task orianted approch
DESCRIPTION
محاضرة دكتور مجدى التالتة .. و دى اللى نذاكرها من هنا مش من الكتابTRANSCRIPT
االنعام سورة163و162اآلية
Impairment Impairment
DisabilityDisability
Handicap Handicap
Stroke
Need
Continuous rehabilitation
Sensory Disturbance
Sensory Disturbance
Neurological DisordersNeurological Disorders
Neurological DisordersNeurological Disorders
Gait problems Gait problems
Perceptual Impairment
Perceptual Impairment
Neuromuscular impairment
Neuromuscular impairment
Impaired U.E Function
Impaired U.E Function
BalanceDisordersBalance
Disorders
stroke
Inability to carry out activities of daily living and social activitiesInability to carry out activities of daily living and social activities
Motor Impairment
Lack of cortical driveLack of cortical drive Lack of cortical driveLack of cortical drive
Disorganization of the motor outputDisorganization of the motor output
Disorganization of the motor outputDisorganization of the motor output
Lack of firing of agonist
Lack of firing of agonist
Over activities of the antagonist
Over activities of the antagonist
Neuromuscular impairmentcan be attributed to
Cocontraction of the agonist and antagonist
Cocontraction of the agonist and antagonist
Task specific control problemTask specific control problem
Inability to recruit muscle during automatic taskInability to recruit muscle during automatic task
Standing Balance TaskStanding Balance Task Locomotor Task (walking)Locomotor Task (walking)
Such asSuch as
Upper Extremity Tasks Upper Extremity Tasks (Grasping – Reaching – Manipulation (Grasping – Reaching – Manipulation
– – Feeding & Dressing)Feeding & Dressing)
Following stroke some of tasks are generally become more difficult
Normal Standing Balance
Development of skilled movements
Locomotion Manipulation
High priority should be given to the treatment of postural control problems
INTEGRAL PART OF ALL MOTOR ABILITIES
SO,SO,
ESSENTIAL FOR
attributed to
Loss of somatosensory sensation.Loss of somatosensory sensation.Muscle weakness.Muscle weakness.Spasticity leads to incoordination. Spasticity leads to incoordination. Impaired equilibrium reactions.Impaired equilibrium reactions.Loss of anticipatory reactions.Loss of anticipatory reactions.
Disturbed standing balance task in stroke patients
Disturbed walking task in stroke patient can be attributed to
Inability to maintain standing balance.Difficulty to shift weight bearing.Inability to take step by the affected limb.Improper joint alignment of L.L.Difficulty to control the position of the feet in standing.
Different therapeutic approaches are available for
management of stroke patient
Although
The functional outcome result is
limited.
There are controversial There are controversial issues about the best issues about the best
physiotherapeutic program physiotherapeutic program for rehabilitation of stroke for rehabilitation of stroke
patientspatients
TASK ORIENTED APPROACHTASK ORIENTED APPROACH
Aims to
Reduce disability by optimizing performance of every day task
Based on
Principles of Motor re-learning
System theory of motor control
Training functional movement skill
ProprioceptiveProprioceptive
stimulationstimulation
Modify functional behavior
Modulate motor behavior
Sensory awareness
Proper motor Proper motor engramengram
Training the posture reactions. Training the posture reactions. Training the rising reactionsTraining the rising reactionsControl spasticity and maintain length of the muscle. Control spasticity and maintain length of the muscle. Elimination of unnecessary muscle activity.Elimination of unnecessary muscle activity. Elicit muscle activity necessary for standing balance.Elicit muscle activity necessary for standing balance. Training the antigravity mechanism.Training the antigravity mechanism. Training weight bearing on both legs. Training weight bearing on both legs. Training weight bearing on affected leg.Training weight bearing on affected leg. Practice of the standing task.Practice of the standing task.
Strategies used to achieve Strategies used to achieve standing balance taskstanding balance task
Strategies used to achieve Strategies used to achieve standing balance taskstanding balance task
Sensory awareness
Postural response
Regain normal alignment
ms. strength control spasticity
Standing Balance Standing Balance TaskTask
Muscle strength
Task Oriented ApproachTask Oriented Approach
Parietal lobe
Motor cortex
Appropriate motor neurons
& appropriate number
Appropriate motor neurons
& appropriate numberInappropriate motor neuronsInappropriate motor neurons
Unnecessary activities & Inappropriate co-contraction
Unnecessary activities & Inappropriate co-contraction
Descending excitatory impulses to agonist muscles (more firing)
Abnormal activities of Spastic muscle (reciprocal innervation)
Postural control & balancePostural control & balance
Reducing neural hyper Reducing neural hyper excitability at CNSexcitability at CNS
Spatial orientation.Spatial orientation.
Repeated joint approximationRepeated joint approximation
Muscle toneMuscle tone
Unnecessary ms. activityUnnecessary ms. activity
+ Prime mover (agonist) &
- Antagonist & synergist.
Inappropriate co-cont.
Reducing ms. toneReducing ms. tone
BridgingBridging
HalfHalf bridgingbridging
Exercise to facilitate more Exercise to facilitate more normal movement pattern in normal movement pattern in trunk, pelvis and lower trunk, pelvis and lower extremitiesextremities
with with assistanceassistance
To facilitate selective dorsiflexionTo facilitate selective dorsiflexion,, Hip and knee flexionHip and knee flexion
Exercise to facilitate or Exercise to facilitate or improve selective hip improve selective hip abductors from side lying abductors from side lying
position.position.
Exercise to facilitate the Exercise to facilitate the antigravity mechanism: antigravity mechanism: (facilitation of back extensors (facilitation of back extensors
and hip extensors).and hip extensors).
11
22
Exercise to facilitate and Exercise to facilitate and train postural control from train postural control from quadriped positionquadriped position
11 22
33 44
Weight shift Weight shift exercise exercise from side to from side to side side to improve to improve symmetry of symmetry of weight weight bearingbearing
Training the Training the rising rising reactions reactions (Training on (Training on sitting to sitting to standing standing task):task):
Activities in standing with Activities in standing with weight on both legs:weight on both legs:
Exercise to Exercise to facilitate facilitate and train and train postural postural control from control from standing standing positionposition
Activities in standing with Activities in standing with concentration of weight concentration of weight bearing on the hemiplegic’s bearing on the hemiplegic’s leg.leg.
11 22
33
44
Standing with his weightStanding with his weight over the hemiplegic legover the hemiplegic leg
Task oriented approach depend on Task oriented approach depend on Active participation of the patientActive participation of the patient
Blood supply to brain 20 %Blood supply to brain 20 %
Remodeling of cortical mapRemodeling of cortical map
Brain cells to functionBrain cells to function
More improvement of the ms. responseMore improvement of the ms. response
Physiological efficiencyPhysiological efficiencyMechanical efficiencyMechanical efficiency
Psychological status of the pt.Psychological status of the pt.
Repetitive Stimulus and practiceRepetitive Stimulus and practice Repetitive Stimulus and practiceRepetitive Stimulus and practice
StimulateStimulate functionfunction
StimulateStimulate functionfunction
Skill acquisitionSkill acquisition
Cortical Cortical reorganizareorganiza
tiontionEnhance the rate of spontaneous Enhance the rate of spontaneous
& & optimize recoveryoptimize recovery
Task Oriented ApproachTask Oriented Approach
Task oriented approach via Task oriented approach via early program of proprioceptive early program of proprioceptive training is a beneficial modality training is a beneficial modality for improving the functional for improving the functional outcome and optimizing the outcome and optimizing the recovery in stroke patients.recovery in stroke patients.