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