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Frames of Reference Physical Dysfunction  Structural Rehab Components Biomechanical Rehabilitation Biomech Motor NeuroDec SI Motor Learning Neurodevelopmental Sensory Integration  Structural Components...

Frames of Reference Physical Dysfunction  Structural Rehab Components Biomechanical Rehabilitation Biomech Motor NeuroDec SI Motor Learning Neurodevelopmental Sensory Integration  Structural Components (Mosey) Rehab FUNCTION- THEORETICAL Biomech DYSFUNCTION BASE CONTINUA Motor POSTULATES EVALUATION REGARDING NeuroDec CHANGE SI POSTULATES REGARDING INTERVENTION Rehab Biomech 01 Motor Rehabilitation NeuroDec Frame of Reference SI  Historical Rehab Background Biomech Dr. Dunton (1919) and Dr. Rusk Motor (NYU , 1949) using compensatory techniques NeuroDec American with Disabilities Act (1990) SI Proponents: Pedretti, Trombly  Theoretical Base Rehab 1. A person can regain independence thru compensation Biomech 2. Motivation for independence cannot be separated from the volitional and habitual subsystems Motor 3. Motivation for independence cannot be separated from environmental context NeuroDec 4. A minimum of emotional and cognitive prerequisite skills are needed to make independence possible SI 5. Clinical reasoning should take top-down approach  Postulates Regarding Change and Intervention Rehab Compensate Adapt Activity Biomech for Disability Environment Adaptation Motor NeuroDec Energy ADL Work SI Conservation Retraining Simplification Technique  Independence in ADL, work, leisure will be maximized by using adaptive devices Rehab Example of Problems and Adaptations Biomech Lack of full reach (long handled sponge) Lack of UE strength (speaker phone) Motor Lack of hand skills to stabilize objects (suction base) NeuroDec Lack of supination (swivel spoon) SI Lack of full hand closure (built up handle) Lack of power grip / pinch / functional hand use (universal cuff)  Independence in ADL, work, leisure will be maximized by using environmental modification Rehab Biomech Provide access to public and private facilities (ramps, braille) Motor Promote independence (wheelchair accessible) NeuroDec Promote safety (grab bars) SI Promote energy conservation (electric powered appliances)  Independence in ADL, work, leisure will be maximized by using wheelchair modification Rehab Biomech Facilitate wheelchair transfers (transfer board) Facilitate proper positioning (seat cushions) Motor Overcome architectural barriers (detachable NeuroDec leg rests) Permit self propulsion (electric wheelchair) SI Permit transportation of objects (laptray)  Independence in ADL, work, leisure will be maximized by ambulatory aids Rehab Biomech Reduce weight bearing on legs (crutches) Motor Widen base of support (walker) Substitute for lost limb (prosthesis) NeuroDec Permit transportation of objects (walker SI pouch)  Independence in ADL, work, leisure will be maximized by using adaptive procedures Rehab Substitute for lost AROM (mouthsticks) Biomech Motor Conserve energy (rest breaks) NeuroDec Simplify work (organize) SI  Independence in ADL, work, leisure will be maximized by using safety education Rehab Ensures good body mechanics Biomech Ensures safe transfers Motor Ensures safety for somatosensory loss NeuroDec Ensures cardiac precautions Ensures hip precautions SI Ensures joint protection Rehab Biomech Motor NeuroDec SI Rehab Biomech 02 Motor Biomechanical NeuroDec Frame of Reference SI  Historical Rehab Background Biomech Baldwin – reconstruction Motor approach NeuroDec Taylor – orthopedic approach Licht – kinetic approach SI Biomechanical FOR  Theoretical Base Rehab Physical sciences Biomech Kinetics Motor Anatomy NeuroDec Physiology SI Kinematics Medicine  Assumptions Rehab 1. Most activities have a biomechanical dimension Biomech 2.People with biomechanical impairments may have difficulty with occupational performance Motor 3.Biomechanical impairments can be corrected through NeuroDec adjunctive modalities and enabling activities SI 4.Underlying pathology must be considered so that realistic and appropriate goals can be set  Assumptions Rehab 5. Purposeful activities can be used to treat loss of range of Biomech motion (ROM), strength and endurance 6. After ROM, strength and endurance are regained, the patient Motor automatically regains function 7. Principle of rest and stress NeuroDec 8. Best suited for patients with intact CNS SI 9. Transitional activities ensure that gain in biomechanical function are transferred into the client’s occupational performance  Function-Dysfunction Continuum High-level endurance Rehab Increasing strength Biomech Maintaining strength Motor Increasing ROM NeuroDec Edema control SI Low-level endurance Structural stability  Postulates Regarding Change and Intervention Reduce deficits through direct cause and effect treatment process – exercise and activity Rehab Biomech Motor Enhance development of postural reactions through the reduction of gravity’s demands and aligning the body NeuroDec properly SI Improve functional performance through the use of external supports reducing the need for and demands in postural reactions  Function Physical Rehab Biomech Muscle Endurance Motor NeuroDec Strength SI Joint Range of Motion  Structural Stability and Prevention of Deformity Rehab Biomech Structural stability will be regained in damaged structures by using... Motor Orthosis (dorsal rubber band splint NeuroDec for flexor tendon repair) SI Positioning (wedge for hip replacement)  Edema Rehab Peripheral edema will be reduced by using... Biomech Elevation Motor Pressure (retrograde massage) Temperature control (contrast baths) NeuroDec Active ROM (performance of daily activities) SI  Range of Motion Rehab Passive range of motion will be maintained by using... Biomech Passive ROM (CPM machine) Motor Assisted Active ROM (AAROM of burned hand) NeuroDec Active ROM (gentle AROM for clients in acute flareup of arthritis) SI Scar prevention techniques (pressure garments) Orthosis (foot drop splint)  Range of Motion Rehab Biomech Joint range of motion will be increased by using... Motor Heat (warm water) Scar remodeling (deep friction massage) NeuroDec Passive stretch (joint mobilization) SI Active stretch (finger ladder) Orthosis / positioning (serial casting)  Strength Rehab Strength will be maintained by using... AROM (AROM in anatomical planes) Biomech ADL (morning daily activities, wheelchair propulsion) Motor Strength will be increased by using... NeuroDec Isometric (electrical stimulation) AAROM (skate) AROM exercises (combing) SI Resistive exercises (theraputty)  Endurance Training Endurance training will be initiated by using... Rehab Increased duration (sitting tolerance in minutes) Biomech Motor Increased level in cardiac step program (stand instead of sit to shave) NeuroDec Increased intensity (dress in 10 fewer minutes) SI Increased repetitions (feed self additional bites of food)  Endurance Training Rehab Biomech Endurance training will be completed by using... Increasing MET levels of daily activities Motor Increasing intensity Increasing number of repetitions Increasing duration during monitored activities NeuroDec SI Rehab Biomech Motor NeuroDec SI Rehab Biomech 03 Motor Neurodevelopmental NeuroDec Frame of Reference SI Bobath (NDT), Rood, Brunnstrom, Voss, Knott, Kabat (PNF)  Focus Rehab Neuroanatomy / Neurophysiology Biomech Neuroscience Treatment of paralysis, flaccidity, Motor spasticity NeuroDec Movement disorders SI Framework focus: body structures, body functions, process skills, contexts, and activity demands  Assumptions 1. It is important to remediate foundation Rehab skills that make normal skill acquisition Biomech possible 2. Normal movement is learned by Motor experiencing what normal movement feels like NeuroDec 3. Posture control is essential for limb control SI 4. You cannot impose normal movement on abnormal tone 5. Plasticity of the brain  Function-Dysfunction Continuum Rehab Limb Automatic Biomech Muscle Tone Synergies Reactions Motor NeuroDec SI GMS FMS Strategies Strategies  Postulates Regarding Change and Intervention Rehab Importance of handling Active participation on the part of the client Responsibility on meeting the client’s needs Biomech Motor Creation of motivating environment NeuroDec Use of ongoing assessment Usage of functional activities Sensory feedback through handling SI Preventive strategies Rehab Key Approaches Biomech Rood’s Neurophysiological Approach Motor Brunnstrom Movement Therapy Approach Proprioception Neuromuscular Facilitation Approach NeuroDec Neurodevelopmental Treatment Approach SI  Rood’s Neurophysiological Approach Rehab Sensory input for normalization of tone to evoke Biomech desired muscular responses Developmentally based Movement is purposeful Motor NeuroDec Engagement in activities to produce normal response SI Repetition of sensorimotor responses will result to learning  Rood’s Neurophysiological Approach Rehab Stabilizers before mobilizers Biomech Positioning is a primary concern, especially when little voluntary control exists Motor Extensive use of mats, bolsters, balls, and other specialized NeuroDec equipment is important SI Movement patterns can be incorporated into games, such as tug of war, to provide an occupational focus to regaining motor control  Rood Neurophysiological Approach Facilitation Techniques Inhibition Techniques Rehab Light moving touch Neutral warmth Biomech Fast brushing Gentle shaking or rocking A-icing, C-icing Slow stroking Motor Heavy joint compression Slow rolling Quick stretch, intrinsic stretch, Tendinous pressure NeuroDec secondary ending stretch, stretch Light joint compression pressure Maintained stretch SI Resistance Rocking in developmental Tapping patterns Vestibular stimulation  Brunnstrom Movement Therapy Approach Focuses on reflexes which provide the components of normal Rehab movement Biomech Spastic, flaccid tone, and presence of reflexive movement pattern is part of recovery Motor Reflexive to volitional NeuroDec Incorporation of reflexes and associated reactions Usage of proprioceptive (resistive) & exteroceptive (tactile) SI stimulation to elicit reflexes Think about the movement to increase control  Brunnstrom Movement Therapy Approach Stages of Recovery Rehab Biomech 1. Flaccidity, no voluntary movement 2. Synergies or minimal voluntary movement Motor 3. Synergies performed voluntarily NeuroDec 4. Some deviation from synergy SI 5. Independent or isolated movement 6. Individual joint movement nearly normal with minimal spasticity  Brunnstrom Movement Therapy Approach General Treatment Sequence Rehab 1. Gain some movement through sensory facilitation and reflexes, Biomech including associated reactions. 2. Resist the movement and ask for a holding (isometric) Motor contraction. NeuroDec 3. If the patient can produce an isometric contraction, ask for a lengthening (eccentric) contraction. SI 4. If the patient can produce a controlled lengthening contraction, ask for a shortening (isotonic) contraction.  Brunnstrom Movement Therapy Approach Rehab 5. Once the patient can voluntarily move the limb to some degree, Biomech ask the patient to reverse the movement repeatedly. 6. Provide opportunities for use of the targeted movement and the Motor reversing movement functionally. NeuroDec 7. Provide suggestions of functional situations that would allow practice of the newly acquired movements in daily life. SI  Proprioception Neuromuscular Facilitation Approach Rehab Kabat, Knott, Voss Biomech Developmental sequencing; balanced interplay of agonist Motor and antagonist NeuroDec Uses mass movement patterns which are diagonal in nature SI Uses sensory stimulation; should be multi-sensory Motor learning – no longer needs these cues  PNF Diagonal Patterns of the UE D1 flexion D2 flexion scapula elevated, aBd, rotated; shoulder scapula elevated, aDd, rotated; shoulder Rehab flexion, aDd, external rotation; elbow flexed, aBd, external rotation; elbow flexion flexion or extension; forearm sup; wrist or extension; forearm sup; wrist extended Biomech flexed to the radial side; fingers flexed, aDd to the radial side; fingers extended, aBd Motor Shoulder NeuroDec D1 extension D2 extension scapula depressed, aDd, rotated; shoulder SI scapula depressed, aBd, rotated; shoulder extension, aBd, internal rotation; elbow extended, add, internal rotation; elbow flexion or extension; forearm pro; wrist flexion or extension; forearm pro; wrist extended to the ulnar side; fingers flexed to the ulnar side; fingers flexed, aDd extended, aBd  PNF Diagonal Patterns of the UE Rehab Biomech Motor NeuroDec SI  Neurodevelopmental Treatment Approach Rehab Biomech Berta Bobath, PT and Karel Bobath, MD Originally designed for persons with hemiplegia Motor Also worked with children with cerebral palsy NeuroDec NDT focuses on the sensation of movement; it is not SI movement itself, but the sensation of movement, that is learned and remembered  Neurodevelopmental Treatment Approach Rehab Biomech Normalize muscle tone; inhibit primitive reflexes; facilitate normal postural reactions; association Motor reactions are avoided NeuroDec Developmental (gross to fine, proximal to distal, isometric – eccentric – concentric) SI Improve quality of movement, relearn normal patterns, voluntary control  Neurodevelopmental Treatment Approach extraneous movements when new / difficult tasks Associated movements are performed Rehab forceful movement on the unaffected limb = Biomech Associated reactions increased tone / spasticity on the affected limb Motor Reflex inhibiting partial patterns opposite to the typical abnormal patterns patterns NeuroDec points of the body (proximal); guide movement, Key points of control reduce spasticity SI normal activation of large group of muscles by the Postural tone CNS for the maintenance of posture  Neurodevelopmental Treatment Approach Treatment Techniques Rehab Handling techniques Biomech Weightbearing on the affected side Motor Placing and holding Tapping NeuroDec Trunk rotation SI Scapular mobilization Positions that encourage the use of both sides of the body Avoidance of sensory stimuli that may adversely affect tone Rehab Biomech Motor NeuroDec SI Rehab Biomech Motor NeuroDec SI Rehab Biomech 04 Motor Motor Relearning NeuroDec Frame of Reference SI Gentile (1987, 1992) Carr and Shepherd (1987)  Motor Relearning Program Rehab Janet Carr and Roberta Shepard Biomech Contemporary approach (1990s) Motor Uses dynamical systems model of motor control Emphasize interaction between performer and environment NeuroDec Does not accept the hierarchical sequence of motor relearning SI proposed by other theorists Discourage the early use of compensatory strategies  Theoretical Base Rehab Traditional Biomech Reflex Hierarchical Motor Dynamical Systems NeuroDec Theory Principles SI of Learning Theory  Traditional Reflex Hierarchical Rehab Biomech assumes that motor control difficulties are caused by problems in central nervous system Motor developmental sequence is seen as necessary for normal development, and NeuroDec the central nervous system is viewed as hierarchical with SI “higher” centers controlling “lower” centers  Dynamical Systems Theory Rehab Biomech Views movement as emerging interaction of many systems: Motor person, task, and environment NeuroDec Heterarchical view: subsystems in charge will vary with specific task requirements and environmental demands SI  Practice Rehab Feedback Experimentation Biomech Principles of Motor Learning Theory NeuroDec SI Instruction Variation  Motor Relearning Program Clients Rehab taught to avoid abnormal compensation for weak muscles Biomech Motor Treatment techniques based on extensive study of how normal movement occurs during functional tasks NeuroDec Acknowledge critical role of cognition in motor learning SI Movement patterns practiced in context of tasks, rather than exercises  Motor Relearning Program Rehab Categories of Functional Daily Activities Biomech 1. Upper limb function 2. Orofacial function Motor 3. Sitting up over the side of the bed NeuroDec 4. Balanced sitting SI 5. Standing up & sitting down 6. Balanced standing 7. Walking  Motor Relearning Program Rehab Analysis of function Biomech Placing the client in optimal position to encourage muscle activation Motor Compare the client’s performance to normal movements NeuroDec Analyze missing components (anatomical, SI biomechanical, physiological, behavioral) Select the most essential to the activity then train first  Motor Relearning Program Practice of missing components and activity Explanation and demonstration of component Rehab Biomech Gains visual feedback by paying attention first to his movements Motor Verbal feedback (brief, relevant, concise) is given NeuroDec before and after performance Common errors are checked SI Manual guidance or physical monitoring is done throughout the performance  Motor Relearning Program Transference of learning Rehab Biomech Practice under various environmental and task Motor conditions NeuroDec SI Rehab Biomech Motor NeuroDec SI Rehab Biomech 05 Motor Sensory Integration NeuroDec Frame of Reference SI Jean Ayres, Pat Wilbarger, Margaret Rood, LJ King  Theoretical Base Academic “The neurological process that organizes Self-care sensations from one’s body and from the Behavior Rehab environment and makes it possible to use Biomech the body effectively in the environment” Attention (Ayres) Coordination Motor Convergence of sensory information that Perception comes from many sources to the brain NeuroDec stem and thalamus suggests integration Motor Planning of input at that level Body Scheme SI The brain’s ability to filter, organize and integrate masses of sensory information is Sensory critical to learning Integration  Assumptions The CNS is hierarchically organized. Rehab Meaningful registration of stimuli must occur before the CNS can make a response to it and, Biomech therefore, allow for higher functioning to occur. The brain is innately organized to program a Motor person to seek out stimulation that is organizing. NeuroDec Input from one sensory system can facilitate or inhibit the state of the entire organism. SI There is plasticity within the CNS. Normal human development occurs sequentially.  Postulates Regarding Change and Intervention Integration of sensory input is Rehab holistic Biomech The child’s behavior are influenced by the state of the CNS Motor The functioning of the underlying NeuroDec sensory systems determines the quality of adaptive responses SI For integration to occur, meaningful registration of sensory input is required  Postulates Regarding Change and Intervention Rehab When the child makes an appropriate adaptive response, this contributes further to the development of general sensory Biomech integrative abilities Motor The child needs to be self-directed to act on the environment NeuroDec Intervention is specific to the underlying deficits, not specific to behaviors SI The child’s behavior can be modified thru appropriate sensory inputs  Key Sensory Integrative Abilities Sensory Modulation ability to respond adaptively to sensation over a broad range of intensity and duration Rehab Sensory Discrimination Biomech ability to interpret and differentiate between the spatial and temporal qualities of sensory information- or the “where is it,” “what is it,” and “when did it occur” response. Motor Postural-Ocular Control activating and coordinating muscles in response to the position of the body relative to gravity and NeuroDec sustaining functional positions during transitions and while moving SI Praxis ability to conceive of, plan, and organize a sequence of goal-directed motor actions Bilateral Integration and Sequencing ability to use two parts of the body together for motor activities  Sensory Systems Vestibular Systems Rehab Long lasting effects and most Biomech powerful Motor Has a close relationship with NeuroDec other body systems Provide subjective awareness of body position and SI movement in space  Sensory Systems Tactile Systems Rehab Alerting us to threat, give us Biomech boundaries, basis for body Motor image NeuroDec First sensory system to operate in the uterus SI Arises from receptors located in the skin  Sensory Systems Proprioceptive Systems Rehab Arises from tiny receptors Biomech located in the muscles, tendons Motor and ligaments that surrounds the joints NeuroDec Basis for motor planning and SI body image Telling the brain where body parts are Rehab Biomech Motor NeuroDec SI  Thanks! Thank Rehab Biomech You! Motor NeuroDec CREDITS: This presentation template was created by SI Slidesgo, including icons by Flaticon, infographics & images by Freepik