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thera ex
| Question | Answer |
|---|---|
| most common aaffected artery | middle cerebral artery (MCA) |
| stereotypes;does not permit different combinations of movt; primitive; reflexive; loss of inhibitory ctrl | basic limb synergies |
| "evolution in reverse"; recapitulated during ONTOGENESIS | Hughling Jackson's phylogenetic organization of nervous centers |
| Hughling Jackson's phylogenetic organization of nervous centers: -few combi, most automatic | lowest motor centers |
| Hughling Jackson's phylogenetic organization of nervous centers: -more combi, ^ voluntary, v automatic | middle motor centers |
| Hughling Jackson's phylogenetic organization of nervous centers: -most numerous combi, most voluntary | highest motor centers |
| flexor synergistic pattern of UE | - retraction and/or elev of sh - sh ER, 90deg abd - elbow flex* (acute <) - full ROM FA supn - wrist and finger flex |
| extensor synergistic pattern of UE | - sh girdle prot - sh AddIR* - elbow ext (full ROM) - full ROM FA pron - wrist ext - finger flex/ext |
| flexor synergistic pattern of LE | - hip FAb*ER - knee 90deg flex - ankle DF, inv - toe DF |
| Extensor synergistic pattern of LE | - hip ExAddIR - knee ext* - ankle PF, eve - toe PF (big toe may ext) |
| Typical Posture (from head to toe) | - head & trunk flexed to affected side - scap retracted abd depressed - sh AddIR (2) - elbow flexed (1) - FA pron (3) - wrist & fingers flexed - pelvis retracted and PPT - hip ExIR, Add(2) - ankle DF (1) - subtalar inv - toes flexed |
| weak components (FLATS mm) | Finger flexors Latissimus dorsi Ankle evertors Teres major Serratus Ant |
| Symmetrical tonic neck reflexes (stimulus, reaxn, integ) | S: flex ad ext of neck R: in flex, UE flex & LE ext (v.v) I: 6-7 mos |
| Asymmetrical tonic neck reflex (SRI) | (flex of skull limbs, ext of jaw limbs) S: head rot R: head rot to (L) >> (L) UE ext & (R) UE flex I: 6-7 mos |
| Tonic Labyrinthine Reflex (SRI) | S: head poxn in space R: in supine (belly up), ^ ext tone; in prone (belly down), ^ flexor tone I: 4-6 mos |
| Tonic Lumbar reflex (SRI) | S: change in poxn of trunk c respect to pelvis R: rot to (R) >> flex of (R) UE & ext of (R) LE (v.v) I: |
| reflex tensing of mm & involuntary limb movt in pxs c hemiparesis | Associated reactions |
| commonly elicited during spastic stage | Associated reactions |
| in Assoc. Reaxns, UE reactions tend to be... | SAME flex tend to evoke flex |
| in Assoc. Reaxns, LE reactions tend to be... | OPPOSITE flex tend to evoke ext |
| Brunnstrom's conclusion | 1. may be evoked during flaccid stage 2. ^ voluntary ctrl during & p spasticity 3. may be present years p onset of hemiplegia 4. repeated stimuli to evoke response 5. ^ mm tension of bad limb p removal of stim 6. attitudinal reflex affects ARs |
| theorized by Temple Fay | HOMOLATERAL LIMB SYNKINESIS |
| originates on amphibian level of evolution | HOMOLATERAL LIMB SYNKINESIS |
| RAIMISTE PHENOMENON | (ABD) S: <supine> R abd on lat side of good hip R: abd of bad hip *v.v on add* |
| SEQUENCE OF RESTORATION OF GRASP | |
| 1. return of stretch reflex (monosegmental SC reflex) 2. proprioceptive traction response (plurisegmental SC reflex >> higher centers than SC) 3. grasp reflex (subcortical response) 4. instinctive grasp reflex (cortical component) 5. complete ctrl c G-R b | |
| 7 STEPS IN RESTORATION OF HAND FXN | 1.tendon reflex return & become hyperactive 2. spasticity develops, R to PROMs 3. vol finger flex when faci c proprio stim 4. PTR can be elicited 5. ctrl of hand movt c proprio stim begins 6. v spasticity, grasp c tactile stim on hand 7. (+) true grasp re |
| stretch of flexor mm of one of the jts of UE facilitates coxn of flexor mm of all jts >> total shortening of UE; faci by tonic neck reflex | Proprioceptive traction response (PTR) |
| TRUE GRASP REFLEX | S: distally moving deep P over certain areas of palms & fingers R: ^ >> flex; (if b/n fingers >> abd/add |
| 2 Phases of true grasp reflex | catching and holding phase |
| CATCHING PHASE | (grasp reflex) weak cons of flexor and adductor mm |
| HOLDING PHASE | (traction response) appears only if traction is made on tendons of mm activated during catching phase |
| traction response vs grasp reflex | STIMULUS: traction >> stretch grasp >> tactile |
| common in frontal lobe lesn | instictive grasp reflex |
| instictive grasp reflex | S: stationary contact c palm of hand R: involuntary fist closure ** when elicited, difficult to release |
| "forced groping" | instictive grasp reflex |
| common c parietal lobe lesion | instictive avoiding reaction |
| instictive avoiding reaction | S: fwd-upward dir. of arm (of PT?) R: fingers hyperextend |
| Soque's finger phenomenon | S: arms passively raised overhead R: Fist opened and fingers ext |
| flaccidity stage | Brunnstrom's stage 1 |
| basic limb synergies | Brunnstrom's stage 2 |
| minimal voluntary | Brunnstrom's stage 2 |
| spasticity begins | Brunnstrom's stage 2 |
| in hand, little/no finger flex | Brunnstrom's stage 2 |
| in trunk & limb, min voluntary ctrl | Brunnstrom's stage 2 |
| vol ctrl of movt synergies | Brunnstrom's stage 3 |
| spasticity at its peak | Brunnstrom's stage 3 |
| able to initiate movt | Brunnstrom's stage 3 |
| unable to ctrl form of movt | Brunnstrom's stage 3 |
| contracture tend to develop | Brunnstrom's stage 3 |
| common mm that tend to develop cx | pecs major FA pronators wrist and finger flexors |
| Brunnstrom's stage 3 (hand) | -mass grasp -hook grasp s release -s vol finger ext |
| HKA flexed in sitting and standing | Brunnstrom's stage 3 |
| some movt combi besides limb synergies are masrtered | Brunnstrom's stage 4 |
| placing hand behind the body | Brunnstrom's stage 4 (lats dorsi, rhomboids, teres mj) |
| fwd-hor elev of arm (v linkage of pecs mj and triceps) | Brunnstrom's stage 4 |
| pron-supn c elbows flexed to 90deg | Brunnstrom's stage 4 |
| Brunnstrom's stage 4 (hand) | -lat prehension -semivoluntary finger ext (small ROM) |
| in sitting, 90deg knee flex c foot slidig on the flr | Brunnstrom's stage 4 |
| vol DF s lifting foot of the flr | Brunnstrom's stage 4 |
| more difficult movt combi mastered | Brunnstrom's stage 5 |
| spasticity continuess to decline | Brunnstrom's stage 5 |
| arms raising to side hor | Brunnstrom's stage 5 |
| arms raising fwd and overhead | Brunnstrom's stage 5 |
| pron-supn c elbow ext | Brunnstrom's stage 5 |
| Brunnstrom's stage 5 (hand) | -palmar prehension (cylinder/sphere) -vol mass ext |
| order of difficulty in prehension | hook lat prehension palmar prehension cylindrical spherical |
| isolated NWB knee flex c hip extended while standing | Brunnstrom's stage 5 |
| isolate ankle DF c knee extended while standing (heel fwd in short step poxn) | Brunnstrom's stage 5 |
| indiv jt movt is possible | Brunnstrom's stage 6 |
| coordination approaches normally | Brunnstrom's stage 6 |
| spasticity disappears | Brunnstrom's stage 6 |
| movt are well-coordinated and near normal but c some awkwardeness | Brunnstrom's stage 6 |
| s spasticity on PROM | Brunnstrom's stage 6 |
| Brunnstrom's stage 6 (hand) | -all prehensile types under ctrl -full ROM voluntary finger ext -indiv finger movt present |
| in standing, abd of hip | Brunnstrom's stage 6 |
| ER and IR of knee, and inv and eve of ankle in sitting | Brunnstrom's stage 6 |
| Upper motor neuron lesion sx | (PUSH) -(+)pathologic primitive reflex -spasticity (pyramidal) **rigidity>>extrapyramidal -hyperreflexia (in PD) |
| lower motor neuron sx | (FLAN) -flaccidity -areflexia -(-)pathologic reflexes |
| aka "golden period"; permanent damage to the brain | 3-6 mos |
| Pioneers of the Bobath principle | Karel (neuroligist) and Berta (gymnast and PT) Bobath |
| (FIB) "everyskilled actions takes place against a background of basic patterns of..." | ...postural ctrl, righting, equilibrium, other protective reaxns, RGR (reach, grasp, and release) |
| GOAL in Bobath | to be functional as early as possible |
| proximal key points of ctrl | -neck and spine -sh girdle -pelvic girdle |
| distal KP | -elbow -knee -hands -feet |
| reflex inhibiting patterns in UE | -neck and spine ext -sh ER -elbow and wrist ext -FA supn -thumb abd |
| reflex inhibiting pattern of LE | -hip AbER -hip & knee ext -ankle and toe >>> DF -big toe abd |
| 3 fundamental problems in bobath | 1. abn patterns of coordination of Posture and movt 2. abn qlty of postural tone 3. reciprocal innervations |
| adequate stim produced excitation of flexor grps of mm of an extended leg c simultaneous inh of antagonistic mm gram | reciprocal innervation |
| a |
Created by:
mayshironnah
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