, patient-centered, equitable. Meaningful and cost-effective PT outcomes.
Stability
the inherent ability of an object to remain in or return to a specific state of balance and not fall
Thermoregulation
the maintenance of body temperature within a range that enables cells to function efficiently.
What is are attractor states?
the system in a stable or unstable state
theories of motor control & learning
therapist actions are based on assumptions derived from theories
osteopenia
thinner than average bone density (beginning of OP)
Convection
transfer of heat to moving air or water molecules
Motor learning
understanding of acquisition of skilled actions, set of processes with the steps that lead to a permanent change in performance of a certain movement
how should the trunk be positioned in static sitting position
upright back angle 95-100, slight lordosis
Heat stress index
used to determine heat sensation based on temperature and humidity
Neural regeneration
very slow, may not occur in CNS. More common in PNS
Personal Factors
• Age • Education • Socioeconomic status • Comorbidities • Lifestyle • Exercise • Diet • Psychosocial attributes
Environmental Factors
• External to the individual • Facilitate or hinder impact • Climate • Terrain • Attitudes • Laws
Knowledge of Performance
• Feedback related to the movement pattern used to achieve the goal • You didn't straighten your knee all the way • You knee collapsed in on the way down • Your shoulder blade was too close to your ear on that rep
Neural Regeneration (regenerative synaptogenesis)
• Injured axons begin sprouting • Limited ability in the CNS
Types of Feedback:
• Intrinsic Feedback • Extrinsic Feedback
Autonomous
• Learner continue to refine movement, high level of spacial and temporal organization and movement is relatively error free • "How to succeed" decision
Cortical Re-Mapping
• Modification in the cortical representation of the body occurring in the brain • Occurs following PNS injury, CNS injury, activity, behavior, and skill acquisition *Can occur after decrease in sensory input (amputation) or increase in sensory input (new skill acquisition)*
Neural Plasticity
• Plasticity- the ability to show modification d• A continuum for short-term changes in the efficiency or strength of synaptic connections to long term structural changes in the organization and number of connections among neurons.
Denervation Supersensitivity
• Postsynaptic membrane of a neuron becomes hyperactive to a released transmitter substance
Conceptual Framework Components:
• Principles of motor control & motor learning • Evidence-based clinical practice