Neuro-Motor Control, Stages of Learning, and Stroke PDF

148 NPTE Final Frontier – Mastering the NPTE ‡ Valsalva maneuver and abdominal massage Flaccid or areflexic bowel ➤...

148 NPTE Final Frontier – Mastering the NPTE ‡ Valsalva maneuver and abdominal massage Flaccid or areflexic bowel ➤ Injury at S2–S4 or cauda equina (peripheral nerves) ➤ Parasympathetic connections are not intact; no reflexive emptying will occur ➤ Treat with ‡ Manual evacuation techniques and Valsalva maneuver Heterotopic ossifications Common Generally near large joints No aggressive stretching! CEREBROVASCULAR ACCIDENT (CVA) Types Ischemic: clot or blockage (most common type; accounts for 80% of CVAs) Result of buildup of atherosclerosis plaque followed by thrombus or embolism ➤ Cerebral thrombosis: blood clot within cerebral arteries or their branches ➤ Cerebral embolism: traveling bits of matter that produce occlusion and infarction in cerebral arteries (come from other locations) Hemorrhagic: rupture or leakage of blood vessel Worse prognosis (less common) Hematomas can lead to hemorrhage Types of hematomas ➤ Epidural hematoma: crescent shape; between skull and dura ‡ Change occurs over time (gradually) and is chronic in nature ‡ Often mistaken for dementia Figure 39. Hemorrhagic-Epidural Hematoma. Figure 40. Subdural Hematoma. Book_5566_Ch06.indd 148 18-04-2024 22:17:09  Neuromuscular Physical Therapy 149 Subdural: midline shift; between dura and arachnoid ➤ Acute onset accompanied by headaches and altered mental status ➤ C/L hemiparesis ➤ May have epilepsy Subarachnoid: unable to identify lateral ventricles; between arachnoid and pia ➤ Bleeding into brain (fills) ➤ Worse prognosis (often leads to death) ➤ All gray; cannot see any ventricles (no black) Figure 41. Subarachnoid Hemorrhage. Transient ischemic attack (TIA): temporary period of symptoms from decreased blood supply to brain (not permanent) ➤ Temporary interruption of blood supply to brain ➤ May last a few minutes to several hours; rest break ➤ Preferred for discrete tasks (tasks with specific recognized start and end points) ‡ Example: throwing a ball ➤ Fatigue decreases performance, so be alert for and aware of fatigue during mass practice Distributed practice: rest break > working time ➤ Used if individual has low endurance or fatigue or is mentally “checked out” ➤ Preferred for continuous tasks, superior performance ➤ Preferred most of the time Mental practice ➤ Cognitive rehearsal of task without physical performance ➤ Great for beginners! Transfer Effect of previous practice of a skill on learning of a new skill Can be positive (assisting learning) or negative (hindering learning) Whole vs part transfer Whole: simple training of the whole task Part: complex task broken down into different subtasks ➤ Example: wheelchair training → locking brakes, lifting foot pedals, moving for- ward in chair, and so one ➤ Three components ‡ Fractionization: practicing individual limbs first for an asymmetrical coordi- nated task ‡ Segmentation: separating skill into parts and practicing them so the parts build on each other ‡ Simplification: reducing object manipulation, cognitive load, or speed and adding auditory cues Bilateral transfer Improving performance with one, untrained limb results from practice of similar movements with opposite, trained limb Lead-up tasks Presented to learner for more information on complex task or activity ➤ Learning should begin with simple tasks and become more complex as the indi- vidual demonstrates improved learning retention and ability to perform the task ➤ This can be a useful way to progress the patient and challenge them further Perform postural control in kneeling, half-kneeling, or plantigrade position before standing Overlearning: process of rehearsing a motor skill even after there is no improvement in performance Great for procedural skills! Book_5566_Ch10.indd 329 18-04-2024 22:21:18  330 NPTE Final Frontier – Mastering the NPTE Task-specific training Strategies Emphasize early training: cortical plasticity and overcome learned nonuse Define goal and task: involve patient Determine activities to be practiced: what is appropriate and applicable Determine parameters of practice ➤ Practice schedule: blocked → variable ➤ Practice order of tasks: constant → serial → random ➤ Feedback: KR → KP ➤ Guided movements: used in beginning for learning Incorporate problem solving Use behavior-shaping techniques Structure environment: closed → open Neuroplasticity: recovery of the CNS Locomotor training Motorized treadmill training with body-weight support (BWS) Overground training with BWS Overground training with least restrictive device Constraint-induced movement therapy (CIMT) Less-affected upper extremity (UE) is restrained using a protective hand mitt, which forces the patient to use the affected UE ➤ Often used for brachial plexus injuries Several hours per day, daily, for 2 to 3 weeks Remediation–facilitation intervention Includes Guided movement, neuromuscular facilitation, sensory stimulation Exercises designed to reduce specific impairment and improve function of the involved extremity Goal = enhance or improve recovery Proprioceptive neuromuscular facilitation See subsequent section Levels of motor control This is a progression Mobility: ability to initiate movement through functional range of motion (ROM) Stability: ability to maintain position or posture through cocontraction and tonic holding around a joint Controlled mobility: ability to move within a weight-bearing position or rotate around a long axis Transitioning from tall kneel to half kneel is considered this stage because it requires weight-bearing and some movement Emphasize weight shifting with trunk control or rotation Skill: ability to consistently perform functional tasks and manipulate the environment with normal postural reflex mechanisms and balance reactions Motor development Evolution of changes in motor behavior occurs as a result of growth, maturation, and experience Proprioceptive Neuromuscular Facilitation (PNF) Stretching technique used to improve muscle elasticity Book_5566_Ch10.indd 330 18-04-2024 22:21:18