The Positive Nervous System

Turning and ambulation after activities will be enhanced if pain is controlled or tolerable because promotes muscle relaxation.

The background of Proprioceptive Neuromuscular Facilitation (PNF) is traced back to the late 1940s/early 1950s with Herman Kabat (MD), Margaret Knott (PT), and Dorothy Voss (PT) being the developers of this method. PNF was developed to treat neurological dysfunctions (such as multiple sclerosis and cerebral palsy) . “This was an attempt to gain better control in a population of neurologically impaired instead of just offering the standard treatment at the time which was range of motion exercising and gate belt training”(Knott and Voss, 1968). Even though PNF was developed for neurological dysfunctions overtime it also became principle used in others areas of life such as with athletes and personal/physical trainers. The common misconception with

O: Slow but normal gait, sitting upright on the examination table without any support, able to get up and down without any assistance on the exam table; no grimace on his face, limited lumbar spine range of motion (per TM); no muscle spasm; no impairment of NVS; no muscle atrophy noted; intact reflexes, + 5 strength to lower and upper extremities, peripheral pulses +3, sensation intact; Straight leg test was negative.

Static stretches are intended to improve flexibility by holding a specific movement. For the feet and calves there is the advanced plantar flexor stretch. For the knees and things there are the advanced seated knee flexor stretch and advanced kneeling knee extensor stretch. The hips can be stretch with external rotator and back extensor stretch, along with the advanced seated hip adductor stretch. The arms, wrists and hands can be stretch with the elbow and wrist flexor stretch, triceps brachii stretch, intermediate wrist extensor stretch and intermediate wrist flexor stretch. The shoulder, back and chest can be stretch with the intermediate shoulder flexor stretch, shoulder adductor, protractor and elevator stretch, along with the shoulder adductor and extensor stretch (Nelson & Kokkonen,

Therapeutic exercises are indicated for the same reasons of increasing strength, increasing range of motion, and promoting normal movement patterns allowing this patient to increase her endurance to ambulate, increase her ability to sit, stand, twist, and bend. Indications on this examination of continued muscular spasms throughout the joints, trigger points, adhesions, and neural compression warrants soft tissue mobilization.

Citation: Young IA, Michener LA, Cleland JA, Aguilera AJ, Snyder AR. Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther. 2009;89(7):632-42.

All research shows that all tests conducted and possible differences within each test still lead to similar conclusions. With two different studies that both utilized electromyography as the primary distinction of the activation of the supraspinatus during the empty can test, this can give physical therapists and patients confidence that the validity of the test is tremendously accurate. All of the electromygraphy results deemed the supraspinatus strongly isolated during this test which is a sturdy indication that the test is valid. The third study shown is best in demonstrating the reliability of the empty can test. With the results being so similar in the two clinicians testing, this shows the test to be reliable. This test could have been made even more accurate had there been more clinicians to perform the test with their results compared to each

- Trunke stability exercises have been shown to decrease the rate of recurrent hamestring injury at the first two week which most hamestring reinjured occur as well as at one-year pot intial injury. It shoulde be included in the rehablitaion programe since it act to prevent the recurancy of hamesting injury.

Afferent muscle stretch reflexes are initiated from muscle spindles9. Other afferent receptors such as joint receptors and skin sensors can generate further input8. The sum of these inputs results in reflexive movement in the absence of efferent signals from higher cortical centers7. Afferent neural input from the muscle spindle stretch receptors connected to the muslces intrafusal fibers enters the spinal cord through the dorsal horn9. They are then capable of diverging in order to take different paths and elicit several coordinated responses to a single stimulus9. The patellar reflex is a monosynaptic stretch reflex because the afferent signals synapse directly onto a motor neuron in the spinal cord9. Tapping the tendon pushes on the tissue, which activates stretch receptors within the muscle9. These afferent neural inputs from the receptors send excitatory action potentials to motor neurons in the spinal cord which, elicit the contraction of the quadriceps, extending the lower leg outwards to compensate for the stretch stimulus experienced9. In contrast, in a polysynaptic pathway, the stretch stimuli send afferent signals to the spinal cord that synapse onto inhibitory interneurons, eliciting the inhibition the antagonist (the hamstrings)9. This reciprocal innervation of the agonist and antagonist allows for the appropriate levels of tension to be developed in both muscles to elicit a smooth coordinated

The article “Muscular contributions to hip and knee extension during the single limb stance phase of normal gait: a Theoretical Framework for Crouch Gait” by Allison Arnold, Frank Anderson, Marcus Pandy, and Scott Delp investigates the biomechanics of normal gait in hopes to uncover ideas to help determine treatments for crouch gait. Crouch gait is a bothersome abnormality that affects the gait pattern of people who suffer from the condition of cerebral palsy. It’s characterized by excessive flexion of the hips and knees during standing and excessive use of metabolic energy to complete a single gait cycle. Currently, the treatments for this condition are limited and have unpredictable outcomes due to the unknown biomechanical causes of the excessive flexion in crouch gait. These treatments include surgical lengthening of hamstrings, ankle-foot orthoses, and intense stretching regimens, with patients experiencing results ranging from no improvement in their symptoms to dramatic improvements. The vast array of results from treatments are due to the little understanding medical professionals have of not only abnormal gait patterns (such as crouch gait) but of normal gait as well (Arnold, Anderson, Pandy, and Delp, 2005). Despite the article’s title relating to crouch gait, the purpose of the study conducted was to examine and quantify the accelerations of normal hip and knee movements that were induced by specific muscles during the single limb stance phase and to rank these

Shoulder instability is commonly seen in rehabilitation settings. Many patients come in either with shoulder pain, spasticity, subluxation, decreased range of motion(ROM), stiffness, or instability. Exercise is an effective key component in achieving stability of the shoulder. Therapeutic rehabilitation relies on evidence-based practice to provide the best care to improve function and stability. The purpose of this research study was to investigate the effects of stretching and joint stabilization exercises applied to spastic shoulder joints on improving shoulder dysfunction in hemiplegic patients using three groups of hemiplegic patients (Young Youl You, Jin Gang Her, Ji-Hea Woo, Taesung Ko, & Sin Ho Chung, 2013).

The central nervous system (CNS) is that portion of the vertebrae nervous system that is composed of the brain and spinal cord. Together with the peripheral nervous system (PNS), the other major portion of the nervous system, the CNS coordinates the body's interaction with the environment. The CNS is contained within the dorsal cavity, with the brain in the cranial subcavity (the skull), and the spinal cord in the spinal cavity (within the vertebral column).

The authors concluded that when performing a curl-up on a labile surface, the muscle activity amplitude and coactivation of these muscles changes. Coactivation of these muscles helped to stabilize the spine and the body. They recommend that future studies should be done that will include participants with spinal issues, and a wider range of ages. They also suggest to expand the experiment to test the position when in motion.

The results following surgery included nine of the participant’s range of motion was greater than 90 degrees at six weeks after the operation. Three patients out of the remaining five got back 90 degrees of flexion after surgery after nine weeks. When they did the final tests all of the patients had about 122 degrees of flexion and full extension. The surgery went well and there were no complications for all participants.

Patients in Group 2 (stretch kinesiatrics group) performed repetitive joint exercises for 15 minutes, using an isokinetic dynamometer (CYBEX 6000®, Lumex Inc. Ronkonkoma, NY, USA). Before starting the stretch exercise, the seat of the isokinetic dynamometer was folded to the rear; depending on the presence or absence of hip joint flexion establishment, the patients took a position somewhere between supine and the hip joint flexion position (maximum position at 30° of flexion). Since the angular velocities of joints prevent possible muscle damage resulting from long hours of joint exercises, relatively low velocities of 30 °/sec and 60 °/sec were chosen to simulate natural joint exercises. For the bending and stretching joint exercises, four