問題一覧
1
Swedish physical therapist who made Brunnstrom
Anna Signe Sofia Brunnstrom
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When was Brunnstrom made
1960
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Afferent sensory inputs are necessary prerequisites for efferent motor outputs
reflex control theory
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Facititate and use reflexes to regain motor control in hemiplegic patients
reflex control theory
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Building blocks to complex motor behavior and movements
reflex
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Organized in a hierarchical level to control motor functions in the body
CNS
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Consists of cerebral cortex, midbrain and brainstem & spinal cord
hierarchical control theory
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Cerebral cortex
equilibrium reactions, complex motor movements
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Midbrain
righting reactions, less complex movements
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Brainstem & spinal cord
primitive reflexes, reflexive movements
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CNS injury =
evolution in reverse
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Development of basic limb synergies, associated reactions and tonic reflexes
brunnstrom technique
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Purposeful movements with maximum precision, but with minimum waste of energy
normal synergistic movements
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Do not permit different combination muscles
basic limb synergies
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Early spastic period of recovery
basic limb synergies
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Classifications of BLS
flexor, extensor, mixed
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Voluntary forceful movement in other parts of body readily elicit reflex tensing of muscles
associated reflexes
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Position of the head has marked influence on the outcome of the associated reactions
simons, 1923
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Response of one extremity will elicit the same reaction in its ipsilateral extremity
homolateral limb synkinesis
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Resisted abduction or adduction of the good limb evokes similar reaction in the bad limb
ramiste’s phenomenon
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Flexor energy is elicited
yawning
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Evoke sudden muscular contractions of short duration
coughing and sneezing
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Brunnstrom associated reactions
UE: movements employed elicited the same reactions in the affected limb, LE: movements employed elicited opposite reactions in the affected limb
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Stationary contact with the palm of the hand results to closure of the hand
instinctive grasp reaction
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Same with palmar grasp
instinctive grasp reaction
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With the arm elevated in a forward-upward direction, the fingers and thumb hyperexted stroking the palm in a distal direction exaggerates the posture
instinctive avoiding reaction
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Elevation of the affected UE beyond the horizontal plane results to finger extension and abduction
souques finger phenomenon
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Symmetric tonic neck reflex stimulus
neck flexion, neck extension
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Asymmetric tonic neck reflex stimulus
neck lateral rotation
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Tonic labyrinthine reflex stimulus
supine, prone
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Tonic lumbar reflex stimulus
R trunk rot, L trunk rot
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Symmetric tonic neck reflex response: NECK FLEXION
UE: flexion, LE: extension
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Symmetric tonic neck reflex response: JAW SIDE
UE: extension, LE: extension
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Asymmetric tonic neck reflex response: SKULL SIDE
UE: flexion, LE: flexion
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Tonic labyrinthine response: SUPINE
limbs move into extension
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Tonic labyrinthine reflex response: PRONE
limbs move into flexion
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Tonic lumbar reflex response: R trunk rot
increase flexor tone in RUE and LLE, increase extensor tone in LUE and RLE
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Tonic lumbar reflex response: L trunk rot
increase flexor tone in LUE and RLE, increase extension tone in RUE and LLE
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Stages in Brunstrom stages of motor recovery can be skipped depending on the severity of the insukt and degree of the sensory motor involvement
false
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Pt is completely flaccid, no voluntary movement and pt is bed bound
stage 1
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STAGE 1
pt in completely flaccid, pt is bed bound, no voluntary movement
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STAGE 2
development of limb strategies, no voluntary movement, spasticity appears
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STAGE 3
basic limb strategies develop voluntarily and is marked, spasticity is marked
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STAGE 4
spasticity begins to decrease, movement combinationd deviated from bls and become available
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Stage 5
relative independence of bls, spasticity is waning
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STAGE 6
isolated jt movements, coordination reaching normally, no spasticity
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STAGE 7
normal motor function restored
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Stage 4
placing hand behind body, alternative pronation-supination with 90 deg elbow flexion, elevation of arm to a forward horizontal position
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STAGE 5
arm raising to side horizontal position, alternative pronation-supination with elbow extended, bring hand over head
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Sensory examination
kinesthesia, tactile localization, pressure
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Treatment progress ________, so facilitate the patient’s progress throught the recovery stages
developmentally
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When no motion exists, movement is facilitated using reflexes, associated reactions, proprioceptive facilitation and/or interoceptive facilitation to develop muscle tension in preparation for voluntary movement
false
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Responses of the patient from facilitation combine with the patient’s voluntary effort to produce
semi voluntary movement
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Stimuli that assists in eliciting the synergies
proprioceptive, exteroceptive
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When voluntary effort appears:
isometric, eccentric, concentric, agonist antagonist reversal movement
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Facilitation is reduced or dropped out as quickly as the patient shows ______
voluntary control
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No primitive reflexes, including associated reactions are used beyond
stage 3
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Correct movement is repeated
true
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Practice in the form of ADL
true
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FLEXOR SYNERGY UE
scapular retraction/elevation, shoulder abd, ER, elbow flexion, forearm supination, wrist flexion, finger flexion
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EXTENSOR SYNERGY UE
scapular protraction/depression, shoulder add, IR, elbow extension, forearm pronation, wrist extension, finger flexion
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FLEXOR SYNERGY LE
pelvic anterior tilt, hip flexion, abd, ER, knee flexion, ankle df, toe extension
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EXTENSORY SYNERGY LE
pelvic posterior tilt, hip extension, add, IR, knee extension, ankle pf, toe flexion
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UPPER LIMB MIXED SYNERGY
scapula retraction, shoulder add, IR, elbow flexion, forearm pronation, wrist and finger flexion
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LOWER LIMB MIXED SYNERGY
pelvic posterior tilt, hip add, IR, knee extension, ankle and toe pf