Emphasis on the evidence for locomotor training, dual-task training, and high intensity gait training are included in the intervention sections. Heres the first textbook of neurologic techniques specifically written for physical therapy assistants. The first section covers the basic structure and function of the nervous system, normal motor development, motor control and motor learning, pathophysiology, common treatment interventions and techniques, and the role of the physical therapy assistant in clinical practice.
Sections two and three present techniques for working with adults and children with neurologic disorders and trauma. Case studies in SOAP format and critical thinking questions prepare students for clinical decision making. An abundance of detailed illustrations demonstrate positioning, movement facilitation, handling, cuing, and patient exercises.
Information is presented ina consistent, user-friendly format. Review questions help readers build their mastery of the material. First laying the foundation of the role of the PTA within the orthopedic plan of care, this text offers students the fundamental knowledge needed to best understand how the PT evaluates a patient.
From principles of tissue healing to detailed descriptions of the most common pathologies, tests and interventions for each body region, this text prepares the PTA for best patient education and care. The neuro rehab text that mirrors how you learn and how you practice! Physical therapy, or physiotherapy, is an allied health profession, which helps to promote, maintain or restore a person's health through various methods. A few of such methods are physical examination, diagnosis, prognosis, patient education, physical intervention, rehabilitation, disease prevention and health promotion.
It can be provided as a primary care treatment, or alongside other medical services. Neurological physical therapy or neurophysiotherapy focuses on working with individuals who have a neurological disorder. These can include stroke, chronic back pain, Alzheimer's disease, brain injury, cerebral palsy, Parkinson's disease, spinal cord injury, etc. The techniques involved in neurological physical therapy are wide-ranging and often require specialized training.
Neurophysiotherapy focuses on to relieving pain, improving balance and coordination, and aiding in restoring range of movement and motion.
This book contains some path-breaking studies in the field of neurophysiotherapy. It traces the progress of this field and highlights some of its key concepts and applications. Those with an interest in this field would find this book helpful.
Year after year, this text is recommended as the primary preparatory resource for the Geriatric Physical Therapy Specialization exam. And this new fourth edition only gets better. Content is thoroughly revised to keep you up to date on the latest geriatric physical therapy protocols and conditions. Five new chapters are added to this edition to help you learn how to better manage common orthopedic, cardiopulmonary, and neurologic conditions; become familiar with functional outcomes and assessments; and better understand the psychosocial aspects of aging.
Comprehensive coverage of geriatric physical therapy prepares students and clinicians to provide thoughtful, evidence-based care for aging patients.
Combination of foundational knowledge and clinically relevant information provides a meaningful background in how to effectively manage geriatric disorders Updated information reflects the most recent and relevant information on the Geriatric Clinical Specialty Exam. Standard APTA terminology prepares students for terms they will hear in practice. Coronal s ection through the s kull, meninges , and cerebral hemispheres and the cerebellum.
The area between ce re bral hemis pheres. The s e ction s hows the midline s truc ture s ne ar the top of the s kull.
The thre e laye rs of me ninges , the s uperior the dura mater and the skull is known as the epidural space. From The next or middle layer is the arachnoid. The space between Lundy-Ekma n L: Neurosc ience : fundame ntals for re habilitation, the dura and the arachnoid is called the subarachnoid space.
Lob e s of t h e Ce re b ru m specialized functions as well. This sidedness of brain func- The cerebrum is divided into four lobes—frontal, parietal, tion is called hemispheric specialization or lateralization.
The frontal lobe contains the primary shown in Figure , A. The hemispheres of the brain, motor cortex. The frontal lobe is responsible for voluntary although apparent mirror images of one another, have control of complex motor activities.
In addition to its motor. Ce ntra l s ulcus. Pa rie ta l lobe Fronta l lobe. Te mpora l lobe Occipita l lobe Pons. Me dulla Ce re be llum A S pina l cord. The brain. A, Le ft la teral vie w of the bra in, s howing the princ ipa l divis ions of the bra in a nd the four ma jor lobe s of the ce rebrum. B, Se ns ory homunc ulus. C, Prima ry a nd a s s o- c iation s e ns ory and motor area s of the bra in.
In the left hemi- eration of emotions Lundy-Ekman, The primary motor cortex, located in the frontal lobe, is pri- P a rie ta l lo b e.
The parietal lobe contains the primary marily responsible for contralateral voluntary control of the sensory cortex. Incoming sensory information is processed upper and lower extremity and facial movements. Thus, a within this lobe and meaning is provided to the stimuli. Specific body regions are assigned locations ment, orientation of the eyes and head, and bilateral, sequen- within the parietal lobe for this interpretation.
The pari- planning movements of the mouth during speech and the etal lobe also plays a role in short-term memory functions. The temporal lobe contains the primary auditory cortex.
Gross anatomic differences have been language. Visual perception, musical discrimination, and demonstrated within the hemispheres. The hemisphere that long-term memory capabilities are all functions associated is responsible for language is considered the dominant hemi- with the temporal lobe.
The occipital lobe contains the primary right-handed individuals, are left-hemisphere dominant. The eyes take in visual signals concerning Even in individuals who are left-hand dominant, the left objects in the visual field and relay that information. Newman, ; Guyton, ; Lundy-Ekman, Table lists primary functions of both the left and right As s oc ia tion Corte x cerebral hemispheres.
Association areas are regions within the parietal, temporal, and Le ft He m is p he re Func tio ns. The left hemisphere has occipital lobes that horizontally link different parts of the cor- been described as the verbal or analytic side of the brain.
For example, the sensory association cortex integrates and The left hemisphere allows for the processing of information. The Inte rna l Ca p s ule. The internal capsule contains the major processing of information in a step-by-step or detailed fash- projection fibers that run to and from the cerebral cortex. All ion allows for thorough analysis. For the majority of people, descending fibers leaving the motor areas of the frontal lobe language is produced and processed in the left hemisphere, travel through the internal capsule, a deep structure within the specifically the frontal and temporal lobes.
The left parietal cerebral hemisphere. The internal capsule is made up of axons lobe allows an individual to recognize words and to compre- that project from the cortex to the white matter fibers subcor- hend what has been read.
In addition, mathematical calcula- tical structures located below and from subcortical structures tions are performed in the left parietal lobe. An individual is to the cerebral cortex. The anterior limb connects to result of a functioning left frontal lobe. A final behavior the frontal cerebral cortex, the genu contains the motor assigned to the left cerebral hemisphere is the expression fibers that are going to some of the brain stem motor nuclei, of positive emotions, such as happiness and love.
Common the posterior limb carries sensory signals relayed from the thal- impairments seen in patients with left hemispheric injury amus to the parietal cortex and the frontal signals of the cor- include an inability to plan motor tasks apraxia ; difficulty ticospinal tract. The other two limbs relay visual and auditory in initiating, sequencing, and processing a task; difficulty signals from the thalamus to the occipital and temporal lobes, in producing or comprehending speech; memory impair- respectively.
The right cerebral hemi- input. The internal capsule is pictured in Figure The diencephalon is situated deep within tic abilities. The right side of the brain allows individuals to the cerebrum and is composed of the thalamus, epithalamus, process information in a complete or holistic fashion with- and subthalamus. The diencephalon is the area where the out specifically reviewing all the details. The individual is major sensory tracts dorsal columns and lateral spinothala- able to grasp or comprehend general concepts.
Visual- mic and the visual and auditory pathways synapse. The thal- perceptual functions including eye-hand coordination, amus consists of a large collection of nuclei and synapses. The ability sory impulses traveling upward from other parts of the body to communicate nonverbally and to comprehend what is and brain to the cerebrum. It receives sensory signals and being expressed is also assigned to the right parietal lobe. Moreover, the thalamus relays sensory information recognizing visual-spatial relationships, and awareness of to the appropriate association areas within the cortex.
Motor body image are processed in the right side of the brain. O ther information received from the basal ganglia and cerebellum is functions include mathematical reasoning and judgment, transmitted to the correct motor region through the thalamus. Specific deficits that can be observed in patients The hypothalamus regulates homeostasis, which is the main- with right hemisphere damage include poor judgment and tenance of a balanced internal environment.
This structure is safety awareness, unrealistic expectations, denial of disability primarily involved in automatic functions, including the reg- or deficits, disturbances in body image, irritability, and ulation of hunger, thirst, digestion, body temperature, blood lethargy. The hypo- thalamus is responsible for integrating the functions of both He m is p h e ric Con n e c tion s the endocrine system and the ANS through its regulation of Even though the two hemispheres of the brain have discrete the pituitary gland and its release of hormones.
Another group of nuclei located at the base actions. Communication between the two hemispheres is of the cerebrum comprise the basal ganglia. The basal ganglia constant, so individuals can be analytic and yet still grasp form a subcortical structure made up of the caudate nucleus, broad general concepts.
It is possible for the right hand to putamen, globus pallidus, substantia nigra, and subthalamic know what the left hand is doing and vice versa. The corpus nuclei. The globus pallidus and putamen form the lentiform callosum is a large group of axons that connect the right and nucleus, and the caudate and putamen are known as the left cerebral hemispheres and allow communication between neostriatum.
The nuclei of the basal ganglia influence the the two cortices. Primary responsibilities of the basal ganglia De e p e r Bra in St ru c tu re s include the regulation of posture and muscle tone and the Subcortical structures lie deep within the brain and include control of volitional and automatic movement.
In addition the internal capsule, the diencephalon, and the basal ganglia. The most tional significance to motor function. Amygda la Ma milla ry body S ubtha la mic A nucle us S ubs ta ntia nigra. Inte rna l ca ps ule Ce re bra l pe dunc le. Optic ne rve S upe rior ce re be lla r R. The cerebrum. A, Dience pha lon and ce rebra l hemis phe re s. Corona l s ec tion. B, A deep dis s e ction of the c erebrum s howing the ra dia ting ne rve fibe rs , the corona radiata, tha t c onduc t s ignals in both direc tions betwe en the c e re bra l c orte x and the lowe r portions of the ce ntral nervous s ys te m.
This such as stepping or reaching. The cerebellum also assists with can lead to symptoms of Parkinson disease, which can balance and posture maintenance and has been identified as include bradykinesia slowness initiating movement , akine- a comparator of actual motor performance to that which is sia difficulty in initiating movement , tremors, rigidity, and anticipated. The cerebellum monitors and compares the postural instability.
The limbic system is a group of deep ment actually performed Horak, The hypothalamus and the The brain stem is located between the base of the cerebrum amygdala play a role in the control of primitive emotional and the spinal cord and is divided into three sections reactions, including rage and fear.
The amygdala relays sig- Figure Moving cephalocaudally, the three areas are nals to the limbic system. The limbic system guides the emo- the midbrain, pons, and medulla. Each of the different areas tions that regulate behavior and is involved in learning and is responsible for specific functions.
The midbrain connects memory. More specifically, the limbic system appears to the diencephalon to the pons and acts as a relay station control memory, pain, pleasure, rage, affection, sexual inter- for tracts passing between the cerebrum and the spinal cord est, fear, and sorrow. The midbrain also houses reflex centers for visual, auditory, and tactile responses.
The pons contains Ce re b e llu m bundles of axons that travel between the cerebellum and The cerebellum controls balance and complex muscular move- the rest of the CNS and functions with the medulla to reg- ments. It is located below the occipital lobe of the cerebrum ulate breathing rate. It also contains reflex centers that assist and is posterior to the brain stem.
It fills the posterior fossa of with orientation of the head in response to visual and audi- the cranium. Like the cerebrum, it also consists of two sym- tory stimulation. Cranial nerve nuclei can also be found metric hemispheres and a midline vermis. The cerebellum is within the pons, specifically, cranial nerves V through VIII, responsible for the integration, coordination, and execution which carry motor and sensory information to and from of multijoint movements.
The cerebellum regulates the the face. Cingula te gyrus. Schematic mids agittal view of the brain s hows the relations hip between the ce re bral c ortex, ce re be llum, s pina l c ord, a nd bra in s tem, a nd the s ubc ortic al s truc tures impor- ta nt to func tional movement.
The cauda equina consists of the nerve roots for spi- are located within the medulla, as well as the control centers nal nerves L2 through S5.
Figure depicts the spinal cord for heart rate and respiration. Reflex centers for vomiting, sneezing, and swallowing are also located within the medulla. In addition, the reticular forma- Fronta l lobe S e ns ory a re a tion facilitates the voluntary and autonomic motor Occipita l lobe responses necessary for certain self-regulating, homeostatic Te mpora l lobe functions and is involved in the modulation of muscle tone Me dulla Ce re be llum throughout the body.
Ce rvica l s e gme nt S p in a l C o rd The spinal cord has two primary functions: coordination of motor information and movement patterns and communi- cation of sensory information. Additionally, the spinal cord provides Thora cic s e gme nt a means of communication between the brain and the Conus peripheral nerves.
The spinal cord is a direct continuation me dulla ris of the brain stem, specifically the medulla. The spinal cord is housed within the vertebral column and extends approxi- Lumba r s e gme nt mately to the level of the intervertebral disc between the first two lumbar vertebrae. The spinal cord has two S a cra l s e gme nt enlargements—one that extends from the third cervical seg- ment to the second thoracic segment and another that Dura l s a c conta ining extends from the first lumbar to the third sacral segment.
The principal anatomic parts of the nervous s ys - the conus medullaris. The conus medullaris is composed of tem. From Guyton AC: Basic neurosc ience : anatomy and physi- sacral spinal segments.
Below this level, the spinal cord ology, ed 2, Philadelphia , , WB Saunders. A thin filament, the filum ter- stimuli. The lower portion is referred to as the anterior or ventral minale, extends from the caudal end of the spinal cord horn Figure , B. It contains cell bodies of lower motor and attaches to the coccyx. In addition to the bony protec- neurons, and its primary function is to transmit motor tion offered by the vertebrae, the spinal cord is also covered impulses.
The lateral horn is present at the T1 to L2 levels by the same protective meningeal coverings, as in the brain. It is responsible for processing autonomic information.
In te rn a l An a tom y The periphery of the spinal cord is composed of white matter. The internal anatomy of the spinal cord can be visualized The white matter is composed of sensory ascending and in cross-sections and is viewed as two distinct areas.
A tract is a group of nerve Figure , A illustrates the internal anatomy of the spinal fibers that are similar in origin, destination, and function. Like the brain, the spinal cord is composed of gray These fiber tracts carry impulses to and from various areas and white matter. The center of the spinal cord, the gray mat- within the nervous system. In addition, these fiber tracts cross ter, is distinguished by its H-shaped or butterfly-shaped pattern. Therefore, an injury to the rons and synapses.
The upper portion is known as the dorsal or right side of the spinal cord may produce a loss of motor or posterior horn and is responsible for transmitting sensory sensory function on the contralateral side.
La te ra l gra y horn Ve ntra l gra y horn. Dors a l root fila me nts Ve ntra l white column. Dors a l root. Dors a l root ga nglion S pina l pia ma te r.
S uba ra chnoid s pa ce Ve ntra l root S pina l a ra chnoid. S pina l ne rve. S pina l dura ma te r Ve ntra l root fila me nts.
Dors a l horn Dors a l column. La te ra l horn La te ra l column. The s pinal cord. A, Struc ture s of the s pinal cord and its c onnections with the s pi- na l ne rve by way of the dors al and ve ntral s pina l roots. Note a ls o the cove rings of the s pina l c ord, the me ninges. B, Cros s -s e ction of the s pina l cord. The ce ntral gra y ma tter is divide d into horns a nd a commis s ure. The white ma tte r is divide d into c olumns. Ma jor Affe re n t Se n s ory Tra c ts Two primary ascending sensory tracts are present in the white matter of the spinal cord.
The dorsal or posterior columns carry information about position sense proprio- ception , vibration, two-point discrimination, and deep touch. Figure shows the location of this tract. The fibers of the dorsal columns cross in the brain stem.
Pain and tem- perature sensations are transmitted in the spinothalamic tract located anterolaterally in the spinal cord Figure Fibers from this tract enter the spinal cord, synapse, and cross within three segments. Sensory information must be relayed to the thalamus.
Touch information has to be processed by the cerebral cortex for discrimination to occur. Light touch and pressure sensations enter the spinal cord, synapse, and A are carried in the dorsal and ventral columns. Ma jor Effe re n t Motor Tra c t The corticospinal tract is the primary motor pathway and controls skilled movements of the extremities. This tract originates in the frontal lobe from the primary and premotor cortices, descends through the internal capsule, and con- tinues to finally synapse on anterior horn cells in the spinal cord.
This tract also crosses from one side to the other in the brain stem. A common indicator of corticospinal tract dam- age is the Babinski sign. The sign is present when the great toe extends and the other toes splay. The presence of a Babinski sign indicates that B damage to the corticospinal tract has occurred.
Babinski s ign. A, Norma l. Stroking from the heel to the ball of the foot a long the lateral s ole, then a cros s the ball of the foot, normally c ause s the toes to flex. B, Developmental or patho- Oth e r De s c e n d in g Tra c ts logic. Babinski s ign in res pons e to the s ame s timulus. In people with O ther descending motor pathways that affect muscle tone corticospinal tract les ions , or in infants younger tha n 7 months old, are the rubrospinal, lateral and medial vestibulospinal, tec- the great toe extends.
Although the other toe s may fan out, as s hown, movement of the toe s other than the gre at toe is not required tospinal, and medial and lateral reticulospinal tracts.
The for the Babinski s ign. From Lundy-Ekman L: Neurosc ie nce: funda- rubrospinal tract originates in the red nucleus of the mentals for rehabilitation, ed 4, St Louis , , Els evier, La te ra l Fa s ciculus gra cilis P os te rior fis s ure corticos pina l tra ct de s ce nding to s ke le ta l Fa s ciculus cune a tus mus cle for volunta ry move me nt P os te rior s pinoce re be lla r tra ct. Rubros pina l tra ct de s ce nding for Ante rior s pinoce re be lla r pos ture a nd mus cle tra ct a s ce nding from coordina tion proprioce ptors in mus cle a nd te ndons for pos ition s e ns e La te ra l s pinotha la mic tra ct a s ce nding for Ve s tibulos pina l tra ct pa in a nd Re ticulos pina l tra ct Ante rior corticos pina l tra ct te mpe ra ture fibe rs s ca tte re d Te ctos pina l tra ct.
Cros s -s ection of the s pinal cord s howing tracts. Fibers from this tract facilitate flexor CNS, including the cranial nerves exiting the brain motor neurons and inhibit extensor motor neurons.
Proxi- stem and the spinal roots exiting the spinal cord, many mal muscles are primarily affected, although the tract does of which combine to form peripheral nerves. These nerves exhibit some influence over more distal muscle groups. Figure provides of movement errors. The lateral vestibulospinal tract assists a schematic representation of the PNS and its transition to in postural adjustments through facilitation of proximal the CNS.
Regulation of muscle tone in the neck The PNS is divided into two primary components: the and upper back is a function of the medial vestibulospinal somatic body nervous system and the ANS. The somatic tract. The text also includes a new chapter on Autism Spectrum Disorder. Helpful learning aids in each chapter include objectives and summaries, open-ended review questions, line drawings and photos, step-by-step illustrated intervention boxes, tables, and charts.
Comprehensive content on the role of neurologic rehabilitation focuses on the treatment of adults and children with neuromuscular impairments and explores concepts in neuroanatomy, motor control and motor learning, and motor development. Open-ended review questions at the end of each chapter allow you to test your knowledge of material covered in the chapter. Case studies include subjective and objective observation, assessment, planning, and critical decision-making components, and provide context for you regarding the patient examination and treatment process.
Over illustrations and photographs detailing anatomy, physiology, evaluation, pathology, and treatment enhance your learning resources. Best evidence for interventions; clear, concise tables; graphics and pictures; and current literature engage you in the spectrum of neurologic conditions and interventions. Autism Spectrum Disorder chapter covers clinical features, diagnosis, and intervention, with a special focus on using play and aquatics, to support the integral role of physical therapy in working with children and families with autism.
Neuroanatomy chapter provides a more comprehensive review on nervous system structures and their contributions to patient function and recovery after an injury or neurologic condition. Adult chapters feature updated information on medical and pharmacological management. The Core Set of Outcome Measures for Adults with Neurologic Conditions assists you in measuring common outcomes in the examination and evaluation of patients. Review questions are included at the end of each chapter, with answers at the back of the book.
Illustrated step-by-step intervention boxes, tables, and charts highlight important information, and make it easy to find instructions quickly. NEW photographs of interventions and equipment reflect the most current rehabilitation procedures and technology. UPDATED study resources on the Evolve companion website include an intervention collection, study tips, and additional review questions and interactive case studies.
The chapters describe the lifestyle of each individual before the onset of brain damage and the subsequent symptoms, neuropsychological assessment, rehabilitation, and long-term outcome of their condition.
Although improvement for those with severe brain injuries is slow and limited, the patients described in the book made some progress after their admission to rehabilitation services.
The exhaustive analysis of each case and a step-by-step description of management will serve as an inspiring and informative guide for students, professionals and other caregivers. It reviews basic theory and covers the latest screening and diagnostic tests, new treatments, and interventions commonly used in today's clinical practice.
This edition includes the latest advances in neuroscience, adding new chapters on neuroimaging and clinical tools such as virtual reality, robotics, and gaming. Written by respected clinician and physical therapy expert Darcy Umphred, this classic neurology text provides problem-solving strategies that are key to individualized, effective care.
A section on neurological problems accompanying specific system problems includes hot topics such as poor vision, pelvic floor dysfunction, and pain. A problem-solving approach helps you apply your knowledge to examinations, evaluations, prognoses, and intervention strategies.
Evidence-based research sets up best practices, covering topics such as the theory of neurologic rehabilitation, screening and diagnostic tests, treatments and interventions, and the patient's psychosocial concerns Information. Case studies use real-world examples to promote problem-solving skills.
0コメント