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