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OTA Roles in Sensorimotor Approaches

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-must be familiar with several sensorimotor approaches, principles, and specific techniques -must implement only with specific direction from the occupational therapist -must be trained and adequately supervised -must receive instruction about the nature of the technique, the specific procedure for application, the expected response, the possible risks and contraindications from the OTR

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Rood

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appropriate sensory stimulation can elicit specific motor responses. Combines controlled sensory stimulation w a sequence of positions & activities that replicate normal motor development to achieve purposeful muscular response

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Rood Basic Assumptions

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1. Normal muscle tone is a prerequisite to movement 2. Treatment begins at the developmental level of functioning 3. Motivation enhances purposeful movement 4. Repetition is necessary for the reeducation of muscular responses

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light work muscles

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mobilizers; primarily flexors and adductors. primary function: skilled movement patterns

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heavy work muscles

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stabilizers; extensors and abductors. primary function: allow maintenance of posture and holding patterns of movement.

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Rood on reflexes

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they are the foundation of voluntary motor act. they are modified, controlled & integrated by the CNS, begin therapy by eliciting responses on this level and use developmental patterns to improve the motor response

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cephalocaudal rule

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tx begins at head and proceeds downward

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Rood Principles of Treatment

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1. Reflexes can be used to assist or retard the effects of sensory stimulation 2. Sensory stimulation of receptors can produce predictable responses 3. Muscles have different duties 4. Heavy work muscles should be integrated before light work muscles

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Rood Sequence of Motor Development

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1. Reciprocal inhibition (innervation) 2. Co-contraction 3. Heavy work 4. Skill

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reciprocal inhibition

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early mobility stage that serves a protective function. agonist contracts while antagonist relaxes

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co-contraction

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opposing muscles contract simultaneously, resulting in stabilization of the joint. allows individual to hold a position or an object for a longer time

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heavy work

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proximal muscles move & distal muscles stay fixed. i.e. creeping- shoulders and hips move, but hands & feet are fixed

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skill

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highest level of control; combines the efforts of mobility and stability. proximal is stabilized & distal moves. i.e. screwing in a lightbulb

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cutaneous stimulation

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-light moving touch -fast brushing -icing

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proprioceptive stimulation

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-heavy joint compression -quick stretching -tapping -vestibular stimulation -vibration -neutral warmth -light joint compression -elongate hypertonic extremities -oflactory & gustatory

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Movement Therapy

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Brunnstrom approach. treatment of hemiplegia. Damaged CNS has undergone an evolution in reverse and regressed to former patterns of movement, including limb synergies.

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limb synergies

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gross patterns of limb flexion & extension that originate in primitive spinal cord patterns & primitive reflexes. group of muscles acting as a fixed unit.

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flexor synergy UE

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scapular adduction & elevation, shoulder abduction & external rotation, elbow flexion, forearm supination, wrist flexion, and finger flexion

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extensor synergy UE

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scapular abduction & depression, shoulder adduction & internal rotation, elbow extension, forearm pronation, and wrist & finger flexion or extension

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flexor synergy LE

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hip flexion, abduction, & external rotation, knee flexion, ankle dorsiflexion & inversion, and toe extension

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extensor synergy LE

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hip abduction, extension & internal rotation, knee extension, ankle plantar flexion & inversion, and toe flexion

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characteristics of synergistic movement

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flexor synergy more common in arm, extensor synergy more common in leg.

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Brunnstrom Motor Recovery Stages

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1. flaccidity 2. spasticity 3. spasticity peaks; flexion & extension synergy present 4. knee flexion past 90º in sitting 5. knee flexion with hip extended in standing 6. Hip abduction in sitting or standing

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associated reactions

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movements seen on the hemiplegic side in response to forceful movements on the normal side. can be used to initiate synergies by giving resistance to the contralateral muscle groups on the unaffected side.

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Brunnstrom General Treatment Goals

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-bed positioning -bed mobility -balance & trunk control -shoulder ROM -shoulder subluxation

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bed positioning

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begins during flaccid stage. promotes normal alignment & decreases influence of hypertonic muscles=prevention of contractures & deformities. instruct to use unaffected hand to support affected hand

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bed mobility

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turning toward the affected side is easier. should instruct pt to swing affected arm and leg toward unaffected side to roll that way.

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balance & trunk control

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hemiplegia often leads to pt leaning toward affected side. help improve this, during tx have pt's sitting posture be altered in various directions. eventually, have pt reach in various directions.

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shoulder ROM

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shoulder joint should be mobilized through guided trunk motion without forceful stretching. have pt sit and move trunk while OTA guides shoulder through movements. pt focus is on trunk movement.

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shoulder subluxation

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should be prevented by activating the rotator cuff muscles

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Brunnstrom OT application

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-Help pt use newly learned mvmt patterns for functions & purposeful activity -reinforce & encourage any voluntary mvmt of the affected limb during ADLs.

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PNF (proprioceptive neuromuscular facilitation)

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based on normal movement and motor development. use mass mvmt patterns that resemble normal mvmt during functional activities. facilitation techniques include manual contacts, verbal commands, and visual cues.

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PNF Principles of Treatment

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1. normal motor development proceeds in a cervicocaudal and proximodistal direction. 2. early motor behavior is dominated by reflex activity 3. motor behavior is expressed in an orderly sequence of total patterns of movement and posture 4. the growth of motor behavior has a rhythmic and cyclical trend, as evidenced by shifts b/t flexor & extensor dominance 5. normal motor development has an orderly sequence but lacks a step-by-step quality 6. establishing a balance b/t antagonists is a main objective 7. improvement in motor ability depends on motor learning 8. goal directed activities coupled with techniques of facilitation are used to hasten learning of total patterns of walking and self care activities

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Motor Learning

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multisensory approach: auditory, visual, and tactile systems used to achieve response.

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verbal commands

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should be brief and clear. timing & tone are also important

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verbal mediation

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pt says aloud the steps of an activity

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visual stimuli

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help to initiate and coordinate movement. should be monitored to ensure tracking.

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tactile input

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essential to guide and reinforce the desired patterns of movement. manual contacts provide this

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diagonal patterns

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mass movement patterns observed in most functional activities. two are present for each part of the body. each has a flexion and extension component and a rotation or movement toward or away from the midline component. unilateral and bilateral

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UE D1 flexion

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brushing left side of hair with right hand

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UE D1 extension

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pushing open car door

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UE D2 flexion

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brushing right side of hair with right hand

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UE D2 extension

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pitching a baseball, buttoning pants on left side with right hand

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symmetrical patterns

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paired extremities perform like movements at the same time. ex. taking off pullover shirt or sweater or reaching to lift large item off high shelf.

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asymmetrical patterns

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paired extremities perform movements on one side of the body; facilitates truck rotation. Chopping and lifting, putting an earring on using both hands.

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reciprocal patterns

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paired extremities perform movements in opposite direction at same time;have stabilizing effect on head,neck and trunk. ex pitching a baseball or walking on a balance beam

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total patterns

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developmental postures; require interaction b/t proximal and distal components. maintenance of posture is important, if unable to maintain, emphasis is placed on assumption of posture

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manual contact

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OTAs hands on pt. pressure from touch is used to facilitate and provide sensory cues for the direction of anticipated movement

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stretch

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used to initiate voluntary movements & enhance speed of response and strength in weak muscles. should coincide w verbal commands

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traction

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facilitates joint receptors by separating joint surfaces. promotes movement. contraindicated after surgery or fractures or with shoulder subluxation

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approximation

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facilitates joint receptors by compressing joint surfaces. creates stability and postural control

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repeated contraction

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a technique based on the idea that repetition of an activity is necessary for motor learning and helps dev strength, ROM, and endurance

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rhythmical initiation

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used to improve the ability to initiate mvmt. ex. apraxia, Parkinson's

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relaxation techniques

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are an effective means of increasing ROM esp when pain or spasticity increases with passive stretch

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PNF OT applications

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-Incorporate appropriate diagonal patterns into functional treatment activities -Verbal and tactile cues should promote functional movement patterns

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NDT

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focus on relearning normal movement. encourages use of both sides. alignment & symmetry of trunk are needed for normal movement

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Goal of NDT

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help a pt experience & relearn normal mvmts. Quality of mvmt is more important that quantity. good trunk control & coordinated movement

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Tools of NDT Tx

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used to normalize or balance tone & include facilitation techniques. inhibition techniques, and key points to guide normal movement patterns (primarily shoulder & pelvis)

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How to Normalize Muscle Tone

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-weight bearing over affected side -trunk rotation -scapular protraction -anterior pelvic tilt -facilitation of slow, controlled movements -proper positioning -incorporation UE into activity

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NDT OT application

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During dressing activities (donning shirt, undergarments, pants, socks, & shoes) should be performed sitting in firm back chair to provide stability & improve balance

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