Question 1

NDT is referred to as what

Accepted Answer

Bobath approach  Bc it was developed by Berta and Karel Bobath

Question 2

What is the MAIN assumption of NDT

Accepted Answer

it is impossible to superimpose normal movement patterns over abnormal patterns

Question 3

NDT is one of the most commonly used treatment approaches in OT for treatment in what

Accepted Answer

-children with neurological deficits -adults with hemiplegia and tbi

Question 4

What are all of the assumptions of NDT

Accepted Answer

*Model of motor control Originally assumed the hierarchical organization of CNS* Continues to view the CNS as important for movement, but has also adopted the view that movement is a result of multiple interacting processes.   *CNS damage results in motor dysfunction* -Development of abnormal tone and movement -Loss of effective movement responses  Normal movement can not be superimposed on abnormal movements   *Function improved through use of effective movement patterns* -Handling: - manual hands on interventions designed to change muscle tone and normalize the quality of the pateint\'s movements. Handling is used for inhibition and facilitiation -Key points of control -Inhibition/facilitation

Question 5

NDT looked at what kind of system

Accepted Answer

*Looked at hierarchical system*  Hierarchical - spinal cord - brainstem- cortical  Cephalo-caudal, proximal - distal, gross to fine

Question 6

what are associated reactions

Accepted Answer

involuntary and nonfunctional changes in limb position and muscle tone associated with difficult or stressful activities

Question 7

facilitation vs inhibition

Accepted Answer

Facilitation: manual techniques and other processes including tactile and verbal feedback used to help the patient achieve a more normal quality of movement  Inhibition: manual techniques and positions used to decrease or eliminate the effects of spasticity and/or abnormal reflex activity

Question 8

Flaccidity  Increased tone Severe tone

Accepted Answer

Flaccidity: no movement  Increased tone: abnormal patterns Severe tone: posturing

Question 9

Distributed model of control

Accepted Answer

Lesion can result in: -Abnormal tone -Disturbed synergistic organization -Weakness -Perceptual deficits -Impaired sensation -Dec ROM -Balance deficits

Question 10

Systems model of motor control

Accepted Answer

Looks at multiple interacting processes   Task goals in the center of: -environmental systems -comparing systems -sensorimotor systems -musculoskeletal systems -commanding systems -regulation systems

Question 11

Motor impairments result in what

Accepted Answer

movement dysfunction

Question 12

Positive signs vs negative signs

Accepted Answer

*Positive Signs*  Spasticity: lack of control from descending tracts -Impaired muscle activation -Impaired motor execution  *Negative Signs* Weakness -Insufficient Force Generation Impaired anticipatory postural Control Hypokinesia -poverty of Movement Loss of Fractionated or Dissociated Movements

Question 13

What is spasticity

Accepted Answer

\"an upper motor neuron disorder that is characterized by velocity-dependent increases in tonic stretch reflexes with exaggerated tendon jerks and clonus resulting from *hyperexcitability of the stretch reflex*\"

Question 14

What kind of input does spasticity have

Accepted Answer

*enhanced excitatory input*  *Reduced inhibitory input because of impaired descending pathways*

Question 15

What are the steps to the knee jerk reflex

Accepted Answer

1. afferent impulses from stretch receptor to spinal cord  2. efferent impulses to alpha motor neurons cause contraction of the stretched muscle that resists/reverse the stretch  3. efferent impulses to antagonist muscles are dampled (reciprocal inhibition)

Question 16

Early vs recent research on spasticity

Accepted Answer

In early NDT research spasticity was thought to be the primary impairment creating movement dysfunction  Recent research has shown that even when spasticity is inhibited through medication, positioning, biofeedback or dorsal rhizotomy *movement dysfunction remains and is more related to negative symptoms of strength, timing, and sequencing*.

Question 17

Excessive Co-activation (Co-contraction) is what type of strategy

Accepted Answer

compensatory   Ex: locking your knee into extension Creates joint stiffness

Question 18

What is referred to as fixing in NDT

Accepted Answer

reduction in DOF strategy

Question 19

Impaired muscle synergies

Accepted Answer

Functional linking or coupling of muscle groups  Patterns can be so strong (stereotypical) that they restrict adaptation to conditions for variable and fluid movement

Question 20

Spasticity results in what

Accepted Answer

Positive sign impaired muscle activation (co-activation)  impaired motor execution

Question 21

What are the problems with impaired motor execution

Accepted Answer

problems with  -modulation and scaling of forces -Problems with *timing -Sequencing -Associated reaction: overflow of movement

Question 22

What are the problems seen with difficulty with force modulation

Accepted Answer

Difficulty executing appropriate force & tension for grasp & release -They can grasp a cup but can not release the grasp on the cup  -Difficulty controlling acceleration & deceleration -Due to a lack of breaking movement/deceleration from antagonist Example: difficulty scaling forces to grasp a cup, inability to release

Question 23

What are the problems seen with difficulty with timing

Accepted Answer

difficulty initiating, slow performance, & difficulty terminating movement* -Inadequate force generation to overcome gravity, or antagonist restraint -Inadequate speed of force generation -Insufficient ROM to allow movement -Abnormal postural control -Inadequate reaction time

Question 24

What are the problems seen with difficulty with sequencing

Accepted Answer

-Activate muscles in the wrong sequences -Muscles firing in opposition to the movement -Prolonged contraction in a movement -Firing wrong muscle Ex: pectoralis major kicks in first (UE extension synergy)

Question 25

What is associated reaction

Accepted Answer

overflow of movement  -Widespread contractile activity in same body segment or in other body segments such as the unaffected side -Part of normal development -Can also be an indication that the task requirements are greater than the client can handle to be self organizing

Question 26

what is an example of negative symtpoms

Accepted Answer

insufficient force generation- weakeness

Question 27

What are the primary and secondary causes of the negative symptom of the inability to generate enough force for posture & movement WEAKNESS

Accepted Answer

*primary* -Insufficient descending neural activity converging on spinal motor neuron pool -Reduced number of motor units -Difficulty modulating firing frequency   *Secondary causes* -Atrophy from disuse -Atypical development of fiber type

Question 28

Impaired Anticipatory Postural Control

Accepted Answer

(negative symptom) Generation of force prior to intended movement to set posture -Need to anticipate force, velocity, and direction of intended movement and objects involved -Difficulty wt. shifting to adjust posture -Can not anticipate postural shift needed to engage in an reach so they don\'t do it  -Difficulty moving in and out of postures  Secondary causes: -Inability to engage in one\'s environment or at will. -Increases risk for falls

Question 29

Hypokinesia

Accepted Answer

poverty of movement (negative symptom)

Question 30

What are the sterotypical movement of hypokinesia

Accepted Answer

-There is a lack fluidity, variety, or complexity -Ranges of movement small  -Usually flexion & extension without rotation -Difficulty getting in and out of postures

Question 31

Adults with stroke have paucity of movement (hypokinesia)

Accepted Answer

-Do not automatically adjust posture in sitting (risk of pressure sores and decubiti) -Tend to have all their weight on affected side in sitting  -Do not spontaneously practice movements -Results in malalignment of posture - pelvic obliquity, scoliosis, kyphosis. See problems affecting cervical and lower extremities

Question 32

What is a loss of Fractionated/Dissociated Movements

Accepted Answer

Difficulty making precise, isolated, independent joint movements

Question 33

What are the results in sterotypic patterns for loss of Fractionated/Dissociated Movements

Accepted Answer

Loss of hand dexterity Loss of trunk rotation Loss of movement in mid ranges

Question 34

What are problems that result from sensory impairments

Accepted Answer

tactile, proprioceptive, vestibular, visual  On the affected side inability to: -Detect & identify incoming information -Interpret input: A fly can go on the unaffected side and they can react, but if it is on the affected side the input and output is affected so they will not respond -Modulate inputs to match task & environmental demands -Match information with experience, memory, & specific tasks

Question 35

NDT\'s view of movement Control Problems after Stroke include what?

Accepted Answer

-A loss in postural control -Abnormal tone -Inability to activate muscles automatically to maintain body in balance at rest and during movement

Question 36

A loss of postural control after a stroke results in what

Accepted Answer

-Difficulty shifting weight -Difficulty maintaining stable body position against gravity -Difficulty activating equilibrium responses when balance is challenged -When you can not weight shift you see little steps. When you weight shift evenly you will have normal step length

Question 37

What is abnormal tone (what are the 2 types)

Accepted Answer

motor impairment associated with hemiplegia. -alterations in muscle tension and resistance to passive stretch  Flaccidity: muscle tone is lower than normal  Spasticity: develops gradually in selected muscles and is characterized by excessive muscle stiffness and slow effortful movements  -You may not see spasticity right away

Question 38

NDT teaches you to use what paradigm

Accepted Answer

Force use paradigm Forces the person to use the affected side so they work on *programming*

Question 39

The inability to activate muscles automatically to maintain body in balance at rest and during movement results in the loss of what and prevents people from doing what

Accepted Answer

Loss of selective movement control of the muscles controlling movement of the hemiplegic arm and leg   Prevents people from using hemiplegic arm, and tends to force reliance on one-handed techniques

Question 40

What are the principles of NDT

Accepted Answer

1. Abnormal patterns of muscle tone and motor control are the major impairments interfering with normal motor control of the body.  2. Techniques (Inhibition/facilitation, handling with key points of control and adjusting environmental demands ) decrease abnormal reflex activity and muscle tone while increasing normal patterns of movement on the hemiplegic side.  3.Rejects use of compensatory approaches that neglect potential for function or encourage abnormal movement and reflex activity (=Task oriented approach)

Question 41

What are handling techniques for NDT of patients with strokes

Accepted Answer

Manual techniques to address malalignment of posture, muscle imbalance and movement control   Handling - reflects hands-on aproach. -Dynamic process   -activates movement responses to decrease abnormal tone and  -Improves coordination and re-educate normal movements

Question 42

What are steps to using the handling techniques

Accepted Answer

1. By providing specific tactile, proprioceptive, and kinesthetic messages 2. Using key points of hand placement to control movement patterns that the therapist wishes to influence 3. Inhibition and facilitation   -To influence posture and movement of trunk, shoulder girdle, and hip use *proximal and distal* key points

Question 43

Inhibition and facilitation techniques of handling exercises

Accepted Answer

-Treatment typically begins with Joint mobilization  -Weight bearing facilitates muscle activation and control and inhibiting the abnormal movements   -Inhibition to decrease spasticity and block or eliminate abnormal patterns of movement.  -After muscle tone is normalized, facilitation techniques are used while engaging in functional components of a task. -Once you have addressed the muscle tone you can work on things like reaching   *Assumption is that facilitation will minimize learning of abnormal movements by allowing patient to practice normal patterns of movement.*

Question 44

What approach do NDT therapists use

Accepted Answer

task oriented approach   occupation-as-means and occupation-as-end to ensure improvements are incorporated into occupational performance.

Question 45

NDT\'s relationship to occupational functioning

Accepted Answer

Bobaths believed that treatment directed *toward improving the status of sensorimotor performance* components would result in improved occupational performance.  Frequently, when patients learn new movements, they often spontaneously use these movements functionally.

Question 46

Occupation as ends

Accepted Answer

-Patient is directly involved in learning an *activity or task*. -Intervention is individualized and the treatment environment is constantly modified so occupation-as-end techniques are designed to maintain symmetry, bilateral use, in corporation of involved extremities into task performance -Using force used paradigm: making sure the extremity is involved in some way when performing a task

Question 47

Occupation as means

Accepted Answer

-Therapist uses activities therapeutically to influence impairments and provide opportunities for motor learning and practice. -*Incorporates movement patterns that the patient can perform independently without asymmetry or excessive use of the uninvolved side.* -Helps client focus on end goal rather than specifics of movement (implicit learning/procedural learning) -Get them to focus on an end goal you are involving a *procedural form* of learning

Question 48

Assessment in the NDT Approach gather what information

Accepted Answer

-Movement control and functional status -Problems interfering with functional use of hemiplegic side -Patient\'s response to handling

Question 49

Assessments in the NDT approach can be gained through what

Accepted Answer

Observation of patient\'s behavior -Typical posture -Preferred movement patterns (ask them to reach for something) -Spontaneous use of hemiplegic side  Observations of patient\'s performance in: -ADLs -Transfers -Bed mobility  -Evaluation of motor patterns and the patients response to being moved

Question 50

What are the Treatment Goals for the Stages of Recovery for NDT and strokes

Accepted Answer

1. Address limitations in ADLs and IADLs 2. Address impairments in basic abilities and capacities in the trunk and arm, including identifying problems that may benefit from inhibition or facilitation  Ex rotational movements to help with reach  3. Adapted techniques for ADL, bed mobility, transfers, and wheelchair management: Ex: modify a WC to aid manoeuvring. You may have to take off the armrest if they have posture control and they don\'t have ROM 4. Prevent learned neglect, postural asymmetry, or associated reactions -Look at what it is that is actually limiting them from engaging in the task. Look at it in a multidemential way 5. Inhibiting abnormal tone and movement for spasticity

Question 51

How do you inhibit abnormal tone and movement

Accepted Answer

By increasing normal movement responses in ANTAGONISTIC muscles  -Improving occupational performance by incorporating hemiplegic side into task performance -Training of new tasks -Decrease compensation in tasks that are performed independently

Question 52

Integrating NDT into OT practice

Accepted Answer

-Most effective when everyone on team uses similar approach to management -Client has one unified message and internalizes what is right.  -You shouldn\'t give them a hemiwalker if you are trying to get them to use the affected side as well -Occupational therapist can have a significant effect on tone management and movement by integrating NDT principles and techniques into practice if the interdisciplinary team uses the same approach

Question 53

Treatment of the Hemiplegic Arm is designed to address what impairments

Accepted Answer

-Subluxation -Abnormal tone -Pain -Loss of movement control related to deficits in capabilities and occupational performance

Question 54

What are specific inhibition treatments for hemiplegic arm

Accepted Answer

Inhibition Techniques: joint mobilization and weight bearing  Focus on reflex-inhibiting patterns -Scapula/UE mobilization (UE lab) and trunk mobilization (Posture lab) -Trunk mobility & rotation -Weight bearing

Question 55

What are specific facilitation treatments for hemiplegic arm

Accepted Answer

-Re-educate selective arm movements -Teach patient to use the arm for weight bearing -Increase skilled use of the hand

Question 56

Both inhibition and facilitation are used in every treatment so that...

Accepted Answer

changes in tone and muscle length are immediately translated into motor and functional performance.  Adapt the environment and task, so pt. can incorporate the learned skills in everyday routine.   Have the family approach on the affected side so that they can begin working on the neglected side  Train family and nursing staff on recommendations on how to adapt the environment, how to cue and how to facilitate desired movements.

Question 57

What is the assumption of inhibition

Accepted Answer

Normal movements cannot be facilitated in the presence of abnormal tone and reflex activity.

Question 58

Why use inhibition to reduce spasticity and for intervention

Accepted Answer

Reduction of spasticity allows pt. to follow guided movement more easily and to initiate arm movements outside of synergy.  For intervention: joint mobilization

Question 59

Reflex-Inhibiting Patterns

Accepted Answer

Gradually move arm into a position that includes shoulder girdle depression, shoulder external rotation, elbow and wrist extension, and an open hand.  Use trunk rotation and shoulder mobilization start in supine -> sitting and move into weight bearing in sitting to inhibit flexor spasticity in the arm.

Question 60

In presence of low tone and weakness rather than spasticity, inhibition techniques are used for the following:

Accepted Answer

To maintain muscle length and normal joint mechanics  To prevent development of spasticity and abnormal coordination

Question 61

How should you place a pt when in wheelchair or bed

Accepted Answer

-Flaccid arm should be positioned in bed to maintain muscle length. -Elbow extension -Shoulder girdle abduction -External rotation -Flaccid arm should be positioned in wheelchair to prevent subluxation and spasticity. -Maintain alignment, don\'t have their arm sitting on a foam pad elevating their shoulder

Question 62

How to position pt in supine

Accepted Answer

Don\'t put a towel in their hand   Towel: -Under knee -Affected hip -Arm in extension on a pillow

Question 63

How to position pt in side lying on unaffected side

Accepted Answer

Affected arm on a pillow Affected side leg on a pillow

Question 64

Positioning in side lying affected side

Accepted Answer

Maintain shoulder protraction and abduction and have elbow in extension

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