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Romberg Test
- used to determine if the pt can stand w/ both feet together, arms out to their side, eyes open or closed.
- if they can do so w/o swayin gor losing their balance, they do not have a positive (+) Romberg Test.
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Tandem Walking Test
- used to determine balance at a slightly higher level than the basic Romberg Test.
- Pt walks heel to toe for several feet with or w/o eyes open and ifthey can maintain balance, the test is negative.
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Others test can be used that are more formal balance test
- Tinettie Assessment Tool
- Berg Balance Scale
- Get Up and Go Test
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Cranial Nerve Assessment
Olfactory Assessment I
Sense of Smell
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Cranial Nerve Assessment
Optic II
- Visual acuity
- ability to see near and far
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Cranial Nerve Assessment
Oculomotor III
- visual tracking
- depth perception
- pupil response to light
- peripheral vision
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Cranial Nerve Assessment
Troclear IV
visual tracking (vertically)
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Cranial Nerve Assessment
Trigiminal V
- motor to mastication muscles,
- sensory, pain and temp to the TMJ, face oral and eye structures, nasal cavity, frotnal sinuses, side of head and scalp
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Cranial nerve assessment
Abducens VI
visual tracking (laterally)
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Cranial Nerve Assessment
Facial VII
- motor for facial expressions and gland productions
- sensory to anterior 2/3 of tongue and small area of skin behind the ear
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Cranial Nerve Assessment
Vestibulocochlear VIII
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Cranial Nerve Assessment
Glossopharyngeal IX
- Motor for gag reflex and swallowing
- Sensory to posterior 1/2 of tongue, skin of external ear, taste from posterior 1/3 of tongue and parotid gland production
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Cranial Nerve Assessment
Vagus X
- motor to pharynx, larynx and swallowing
- sensory to skin around ear, pharynx esophagus, trachea, organs alimentary canal and aortic arch
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Cranial Nerve Assessment
Spinal Accessory XI
motor to SCM and trapezius
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Cranial Nerve Assessment
Hypoglossal XII
motor to tongue muscles
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Deep Tendon Reflex Testing
Biceps Reflex
- (C5, C6)
- hammer over the biceps tendong to elicit elbow flexion
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Deep Tendon Reflex Testing
Brachioradialis Reflex
- (C5, C6)
- Hammer over the brachioradialis tendon to elicit elbow flexion
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Deep Tendon Reflex Testing
Triceps Reflex
- (C6, C7)
- hammer over the triceps tendon to elicity elbow extension
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Deep Tendon Reflex Testing
Quadriceps Reflex
- (L2-L4)
- hammer over the patellar tendon to elicity knee extension
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Deep Tendon Reflex Testing
Achilles Reflex
- (S1-S2)
- hammer over the calcaneus tendon to elicit ankle plantar flexion
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Mobility
- Rhythmical Rotation (RRo)
- Rhythmic Initiation (RI)
- Hold Relax Active Contraction (HRAC)
- Hold Relax (HR)
- Traction (Tx)
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Stability
- Rhythmic Stabilization (RS)
- Alternating Isometrics (AI)
- Slow Reversal (SR)
- Contract Relax (CR)
- Traction (Tx)
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Controlled Mobility
- Repeated Contractions (RC)
- Agonistic Reversal (AR)
- Timing for Emphasis (TE)
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Skill
- Resisted Progression (RP)
- Normal Timing (NT)
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Facilitation of Muscle Contractions
- Quick stretch
- Tapping/manual contact (ayers and rood)
- Resistance
- Vibration (ayers and rood)
- Approximation
- quick ice (rood)
- burshing (rood)
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Inhibition Techniques
- Prolonged stretch
- Pressure on long tendongs
- Slow stroking down posterior rami
- Traction
- Neutral Warmth
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The format for PNF pattersn is learned by following the five activities listed
- Movement overview
- Normal Timing
- Manual Contacts
- Commands
- Range limiting factors
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Movement overview
a general picture of th emotion for the limb or trunk
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Normal Timing
- the normal firing pattern for the muscle groups
- e.g. proximal to distal or vice versa
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Manual Contacts
for the right and left hand for each movement
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Commands
For Preparatory and for Action fo reach movement
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Range limiting factors
what structures if tight will limit the motion
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Trunk Patterns
- Flexion/Rotation (R)-Command is
- "Up and twist right, down and return to neutral
- Flexion/Rotation (L)-Command is
- "up and twist left, down and return to neutral"
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Upper Extremity Patterns
- Flexion/Adduction (D1)-Command is
- "up and in, down and out"
- Flexion/Abduction (D2)-Command is
- "down and in, up and out"
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Lower Extremity Patterns
- Flexion/Adduction (D1)-Command is
- "up and in, down and out"
- Flexion/Abduction(D2)-Command is
- "down and in, up and out"
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PNF Technique
Approximation
- Therapist's Role-Joint compression manually or w/ gravity through weight bearing
- Patient's Role-Help maintain joint integrity
- Activity Enhanced-Stability, postural control, weakness
-
PNF Technique
Agonist Reversals (AR)
- Therapist's Role-Move pt. through full range w/ slow contraction in increments
- Patient's Role-Maintains balance during incremental contraction of concentric and then eccentric lengthening of same muscle groups
- Activity Enhanced-Postural contro, weakness and transition skills
-
PNF Technique
Alternating Isometrics (AI)
- Therapist's Role-Applying resistance first in one direction and then in the opposite direction
- Patient's Role-Maintaion position isometrically w/o losing blaance or stability
- Activity Enahnced-Stability, postural control, weakness
-
PNF Technique
Contract-Relax (CR)
- Therapist's Role-Take passively to end range, rotate, resist movement, move thorough new range, passively
- Patient's Role-Contract against resistance at end range in rotation, relax, allow movement through new range passively.
- Activity Enhanced-Flexibility, strength and endurance
-
PNF Technique
Contract-Relax Active Contraction (CRAC)
- Therapist's Role-Take passively to end range, rotate, resist movement move thorough new range, actively
- Patient's Role-Contract against resistance at end range in rotation, relax, actively help with movement though new range
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PNF Technique
Active-Assistive Movement (AAM)
- Tehrapist's Role-Move passively through pattern and then aid movement, actively
- Patient's Role-Allow passive movement through pattern and then help actively
- Activity Enahanced-ROM, strength, and endurance.
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PNF Technique
Hold-Relax (HR)
- Therapist's Role-Take passively to end range, resist contraction w/o movement, move thorough new range, passively
- Patient's Role-Contract isometrically against resistance at end range, relax allow movement through new range, passively
- Activity Enhanced-ROM, spasms, pain and flexibility
-
PNF Technique
Hold-Relax Active Contraction (HRAC)
- Therapist's Role-Take passively to end range, resist contraction w/o movement, move through new range, actively
- Ptient's Role-Contract isometrically against resistance at end range, relax, actively help w/ movement through new range
- Activity Enhanced-ROM, spasms, pain, and flexibility
-
PNF Technique
Hold-Relax Active Motion (HRAM)
- Therapist's Role-Start in mid or shortened range, resist contraction w/o movement, move to lengthened range, passively
- Patient's Role-Resist movement in mid or shortened range isometrically, allow passive range to full length of muscle, resist full range
- Acivity Enhanced-Poor initiation of movment, pain, weakness
-
PNF Technique
Repeated Contractions (RCs)
- Therapist's Role-Move through range against resistance to point of weakness, apply quick stretch, continue w/ pattern
- Patient's Role-Resist movement w/ contraction until point of weakness, relax at stretch, move into contraction again
- Activity Enhanced-Weakness, endurance and coordination
-
PNF Technique
Traction
- Therapist's Role-Distraction applied to joints
- Patient's Role-Maintain stability through pattern
- Activity Enhanced-Weakness, mobilization
-
PNF Technique
Resisted Progression (RP)
- Therapist's Role-Resist pattern of movement w/ stretch or tracking resistance
- Patient's Role-Move against patterns of resistance and maintain balance
- Activity Enhanced-Poor timing and endurance
-
PNF Technique
Rhythmic Initiation (RI)
- Therapist's Role-Begin in relaxed state, passive movements through increments of range, AAM to resisted movements wi/ tracking resistance
- Patient's Role-Relax through increments of movement, AAM to resisted movements / contractions
- Activity Enhanced-Relaxation, decrease hpertonicity
-
PNF Technique
Rhythmic Rotation (RRo)
- Therapist's Role-Relax, slow passive rotation around longitudinal axis, passive movement opposite spastic pattern
- Patient's Role-Relax, passive movement in rotational pattern, passive movement in opposite direction
- Activity Enhanced-ROM, hypertonicity
-
PNF Technique
Rhythmic Stabilization (RS)
- Therapist's Role-Resist contraction of opposite muscle groups, isometrically, no relaxation
- Patient's Role-Resist isometricall w/ no relaxation
- Activity Enhanced-ROM, stability and postural control
-
PNF Technique
Shortened Held Resisted Contraction (SHRC)
- Therapists's Role-Place in shortened position, isometric contraction w/ resistance
- Patient's Role-Isometric contraction against tracking resistance in shortened range
- Activity Enhanced-Stability postural control and weakness
-
PNF Technique
Slow Reversals (SRs)
- Therapist's Role-Begin in limited, slow range, increas range w/ grading of resistance
- Patient's Role-Slow, isotonic contraction through range and return back through range
- Activity Enhanced-Progression of movement patterns and transition skills
-
PNF Technique
Slow Reversal-Hold (SRH)
- Therapist's Rols-Begin in limited, slow range, increase range w/ grading of resistance, hold isometrically at end range
- Patient's Role-Slow, isotonic contraction through range and return back through range, hold isometrically at end range
- Activity Enhanced-Progression of movement paterns and transition skills
-
PNF Techniques
Tapping
- Therapist's Role-Taping stimulus over muscle belly
- Patient's Role-Stimultes muscle spindle increasing muscle activity
- Activity Enhanced-Weakness and hypotonia
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