MS Stretching - Daily PDF

MS Stretching – daily Self-stretch, caregiver assist Strengthening – 2-3x, 1-3 sets, 8-15 reps 60-80% 1RM Strength training may be better tolerated with less fatigue if completed intermittently through the day and alternating between upper and lower body muscle groups. Aerobic exercise – 3-5x Intens...

MS Stretching – daily Self-stretch, caregiver assist Strengthening – 2-3x, 1-3 sets, 8-15 reps 60-80% 1RM Strength training may be better tolerated with less fatigue if completed intermittently through the day and alternating between upper and lower body muscle groups. Aerobic exercise – 3-5x Intensity = (RPE) Warm Up/Cool Down 1-2/10, Exercise 3-5/10 Goal to achieve 20-30 minutes 4 Ps: Pacing, planning, prioritizing, positioning Bowel and Bladder Concerns - QoL issue ** PTAs can help – Biofeedback +Pelvic floor training MS people do not have flaccid paralysis MS inspiration training is GOOD HEMISPHERE Left Hemisphere Verbal/Analytical Side Allows for processing of information in a sequential, organized, logical, and linear manner Production and processing of language Logic Daily activities Language and grammar Memory Analytic and detail Science Strategy Facts Word of songs The left hemisphere of the brain is primarily responsible for all of the following EXCEPT: Multitasking Right Hemisphere Nonverbal and artistic abilities Visual-perceptual function Nonverbal communication Language comprehension Creativity Feelings Concentration Photo memory Visualization Imagination Decision making Multitasking Intuition Arts and rhythm Active listening skills A PTA working with a 26 y.o. with right hemisphere damage should be prepared for all of the following deficits EXCEPT: Analytical Skills Anterior Circulation Arteries - All arteries to the brain come from aortic arch Common carotid arteries - Responsible for blood supply to majority of cerebrum Right and Left carotid arteries divide into internal and external carotids External carotids supply the face Internal carotids supply the cerebral hemispheres – frontal, parietal lobes and part of temporal and occipital Also supplies optic nerves and retina of the eyes Internal carotids bifurcate into anterior and middle cerebral arteries (right and left) Middle Cerebral Artery – largest and most often occluded, Supplies lateral surface of brain, Also deep portions of frontal and parietal lobes Anterior Cerebral Artery Supplies superior border of frontal and parietal lobes 1. Anterior Cerebral Artery – flat affect, urinary incontinence 2. LEFT Middle Cerebral Artery – aphasia  3. RIGHT Middle Cerebral Artery - 4. Posterior Cerebral Artery - contralateral sensory loss without motor loss Posterior Circulation Composed of two vertebral arteries Supplies brain stem, cerebellum, medulla and upper spinal cord Vertebral arteries combine to form Basilar Artery Supplies Pons and Cerebellum Basilar divides into right and left posterior cerebral arteries Supplies occipital and temporal lobes Anterior and posterior communicating arteries interconnect and form CIRCLE OF WILLIS White Matter Appears white because of fat within the myelin Composed of axons Carry info away from cell bodies Found in brain and spinal cord Bundled together to form tracts Gray Matter Areas with large numbers of cell bodies and dendrites Cell bodies produce gray color Covers the entire cerebrum; is the cerebral cortex Also deep in the spinal cord Dorsal (posterior) transmits sensory stimuli Ventral (anterior) transmits motor impulses Frontal – primary motor cortex - Broca's area – speech production Parietal – primary sensory cortex - Short term memory functions Temporal – primary auditory cortex - Wernicke's area – speech comprehension Occipital – primary visual cortex - Organize, integration, interpretation of visual information Brain Areas and Their Functions 1. Responsible for regulation of posture, muscle tone, and volitional/automatic movement o Answer: Cerebellum 2. Primary sensory cortex, responsible for short-term memory o Answer: Parietal Lobe 3. Houses reflex centers for autonomic body functions, responsible for homeostatic function o Answer: Brain Stem 4. Organizes, integrates, interprets visual information o Answer: Occipital Lobe 5. Controls balance and complex muscular movements; assists with posture maintenance o Answer: Cerebellum 6. Primary auditory cortex o Answer: Temporal Lobe 7. Primary motor cortex o Answer: Frontal Lobe A patient cannot discern between hot/cold stimulus. This would indicate a problem with the _Lateral Spinothalamic Tract Anterior Spinothalamic common problems - Loss of crude touch sensation Equilibrium Tests These tests check how well someone can balance and stand still. They involve: Standing up straight Keeping the body stable Maintaining good posture Key points: Done while standing upright Focuses on gross motor skills (big movements) Looks at both static (still) and dynamic (moving) positions Nonequilibrium Tests These tests assess movement and balance while sitting. They include: Moving arms and legs Shifting weight Changing positions Key points:  Performed while seated Involves both gross and fine motor skills Examines static and mobile aspects of movement The main difference is that equilibrium tests focus on standing balance, while nonequilibrium tests evaluate seated movements and stability. Both help assess overall coordination and motor control. 1. Mobility: Basic movement range 2. Controlled Mobility: Coordinated movements within range 3. Stability: Maintaining position against external forces 4. Skill: Complex, precise movements PNF Techniques and Their Primary Stages 1. Slow Reversal: Controlled Mobility o Promotes smooth transitions between muscle groups o Enhances coordination of movements 2. Hold Relax Active Movement: Mobility o Increases range of motion by reducing muscle tension o Helps overcome restrictions in movement 3. Rhythmic Rotation: Controlled Mobility o Improves coordination and timing of movements o Enhances proprioception during dynamic activities 4. Rhythmic Stabilization: Stability o Strengthens stabilizing muscles o Improves ability to maintain position against external forces 5. Alternating Isometrics (AI): Stability o Develops strength and control for maintaining posture o Enhances ability to resist external forces 6. Agonist Reversal: Controlled Mobility o Promotes smooth transitions between muscle groups o Improves coordination of movements 7. Resisted Progression: Skill o Develops strength and control for complex movements o Enhances precision and speed of actions Anterior Cord Syndrome – incomplete, from cervical flexion, loss of motor function, no pain/temperature sense below level of lesion – Central Cord Syndrome – incomplete, from cervical hyperextension – damages spinothalamic/corticospinal tract/dorsal columns. UE more present, more motor deficits than sensory Posterior Cord Syndrome – incomplete, from a variety of things, motor function preserved, loss of pain perception, proprioception, 2 point discrimination, stereogenesis Cervical levels – C1-C3, I turn my head so I can see C4 Breathe more, shrug my shoulders to ignore C5 Arms up high, bend my elbows, pretend to fly C6 Pick up sticks, tenodesis helps me exist C7 I’m in heaven, transfer myself, independent livin’ C8 This is great – now my thumb can manipulate Incomplete better outcomes than complete T1-T11 – therapeutic ambulation with orthoses in // bars T12-L2 – household ambulation with orthoses L3 – community ambulation with orthoses L4-L5 – community ambulation – may only need AFO & AD S1-S2 - AFO able to use tenodesis – C6 will require full time care – C4 can independently complete a squat pivot or sliding board transfer – C7 improved hand function allows for wheelies in wheelchair – C8 with adaptations this is the highest level that may use manual wheelchair – C5 Which of the following examples BEST reflects the concepts of selective stretching that may directly impact functional recovery for a patient who has sustained a C6, ASIA A injury? Encouraged adaptive shortening of the long finger flexors to enhance grasp with tenodesis According to the ASIA Classification Scale, the labeled motor level of a spinal cord injury is the lowest level with _______ strength or the superior segment with _______ strength. 3/5; 5/5 Consider Cardiac Rehab Phase II. Which are the true statements? EKG is required during all sessions EKG is required during exercise test prior to starting rehab goal is to increase exercise capacity to 7 METS Cerebral Palsy – GMFCS 1 – amb no limitations 2 – Some limitations 3 – Uses AD 4 – Self mobility w/ some limitations, may use power w/c 5 – Dependent GMFCS Level I ▪ Can walk indoors and outdoors and climb stairs without using their hands for support. ▪ Can run and jump. ▪ Has decreased speed, balance, and coordination. GMFCS Level II ▪ Can walk indoors and outdoors and climb stairs using a railing. ▪ Experiences difficulty with uneven surfaces, inclines, or while in crowds. ▪ Can minimally run or jump. GMFCS Level III ▪ Walks with assistive mobility devices indoors and outdoors on level surfaces. ▪ May be able to climb stairs using a railing. ▪ May propel a manual wheelchair; may require assistance for long distances or uneven surfaces. GMFCS Level IV ▪ Walking ability is severely limited, even with assistive devices. ▪ Uses a wheelchair most of the time and may propel their own power wheelchair. ▪ May participate in standing transfers. GMFCS Level V ▪ Has physical impairments that restrict voluntary movement control and the ability to maintain head and neck position against gravity. ▪ Experiences impairment in all areas of motor function. ▪ Can’t sit or stand independently, even with adaptive equipment. ▪ Can’t independently walk, though may be able to use powered mobility devices. ▪ LEVEL I - Walks without Limitations ▪ LEVEL II - Walks with Limitations ▪ LEVEL III - Walks Using a Hand-Held Mobility Device ▪ LEVEL IV - Self-Mobility with Limitations; May Use Powered Mobility ▪ LEVEL V - Transported in a Manual Wheelchair ▪ 1. Child walks without assistance. Runs and jumps, but slowly and/or with poor coordination. This description matches GMFCS Level I. Here's why: GMFCS Level I describes children who can walk indoors and outdoors and climb stairs without using their hands for support 2. They can run and jump, although they may experience decreased speed, balance, and coordination 2. 2. Walking always requires use of handheld AD such as walker or crutches. This description aligns with GMFCS Level III. Here's the reasoning: GMFCS Level III states that children walk with assistive mobility devices indoors and outdoors on level surfaces 2. They may be able to climb stairs using a railing 2. This level also mentions that children may propel a manual wheelchair, possibly requiring assistance for long distances or uneven surfaces 2. 3. Use of wheelchair in most settings. Older children may operate a power wheelchair. This description corresponds to GMFCS Level IV. Here's the explanation: GMFCS Level IV describes walking ability that is severely limited, even with assistive devices 2. Children in this level typically use a wheelchair most of the time and may propel their own power wheelchair 2. They may still participate in standing transfers 2. Cardiovascular VO2 max testing targets end point HR Submax used for symptoms ACSM Absolute Contraindications Severe arterial hypertension (i.e., systolic blood pressure of >200 mm Hg and/or a diastolic blood pressure of >110 mm Hg) at rest HR is used for calculations of VO2 Termination Criteria for GXT Blood Pressure Responses SBP fails to rise with increase in PO SBP drops more than 10 mmHg SBP increases to more than 250 mmHg DBP rises more than 20 mmHg from resting value DBP rises above 110 -120 mmHg Heart Rate Responses Decrease in HR with increase in PO Increase in HR > 220 beats per minute Inappropriate bradycardia Signs and Symptoms Subjects requests to stop Progressive angina → stop at 3+ Progressive dyspnea → stop at 3+ Marked dyspnea Cyanosis Vasoconstriction (pale, cold, clammy skin) Cessation of sweating Syncope Malfunctioning Equipment Astrand cycling test – steady state test Bruce Treadmill test – incremental test Seated step test Beta blockers = lol – HTN, HF, MI, angina Primitive Reflexes - Integrated by 2-6 months old-spinal cord level Rooting 28 weeks gestation → 3 months – sucking finger – interferes with midline control of head, visual tracking, and interactions Sucking – survival reflex – 28 weeks gestation -> 2-5 months Moro – 28 weeks gestation → 5-6 months – abduction and extension of UE-> supine -> head extend back 20-30 degrees Crossed extension – 28 weeks gestation → 1-2 months (flexion and ADD of other leg, extension to push examiner away Plantar grasp – supine – flexes toes – not integrate? No ability to stand with flat feet, bad balance, no weight shifting in standing Galant – 32 weeks gestation → 2 months -> prone brushing on side of trunk -> trunk curves to stimulus(same side) doesn’t integrate? Bad sitting balance can lead to scoliosis Palmer grasp – last simple reflex to integrate -> supine index finger in hand Not integrate?WB on open hand for propping bad, bad creeping, bad protective response Spontaneous Stepping – if bad? – bad standing, walking, balance, weight shifting, coordination of LE Tonic reflexes – brain stem Asymmetrical Tonic neck reflex (ATNR) Birth – 4-6 months – turn head, extension of extremities on face side, flexion of extremities on skull side – not integrated? Interferes with feeding, visual tracking, midline use of hands, Bilateral use of hands, rolling, crawling/creeping SYMMETRICAL Tonic Neck reflex (STNR) 4-6 months – 10-12 months – prone over knee flex/ext head. Neck flex – UE flexion and LE extension NECK Extension – UE Extension and LE flexion – interferes with prop on arms in prone, attaining and maintaining all 4s, crawling sitting balance with head turns, use of hands in sitting Tonic labryinthe – birth -> 6 months. Supine pull to sit and neck extended, prone – help lift head Response – supine child will not flex to sit secondary to extensor tone, Prone – child will not lift head secondary to flexor tone. Interferes with rolling, prop on elbows in prone, trunk flexion to come to sit, full body extension impacts balance in sitting and standing Right Reatcions – processed in midbrain- affects posture 1 Month Hands fisted Thrusts upper extremities and lower extremities in play while supine Holds head erect for 3 seconds when upright and shoulders stabilized 2 month Lifts head with airplane hold Holds head erect up to 15 seconds when upright Holds legs up - 2 sec in supine Can make crawling movements in prone 3 month Turns side to back Attempts hand to mouth in supine  Retains Ring position in supine Displays symmetrical movements in supine Adjusts Head to Ventral in prone Holds head steady when being moved in upright 4 month Holds head in midline in supine Elevates self with arm in prone Head at 45* and lowers with control and progresses to 90* in prone Sits with support Hands open 5 month Shifts weight on upper extremities in prone Turns back to side Rotates wrists Raking 6 months Palmer Grasp Sits alone Rolling prone to supine Reaches unilaterally Start to show partial thumb opposition to grasp objects 7 month Sits alone steadily Rolls supine to prone Radial palmer grasp Grasps foot with hands in supine Makes early stepping movements in standing with trunk assist 8 month Sitting Raises self to sit (supine –> side --> sit up) Supports weight on lower extremities momentarily when in standing with trunk support Pulls to stand Shifts weight while standing Brings objects to midline in sitting Rocking on all fours 9 month Creeping – army crawl to creeping Radial digit grasp Rotates trunk when sitting alone 10 month Moves from Sitting to Creeping and back to sit Pulls to stand (sitting/creeping) Attempts to walk Attempting cruising along furniture 11 month Sits down from standing Cruising Uses pads of fingertips to grasp tiny objects 1 --> 2 years old Walking balance, squats, stairs with assistance 13 Months – Stands alone, walks alone (7 – 18 months) 14 – 16 Months – Walks with greater coordination, throws a ball, squats briefly 17 – 19 Months – Walks up/down stairs with assist, walks backwards, walks sideways 20 – 22 Months – Squats to play, stands on one foot with assist 23 – 25 Months – Uses hands to hold paper in place, runs with coordination, arm swing in gait 2-3 y/o 13 Months – Stands alone, walks alone (7 – 18 months) 14 – 16 Months – Walks with greater coordination, throws a ball, squats briefly 17 – 19 Months – Walks up/down stairs with assist, walks backwards, walks sideways 20 – 22 Months – Squats to play, stands on one foot with assist 23 – 25 Months – Uses hands to hold paper in place, runs with coordination, arm swing in gait 3 years to 6-7 Years old Running, Jumping, Hopping, Skipping, Throwing, Catching 3 years – Copies circles, eye-hand coordination, buttons one button, jumps over rope, hops twice on one foot, maturing gait, walks up/down stairs alternating feet independently 4 years – Galloping, throws ball, catch a ball with assist 5 years – Skipping, catch a ball independently, hand dominance 6/7 - 10 years – Develop mature gait, running, throwing, catching Reminder – most kids enter kindie at age 5; helpful to recall 7 is a key age – lots comes together here which is 1st -2nd grade BRUNNSTROM - stroke