neuro summary 5-10 exam.pdf

5.7 Tranfers - Hemiparetic Interventions Patient Presentations - Lateral Trunk Posture - Forwards Trunk Posture - Decreased Anterior Trunk Translation Examples of Recovery-Based Lead-Up Skills - Work on lead up skills before working on transfer task - May not take long - If patient requires augmente...

5.7 Tranfers - Hemiparetic Interventions Patient Presentations - Lateral Trunk Posture - Forwards Trunk Posture - Decreased Anterior Trunk Translation Examples of Recovery-Based Lead-Up Skills - Work on lead up skills before working on transfer task - May not take long - If patient requires augmented feedback to attain posture, may provide lumbar/thoracic facilitation to neutral - Postural Alignment - Lumbar Facilitation to Neutral - Hands open on lumbar aspects of spine - Scoop up and In, use body at same time - Feet placement important in different positions - Thoracic Facilitation - Hand open on thoracic aspects of spine - Down and in - Feet placement important in different positions - Lower Trunk Weight Shifting for Anterior Weight Shifting - Primary target tissue is lumbar extensors - Anterior Weight Shifting, bring forward with you - Mobilization - Patient needs to be able to attain posture before doing this - Allows for appropriate ROM for active control - Video Demonstration G Transfer Types - Scoot/Squat Pivot (1st technique used) - Allows earlier independence - Lower to ground - Less fear of falling - Multiple scoots -> Squat Pivot - W/ or w/o transfer board - Stand Pivot Transfer - Patient can perform scoot/squat pivot - Requires more balance - Requires movement of feet - Video Demonstration, PT Fun Review Intervention Ideas - Perform task analysis - Can see if difficulty from motor control, fear, strength deficit, or perceptual deficit - Break task down into preparatory interventions as needed - Incorporate alternate variables to challenge motor learning - Difficulty w/ Anterior Trunk Translation - Place bedside table in front of patient or Swiss ball - Have them roll forward & backward - Can decrease anxiety during transfer task - Challenging the patient - Change the surface type patient transfers onto - Learned non-use of paretic side - Place step under less involved non-paretic leg to facilitate more WB to paretic side 5.8 Transfers - Paraparetic Interventions Clinical Decision Making - Extensive history & interview process - Recovery-Based Interventions - Similar to hemiparetic transfers - Emphasizes re-establishing function of involved limbs - Compensatory-Based Interventions - Utilized w/ AIS A spinal cord injury - Utilized w/ conditions w/ poor prognosis for recovery - Utilized if safety is of utmost concern Transfer Types - Recovery-Based - Scoot Pivot - Squat Pivot - Stand Pivot - Compensatory - Angular momentum may need to be performed to lift bottom up & over onto alternate surface - Termed head-hips relationship - Types - Scoot Pivot w/ transfer board - Also prone pivot transfer - Scoot pivot w/o transfer board & Video Demonstration Compensatory Lead Up Skills for Transfers - Hooking 1 arm around wheelchair push handle - Shifts hips forward into chair - Technique used when individuals have no trunk control - Essential for individuals w/ diagnoses like C5-C6 complete SCI - Triceps not fully innervated - for positioning to offload pressure injuries - Placement & Removal of transfer board - Significant lateral weight shifting w/ or w/o arm hooked around wheelchair - Repetitive practice allows for more efficiency - Teach forward lean during transfer, ischial tubs near back of board Recovery Lead up Skills for Transfers - Triceps Dips - Pushing up to unweight bottom fully for successful transfer - Anterior Forward Translation - Weight shifting assists patient during transfer - Part-Task Facilitation - Weight shift w/ lumbar paraspinals as contact w/ & w/o patients butt off mat 5.9 static & dynamic sitting interventions recovery based interventions: static sitting static/dynamic sitting determined by pt goal goal: remain still = static balance goal: mvment promotion= dynamic sitting balance static sitting: utilized early in reb -stability (postural control in trunk) > mobility & wt shift (for limbs> controlled mobility> skill pts w good prognosis for static sitting w/o external aids/assistance WB extremities used for pts w hemiparesis/paraparesis to enhance proprioceptive feedback diff methods used 1. changing surface pt sitting (swiss ball) 2. PNF: rhythmic stabilization provided by PT challenges should be progressive and realistic -dual tasking used to challenge a. short sitting b. long sitting (legs extended on mat) compensatory based static sitting required when trunk activation is limited uses tripod/A frame prop sit position: requires arms to be positioned ant or post to hips DONT want arms in line w butt bc pt can fall forward/backward may attempt head righting to maintain position objective: pt remains sitting as they use head righting & UE compensatory mvmnts to put cones on a pole in front of them (video) recovery based dynamic sitting attained by weight shifting 1.WB done w or w/o UE depending on objective 2.WB good for pts that need proprioceptive feedback in UE 3.wt sift away from more involved side (pts w hemiparesis)>>wt shift forward in middle>>wt shift across body toward more paretic side w/in BOS outside BOS -water bottle or plastic cup better for fxnal significance than colored cone remember saliency compensatory based dynamic sitting summary muscle substitution - head righting UE mvmnt - all to wt shift recovery vs compensatory strategies static sitting -goal is to remain stable video: pt using lumbar extensors to right her body vertical -w stand perturbations dynamic sitting -goal is to shift wt w/in or outside BOS 5.10 UE Interventions Lead-up skills Alignment check for proper alignment in the pelvis, trunk, scapula, and proximal UE Stability/mobility Trunk Shoulder Elbows Wrists and Hands After improving alignment, we can work towards improving gross movements, fine motor tasks involving prehension, and then manipulation of objects in either a unilateral or bilateral action SCAPULA SCAPULA IS IN IN DEPRESSION ELEVATION PROTRACTION SCAPULA SCAPULA IN ABI RETRACTION IN ADD When scapulohumeral rhythm is maintained, we can then provide functional interventions Challenge gross motor and fine motor bilateral integration patterns for daily life functions Common activities of daily living of what patients may need to learn Gross Motor Donning Doffing clothes Stabilization Feeding Fine Motor Prehension Pinch Bilateral Integration Food Prep Sports Hygiene UE Assessment Any Shoulder Pain ? GH Impairment Trauma? Improper Handling? Poor Positioning Immobility Learned- Non use Atrophy UE Weightbearing Allows for extremity to be used this predisposing fnctional movmement 2 types of weightbearing Forearm forearm and hand are supported on a surface to bear weight. Can be done sitting or modified standing position Flaccid or spastic arm for proper neutral alignment Can improve proprioception creating approximation Excellent to allow weightbearing with neutral posture and decrease GH subluxation while also activating prox and dist UE muscles Allows for more prox scapular stabilization and mobility as the trunk moves with weight shifting Extended Arm more challenging. Needs activation of muscles of the elbow wrist and hand thereby promoting increased UE stability by means of proprioceptive feedback A required position for bed mobility and functional transfers This also encourages thoracic extension and scapular stabilization 3 positions for EXTENDED ARM Anterior to hips- promotes increased weight bearing to UE to promote a variety of movements without relying on trunk stability In Line with hips- requires more trunk control and is more neutral positions Posterior to hips- requires increased structural stability of the GH joint. THis is the most difficult position of the 3. Clinician may need to avoid subluxation if patient presents with hypotonia by stabilizing the GH joint. Triceps may also be pressed downward and inward to extension of the elbow. Do not lock out their elbow, as patients need to rely on the muscles for stability and not by stacking the bony structures and ligaments. If patient can’t extend arm, then locking out may be needed for compensatory purpose Gentle mobilization may need to be done to avoid impingement of carpal bones to preserve the arches of the hand Weightbearing sequencing 1st sequence usually initiated towards less involved non paretic side. Closed chained weight shifting approach with affected side being stabilized for dynamic movement. Like reaching 2nd sequence simultaneous movement of both arm and the body affected arm is being assisted with the uninvolved arm. 3rd sequence. Most Challenging arm movement with a stable body. Open chained activities. Wiping the table movement. Active participation and control of UE.