PT management of patients with sensori-motor disorders ??????????? - PowerPoint PPT Presentation

Loading...

PPT – PT management of patients with sensori-motor disorders ??????????? PowerPoint presentation | free to download - id: 5aac7d-NjViM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

PT management of patients with sensori-motor disorders ???????????

Description:

PT management of patients with sensori-motor disorders – PowerPoint PPT presentation

Number of Views:114
Avg rating:3.0/5.0
Slides: 66
Provided by: kmmcCn5
Learn more at: http://www.kmmc.cn
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: PT management of patients with sensori-motor disorders ???????????


1
PT management of patients with sensori-motor
disorders ???????????
  • ??????????????
  • ??? ??

2
Treatment approach - ICF
Enhance physiological function
  • Improve
  • Individual
  • Minimize
  • Reduce
  • Society

Disability Activity
Handicap Participution
3
Hollstic approach
Individual
Task
Environment
4
Passible sensory and motor impairments
Loss of sensation
Altered biomechanical alignment(????????)
Pain
  • Balance
  • Coordination
  • Cognition perception
  • (????)

Abnormal synergy
Weakness
Movement Task
Joint stiffness, soft tissure shortening
Muscle tone
5
Sensory re-education
  • Tactile(??), hot, cold, 2-point,
    stereognosis(?????)
  • Discriminative(??), protective(????)
  • Early training Detection and location of
    stationary and moving light touch stimuli(??)
  • Progression size, shape, object
    recognition(??), 2-point discrmination
  • High level of attention and memory

6
Sensory re-education
  • Protect from noxious and injurious stimuli
    (????????????)
  • If sensation does not recover
  • Compensation e.g. vision for deficit in tactile
    sensation (??????????)

7
Passible sensory and motor impairments
  • Abnormal biomech alignment
  • Selective motion
  • Weakness
  • Muscle tone

8
Biomechanical alignment
  • Normal alignment most efficient
  • Abnormal alignment affect movement

9
Abnormal alignment in standing (postural set)
  • Marked asymmetry(??????)
  • No weight bearing over R LL
  • R LL adducted, planterflex
  • R UL flexed
  • L trunk is shortened

10
Treatment
  • Correct (??)
  • alignment of
  • the trunk, UL
  • and LL in
  • sitting
  • Weight bearing(??)
  • over R LL

11
  • IN a more narmal postural set
  • Weight
  • bearing and
  • strengthing ex

12
Muscle tone
Spasticity
??
Flaccidity
??
13
Muscle tone
  • Amount of tension in a relaxed muscle
  • Tension stiffness
  • Maintain posture(????) prevent too much sway
  • Make muscle ready to shorten
  • Person with intact neuromuscular system, muscle
    tone is minimal i.e. resistance to passive
    movement is minimal
  • Muscle tone can change according to posture and
    anxious level

14
Facilitation(??) i.e. Cerebellom Motor cortex(????) Pontine(??) Reticular(????) Formation
Inhibition(??) i.e. Bulbar(??) reticular Formation
15
Muscle tone
  • Abnormal muscle tone
  • Hypotonous flaccid
  • Hypertonous spasticity, rigidity

16
Spasticity pathophysiology ????????
  • Lesion of CNS (????????)
  • Lack of supra-spinal inhibitory signals on
    stretch reflex(???????????????)
  • Definition A motor disorder(??)
    characterized(??) by a velocity-dependent
    increase in tonic stretch reflex

17
A comparison between age-matched normal spastic hemiparetic subjects Hyperactive tonic stretch reflexes - increase resistance to passive movement
18
Spasticity - pathophysiology
  • Lesion of CNS
  • Lack of supra-spinal inhibitory signals on
    stretch reflex
  • Definition A motor disorder characterized by a
    velocity-dependent increase in tonic stretch
    reflex
  • Velocity Resistance

19
Manifestation(??, ??) of spasticity
  • Exaggerated(???) stretch reflex
  • Tonic increase resistance to passive movement
  • Phasic increase tendon jerk
  • Clasp knife response
  • Increase tone to a certain range and follows by a
    sudden reduction of tone
  • Clonus
  • Abnormal posturing of the limbs, contracture, pain

20
Spasticity
  • Baclofen(???)
  • Synapses(??)
  • Rhizotomy(??????)
  • Afferent(???)
  • Botulinum(???)
  • neuro-muscular junction(??????)

21
Treatment to reduce spasticity
  • Enhance inhibition of stretch reflex
  • Pharmacological treatment
  • Baclofen (oral, intrathecal) a derivative of
    GABA
  • Botulinum (Intramuscular) inhibiting the
    release of acetylcholine
  • Surgical treatment
  • Rhizotomy removal of dorsal rootlets, to reduce
    the afferent inputs into the spinal cord

22
(No Transcript)
23
  • Surgical treatment
  • (????)
  • Rhlzotomy removal of rootlets, to reduce the
    afferent inputs into the spinal cord
  • Reduce spasticity over calf muscles

24
Spasticity
  • Enhance Inhibition of stretch reflex(??????????)
  • Prolonged stretch(????)
  • Positioning
  • Splint
  • Serial casting
  • Stretch 6 hours
  • Ice therapy 20 minutes

Physiotherapy
25
TENS Spasticity Enhance pre-synaptic
Inhibition (???????)
  • TENS applied on fibula head (common peroneal
    nerve) to reduce spasticity of ankle
    planterflexors
  • Parameters(??)
  • 0.2 ms square pulse
  • 99 Hz
  • 2sensory threshold
  • 60 minutes
  • 5 times a week for 3 weeks

26
Flaccidity(??) Enhance excitation of stretch
reflex(?????????)
  • Quick stretch(????)
  • Brisk touch
  • Quick tapping(????)
  • Quick stroke of ice

27
Muscle tone and Muscle strength
  • No clinical or experimental(??) evidence(??)
    support
  • Normalise spasticity
  • Muscle tone is poorly related with functional
    disability
  • Indeed, poor motor control lack of isolated
    control(??????) of individual muscles, muscle
    weakness, impaired dexterity(?????) , along with
    tissue changes is usually more limiting

Improved motor performance(???????)
28
In addition to strength, Isolated
control ????,????
The ability to control the muscle force is
essential
29
Lack of isolated (selective) control
  • Stereotyped(??)
  • Abnormal movement synergy(????)

30
Abnormal synergy
  • Mass flexion
  • Sh flexion
  • Elbow flexion

31
Isolated / selective control
32
  • Abnormal flexor synergy
  • (??????)

Flexion of hip associated with flexion of the knee during heel-strike
33
Isolated knee and hip control
34
Spastic muscle can be weak
35
Spasticity and weakness
Diplegia Walk on tip-toe
Spastic gastrocaemius
36
Spasticity and weakness
Rhizotomy Surgical procdure to reduce spasticity in gastrocaemius
  • Marked
  • weakness of
  • gastrocaemius

37
Strengtheming will increase spasticity ?
  • Chronic patients gt 9 months of stroke
  • 10-week program of aerobic and strenthening
    exercise (concentric, eccentric)
  • Improvement Total peak torque of affected leg,
    walking speed improved, Quality of life with no
    increase in quad and plantar flexor spasticity
  • Isokinetic strengthening increased muscle
    strength and gait velocity without increase in
    spasticity

38
Strengthing
  • Care must be taken to strengthen a spastic muscle
  • Correct movement patterns and optimal resistance

It is inappropriate to use effortful exercise or any exercise that elicits associated reaction and/or abnormal synergy
39
Strengthening Increase force output
  • Functional electrical stimulation
  • Assisted, active movement
  • Proprioceptive neuromuscular facilitation
  • Task specific
  • Action (concentric, eccentric, isometric)
  • Velocity, Angle

40
Functional electrical stimulation
Contraction of agonist
Reciprocal inhibition of antagonists
41
Sensory input
Ice, tapping stroking brushing
42
Assisted active and active exercises
43
Proprioceptive Neuromuscular Facilitation
  • Patients with neurological and orthopaedic
    conditions
  • Sensory input to regain strength using all
    available sensory inputs
  • Tactile manual contact to guide the motion
  • Verbal simple and precise
  • Visual patients eyes follow the movement
  • Proprioceptive
  • Movement traction to stretch muscle to enhance
    contraction
  • Stabilization joint compression (approximation)
    to increase contraction muscles

44
Proprioceptive Neuromuscular Facilitation
  • Synergetic movement pattern
  • What patients can DO Irradiation from strong
    to weak muscle group
  • Resistance to get Optimal Response from patients
    max awareness, strength, coordination,
    endurance
  • Stability before mobility
  • Promote functions

45
PNF basic pattern
  • Flex add-ER Flex abd-ER
  • Ext add-IR Ext abd-IR
  • Flex add-ER Flex abd-IR
  • Ext add-ER Ext abd-IR

46
Flex - abd - ER
47
PNF Tactile, proprioceptive, verbal, visual,
Active participation
  • Upper limb
  • Flexion-
  • abduction-
  • external
  • rotation and
  • Extension-
  • adduction-
  • Internal rotation

48
Proprioceptive Neuromuscular Facilitation
Special techniques
  • Rhythmic initiation
  • to promote initiation of movement
  • passive assisted active active
    resistive
  • Repeated contraction
  • to promote strength of agonists
  • repeated stretch, repeated contraction
  • Dynamic reversal
  • and to promote strengrh of agonists and
    antagonists
  • facil active movement in one direction, followed
    by movt in opposite ditection

49
Proprioceptive neuromuscular facilitation
repeated contraction
Flex-Abd-Ext Rot
  • Stretch elicit contraction to
  • promote movement

50
Proprioceptive neuromuscular facilitation
dynamic reversal
Flex-Abd-Ext Rot
Ext-Add-Int Rot
  • Stretch elicit contraction to
  • promote movement

51
Strengthening
  • Isokinetic training
  • Theraband, weights
  • Task-specific training
  • Sit-to-stand
  • Walking
  • Upstairs

52
Normalise muscle tone Improve strength Improve
isolated control
53
Possible sensory and motor impairments
  • Pain
  • Joint stiffness, soft
  • tissue shortening

54
Pain
55
Shoulder pain
  • Incidence 72 of patients with hemi
  • Minor causes subluxation of shoulder

56
  • Poor Handling
  • Poor Lifting
  • Techniques

57
  • Glenohumeral malalignment
  • Weakness of rotator cuff
  • Spasticity
  • Flaccidity
  • Poor trunk posture

58
Impringement i.e. supraspinatus, Biceps,
bursa Adhesive capsulitis
59
Preventable
  • Good transfer techniques
  • Good positioning
  • Alignment and Control of shoulder complex
    scapula, glenohumeral joints

60
  • Treatment
  • Physical agents
  • Steroid injection
  • Re-align GH joint
  • Careful ROM
  • activities

61
Improve Joint stiffness and muscle length
62
Non-neural components shortening, soft tissue
changes
Streching
63
Stretching, Resting splint
64
Practical
  • 12 hours
  • UL, LL, Trunk
  • Review VCD
  • You MUST change into T-shirt and Shorts for ALL
    PRACTICAL CLASSES

65
Thanks!!
About PowerShow.com