TE II WK 1 Perkins Lecture - UMN LMN Motor development, learning, ect
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| Upper Motor Neuron Syndrome/Lesion refers to ? | involvement of the nervous system above the anterior horn cell.
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| Where do UMN lesions occur? | In the CNS - brain, brain stem, or spinal cord.
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| Examples of UNM lesions | CVA, CP, TBI
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| Lower Motor Neuron Syndrome/ Lesion refers to ? | involvement of the nervous system at or below the anterior horn cell.
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| Where do LNM lesions occur? | In the PNS- anterior horn cell, motor cranial nuclei, peripheral nerve, myoneural junction.
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| What happens within the nervous system with a LMN lesion? | The CNS is left intact however it does not allow for connection to the periphery.
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| Examples of LNM lesions | Poliomyelitis, Gullain Barre, peripheral nerve injuries.
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| Signs of UMN lesion | The following signs indicate UMN lesion. (pt. presents with these signs)
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| Muscle tone is _________ in a pt. with a UMN. | abnormal
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| Is muscle atrophy present with an UMN lesion? | No
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| Patients will present a condition of what type of reflexes? | Hyperreflexia
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| Is Babinski or Clonus present in UMN lesions? | No
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| What kind of paralysis presents with UMN lesions? | Spastic
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| Is fatigue present with UMN lesions? | yes
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| Pt.s with UMN lesions present with conditions such as ataxia and athetosis, which are what kind of disorders? | movement
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| What type of reflex patterns do pt.s with UMN lesions present with? | primitive
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| pt.s with UMN lesions will have difficulties with tone that will differ known as what? | dystonia
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| LMN lesion signs | pt.s with LMN lesions will present with the following indicators.
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| Tone is not present with LMN lesions known as what? | hypotonia.
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| Will marked atrophy be present? | yes
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| Pt. with a LMN lesion will present with spontaneous actions of muscle known as what? | fasciculations or fibrillations
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| pt.s with LMN lesions present with sluggish or minimal movement reflexes known as what condition? | hyporeflexia
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| Are Clonus and Babinski present with a LMN lesion? | no
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| What type of paralysis is present with a LMN lesion? | flaccid
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| Is fatigue present with a LMN lesion? | yes
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| Tone | passive resistance to stretch offered by a muscle group to external manipulation. Includes both neural and nonneural components. There is a broad range of muscle tone abnormal abnormalities.
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| Normal Tone | tone which is high enough to control the body against gravity but low enough to allow movement.
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| Spasticity/Hypertonicity | velocity dependent increase in muscle's resistance to passive stretch.
slow speed = less resistance
fast speed = increased resistance
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| Rigidity | involuntary increase in resistance of muscle to passive stretch that is uniform throughout the range of motion of the muscle being stretched which is not velocity dependent.
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| Hypotonicity (low tone) Flaccidity (no tone) | No resistance to passive muscle stretch.
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| Clonus | a series of repetitive, rhythmic, contractions, relaxations, and contractions with the sudden application of sustained stretch to a muscle.
Often elicited when the tendon reflexes are exaggerated after a UMN lesion.
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| Hyperreflexia | exagerrated/ increased deep tendon reflexes
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| Hyporeflexia | decreased deep tendon reflexes
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| Babinski | An extension or dorsiflexion of the great toe with fanning of the other toes with the stimulus of stroking the lateral aspect of the sole of the foot - considered a sign of cortical motor tract damage- UMN lesion.
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| Primitive reflex | spontaneous, stereotypical patterns of motor activity, associated with a variety of stimuli.
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| Athetosis | slow writhing movements of the neck, trunk, or limbs, which are not marked in the distal segments of the limb. UE usually involved more than the LE. Athethoid movements are exaggerated by attempts to use the limb in voluntary movements.
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| Chorea | INVOLUNTARY jerky movements
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| Weakness (paresis) | lower strength of active muscle contraction than that expected with consideration of age, sex and body habits. The inability to generate sufficient force or tension for the purpose of posture or movement.
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| Paralysis | Complete inability to activate muscle contraction
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| Fatigue | Inability to sustain a work performance level for a voluntary muscle contractile activity at normal levels.
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| Ataxia | a problem of incoordination with delays in the initiation of movement or errors in the range, force, or metrics of a movement - seen with voluntary movements.
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| Muscle atrophy | When the motor supply to the muscle is disrupted, myofibrils and sarcoplasm are lost. The muscle cell becomes smaller and is referred to as atrophic.
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| Apraxia | Inability to carry out a purposeful movement.
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| Normal Motor Development | the acquisition and production of movement across the lifespan - occur in sequence and are age relate - requires intact sensory, muscular, nervous, and cardio systems.
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| Developmental Sequence | Sequential motor acquisition
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| Directional Concepts | Identify the direction in which growth and development occur.
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| Cephalic to Caudal | Development progresses from head to trunk-
Head control before trunk control
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| Proximal to Distal | Development occurs from proximal to distal
- midline to the neck, then midline to the trunk, then the shoulders and pelvis before controlling the arms, legs, hands, and feet.
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| Asymmetrical to Symmetrical | Head and trunk : newborns start life with head to one side and become more midline about 4 months
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| Gross to Fine Motor | Overall changes in motor skill acquisition is from gross, large muscle movements to fine, more discrete movements.
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| Gross Motor Skills relate to what? | Motor milestones which pertain to the synergy of large muscle groups. (Large muscle groups working in sync to produce movements such as rolling, sitting, crawling, creeping, cruising, running, hopping, skipping, ect.)
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| Fine motor skills relate to what? | manual dexterity and coordination of the hand which pertains to the synergy of small muscles in the hand.
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| Kinesiologic Concepts |
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| Extension- Flexion | Crucial to development is the balance between flexors and extensors around a joint or body part esp. the neck and trunk.
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| Mobility- Stability Stages | Mobility
Stability
Mobility on Stability with distal end fixed
Mobility on Stability with distal end free
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| Reflexes to Reactions | Reflexes are present first followed by reactions.
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| Reflexes | auto response to stimuli
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| Postural Reactions | auto responses to loss of balance
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| What are the three types of postural reactions? | Protective, righting, and equilibrium.
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| Protective reactions | seen in response to quickly lowering the body toward a supporting surface.
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| Righting reactions | a maintenance or restoration of the proper alignment of the head or trunk in space. Righting reactions become incorporated into equilibrium reactions and therefore persist as part of our automatic balance mechanism.
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| Equilibrium Reactions | involve a total body response to a slow shift of the center of gravity outside the BOS.
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| Weight Shift | Every movement involves a weight shift that alters the center of gravity.
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| Treatment Approaches |
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| Conventional Approach | worked on strengthening individual muscles not synergies between muscles - functional activity training without regard to compensation.
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| Muscle ( Movement ) Re-education = Neurofacillitaition approaches = Neurophysiologic approaches | re-ed of movement patterns
NDT (Bobath), PNF, Brunnstrom, Rood
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| Task- orientated Approach (Newest) | Uses dynamic systems model of motor control to justify its treatment approach - MOTOR CONTROL.
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| Motor Control | How the nervous system controls the initiation and execution of movement.
The scientific field of study concerned with how movement is controlled genetically or learned through practice.
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| General Principles | - Motor learning is a process of problem solving
- Utilizes effective compensations if necessary
- Utilizes the environment
- Not concerned with the movement per se. The movement is a means by which the goal directed behaviors achieved.
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| Analysis of Tasks | What are the components of the task/ skill - A. Task B. Environment C. Performer
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| Task | - goal/ skill acquisition (function the PTA wants to obtain)
- What are the requirements of the task
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| Environment _ What do you need to do with it? | - regulate the environment
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| Performer - What two things do you need to know about your pt.? | - selective attention of pt (cognitive awareness)
- learning style of pt.
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| NS Recovery following NS injury- What two things should be kept in mind concerning NS recovery? | - Windows of "spontaneous recovery"- - Neural plasticity
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| Windows of spontaneous recovery | -This means the recovery seen after neural shock.
-pt. can learn or relearn after, but due to neural plasticity, windows are best recovery time
- guidelines are general and each person is different.
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| Neural plasticity | The brain's ability to make another connection following neural insult - makes another route, picking up neurons along the way to retrain with new pathway
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| Neural plasticity of the PNS - nerves are concerned with doing what? | regeneration
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| Neural plasticity of the CNS - nerves are concerned with doing what? | reorganization
-reorganization w/ motor learning
-thought to occur w/ growth of new synapses of cell bodies making connections.
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| Window of spontaneous recovery following a TBI | 1 year
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| Window of spontaneous recovery following a CVA | 6 months
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| Window of spontaneous recovery following a SCI | 3-6 months
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| Motor learning | a set of processes associated with practice or experience leading a relatively permanent change in behavior/skill.
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| Skill acquisition | defined as the ability to achieve a desired outcome with consistency (doing task safely, flexibility (in diff. environments/ terrain), and efficiently (least energy consumption).
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| Indicators of motor learning | retention & transferability
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| Strategies to improve motor learning | A. treat for specific STAGE of motor learning
B. PRACTICE (in parts, whole, in a variety of settings)
C. MOTIVATION (learn pt. goals, likes/dislikes, hobbies)
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| Three Stages of Motor Learning - What are they? | A. Cognitive (Early) Stage
B. Associative (Intermediate) Stage
C. Autonomous (late) Stage
(refer to O'Sullivan table 13-5)
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| Applications of motor learning to therapeutic interventions |
A. practice schedule
B. Feedback
C. demonstration/modeling
D. types of learning
E. goal directed task - motivation
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| Block practice | a set of practice trials that concentrate on one specific task and then switches to another.
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| Random practice | switching between tasks in tx sessions, in a natural random order (*promotes more learning*)
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| Feedback during practice | verbal and manual cues
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| Frequency of feedback | frequency at which feedback is given
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| Summary of feedback | type of feedback in which feedback is given in summary form after a series of task trials with no feedback. Feedback regards all the trials together as a whole.
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| Faded feedback | Type of feedback in which feedback is given frequently in the earlier stages and then generally reduced as practice progresses.
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| Bandwidth Feedback | Type of feedback in which error information is only given if the movement of the task is outside a predetermined band of correctness.
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| Key with Feedback | Type of feedback in which less Feedback is better, and let what you say be meaningful
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| What are the three types of learning styles you may encounter with your pt.s? | auditory
visual
kinesthetic
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| What does goal directed task mean? | A goal directed task is meaningful to the pt. It is motivational because it is a task the pt. is interested in doing. It has meaning to the pt.
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| KEY THINGS TO REMEMBER WHEN TREATING NEUROLOGICALLY INVOLVED PATIENTS | -Task is goal directed
-To progress pt principles of:
--directional concepts in normal development
--mobility - stability stages
--progress from Cognitive to Automatic responses
--Application of motor learning principles to tx program
--Avoid compen
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