AHPT 614 - Interventions for Performance initiation, Motor control, stabilization

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You can skip directly to the performance initiation, stabilization, and motor control phase if...
signs of inflammation are absent, decreasing, or are not worsened with the introduction of these exercises for greater than 24 hours
The performance initiation, stabilization, and motor control phase occurs during which stage of tissue healing?
Proliferative or remodeling stages
Full mobility is not required in this stage, but...
pain free range to exercise is essential
Describe the general parameters for exercises in the performance initiation, stabilization, and motor control stage:
exercises in this phase are completed daily, with a high number of repetitions and a low weight (<50% 1RM for isotonic exercises OR 25-50% MVC for isometrics) which allows the body to maintain a predominately aerobic supply of energy
_______ ___________ and _________ are essential to enable full tissue healing as they induce tissue adaption, introduce stress, and aid in _______ _________ and _______ ________ for functional activities.
Muscle contraction and initiation; joint stability and motor control
Which exercise principle should be applied to exercise prescription during this stage?
The principle of specificity
What does performance (muscle) initiation involve?
- initiate loading to tissues
- proper recruitment of muscles - synergists and stabilizers
- increase CV and muscle endurance - initial loads will not alter capacity
- increase muscle effective acceleration and deceleration responses (motor control at end ranges)
- demonstrates muscle control during functional activities
What are the FITT parameters for performance initiation?
Freq: 2-3x/wk, nonconsecutive days

Intensity: 40-60% 1RM; goal is to activate motor neurons

Time: to or before fatigue; rest breaks incorporated

Type: Isometric - Isotonic - Eccentric - Concentric - Open Chain - Close Chain
Stability interventions involve:
- static control
- coordination of motor and sensory components
- balance of soft tissue function around a joint or body part
- provides a stable foundation from which to move
What are the FITT parameters for stability interventions?
Freq: High volume
Intensity: Light to moderate
- specificity of muscles
Time: increase time to fatigue
Type: isometric hold - high repetitions
What is motor control?study of human movement and the systems that control it under normal and pathological conditionsMotor control involves:- Graded resistance - Reinforcement - verbal and visual stimulation - traction - approximation - Timing - Neural inputs - rhythmic initiation - rhythmic stabilization - reflex inhibiting postures - combined isotonics and dynamic reversalsHow should Isotonics for motor control be performed?through functional range at slow velocity with emphasis on control - facilitatory tactile, verbal, visual techniques to improve recruitment, synergies, and better movement strategiesWhat are the FITT parameters for motor control interventions?Freq: often; multiple times a day, most days of the week Intensity: low to moderate intensity (40-60% 1RM) - need proper activation of motor units - avoid faulty movement patterns Time: avoid fatigue; short bouts with rest Type: isometric - isometric with increasing movements of limbs and then trunkMobility:ability to initiate a movementStability:stabilize a new static position and control gravityMobility on Stability or Controlled Mobility:Make movements in a stable position or with a stable baseSkill:manipulate the environment with dynamic, proximal stabilityCoordination:The ability to use different parts of the body together smoothly and efficiently correct timing and sequencing of muscle firingPNF:incorporates motor learning and motor control irradiation - overflowMET:gentle muscle contractions of the patient to relax and lengthen muscles and normalize joint motionStability:Ability to hold a proximal or distal segment in a stationary position or control a base during movementMotor control:the process of initiating, directing, and grading purposeful voluntary movementIsometrics for motor control:Rhythmic stabilization - isometric contractions between agonist and antagonist musclesIsotonics for motor control:Combination of isotonics - combination of concentric, stabilizing, and eccentric contractions through agonist motionRhythmic Initiation for motor control:Rhythmic motion of the limb through the desired range, starting with passive motion and progressing to active resisted motion; Influences motor planning and coordinationWhat are the goals for motor control techniques using PNF?Increase ROM and strength through new motion AND Decrease muscle fatigue in strengthening phaseWhat PNF techniques can be used to increase ROM and strength through new motion?Rhythmic initiation Contract/hold relax Dynamic reversal Isotonic through ROMWhat PNF techniques can be used to decrease muscle fatigue in strengthening phase?Repeated stretch Dynamic reversal patterns combined isotonicsWhat are the elements of MET?- identification of a resistance barrier - the use of an isometric or sometimes isotonic contraction - 10-12 seconds - A response to that contraction, which appears to facilitate easier movement to a new barrier - or past a new barrier, into stretch - Hold 15-30 sec; repeat 3-4 times (the final position for 25-30 seconds)Both MET and PNF involve the use of...isometric contractions prior to (or during) stretching or movement____, in its original osteopathic setting, aimed to restore joint function to normal.MET____ identifies the restriction barrier at which the isometric contraction commences. The restriction barrier appears to involve moving the area to an end of range, where the patient perceives mild discomfort.PNFIn ____ the restriction barrier is most commonly described as the very first perceived sign of tension, resistance, bind - or even short of that.MET____ frequently calls for a far longer and stronger isometric contraction.PNFIn _____, 20% or less of available strength is requested.METIn _____, the therapist applies measured resistance while the patient holds the position.PNFIn ____, it is always the patient, and not the therapist, who introduces isometric effort.METUpper crossed syndrome:inhibited (weak): - deep cervical flexors - lower trap/serratus anterior/rhomboids Facilitated (tight): - Upper trapezius/levator scapula - SCM/PectoralsLower crossed syndrome:Inhibited (weak): - abdominals - glute min/med/max Facilitated (tight): - rectus femoris/ilipsoas - Thoracolumbar extensorsWhat are commonly underactive stabilizer muscles?Gluteus medius Gluteus maximus Transversus abdominis Lower trapezius Deep neck flexor Serratus anterior DiaphragmUnderactive stabilizer: Gluteus medius Overactive synergist(s): ? Shortened antagonist: ?Overactive synergist(s): TFL, QL, piriformis Shortened antagonist: Thigh adductorsUnderactive stabilizer: Gluteus maximus Overactive synergist(s): ? Shortened antagonist(s): ?Overactive synergist(s): Iliocostalis lumborum, hamstrings Shortened antagonist: iliopsoas, rectus femorisUnderactive stabilizer: Transversus abdominis Overactive synergist(s): ? Shortened antagonist(s): ?Overactive synergist(s): Rectus abdominis Shortened antagonist: iliocostalis lumborumUnderactive stabilizer: Lower Trapezius Overactive synergist(s): ? Shortened antagonist(s): ?Overactive synergist(s): Levator scapulae, upper trapezius Shortened antagonist: Pectoralis MajorUnderactive stabilizer: Deep neck flexors Overactive synergist(s): ? Shortened antagonist(s): ?Overactive synergist(s): SCM Shortened antagonist: SuboccipitalsUnderactive stabilizer: Serratus Anterior Overactive synergist(s): ? Shortened antagonist(s): ?Overactive synergist(s): Pectoralis major/minor Shortened antagonist: RhomboidsUnderactive stabilizer: Diaphragm Overactive synergist: ?Scalenes, pectoralis major