Neurophysiological theories

 were developed to be used with

CERABRAL CORTEX OR BRAIN STEM DAMAGE (CNS OR UPN DAMAGE)

The cerebral cortex is responsible for:

VOLUNTARY MOVEMENT

NEUROLOGICAL THEORIES

are used with diagnoses such as:

TBI, CVA, CP

where voluntary motor control

 is lost due to CNS damage

Normal humans move in:

The most efficient, quick way with smooth, controlled movements

BRAIN DAMAGE-Impairs smooth, controlled movement. The cerebral cortex is not balancing facilitation and inhibition of muscles which produces:

ABNORMAL TONE (SPASTIC OR FLACCID)

Treatment of Neurophysiological Theories

focus on:

SENSORY MOTOR Organization

The goal of treatment of the

 Neurophysiological heories is to:

Effect an ESSENTIAL CHANGE

 in the physiological or behavioral

organization of the CNS.

Similarities of Neurological Theories:

1. Important in movement & sensations

2. Repittion

3. All emphasize the fact that after the dev. of basic movement & postures, skilled movements automatically follow 

Differences of Neurological Theories :

Whether attention is directed

toward movement or on goal.

• BOBATH & ROOD Focus on Goal-Goal Directed Movement- End Goal 
• BRUNNSTROM & PNF Focus on the Movement

Should spinal & brain stem reflexes

be used to elicit movement?

• BRUNNSTROM- SHOULD ELICIT MOVEMENT

•  BOBATH-NORMAL MOVEMENT- WE SHOULD INHIBIT MOVEMENT

Should redevelopment of motor control be sought in an ontogenetic (developmental) sequence or a proximodistal sequence?

• PNF & ROOD USE ONTONGENETIC

• BOBATH & BRUNSTROM USE
•  PROXIMAL & DISTAL

Rood's Approach:

SENSORY MOTOR APPROACH

BOBATHS Approach:

NEURODEVELOPMENTAL APPROACH

(NDT)

Brunnstrom used:

MOVEMENT THERAPY

Knott and Voss approach:

PNF - (PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION)

PNF(PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION)

-Principles developed from normal human development & can be used with all patients with CNS OR UMN DAMAGE

-Stresses SPIRAL & DIAGONAL PATTERNS of movement used in a goal directed manner.

 -Uses weight bearing patterns such as crawling, kneeling, etc.

 -Manipulation by the therapist is an integral part of treatment.

 -ALL HAVE ONE ULTIMATE GOAL-TO DECREASE MOTOR RESPONSES

MOVEMENT THERAPY

• Studies done only with CVA pts
• Uses SENERGY & patterns of movements pt goes through during the recovery process
• Specific stages of recovery for specific movements.
• 6 DETAILED STAGES are objective.
• Progress is shown in each stage which is helpful

NEURODEVELOPMENTAL APPROACH

• 3 types of training: Adult Hemi (3 week course); Pediatrics (8 week course); & Babies (6-8 week course).
• Treats pt. as WHOLE; not extremity in isolation.
• Focus- learn & relearn of NORMAL MOVEMENT
•  Requires pt. feel what normal is.
• THEORY DOES NOT USE REFLEXES; allow abnormal movement.

SENSORY MOTOR APPROACH

-Utilizes appropriate sensory stimulation to elicit a specific motor response in order to progress patient through a SPECIFIC DEVELOPMENTAL SEQUENCE

 -Movement is GOAL DIRECTED.

 -Uses SENSATION & REPITITION to control movement.

 -Repetition is necessary for learning.

 -Includes use of icing, fast brushing, tapping and other sensory stimulation.

A neurophysiological treatment approach:

The Rood approach

The Rood approach is based on

• Use of sensory stimulation to effect motor responses.
• Rood combined controlled sensory stimulation with a sequence of positions and activities to replicate normal progression of motor skills to achieve purposeful muscular responses.

Basic assumptions of Rood’s theory:

• Normal muscle tone is a prerequisite to movement -Tone is constantly changing based on demands of motor activity; demands on muscle groups are different:
• Treatment begins at the developmental level of functioning
• Motivation enhances purposeful movement
• Repetition is necessary for reeducation of muscular responses

MOBILITIY (innervation)

or reciprocal inhibition

Serves as a protective function – agonist contracts while its opposite (antagonist) relaxes

Example: infants who randomly flex and extend their arms and legs

Occurs when opposite muscles contract simultaneously- stabilized joint

Example: trunk muscles cocontract when you’re standing upright

STABILITY

Proximal muscles move &

Distal segments are fixed

 Example: infant creeping in quadruped, hands and feet are fixed but shoulders and hips move

• Highest level of control combines mobility and stability
• proximal segment stabilizes while distal moves freely
• Example: reaching overhead to unscrew a light bulb

• PROTECTIVE POSITION
• MOBILITY POSTURE
• TOTAL FLEXION RESPONSE
• REQUIRES HEAVY WORK OF PROXIMAL MUSCLES & TRUNK
• RECOMMENDED FOR CLIENTS WHO DO NOT HAVE RECIPRICAL FLEXSION PATTERN OR DO HAVE EXTENSOR TONE

Supine withdrawal or flexor withdrawal

• ARM & LEG FLEX ON SAME SIDE OF THE BODY
• MOBILITY PATTERN FOR UPPER & LOWER EXTREMITIES AS WELL AS LATERAL TRUNK
• GOOD POSITION FOR PATIENTS WHO ARE DOMINATED BY REFLEXES

Roll over

• REQUIRES FULL ROM OF NECK, SHOULDER, TRUNK, AND LOWER EXTREMITY EXTENSION
•  A MOBILITY AND STABILITY PATTERN
•  PLAYS AN IMPORTANT ROLL IN PREPARATION FOR STABILITY IN THE UPRIGHT POSTION

Pivot prone or prone extension

• FIRST REAL STABILITY PATTERN
• NEEDED TO RAISE HEAD AGAINST GRAVITY
•  USED TO DEV. HEAD CONTROL AND STABILITY OF THE NECK

Neck co-contraction

• Stability pattern
• Gives opportunity for shifting weight BEARING ON ELBOWS
•  DEV. STABILTY IN SCAPULA AND SHOULDER AREAS
• GIVES OPPURTUNITY FOR WEIGHT SHIFT AND SEE ENVIROMENT BY LOOKING UP

Prone on Elbows

• HELP DEV. STABILITY OF LOWER EXTREMITIES AND TRUNK
•  INITIALLY JUST HOLDING POSITION
•  EVENTUALLY BEGIN TO WEIGHT SHIFT

Quadruped Position –(ALL FOURS)

• SKILL OF UPPER TRUNK
• FREES UPPER EXTREMITIES TO BE ABLE TO PERFORM ACTIVITIES
•  HELP TO MAINTAIN AND ACHIEVE BALANCE.

Static standing

COMBINE THE SKILL,

MOBILITY, AND STABILITY.

Walking

CUTANEOUS STIMULATION

STIMULATION TO SKIN OR RIGHT BELOW

(SUPERFICIAL) ACTIVATE SUPERFICIAL MUSCLE AS WELL (FACILITORY)

WHAT DOES LIGHT

MOVING TOUCH OF THE SKIN DO?

• ACTIVATE SUPERFICIAL MUSCLES

• ELLICIT A REFLEXIVE WITHDRAWAL RESPONSE (INITIATE GENERAL MOVEMENT)

FAST BRUSHING WITH

A BATTERY OPERATED

BRUSH OVER A MUSCLE BELLY

RESULTS ARE DELAYED AND HAVE A MAXIMUM EFFECT OF 30 MINUTES AFTER THE TECHNIQUE/AFTER

ICING

• USED TO FACILITATE A FLEXOR WITHDRAWAL RESPONSE IN SUPERFICIAL MUSCLES
• CAN BE USED TO FACILITATE OPENING AND CLOSING OF MOUTH TO AID IN SWALLOWING

PROPRIOCEPTIVE STIMULATION

• Facilitation of joint and muscle receptors and the vestibular system
• Gives the clinician more control over motor response as muscle response lasts as long as stimulus is applied

Heavy Joint Compression

FACILITATE CONTRACTION AT THE JOINT BEING COMPRESSED

• APPLIED BY HOLDING PROXIMAL BONY PRIMINENCES OF EXTREMITY TO BE STRETCHED WHILE MOVING DISTAL JOINT IN ONE DIRECTION
•  IN ORDER TO FACILITATE SOME JOINT CONTRACTION
• RESPONSE IS IMMEDIATE AND SHORT LIVED

Where and how does Tapping occur?

• OVER THE MUSCLE BELLY W/FINGER TIPS THAT YOU ARE TRYING TO GET TO CONTRACT
• NEVER TAP OVER SPASTIC MUSCLE

• QUICK IRREGULAR MOVEMNT THAT FACILITATES GENERAL MOVEMENT OR POSTURAL RESPONSES (used with cp, tbi)
• CAN BE HARMFUL; MUST BE SUPER CAUTIOUS  (SWING A CHILD)

Vibration

• LIGHT TAPPING
• NEVER USE OVER SPASTIC MUSCLES AND NOT USED ON CHILDREN UNDER 3 AND OVER 65

• FOR FACILITORY WOULD BE AN UNPLEASANT ODOR
• WILL TRIGGER PROTECTIVE RESPONSES OR REFLEX
• COULD FACILITATE CRANIAL NERVES

olfactory and gustatory stim

6 FACILITORY Methods

1. Heavy Joint Compression

2. Quick Stretch

3. Tapping

4. vestibular stimulation

5. vibration

6. olfactory and gustatory stim

6 INHIBITORY Methods

1. NEUTRAL WARMTH

2. MANUAL PRESSURE

3. LIGHT JOINT COMPRESSION

4. MAINTAIN STRETCH

5. OLFACTORY AND GUSTATORY

6. VESTIBULAR STIMULATION

VESTIBULAR STIMULATION:

SLOW ROCKING TO RELAX

MAINTAIN STRETCH

• POSTIONING IN ELLONGATED POSITION
• SOMEONE WITH SEVERE SPASTICITY

OLFACTORY AND GUSTATORY-

PLEASANT ODORS

NEUTRAL WARMTH-

GENERAL RELAXATION & USED TO DECREASE MUSCLE TONE

LIGHT JOINT COMPRESSION-

• INHIBIT SPASTIC MUSCLES AROUND THE JOINT
•  USED TO ALLEVIATE PAIN IN A HEMIPLEGIC SHOULDER

MANUAL PRESSURE -

• APPLIED TO ATTENENCE INSERTION OF MUSCLE OR CROSS LONG TENDON
• TO INHIBIT FLEXOR TONE
•  HARD SURFACE WORKS BETTER THAN SOFT SURFACE