Podcast
Questions and Answers
When performing cranial nerve testing, what is the PTA's primary role concerning the data?
When performing cranial nerve testing, what is the PTA's primary role concerning the data?
- Prescribing medication based on cranial nerve deficits.
- Performing complex diagnostic procedures independently
- Providing treatment based on impact to therapy
- Interpreting test results and documenting accurately in the chart. (correct)
When testing cranial nerves, what implications must the PTA understand?
When testing cranial nerves, what implications must the PTA understand?
- Advanced surgical techniques to correct cranial nerve damage.
- Insurance reimbursement policies for cranial nerve testing.
- Precautions, safety issues, and the potential impact on patient function. (correct)
- The specific medications that can address cranial nerve dysfunction.
What finding indicates a positive test for cranial nerve I (Olfactory)?
What finding indicates a positive test for cranial nerve I (Olfactory)?
- Accurate identification of a sweet scent.
- Reporting a tingling sensation in the nose.
- Detecting a sharp pain when exposed to strong smells.
- Inability to identify a familiar odor. (correct)
During Optic nerve testing, if a patient is unable to visually identify the characters on an eye chart, what does that entail?
During Optic nerve testing, if a patient is unable to visually identify the characters on an eye chart, what does that entail?
When testing cranial nerve III (Oculomotor), what observation would indicate a positive test?
When testing cranial nerve III (Oculomotor), what observation would indicate a positive test?
During trochlear nerve assessment, a patient presents with diplopia and inability to look down. How would the PTA document that?
During trochlear nerve assessment, a patient presents with diplopia and inability to look down. How would the PTA document that?
While assessing the trigeminal nerve (CN V), which finding during sensory testing would indicate a potential issue?
While assessing the trigeminal nerve (CN V), which finding during sensory testing would indicate a potential issue?
When assessing the motor function of the trigeminal nerve (CN V), what observation would indicate a positive test?
When assessing the motor function of the trigeminal nerve (CN V), what observation would indicate a positive test?
What is assessed when examining the abducens nerve (CN VI)?
What is assessed when examining the abducens nerve (CN VI)?
What could be the likely finding of a patient with facial nerve damage, when smiling?
What could be the likely finding of a patient with facial nerve damage, when smiling?
What is an expected finding when assessing the vestibulocochlear nerve?
What is an expected finding when assessing the vestibulocochlear nerve?
When assessing a patient with suspected glossopharyngeal nerve (CN IX) damage, what finding would suggest a positive test during sensory examination?
When assessing a patient with suspected glossopharyngeal nerve (CN IX) damage, what finding would suggest a positive test during sensory examination?
During motor testing of the glossopharyngeal nerve (CN IX), a therapist touches the pharynx with a tongue depressor, what response indicates intact function of CN IX?
During motor testing of the glossopharyngeal nerve (CN IX), a therapist touches the pharynx with a tongue depressor, what response indicates intact function of CN IX?
What is an examination technique used to test Vagus Nerve?
What is an examination technique used to test Vagus Nerve?
When testing cranial nerve XI (Accessory), what action would the patient perform, and what would the therapist do to assess the nerve?
When testing cranial nerve XI (Accessory), what action would the patient perform, and what would the therapist do to assess the nerve?
To assess CN XII (Hypoglossal Nerve), what action would the patient be asked to perform?
To assess CN XII (Hypoglossal Nerve), what action would the patient be asked to perform?
When performing Proprioceptive Neuromuscular Facilitation (PNF), what term describes resistance that matches the patient's output?
When performing Proprioceptive Neuromuscular Facilitation (PNF), what term describes resistance that matches the patient's output?
When referencing Manual Contacts during PNF, where should the therapists hands be placed?
When referencing Manual Contacts during PNF, where should the therapists hands be placed?
Why is correct body position and mechanics emphasized during PNF techniques?
Why is correct body position and mechanics emphasized during PNF techniques?
A PTA is about to perform quick stretch to the patients lower extremity. What is the most appropriate way to perform it?
A PTA is about to perform quick stretch to the patients lower extremity. What is the most appropriate way to perform it?
During PNF, what does 'irradiation' refer to?
During PNF, what does 'irradiation' refer to?
A patient reports increased pain during traction applied during approximation. Which action is most appropriate?
A patient reports increased pain during traction applied during approximation. Which action is most appropriate?
What is the purpose of visual cues in PNF?
What is the purpose of visual cues in PNF?
When using verbal cues in PNF, what are the proper phases and order they should be?
When using verbal cues in PNF, what are the proper phases and order they should be?
Your patient must perform UE D1 flexion pattern during PNF, which components are involved?
Your patient must perform UE D1 flexion pattern during PNF, which components are involved?
During UE D1 Extension during PNF, where does the therapist contact the arm and instruct the patients to move to?
During UE D1 Extension during PNF, where does the therapist contact the arm and instruct the patients to move to?
A patient says, 'Click in your seatbelt' during the therapy. What PNF is being demonstrated by saying this?
A patient says, 'Click in your seatbelt' during the therapy. What PNF is being demonstrated by saying this?
A patient is performing 'Fire Hydrant' exercise. This exercise is related to which pattern?
A patient is performing 'Fire Hydrant' exercise. This exercise is related to which pattern?
Patient performs 'Soccer Kick'. Which extremity pattern is it related to?
Patient performs 'Soccer Kick'. Which extremity pattern is it related to?
A patient in a side-lying position is performing combined scapular and pelvic patterns. What are the possible movements they can perform by using trunk patterns?
A patient in a side-lying position is performing combined scapular and pelvic patterns. What are the possible movements they can perform by using trunk patterns?
What kind of technique must be used to facilitate rolling from supine to sidelying?
What kind of technique must be used to facilitate rolling from supine to sidelying?
Which stage of motor control promotes stability in a weight bearing antigravity position?
Which stage of motor control promotes stability in a weight bearing antigravity position?
What does 'skill' mean concerning PNF?
What does 'skill' mean concerning PNF?
What is the aim of PNF techniques?
What is the aim of PNF techniques?
Which PNF technique focuses on improving initiation, coordination and relaxation?
Which PNF technique focuses on improving initiation, coordination and relaxation?
To teach the patient the task what will need to be introduced during rhythmic initiation?
To teach the patient the task what will need to be introduced during rhythmic initiation?
A therapist applies force while a patient resists. Which of the following technique?
A therapist applies force while a patient resists. Which of the following technique?
A PTA uses alternating isometrics on a patient with trunk instability while sitting. What are the primary facilitating elements the PTA should use?
A PTA uses alternating isometrics on a patient with trunk instability while sitting. What are the primary facilitating elements the PTA should use?
During trunk stability using alternating isometrics, the clinician applies manual contact on the anterior shoulder, and switches one hand to the posterior trunk. Which verbal cue is appropriate?
During trunk stability using alternating isometrics, the clinician applies manual contact on the anterior shoulder, and switches one hand to the posterior trunk. Which verbal cue is appropriate?
To promote stabilization about the joint, you need to enhance stability through co-contraction of muscles. The resistance is applied with:
To promote stabilization about the joint, you need to enhance stability through co-contraction of muscles. The resistance is applied with:
The PTA shifts hand placements often. Which PNF technique is being used?
The PTA shifts hand placements often. Which PNF technique is being used?
For controlled mobility, what reversals are needed?
For controlled mobility, what reversals are needed?
To promote eccentric control during Agonist Reversals, the patient should?
To promote eccentric control during Agonist Reversals, the patient should?
To document PNF technique what do you need to link?
To document PNF technique what do you need to link?
A patient exhibits foot drop and excessive plantarflexion during the swing phase of gait. Which of the following AFO types would be MOST appropriate to address this gait deviation?
A patient exhibits foot drop and excessive plantarflexion during the swing phase of gait. Which of the following AFO types would be MOST appropriate to address this gait deviation?
A patient presents with genu recurvatum (knee hyperextension) during the loading response of gait due to quadriceps weakness. Which AFO would be MOST appropriate?
A patient presents with genu recurvatum (knee hyperextension) during the loading response of gait due to quadriceps weakness. Which AFO would be MOST appropriate?
What is the primary reason for PTAs to study cranial nerve testing?
What is the primary reason for PTAs to study cranial nerve testing?
A patient reports a loss of smell after a recent head trauma. Which cranial nerve is MOST likely affected?
A patient reports a loss of smell after a recent head trauma. Which cranial nerve is MOST likely affected?
A patient is unable to accurately identify sweet and salty substances on the anterior aspect of their tongue. This finding indicates a potential issue with which cranial nerve?
A patient is unable to accurately identify sweet and salty substances on the anterior aspect of their tongue. This finding indicates a potential issue with which cranial nerve?
During upper extremity D1 flexion PNF pattern, what combination of movements occurs at the shoulder?
During upper extremity D1 flexion PNF pattern, what combination of movements occurs at the shoulder?
During the upper extremity D2 extension PNF pattern, the patient's forearm is typically positioned in:
During the upper extremity D2 extension PNF pattern, the patient's forearm is typically positioned in:
A patient performing the lower extremity D2 flexion PNF pattern is asked to perform what motion?
A patient performing the lower extremity D2 flexion PNF pattern is asked to perform what motion?
A PTA is working with a patient on rolling from supine to sidelying, integrating trunk patterns. Which PNF technique would MOST effectively facilitate this?
A PTA is working with a patient on rolling from supine to sidelying, integrating trunk patterns. Which PNF technique would MOST effectively facilitate this?
Which statement describes the correct application of manual contacts in PNF?
Which statement describes the correct application of manual contacts in PNF?
During PNF, how does the therapist's body position influence patient movement?
During PNF, how does the therapist's body position influence patient movement?
A PTA applies a quick stretch to a patient's quadriceps. What is the PRIMARY goal of this action?
A PTA applies a quick stretch to a patient's quadriceps. What is the PRIMARY goal of this action?
Which condition is a CONTRAINDICATION for applying a quick stretch during PNF?
Which condition is a CONTRAINDICATION for applying a quick stretch during PNF?
What is 'irradiation' in the context of PNF techniques?
What is 'irradiation' in the context of PNF techniques?
A PTA is using joint traction during PNF. What is the PRIMARY purpose of this technique?
A PTA is using joint traction during PNF. What is the PRIMARY purpose of this technique?
A patient reports increased pain during joint approximation. What action is most appropriate?
A patient reports increased pain during joint approximation. What action is most appropriate?
In PNF, what is the purpose of incorporating visual cues into treatment?
In PNF, what is the purpose of incorporating visual cues into treatment?
Which of the following BEST describes the correct sequence of verbal cues in PNF?
Which of the following BEST describes the correct sequence of verbal cues in PNF?
A patient is asked to 'step down and out into my hand' during PNF. This cue is MOST likely associated with which lower extremity pattern?
A patient is asked to 'step down and out into my hand' during PNF. This cue is MOST likely associated with which lower extremity pattern?
A patient is performing a 'fire hydrant' exercise, which involves hip flexion, abduction, and external rotation. This exercise is MOST closely related to which PNF pattern?
A patient is performing a 'fire hydrant' exercise, which involves hip flexion, abduction, and external rotation. This exercise is MOST closely related to which PNF pattern?
During alternating isometrics, what is the PRIMARY focus of the technique?
During alternating isometrics, what is the PRIMARY focus of the technique?
A PTA is using alternating isometrics on a patient to improve trunk stability in sitting. Where should the manual contacts be placed to BEST achieve this goal?
A PTA is using alternating isometrics on a patient to improve trunk stability in sitting. Where should the manual contacts be placed to BEST achieve this goal?
During Rhythmic Stabilization, force is applied in one direction, and the clinician changes hand placement in a different direction while:
During Rhythmic Stabilization, force is applied in one direction, and the clinician changes hand placement in a different direction while:
A patient is demonstrating difficulty with initiating movement. Which PNF technique would be MOST appropriate to address this?
A patient is demonstrating difficulty with initiating movement. Which PNF technique would be MOST appropriate to address this?
In which order does rhythmic initiation progress?
In which order does rhythmic initiation progress?
What does the PNF technique hold-relax aim to improve?
What does the PNF technique hold-relax aim to improve?
A PTA is using the 'Hold Relax' technique. The patient performs an isometric contraction of the antagonist, during which what verbal cue is given?
A PTA is using the 'Hold Relax' technique. The patient performs an isometric contraction of the antagonist, during which what verbal cue is given?
What is emphasized when using the rhythmic stabilization technique?
What is emphasized when using the rhythmic stabilization technique?
What is the goal of slow reversal?
What is the goal of slow reversal?
During slow reversals, what happens at the end of the desired range?
During slow reversals, what happens at the end of the desired range?
What is the PRIMARY focus of Agonist Reversals?
What is the PRIMARY focus of Agonist Reversals?
In which pattern does the patient move back to start position while the clinician resists the movement?
In which pattern does the patient move back to start position while the clinician resists the movement?
Neuromuscular re-education should be?
Neuromuscular re-education should be?
When documenting PNF, what needs to be linked?
When documenting PNF, what needs to be linked?
A patient exhibits excessive ankle plantarflexion during the swing phase, resulting in foot drop. Besides the AFO, what else is needed?
A patient exhibits excessive ankle plantarflexion during the swing phase, resulting in foot drop. Besides the AFO, what else is needed?
A patient presents with knee hyperextension during the loading response of gait. What is the MOST likely cause of this gait deviation?
A patient presents with knee hyperextension during the loading response of gait. What is the MOST likely cause of this gait deviation?
A patient demonstrates excessive knee flexion throughout the stance phase of gait. Which of the following is the MOST likely cause?
A patient demonstrates excessive knee flexion throughout the stance phase of gait. Which of the following is the MOST likely cause?
What is the purpose of using an orthotic?
What is the purpose of using an orthotic?
Which gait deviation is an articulating AFO with dorsiflexion assist addressing?
Which gait deviation is an articulating AFO with dorsiflexion assist addressing?
Which of the following is a characteristic of a standard, rigid AFO?
Which of the following is a characteristic of a standard, rigid AFO?
A patient with foot drop requires an AFO. Which type of AFO would be MOST appropriate to address this?
A patient with foot drop requires an AFO. Which type of AFO would be MOST appropriate to address this?
A patient has excessive knee hyperextension, what kind of AFO can prevent it?
A patient has excessive knee hyperextension, what kind of AFO can prevent it?
A patient would MOST likely require SMO if the patient need stabilization of?
A patient would MOST likely require SMO if the patient need stabilization of?
A patient requires an AFO due to moderate edema in the fee, what is the possible choice?
A patient requires an AFO due to moderate edema in the fee, what is the possible choice?
A patient full passive knee extension is seen in standing. Which of the following AFO would be MOST appropriate?
A patient full passive knee extension is seen in standing. Which of the following AFO would be MOST appropriate?
In PNF, what is the underlying principle regarding the therapist's body mechanics in relation to the patient's movement?
In PNF, what is the underlying principle regarding the therapist's body mechanics in relation to the patient's movement?
When applying a quick stretch during PNF, which factor is MOST important to consider for optimal muscle activation?
When applying a quick stretch during PNF, which factor is MOST important to consider for optimal muscle activation?
How does 'irradiation' within the principles of PNF, influence muscle activation during therapeutic exercise?
How does 'irradiation' within the principles of PNF, influence muscle activation during therapeutic exercise?
What is the PRIMARY purpose of applying joint traction during PNF techniques?
What is the PRIMARY purpose of applying joint traction during PNF techniques?
When using verbal cues in PNF, what is the primary purpose of the preparatory command?
When using verbal cues in PNF, what is the primary purpose of the preparatory command?
Which combination of movements comprises the UE D1 flexion pattern in PNF?
Which combination of movements comprises the UE D1 flexion pattern in PNF?
A Physical Therapist Assistant (PTA) is guiding a patient through the lower extremity D2 extension pattern. What combination of movements would the PTA expect to observe?
A Physical Therapist Assistant (PTA) is guiding a patient through the lower extremity D2 extension pattern. What combination of movements would the PTA expect to observe?
What does the PNF technique, 'Rhythmic Rotation' primarily aim to address?
What does the PNF technique, 'Rhythmic Rotation' primarily aim to address?
Which BEST describes the order of components during Rhythmic Initiation?
Which BEST describes the order of components during Rhythmic Initiation?
What is the PRIMARY goal when using the 'Hold-Relax' PNF technique?
What is the PRIMARY goal when using the 'Hold-Relax' PNF technique?
What is the primary focus when implementing Alternating Isometrics?
What is the primary focus when implementing Alternating Isometrics?
During trunk stability exercises, what verbal cue is most appropriate to use during PNF Alternating Isometrics?
During trunk stability exercises, what verbal cue is most appropriate to use during PNF Alternating Isometrics?
What are the key aspects emphasised during the Rhythmic Stabilization technique to enhance stability
What are the key aspects emphasised during the Rhythmic Stabilization technique to enhance stability
During Slow Reversals, what adjustment does the therapist make at the end of the desired movement range?
During Slow Reversals, what adjustment does the therapist make at the end of the desired movement range?
What is the primary focus of Agonist Reversals PNF technique?
What is the primary focus of Agonist Reversals PNF technique?
When should neuromuscular re-education be?
When should neuromuscular re-education be?
If a patient exhibits excessive knee hyperextension during the loading response of gait due to quadriceps weakness, what type of AFO would be MOST appropriate?
If a patient exhibits excessive knee hyperextension during the loading response of gait due to quadriceps weakness, what type of AFO would be MOST appropriate?
Which of the gait deviations is SMO MOST helpful in addressing?
Which of the gait deviations is SMO MOST helpful in addressing?
For a patient presenting with moderate edema and significant fluctuations in limb volume, which AFO design would be most suitable?
For a patient presenting with moderate edema and significant fluctuations in limb volume, which AFO design would be most suitable?
Which of the following AFOs will allow for the MOST normal ankle movement?
Which of the following AFOs will allow for the MOST normal ankle movement?
Flashcards
Why test cranial nerves?
Why test cranial nerves?
Indicator of various functions. Helps determine safety, teaching techniques and affects function.
Olfactory Nerve (CN I) test
Olfactory Nerve (CN I) test
Patient blindfolded, familiar item placed under nose.
Positive Olfactory Nerve Test
Positive Olfactory Nerve Test
Inability to identify a familiar odor.
Optic Nerve (CN II) test
Optic Nerve (CN II) test
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Positive Optic Nerve Test
Positive Optic Nerve Test
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Oculomotor Nerve (CN III) test
Oculomotor Nerve (CN III) test
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Positive Oculomotor Nerve Test
Positive Oculomotor Nerve Test
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Trochlear Nerve (CN IV) test
Trochlear Nerve (CN IV) test
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Positive Trochlear Nerve Test
Positive Trochlear Nerve Test
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Trigeminal Nerve (CN V) test
Trigeminal Nerve (CN V) test
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Positive Trigeminal Nerve Test
Positive Trigeminal Nerve Test
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Abducens Nerve (CN VI) test
Abducens Nerve (CN VI) test
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Positive Abducens Nerve Test
Positive Abducens Nerve Test
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Facial Nerve (CN VII) test
Facial Nerve (CN VII) test
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Positive Facial Nerve Test
Positive Facial Nerve Test
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Vestibulocochlear Nerve (CN VIII) test
Vestibulocochlear Nerve (CN VIII) test
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Positive Vestibulocochlear Nerve Test
Positive Vestibulocochlear Nerve Test
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Glossopharyngeal Nerve (CN IX) test
Glossopharyngeal Nerve (CN IX) test
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Positive Glossopharyngeal Nerve Test
Positive Glossopharyngeal Nerve Test
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Vagus Nerve (CN X) test
Vagus Nerve (CN X) test
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Positive Vagus Nerve Test
Positive Vagus Nerve Test
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Accessory Nerve (CN XI) test
Accessory Nerve (CN XI) test
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Positive Accessory Nerve Test
Positive Accessory Nerve Test
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Hypoglossal Nerve (CN XII) test
Hypoglossal Nerve (CN XII) test
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Positive Hypoglossal Nerve Test
Positive Hypoglossal Nerve Test
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Proprioceptive Neuromuscular Facilitation (PNF)
Proprioceptive Neuromuscular Facilitation (PNF)
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Manual Contacts (PNF)
Manual Contacts (PNF)
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Body Position & Mechanics (PNF)
Body Position & Mechanics (PNF)
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Quick Stretch (PNF)
Quick Stretch (PNF)
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Manual Resistance (PNF)
Manual Resistance (PNF)
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Irradiation (PNF)
Irradiation (PNF)
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Joint Facilitation (PNF)
Joint Facilitation (PNF)
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Traction (PNF)
Traction (PNF)
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Approximation (PNF)
Approximation (PNF)
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Timing of Movement (PNF)
Timing of Movement (PNF)
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Patterns of Movement (PNF)
Patterns of Movement (PNF)
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Visual Cues (PNF)
Visual Cues (PNF)
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Verbal Input (PNF)
Verbal Input (PNF)
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D1 and D2 (PNF)
D1 and D2 (PNF)
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Trunc Stability in sitting with the PNF model.
Trunc Stability in sitting with the PNF model.
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Mobility (PNF
Mobility (PNF
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stability (PNF)
stability (PNF)
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Controlled mobility (PNF)
Controlled mobility (PNF)
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Skill (PNF)
Skill (PNF)
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Holding realx (PNF)
Holding realx (PNF)
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Alternating Isometrics
Alternating Isometrics
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Rhythmic Stabilzation
Rhythmic Stabilzation
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Slow reversal PNF
Slow reversal PNF
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Study Notes
- PTA 1015 covers cranial nerves, gait/orthotics, and PNF
Objectives
- Discuss the role of PTAs in cranial nerve testing and interpretation
- Perform testing for all cranial nerves and link results to impact therapy
- Review common gait deviations seen in CVA
- Determine which AFO will address which gait deviation in CVA
- Explain the 10 basic principles of PNF
- List and describe each of the upper (UE) and lower extremities (LE)
- List and describe each PNF technique, stating the motor control stage it promotes
Cranial Nerve Testing
- Indicator of various functions
- PTAs interpret cranial nerve testing within a chart
- Implications for roles regarding safety, teaching/learning, and function
Cranial Nerve I - Olfactory
- Test involves a blindfolded patient identifying a familiar item placed under their nose
- A positive test is the inability to identify the odor
- Impacts therapy and patient safety
Cranial Nerve II - Optic
- Test involves the patient standing a selected distance from a vision chart and reading it
- A positive test is the inability to correctly read it
- Impacts therapy, teaching, and learning
Cranial Nerve III - Oculomotor
- The test involves a sitting patient tracking a moving object without head rotation
- Positive test will display tracking deficit, ptosis or asymmetry
- Impacts therapy
Cranial Nerve IV - Trochlear
- Test involves a sitting patient tracking a pen with their eyes as it moves inferiorly
- Movement/rotation of the head is prohibited
- Inability to track downward and/or diplopia is a positive test
- Impacts therapy
Cranial Nerve V - Trigeminal Sensory
- The test involves a sitting patient with their eyes closed
- Therapists alternate touching the patient's face with a cotton ball and safety pin randomly
- The patient is asked to clarify sharp or dull sensations
- Impaired or absent sensation due to difficulty differentiating is a positive test
- Impacts therapy
Cranial Nerve V - Trigeminal Motor
- Assesses mandibular protrusion, retraction, and lateral deviation
- Patients clench teeth as the therapist tries to push down on lower jaw to open mouth
- Impaired ability to move through motions or hold jaw closed is a positive test
- Impacts therapy
Cranial Nerve VI - Abducens
- The test involves a sitting patient abducting their eyes without rotating their head
- It is performed one side at a time, and it is permissible if the other eye moves
- A positive test shows the inability to abduct eyes
- Impacts therapy
Cranial Nerve VII - Facial Sensory
- Test involves a sitting patient with eyes closed
- The patient distinguishes between sweet and salty substances placed on the anterior tongue
- An inability to accurately identify sweet and salty is a positive test
- Impacts therapy
Cranial Nerve VII - Facial Motor
- Test involves asking the patient to mimic facial expressions
- They are asked to close their eyes tightly, smile and show teeth, whistle, and puff cheeks
- The patient being unable to mimic expressions is a positive test
- Impacts therapy
VII Cranial Nerve - Vestibulocochlear
- The test requires a quiet location where the therapist stands behind patient on one side, with the patient’s eyes closed
- Gently bring a ticking watch or rub fingers toward the patient's ear, documenting when the patient can hear the sound
- Distance between the sound source and the patient's ear should be recorded
- Inability to hear noise at 18-24 inches or significant bilateral differences indicate positive test
- Impacts therapy
Cranial Nerve IX - Glossopharyngeal Sensory
- Salty, sweet, bitter, or sour items are placed on the posterior third of the tongue
- The patient's eyes are closed and should state what they had tasted
- Unable to distinguish taste is a positive test.
- Impacts therapy
Cranial Nerve IX - Glossopharyngeal Motor
- Patient is sitting
- Uses a tongue depressor, to press down on tongue and touch pharynx
- Inability to gag indicates positive test
- Impacts therapy
Cranial Nerve X - Vagus
- The test is the same as CN 9 for motor (gag reflex)
- Patient is asked to swallow and say “Ahh”
- The inability to do these motor tasks indicates a positive test
- Impacts therapy
Cranial Nerve XI - Accessory
- Test involves the patient sitting with arms rested at their sides
- The patient will shrug their shoulders and hold their position
- The therapist applies resistance through shoulders in the direction of shoulder depression
- The inability to maintain the test position indicates a positive test
- Impacts therapy
Cranial Nerve XII - Hypoglossal
- The dentist involves the patient sitting
- Therapist will ask the patient to protrude tongue
- Inability to fully protrude the tongue or deviation to one side indicates a positive test
- If injured, deviation is toward the injured side
- Impact on therapy
Intro to PNF (Proprioceptive Neuromuscular Facilitation)
- Basic PNF techniques consist of manual contacts, body position and body mechanics, stretch, manual resistance, irradiation, joint facilitation, timing of movement, patterns of movement, visual cues, and verbal input
Manual Contacts
- Hands are always placed on target muscle groups and in the direction of the desired movement
- A lumbrical grip is used
Lumbrical Grip
- Controls movement
- Provides optimal resistance
- Prevents wrap around grip
Body Position and Body Mechanics
- The therapist's body movement mimics the desired movement, and should be in the same diagonal that the movement is occurring
- Resistance of the movement is created through the therapist's body weight
Quick Stretch
- Utilizes stretch reflex by putting the patient's muscle in elongated position to increase the motor response of the muscle contraction
- Gentle movement of the body is used and should be a tap, not a forceful pull or thrust
Contraindications to Quick Stretch
- Joint hypermobility, pain with quick stretch, open wounds/lacerations, bony block/abnormal end feel, unstable bony union (fracture), acute inflammation, infection and hematoma/tissue trauma
- Precautions include spasticity and normal bony end feel.
Manual Resistance
- The therapist uses manual resistance with their hands and body weight to strengthen/train target muscles
Contraindications to Manual Resistance
- Joint hypermobility, unstable bony union, pain with AROM/MMTs, open wounds/lacerations, inflammation, and severe cardiopulmonary disease
Irradiation
- The spread of muscle activity in response to resistance
- Overflow is the response from strong muscle groups to weaker ones
- Irradiation can be ipsilateral or contralateral
- Occurs from extremities to trunk or trunk to extremities
Joint Facilitation
- Two types of joint facilitation include traction and approximation
- Traction creates elongation of the body segment to facilitate motion and decrease pain
- Approximation promotes stability and weight bearing via compression
- Avoid traction/approximation if pain is increased
- Consider the source of pain and any underlying pathology
Timing of Movement
- It's important for movements to be smoth, fluid and have perfect timing
Patterns of Movement
- PNF movements flow in unique diagonal patterns
- These movements move alongside the diagonal structure of muscles and planes of most functional movements
Visual Cues
- Giving patients visual cues helps them guide and direct movements
Verbal Input
- Three phrases can be used, consisting of the preparatory, action and correction phase
Extremity Patterns
- Two diagonal patterns, D1 and D2
- Patterns are named for the direction of movement occurring in the proximal joint
- D1 patterns can be used for flexion or extension
- D2 patterns can be used for flexion or extension
UE Extremity Patterns
- Four UE patterns consist of D1 flexion/extension and D2 Flexion/Extension
- D1 Flexion consists of scapular anterior elevation, shoulder flexion, should adduction, shoulder external rotation, elbow extension, forearm supination, wrist flexion, wrist radial deviation, finger flexion
- D1 Extension consists of scapular posterior depression, shoulder extension, shoulder abduction, shoulder internal rotation, elbow extension, forearm pronation, wrist extension, wrist ulnar deviation, finger extension
- D2 Flexion consists of scapular posterior elevation, shoulder flexion, shoulder abduction, shoulder external rotation, elbow extension, forearm supination, wrist extension, wrist radial deviation, finger extension
- D2 Extension consists of scapular anterior elevation, shoulder extension, shoulder adduction, shoulder internal rotation, elbow extension, forearm pronation, wrist flexion, wrist ulnar deviation, finger flexion
D1 Flexion Pattern - Beginning Position
- The clinician faces the patient's feet
- Proximal contact: anterior aspect of the patient's humerus just proximal to the elbow (biceps)
- Distal contact: placed on patient's palm, similar to holding hands
D1 Flexion Ending Position
- Clinician pivots to face patient
- Manual contacts may shift to accommodate patient effort
D1 Extension Pattern - Beginning Postion
- The clinician stands in the diagonal position facing the patient
- Distal contact is on the dorsum of the patient's hand
- Proximal: posterior humerus, just proximal to the elbow (triceps)
D1 Extension Pattern - Ending Position
- Clinician shifts body weight and position to accommodate movement (may need to squat)
- Manual contacts remain on the dorsum of hand and upper arm
D2 Flexion Pattern - Beginning Position
- The clinician faces the patient
- Distal and proximal contact is on the dorsum of patient's/clinician's hand contacting the patient's anterior distal humerus (biceps)
D2 Flexion Pattern - Ending Position
- Clinician's hand begins to supinate as the patient moves through the range causing the palm contacting the patient's posterior humerus
- Clinician shifts back as needed to accommodate patient movement
D2 Extension Pattern - Beginning Position
- The clinician stands in the diagonal position and faces the patient
- Distal contact: patient's palm
- Proximal contact: dorsum of clinician's hand placed on the post/medial arm surface just proximal to the elbow (triceps)
D2 Extension Pattern - Ending Position
- Clinician pivots to face the patient's feet as the patient moves through the range
- The clinician supinates their forearm, so the the patient's posterior forearm ends up in the clinician's open hand
LE Patterns
- Four LE patterns include D1 flexion and extension, and D2 flexion and extension
LE D1 Flexion
- Consists of pelvic anterior elevation, hip flexion, hip adduction, hip external rotation (ER), knee flexion, ankle dorsiflexion, ankle inversion
- LE D1 Flexion resembles "CROSSING LEGS."
LE D1 Flexion Pattern - Beginning Pattern
- The patient begins in a supine position with the lower extremity extended
- The clinician stands in the diagonal facing the patient's feet
- Distal contact: dorsum of the foot
- Proximal contact: anterior thigh (medial quads)
LE D1 Flexion Pattern - Ending Pattern
- As the patient moves toward the range, the clinician pivots to face the patient
- The clinician shifts their weight to accommodate resistance, keeping manual contacts the same
LE D1 Extension
- Consists of pelvic posterior depression, hip extension, hip abduction, Hip internal rotation (IR), knee extension, ankle plantar flexion, ankle eversion
- LE D1 extension resembles "STANCE PHASE OF GAIT."
LE D1 Extension - Beginning Postion
- Patient begins in a supine position with the lower extremity flexed
- Clinician stands in the diagonal facing the patient
- Distal contact: the plantar surface of the patient's foot
- Proximal contact: the posterolateral thigh (lateral hamstrings)
LE D1 Extension - Ending Position
- As the patient moves in their full range, the clinician shifts weight to accommodate resistance, maintaining manual contact
LE D2 Flexion
- Consists of pelvic posterior elevation, hip flexion, hip abduction, hip internal rotation (IR), knee flexion, ankle dorsiflexion, ankle eversion
- LE D2 flexion resembles a "FIRE HYDRANT."
LE D2 Flexion Pattern - Beginning
- Patient begins in a supine position with the lower extremity extended
- Clinician stands in the diagonal facing the patient's feet
- Distal contact is placed on the dorsolateral foot
- Proximal contact is on the anteriorlateral thigh (lateral quads)
LE D2 Flexion Pattern - Ending
- Clinician shifts their weight to accommodate effort as the patient moves into range
- Subtle adjustments in hand positioning may occur if needed
LE D2 Extension
- Consists of pelvic anterior depression, hip extension, hip adduction, hip external rotation (ER), knee extension, ankle plantar flexion, ankle inversion
- LE D2 EXTENSION resembles a "SOCCER KICK."
LE D2 Extension Pattern - Beginning
- Patient begins in a supine position with the lower extremity flexed and abducted
- Clinician stands in the diagonal facing the patient's feet
- Distal contact: the plantomedial surface (arch) of the patient's foot
- Proximal contact: the posteriomedial thigh (medial hamstrings)
LE D2 Extension Pattern - Ending
- Full ankle motion and hip rotation should be achieved by mid-range
- Clinician may pivot their distal hand and shift weight to accommodate the patient's effort as they move towards full range
Trunk Patterns - PNF
- The PNF approach considers the trunk the foundation for controlled movements
- The scapula and pelvis connect the trunk and the extremities
- Scapular and Pelvic patterns can be combined to improve trunk ROM quality, sequence of movement, coordination, and strength
- The side lying position is a way to perform combined scapular and pelvic patterns
- Combined patterns are components of many functional activities like gait, rolling, scooting
Mobility PNF Techniques
- It refers to the initiation of movement through the available ROM (i.e. shoulder ROM)
- Examples include rhythmic motion, rhythmic initiation, and hold relax
Stability PNF Techniques
- It refers to the ability to maintain a steady position in a weight-bearing, antigravity position
- (i.e. quadruped stance)
Controlled Mobility PNF Techniques
- It is mobility superimposed on previously developed postural stability
- i.e. shoulder flexion with elbow extension and weight bearing through UE.
Skill PNF Techniques
- It is the most mature movement type focused on controlled movement in a stable posture
- Alternating arms and legs in quadruped to crawl/creep
PNF Techniques
- Goal to promote functional movement through facilitation, inhibition, strengthening, or relaxation of muscle groups
- Techniques can focus on improving motor control in specific stages
Rhythmic Rotation
- Intended to improve relaxation and decrease tone and spasticity
- A slow rhythmic rotary motion around the proximal joint
Rhythmic Initiation
- Focuses on improving mobility by improving coordination, relaxing initiation with sequence of PROM, AAROM, AROM and resistance
- Passive movement is introduced to encourage relaxation and teach the patient task (PROM),
- Next, relax and assist with the task (AAROM). Clinician no longer assists and the movement becomes active (AROM), resistance and quick stretch may be applied to promote increased muscle contraction
###Rhythmic Initiation Progressions
- Repetitions vary
- Some need PROM before gaining mobility and learning the pattern while others get it down with couple of repetitions of PROM before being able to assist with the activity
Rhythmic Initiation Steps
- Patient needs to perform movement entirely on own with pattern of 1 set of 8 reps when going from AAROM to PROM
- Needs to be appropriate for strength training to AROM with 3 sets of 12 reps with fatigue and correct form
Rhythmic Initiation Utility
- frequently utilized with low-level patients who have trouble with initiation
- The technique works especially well for those with visual/hearing deficits, cognitive deficits, or a language barrier
Hold Relax
- Technique is used to increase passive joint mobility and decrease movement-related pain
- Includes resisted isometric contraction, verbal cues, and passive stretch
- Clinician moves the body segment to the limit of pain free motion
- The patient then maintains position when the clinician resists an isometric contraction of an antagonist muscle group
- Patient is told to slowly relax and the therapist moves the part through a greater ROM in the desired direction, then repeats until there are no gains
Alternating Isometrics
- Promotes stability, strength, and endurance for identified muscle groups or in a specific position
- Facilitates isometric contractions of both agonist and antagonist muscle groups in an alternating manner
- Manual contacts and verbal cues are the primary cue, and are applied in sitting and developmental postures, or using a form of extremity patterns
Rhythmic Stabliization
- Technique designed to enhance stability through co-contraction of the muscles surrounding the target joint(s)
- Resistance promotes isometric contraction
- This technique emphasizes a rotary component when applied to promote stabilization about a joint(s)
- Muscular force is built up in one direction and the hand placement is changes emphasizing rotation
Slow Reversals
- Slow reversals address controlled skill and mobility, and is a versatile technique that can improve coordination, ROM, and strength
- Concentric contraction of the agonist pattern is facilitated through manual contacts and verbal cues
- At the end of the desired range the manual contacts are changed to facilitate the antagonist pattern
- Resistance must accommodate patient effort; either partial or full ROM may be addressed in the technique
Agonist Reversals
- Technique that promotes functional stability in a controlled manner, therefore addressing controlled skill and mobility.
- Promotes increasing endurance, strength, coordination and training eccentric control
- Both concentric and eccentric contraction of the agonist muscle group is utilized
PNF Dosage
- Neuromuscular Re-education – performed until fatigue (or form fails), daily
- Endurance – 15 – 50 reps, 2-4 sets, 2-5 days/wk
- Strengthening – 8 -12 reps, 1-3 sets, 2-3 days/wk
PNF Documentation
- State subj info first and link the pattern/technique to the patient's impairment with functional limitation
- Outline needed reps, resistance, VC and any subject information during treatment
- Note the response (progression/regression of goals) and plan for the next treatment
Why Use Orthotics?
- For external stability and support for foot clearance during swing, enhancing safety and reducing risk and conserve energy.
Common Gait Deviation Review
- Excessive Ankle Plantar Flexion in initial contact, and loading response is treated with controlled pre tibs for limited ankle ROM
- Knee Extension in LR to midstance is caused from quad weakness.
- Increased hip flexure
Supramalleolar Orthoses (SMO)
- Prevents excess inversion and eversion at the ankle (medial/lateral support), best used on pediatric clients
- It shouldn't be applied if pt doesn't have stability
Standard AFO(Rigid = Polypropylene)
- AFO controls foot drop during ISw, control genu recurvatum (knee hyperextension) associated with quadriceps weakness during LR, mst, ts
- Stable and provide medial/lateral stability
- Impedes sit to stand action or Severe weakness
- Don't use if spasticity, swelling, or edma in the foot are presented
Articulating AFO (Hinged- Polypropylene
- More ankle movements occurs
- Can add elements to assist movements: allows more normal ankle, and has to assist or prevent needed motion DF/PF
- PF stop/Posterior Stop
- DF Stop/Anterior Stop
- DF assist
- Contraindications: Edema, severe weakness (2/5 or less in hips) moderate/severe Spasticity
AFO Use
- Hyperextension (controls what is needed medial and Lateral and knee flexion
Dorsiflexion Assist
- Swing cases which keeps foot/heel drop
Ground AFO
- Knee extension during ambulation and full knee extensions
Upright AFO
- Straps to Correct or fluctuate valus
- Don't use on patient with cosmesis
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