neurodevelopmental therapy (NDT) – Flashcards

Unlock all answers in this set

Unlock answers
question
NDT
answer
-referred to as Bobath approach because developed by Berta & Karel Bobath -1940s, continues to develop today -postgraduate certification (8wk ped, 3wk adult, 3wk baby)
question
clinical use of NDT
answer
-children w/ neurological deficits (CP) -adults w/ hemiplegia (stroke, TBI)
question
assumptions of NDT
answer
-models of motor control -dysfunction from CNS damage results -function improved via use of effective mvmt patterns
question
motor impairments result in mvmt dysfuntion
answer
+ signs: spasticity impaired muscle activation impaired motor execution - signs: insufficient force generation - weakness impaired anticipatory postural control hypokinesia: poverty of mvmt loss of fractionated or dissociated mvmts
question
spasticity
answer
-UMN disorder -velocity-dependent increase in tonic stretch reflexes w/ exaggerated tendon jerks & clonus -measured by MAS scale -EARLIER thought to be primary impairment creating mvmt dysfunction -NOW thought to be related to strength, timing, & sequencing
question
spasticity enhanced excitatory input
answer
-increased depolarization from segmental afferents, -enhanced regional exitatory interneurons -enhanced monosynaptic descending pathways
question
spasticity reduced inhibitory input
answer
-reduced reciprocal inhibition of antagonist motor neuron pools by Ia afferents -decreased presynaptic inhibition of Ia afferents -decreased nonreciprocal inhibition by Ibafferents
question
impaired motor activation due to:
answer
-excessive co-activation -impaired muscle synergies
question
excessive co-activation
answer
-creates joint stiffness -reduction in DOF strategy ----referred to often in NDT as 'fixing'
question
impaired muscle synergies
answer
-functional linking/ coupling of muscle groups -patterns can be so strong (stereotypical) that they restrict adaptation to conditions for variable & fluid movement ie. synergirstic pattern= bilateral pull w/ arms & extension of legs to rise to standing of spastic diplegic
question
impaired motor execution due to:
answer
-modulation & scaling of forces -timing -sequencing -overflow
question
modulation & scaling of forces
answer
-difficulty executing appropriate force & tension for grasp & release -difficulty controlling acceleration & deceleration
question
timing dysfunctions
answer
difficulty initiating, slow performance, & difficulty terminating movement
question
sequencing dysfunctions
answer
-muscles firing in opposition to the mvmt -prolonged contraction in a mvmt -firing wrong muscle
question
overflow impairments
answer
-widespread contractile activity in same body segment or far removed (eg. controlateral) -part of normal development -used therapeutically (associated mvmts)
question
another term for insufficient force generation?
answer
weakness
question
primary causes of weakness:
answer
-insufficient descending motor message converging on final neuron pool -reduced # of MU caused by atrophy -difficult modulating firing frequency
question
secondary causes of weakness:
answer
-atrophy from disuse -atypical development of fiber type & dispersion in CP
question
impaired anticipatory postural control
answer
-generation of force prior to intended mvmt to set posture -anticipate force, velocity, & direction of intended mvmt & objects involved
question
hypokinesia
answer
poverty of mvmt
question
child w/ CP hypokinesia mvmts:
answer
-lack fluidity, variety, or complexity -ROM small -usually flexion & extension w/out rotation
question
adults w/ stroke hypokinesia mvmts:
answer
-do NOT automatically adjust postural position in sitting (risk of decubiti) -do NOT spontaneously practice movements
question
loss of fractionation/dissociated mvmts:
answer
-difficulty making precise, independent joint mvmts -results in stereotypical patterns as loss of both hand dexterity & trunk rotation
question
sensory impairments result in mvmt dysfunction inability to:
answer
-detect & identify incoming information -interpret input -modulate inputs to match task & environmental demands -match information w/experience, memory, & specific tasks
question
secondary impairments in musculoskeletal system result in mvmt dysfunction of:
answer
-joints -muscles -skin & fascia
question
joint dysfunctions:
answer
-hypermobility: hypotonia (chronic stretch and malalignment) -hypomobility: hypertonia (contractures) ------common in feet of kids w/ CP -different joints are prone to one or other depending on pattern of hypo & hypertonia involved
question
muscle dysfunctions:
answer
-loss of sarcomeres with atrophy from disuse or restricted movement -restricted mvmt can occur w/ orthotics
question
skin & fascia dysfunctions:
answer
become tight & adhere to muscles, tendons, & bones
question
principles of tx:
answer
-GOAL: retrain efficient movement responses on pt's hemiplegic side -AVOID activities that increase abnormal tone or strengthen abnormal mvmts -techniques to suppress/ inhibit mvmts -activities that STRENTGHEN normal mvmt patterns (co-contraction) -existing motor control on hemiplegic side for occ. performance (ACTIVE mvmt) -ADAPTATIONS & compensations that encourage use of affected side & decrease abnormal mvmt patterns
question
wear bearing exercises for spasticity produce?
answer
-co-contraction pattern on muscles -sustained stretch
question
postural alignment
answer
how body parts relate to each other & gravity -FIRST thing you need to do w/pt
question
postural control
answer
-ability to assume & maintain postures during static & dynamic activity -essential for ALL mvmts
question
base of support
answer
-CANNOT move a part of the body you are weight bearing on
question
weight shift
answer
to unweight the part of the body we want moved we need to know where it's going next
question
reflex inhibiting postures
answer
-patterns that counteract the pull of tight or spastic muscles -used to reduce tone(spasticity) to prepare for mvmt
question
keys points of control
answer
places to put hands that are most effective for controlling the patient's movement - proximal & distal
question
inhibition
answer
prevent mvmt
question
facilitation
answer
create mvmt
question
dissociation of mvmt
answer
-ability to DIFFERENTIATE movements between various parts of the body -part of developmental process -part of breaking up fixed patterns to increase DOF
question
stability
answer
axial-POSTURAL muscles
question
mobility
answer
-DISTAL muscles -dependent on stability as distal mvmts activate a postural adjustment
question
rotation
answer
-DIAGONAL mvmts around trunk which requires dissociation -common in PNF
question
role of sensation
answer
-normal mvmt is learned by experiencing what normal mvmt feels like -now adapted contemporary motor control & motor learning theory for effective mvmt -initially feedback is focused on proprioception -now incorporating +sensation ie. vision
question
T/F? motor learning is a PASSIVE process
answer
false; ACTIVE
question
muscle tone of NDT
answer
-assumption you CANNOT impose normal mvmt on abnormal tone -prepatory task to align
question
co-contraction
answer
simultaneous contraction of all muscles around a joint to block movement (reduce DOF)
question
fixing
answer
voluntary cocontraction
question
underlying tone
answer
generally hypotonicity occurs during mvmt
question
use of inhibition techniques
answer
-decrease abnormal muscle tone interfering w/ passive & active mvmt -restore normal alignment in the trunk & extremities by lengthening spastic muscles -stop unwanted mvmts & associated reactions from occurring during mvmt & function -teach methods for decreasing the abnormal posturing of the arm & leg during task performance
question
main focus of inhibition techniques
answer
-keep ACUTE angle of hip or ANTERIOR pelvic tilt to inhibit spastic legs -always position hips FIRST
question
passive elongation
answer
-shortened muscles lose strength because they are contracting at end ROM -passive ROM gently done to prepare muscles
question
proximal dissociation
answer
-synergistic (attractor) patterns are strong -dissociating or breaking up patterns helps inhibit synergy
question
reflex inhibiting patterns
answer
-positioning to inhibit attractor patterns -position that counteracts the pull of spastic muscles -used to inhibit abnormal tone & to facilitate more normal patterns of muscle activation
question
weight shifting
answer
-wt shifting over small ranges relaxes tone -can be trunk over proximal BOS -can be body over distal BOS -mvmt over BOS you want at end of mvmt -unweight over current BOS -simulates muscles to contract reciprocally rather than static wt bearing
question
limb oscillation
answer
shaking limbs reduces tone ie. arms, fingers
question
joint traction/compression & pressure tapping
answer
facilitates mvmt
question
sweep tapping
answer
-quick brisk slaps of muscle belly in upward sweep -most frequently used on abdominals
question
placing & lowering
answer
-positioning limb & asking client to hold it -start in antigravity position -work up to holding against gravity/ resistance
question
points of control
answer
-therapist facilitates from (where place hands) -proximal or distal control
question
key points of control for inhibiting postures
answer
hips, shoulders, neck
question
inhibition of spasticity in hemiplegic arm using RIP steps:
answer
1 position patient in sitting 2 place hands on hemiplegic arm, use key points of control, pts arm flexed& adducted 3 correct adduction of humerus first, leaving elbow flexed 4 maintain humerus in neutral rotation by side of body & use pressure on top of forearm to extend elbow gradually, if forearm is supinated, pronate it first. 5 when tension in biceps has decreased, slide your hand from top of forearm to wrist & hand; extend wrist to neutral first, leaving fingers flexed 6 when tension in wrist flexors decreased, open fingers, keeping wrist in neutral 7 maintain arm in extension & proceed to weight bearing or guided mvmt
question
process of facilitation steps:
answer
1 restore alignment using key points of control 2 assist desired movement using light hands 3 proceed slowly & feel for pt's response 4 repeat mvmts until pt can actively assist 5 lighten messages of your hands so that the pt moves w/ less assistance; give verbal feedback 6 gradually withdraw control; pt's mvmt control may decline but should NOT produce an abnormal response 7 provide practice opportunities via use of activities
question
research on NDT
answer
-mixed info -bottom line is studies have NOT shown treatment to be effective -concerns about study methodology -more research needed
Get an explanation on any task
Get unstuck with the help of our AI assistant in seconds
New