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TEII WK2 LEC Perkins
TEII WK2 Perkins Lecture - Brunnstrom, Rood
| Question | Answer |
|---|---|
| Common Assumptions underlying Neurophysiologic treatment approaches on how the CNS controls movement | - four approaches will be emphasized. - Approaches are to help normalize muscle tone and promote normal movement patterns. -overlapping concepts - encouraged to mix and match for pt. tx |
| The four approaches presented in this section are: | - Brunnstrom - Rood - PNF - NDT |
| There are several ways to manage tone. They include but are not limited to the following five techniques: | 1. Neurophysiological treatments (Brunnstrom, Rood, PNF, NDT) 2. serial casting 3. orthotics/splinting 4. biofeedback/ E- Stim 5. medications (MEDS OUT OF SCOPE PT/PTA) |
| BRUNNSTROM | -studied CVA's -theorized that basic limb synergies (abnormal mvmnt patterns) were primitive reflex patterns. -concluded that CVA pt. progress thru predictable stages of recovery -some remain in stages permanently - do not progress thru all |
| TIP 1: Not unusual to find that the UE's & LE's are at different stages | TIP 2: LE is usually less affected than the UE. |
| STAGES OF RECOVERY ACCORDING TO BRUNNSTROM | Must move through all stages - no skipping stages - some pt. do not make it to the end stage, they remain in a given stage and exhibit signs and symptoms of that stage - not everything always recovers. |
| Stage One (Brunnstrom) | -Faccidity Stage - no mvmnt is seen and hypotonicity is present. - at risk for sublaxation -FACILITATE IN THIS STAGE |
| Stage Two (Brunnstrom) | -Beginning synergies thru associated reactions or voluntary attempts. - Hypotonicity is beginning to move towards hypertonicity - may feel some muscle tension with ROM -FACILITATE TOWARDS SYNERGY PATTERNS IN THIS STAGE |
| Stage Three (Brunnstrom) | - Synergy obligated- synergy patterns are strong - primitive, automatic, and difficult to control -pt remain here a long time - severly involved may never go further -INHIBIT SYNERGY PATTERNS IN THIS STAGE |
| Stage Four (Brunnstrom) | -When the pt. progresses and spacticity begins to decrease - some mvmnt combos outside of the abnormal synergy start to emerge. _INHIBIT STRONG SYNERGY PATTERNS AND FACILITATE OUT OF SYNERGY PATTERNS |
| Stage Five (Brunnstrom) | - pt. continues to progress outside of the synergy patterns and there is some independent joint mvmnts although it requires great concentration. -FACILITATE OUT OF SYNERGY PATTERNS - MAY HAVE TO INHIBIT SOME TO GET THERE |
| Stage Six (Brunnstrom) | -Active and isolated mvmnts and normal tone is present. -FACILITATE |
| Generally, what stages do we as PTA's want to facilitate in? | 1, 2, 4, 5, 6 |
| Which stages do we generally want to inhibit in? | 3 (also any abnormal mvmnts in 4,5,6) |
| In what stages are associated reactions appropriate? | Stages 1 & 2 |
| What are associated reactions? | Defined as voluntary forceful mvmnts of a body part elicit overflow of mvmnt in an involved body part. Some Voluntarty mvmnts such as sneezing and coughing elicit these responses also. - FACILITATE UNINVOLVED LIMB TO GET SAME REACTION IN INVOLVED LIMB. |
| Ramiste's Phenomenon | -resisted hip abd/add may elicit same response in opp. limb - resist right abd/add may elicit left abd/add -True of UE's and LE's |
| Homolateral limb synkinesis | -resisting the UE on one side may get the same response in the same side LE -example - resisted shoulder flexion in the right UE may elicit Right LE hip flexion. |
| Bilateral UE | resisted, the right UE or LE may elicit the same response in the left UE or LE - |
| Bilateral LE | -resisted motion in one extremity may elicit the opposite response in the opposite extremity - remember flexor withdrawl |
| Soques's Phenomenon | -raising the arms overhead may elicit finger extension - use in flaccid stage one or two |
| Primitive reflexes like ATNR and STNR | -turn head to the right may elicit right UE extension and left UE flexion |
| SYNERGY PATTERNS | UE FLEXION UE EXTESION LE FLEXION LE EXTENSION |
| UE Flexion Pattern | shoulder flx, elevation, and/or retraction, abduction, and external rotation\ elbow flx, forearm supination, wrist flx, and finger flx |
| UE Extension Pattern | Shoulder depression, and/ or protraction, adduction, and internal rotation elbow ext. forearm pronation, wrist ext. and finger ext. |
| LE Flexion Pattern | Hip flx, abduction, and external rotation, knee flexion, ankle dorsiflx, footinversion, and toe ext. |
| LE Extension Pattern | Pelvic retraction, and/or elevation Hip ext., adduction, and internal rotation, knee ext, ankle plantarflx, foot inversion, and toe flx. |
| GENERAL PRINCIPLES OF SYNERGY PATTERNS | There are several general principles to consider when working with patients with synergy patterns. These include the strongest components of the pattern, as well as other reminders |
| Which pattern usually predominates in the UE? | UE Flexion Synergy Pattern |
| Which pattern usually predominates the LE? | LE Extension Pattern |
| In the UE Flexion Pattern, which component is dominate? | Elbow Flexion |
| In the UE Extension Pattern, which components are strongest? | Shoulder Adduction and forearm pronation. |
| In the LE Flexion Pattern, which component is the dominate one? | Hip Flexion |
| In the lE Extenion Pattern, which components are the strongest? | Hip adduction, knee extension, and plantarflexion |
| Typically the strong components are ___________ to show up and ________to leave. | first to show up and last to leave. |
| The strong components tend to ________. If you _________ those components, the rest will ___________. | -strong components tend to lead -Inhibit those and the rest will follow. |
| TIP One: Elicit dominate components in flaccid arm or leg but be careful, we want ISOLATED joint mvmnts NOT multi joint patterns | TIP TWO: Inhibit the multi joint mvmnts and encourage isolated joint mvmnts |
| How can we encourage isolated joint mvmnts? | -Facilitation/inhibition techniques, NDT, PNF -Most always functional activities are included as well |
| Movement Patterns Associated with Stage Four- indicate a pt has progressed to Stage Four | - In sitting, knee flx beyond 90 with the foot sliding backwards on the floor. -Active dorsiflx w/out lifting the heel off the floor -Hip flx past 90 -Partial finger ext. |
| Movement Patterns Associated with Stage Five- indicate a pt has progressed to Stage Five | - Standing, isolated nonweightbearing knee flx, hip ext, (or nearly) - Stand, isloated dorsi, knee ext. heel forward in a position of a short step OR Sit w isolated dorsi w knee ext -isolated ankle eversion to/from inversion w knee ext -full finger |
| MARGARET ROOD | OT/PT - primarily worked with CP kids |
| General principle of Rood #1 | Because motor control output is dependent on sensory input, sensory stimuli are used to activate, facilitate, or inhibit motor responses. -Usually followed by some kind of functional activity or positioning so the body can relearn "normal" fashion. |
| Three kinds of sensory receptors we typically use ? | -Exteroceptors -Proprioceptors -Vestibular receptors |
| Exteroceptors | superficial and can cause reciprocal innervation (senses such as tactile and temp.) |
| Propioceptors | give us muscle awareness (GTO, spindles, joint receptors) |
| Vestibular receptors | semicircular canals |
| The responses we look for with ROOD are: | -Activation -Facilitation of Normal Muscle Tone -Inhibition of abnormal muscle tone |
| What are we looking for with Activation (Rood) | -Elicit a response you don't see or have not seen before - usually sensory stim. (i.e. pt in coma) |
| What are we looking for with facilitation of normal muscle tone? (Rood) | -Enhance a reaction or an existing motor response, changing the quality of a response so that it is stronger, more controlled, or coordinated. |
| What are we looking for with inhibition of abnormal muscle tone? (Rood) | -Decrease an existing motor response to allow a more adaptive or productive pattern to emerge. |
| General Principle of ROOD #2 | -Look for homeostasis in tx -Balance between the sympathetic and parasympathetic (the autonomic nervous system) -Important because it will influence the pt. response to stimuli. |
| What are some examples of ways to include the principles of ROOD in tx? | -tone of voice -rhythmical mvmnts -neutral warmth -ice -joint compression -tapping -vibration -slow rolling -prolonged passive stretch -firm tendinous insertion pressure -weight bearing -ECT. -NOTE:can use individually or in combos. |
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deepolzin
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