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thera ex

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
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*
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
Created by: mayshironnah
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