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TEII WK2 LEC Perkins

TEII WK2 Perkins Lecture - Brunnstrom, Rood

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
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.
Created by: deepolzin