Unit 2 Week 3

Question 1

what are the peripheral consequences (neuromotor impairments) following injury?

Answer 1

afferent (sensory) can be altered (e.g., mechanoreceptors in skin, ligaments, muscles, tendons)

efferent (motor) output can be altered (e.g., muscle inhibition altering muscle contractions)

**these neuromotor impairments may be assessed and treated to restore both afferent and efferent (sensorimotor) pathways

Question 2

neuromotor exercise involves developing motor skills such as: _____

Answer 2

activation
balance
coordination
agility
proprioception

Question 3

what is activation?

Answer 3

the ability to voluntarily contract a skeletal muscle in isolation

Question 4

what is the clinical indication of an activation issue?

Answer 4

following injury clients may be unable to voluntarily fully contract an otherwise healthy muscle - such as when there is an ACL injury at the joint (e.g., arthrogenic muscle inhibition (AMI))

Question 5

how could you test the ACTIVATION of vastus medialis?

Answer 5

1) ask the client to contract the muscle
2) observe for isolated muscle contraction and signs of associated function
3) palpate muscle to determine degree and duration of voluntary contraction before fatigue

Question 6

what is agility?

Answer 6

the ability to change direction to achieve a specific goal

Question 7

how could agility be assessed?

Answer 7

using the Modified Agility ‘T’ Test
- uses a series of movements where an athlete starts at a specific line and travels forward, backwards, side to side, accelerates, decelerates, etc.

Question 8

what is balance?

Answer 8

refers to the complex motor control process that integrates relevant sensory information (i.e., visual, proprioceptive, vestibular) to execute appropriate motor actions to control body positions in the context of the environment and the task

Question 9

how is balance maintained?

Answer 9

it is maintained when the center of gravity is within the base of support

Question 10

what is an example of a static and a dynamic balance test?

Answer 10

static - balance error scoring system (BESS)
dynamic - y balance test (measures and compares bilaterally)

Question 11

what is coordination?

Answer 11

the ability to execute accurate, smooth, controlled movement patterns

Question 12

how could coordination be assessed?

Answer 12

by observing the quality of a single leg squat test
- knee vs hip dominant
- dynamic knee valgus

Question 13

what are the 5 things considered for a good rating on the single leg squat test?

Answer 13

ipsilateral trunk lean
pelvic tilt
hip adduction or internal rotation
dynamic knee valgus
loss of balance

Question 14

what is proprioception?

Answer 14

the ability to sense limb movement and positioning in space

Question 15

how could proprioception be measured?

Answer 15

may be measured through joint position sense (ability to reproduce a joint position)

Question 16

what does the Clinical Practice Guidelines recommend neuromotor exercise for?

Answer 16

resolving neuromotor impairments
reduce injury recurrence risk

Question 17

what are the 6 treatment principles of neuromotor exercise?

Answer 17

frequent practice
meaningful practice
vary sensory input
attentional focus
implicit learning
autonomy

Question 18

purpose of meaningful practice?

Answer 18

stimulate the clients’ function / goal
- want to give tasks that are important and challenging to the client

Question 19

purpose of varying sensory input?

Answer 19

to either amplify or occlude sensory inputs
- adding foam challenges proprioception
- closing eyes creates an increase demand from the other senses
- turning head while on foam challenges the vestibular system

Question 20

what are the 4 types of cueing you can use in varying sensory input for clients?

Answer 20

auditory
imagery
proprioception (monitor back arch with hands)
visual (demonstration/mirror)

Question 21

what is the purpose of external vs internal focus for attentional focus component?

Answer 21

internal is focus on self
external is focus on environment
- focus on self is more conscious and can disrupt automatic control tendencies
- ex of internal could be “bend your knee so it sits over your toes”
- ex of external would be “reach your knee towards to cone infront of you”

Question 22

what is the difference between implicit and explicit learning?

Answer 22

in explicit learning you are overloaded with external information, increasing errors and overloading your working memory

in implicit learning you are promoting more automatic or internal processes, leading to less errors, and reducing the load on your working memory

LESS INSTRUCTION IS BETTER FOR MEMORY

Question 23

why is autonomy important for motor learning?

Answer 23

patients tend to assume a passive role, but CHOICE is important for motor learning

Question 24

what is the general FITTVP for healthy adults and treating neuromotor impairments?

Answer 24

F - 2 -3 times per week
I - optimal is unknown
T- 20-30 mins per day
T - balance, agility and coordination
V - optimal is unknown
P - optimal is unknown

Question 25

what is the best practice for activation? (FITVP)

Answer 25

F - greater than 3 x per day I - % max voluntary contraction (MVC) T- isolated isometric contraction in inner range V - 5-10 seconds, 5-10 reps (depends on ability to maintain contraction quality) P - increase volume to isolated contraction for 10 seconds, 10 reps, or increase through ROM/function (maintaining isometric contraction quality in different angles or in isotonics)

Question 26

what is the best practice for balance / proprioception (FITVP)

Answer 26

F - 3-5 x per week I - effortful to maintain balance T- single leg balance, even surface, eyes open V - 3-5 sets for 30-60 seconds P - increase volume, increase intensity, dual tasking, uneven surface, eyes closed

Question 27

what is the best practice for agility / coordination?

Answer 27

F - 2 -3 x per week I - optimal movement quality (ex avoids knee valgus) T- accelerations, decelerations, side steps, crossovers V - 3 sets of 3-5 reps or 15-30 m P - increase volume, increase intensity (ex speed, external load, dual tasking)

Question 28

what is the best practice for coordination / power? (FITVP)

Answer 28

F - 2-3 x per week I - optimal movement quality (ie good triple flexion) T - double leg jumping V - 3 sets of 3-5 reps P - increase volume, increase intensity (ie distance, height, hops)

Question 29

what type of consequences are present following a peripheral injury?

Answer 29

central consequences! - bilateral impairments (need to do bilateral training) - proximal impairments (multi joint training is needed)

Question 30

why is cognitive loading important following an injury?

Answer 30

cognitive impairments (attention, memory) may contribute to re-injury through impairments in motor behaviours, proprioception and obstacle identification - progressive integration of cognitive loads during rehab may reduce cognitive impairments and re-injury

Question 31

what are some examples of how you could cognitive load?

Answer 31

dual tasks reactive tasks (kicking a ball back and forth while balancing) anticipatory tasks (catching falling markers while balancing) **focusing on another task while training can increase your automatic control

Question 32

can sensorimotor dysfunction be improved with neuromotor exercise?

Answer 32

maybe! consider neuromotor execise to reduce neuromotor impairments and reinjury occurence

Question 33

what is the main goal of neuromotor exercise?

Answer 33

it is fundamentally about motor learning

Question 34

what types of exercise should you consider integrating during neuromotor rehab?

Answer 34

bilateral and multi-joint neuromotor exercise

Question 35

is there cognitive impairment following injury?

Answer 35

emerging evidence says there is - this is why you should integrate cognitive loading during rehabilitation to reduce these impairments and injury recurrence