1. What is the Biomechanical approach?
    Increasing endurance, ROM , strength, & reducing edema are the goals of the biomechanical approach.
  2. What is the (Bobath method) neurodevelopmental approach?
    Used primary with cerebral palsy pts/clients but also applicable to dealing with stroke(hemiplegia), using involuntary responses to movement of the head & body(e.g., postural reflexes & equilibrium reactions) for purposes of modifying muscle tone or eliciting desired movements. The utilization of associated reactions is avoided; such movements are hypothesized to hamper progress beyond the stage in which reflexes & reactions dominate toward performance of normal, discrete voluntary movements. Supplemental proprioceptive stimuli (muscle stretch & tapping") are used to facilitate & direct the individual's emerging responses to the head, neck, and body movement stimuli that elicit equilibrium reactions.

    The focus is on relearning use of normal movement. Development of alignment & symmetry of the trunk & pelvis is emphasized; these conditions  are thought to be necessary for normal function of the extremities.
  3. According to the Bobaths, normalization of muscle tone can be accomplished by using one or more of the following techniques?
    • *Weight bearing over the affected side. This helps to regulate or normalize tone & is one of the most common techniques. It provides sensory input increasing pt's awareness of the hemi side& decrease neglect. It also helps normalize tone throughout the arms.
    • *Weight bearing should be avoided if there if there is hand pain or edema present.

  4. What are associated reaction & how are associated reactions facilitated?
    Associated reaction are movements seen on the hemiplegic side in response to forceful movements on the normal side, can be used to initiate or elicit synergies by giving resistance to the contra-lateral (opposite-side) muscle group on the unaffected side.
  5. what is the Brunnstrom approach?
    (also called the movement therapy treatment approach:
    • This is a occupational therapy treatment approach based on the use of limb synergies(gross limb patterns & primitive reflexes) & other available movement patterns in ADL.
    • Classified in six stages of motor recovery from hemiplegia.
    • * Associated reactions are used with this approach, can be used to initiate or elicit synergies by giving resistance to the contralateral(opposite-side) muscle group on the unaffected side.
    • *Excessive facilitation of associated reactions should be avoided.
  6. Before initiating any intervention strategies for the Brunnstrom approach the OT performs a thorough evaluation of the pt's what?
    Motor, sensory, perceptual, & cognitive functions. The motor evaluation yields information about stages of recovery, muscle tone, passive motions sense, hand function, & sitting & standing balance.
  7. What are the 6 stages of motor recovery of (CVA) hemiplegia ?
    The six stages of motor recovery from hemiplegia are;

    1.(leg) Flaccidity (arm) No movements (hand) No function.

    • 2.(leg)Spasticity develops, min  voluntary movements. (arm) Beginning development of spasticity; limb synergies or some of their components begin to appear as  associated reactions. (hand) Gross grasp beginning;
    • min finger flexion possible.

    • 3. (leg)Spasticity peaks; flexion & extension synergy present; hip-knee-ankle flexion in
    • sitting & standing. (arm) Spasticity increasing;synergy patterns or some of their components can be performed voluntarily. (hand) Gross grasp, hook grasp possible; no release.

    • 4. (leg) Knee flexion past 90 degrees  in sitting, with foot sliding backward on floor;
    • dorsiflexion with heel on floor & knee flexed to 90 degrees.(arm)Spasticity declining; movement combinations deviating from
    • synergies are now possible. (hand) Gross grasp present; lateral prehension developing; small amount of finger extension & some thumb movement possible

    • 5. (leg) Knee flexion with hip extended in
    • standing; ankle dorsiflexion with hip & knee extended. (arm) Synergies no longer dominant; more movement combinations deviation from synergies performed with greater ease. (hand) Palmar prehension,
    • spherical & cylindrical grasp & release possible.

    • 6. (leg) Hip abduction in sitting or standing; reciprocal internal & external rotation of hip combined with inversion & enversion of
    • ankle in sitting. (arm) Spasticity absent except when performing rapid movements; isolated joint movements performed with ease. (hand) All types of prehension, individual finger motion, & full range of
    • voluntary extension possible.
  8. What is limb synergies?
    They are gross patterns of limb flexion & extension that originate in primitive spinal cord patterns & primitive reflexes.
  9. How are synergy pattern's facilitated?
    • The therapist  can briskly  rub skin over the muscle belly with his/her fingertips, thus producing a contraction of the muscle & eliciting the synergy pattern to which the muscle belongs.
    • An example is, briskly rubbing the triceps muscle while the pt attempts to push the arm through the sleeve of a shirt can promote extensor synergy.

    Synergistic movement may be reinforced by the pt's voluntary efforts through visual feedback, such as mirrors or videotapes, or auditory stimuli, such as loud & repetitive commands.
  10. What are flexor synergy?
    The UE that consists of scapular adduction & elevation, shoulder abduction & external rotation, elbow flexion, forearm supination, wrist flexion, & finger flexion.

    Hypertonicity  is usually greatest in the elbow flexion component & least in shoulder abduction & external rotation.

    *In the LE the flexor synergy consists of hip flexion, abduction, & external rotation; knee flexion; ankle dorsiflexion & inversion; & toe extension. Hip flexion is usually the component with the highest tone, & hip abduction & external rotation are the components with the least tone.
  11. What is extensor synergy?
    They consists of scapular abduction and depression, shoulder adduction & internal rotation, elbow extension, forearm pronation, & wrist & finger flexion or extension. Shoulder adduction & internal rotation are usually the most hyertonic components of the extensor synergy, much less tone in the elbow extension component.

    * The LE is composed of hip abduction, extension, & internal rotation; knee extension, & ankle plantar flexion  & inversion, & toe flexion.

    Hip abduction, knee extension, & ankle plantar flexion are usually the most hypertoic components whereas hip extension & internal rotation are usually less hypertonic.
  12. What are the principles of treatment?
    The goal of Brunnstrom's movement therapy is to facilitate progress through the recovery stages that occur after the onset of hemiplegia.

    Progress canbe facilitated by the pt's position & the use of associated reactions.

    Changes in head & body position can influence muscle tone.
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