sweden dns notes 1 · 2017-12-14 · 2 •! •! ((
TRANSCRIPT
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Assoc. Prof. Pavel Kolar, PaedDr., Ph.D. Director
Clinic of Rehabilitation and Sports Medicine
2nd Medical Faculty Charles University
Prague, Czech Republic
Concept of DNS is based on the scientific principles of developmental kinesiology (DK), i.e. the neurophysiological aspects of the maturing locomotor system
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•! Allow to determine the type of the CP - Characteristic for specific forms of neurologic impairment (CP)
•! Evaluation of severity of motor impairment •! Feedback – Therapeutic effect – objective
evaluation
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2. Subcortical level of motor control
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POSTURAL – LOCOMOTOR FUNCTION SUBCORTICAL LEVEL OF CONTROL
Trunk Stabilization
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Tidal breathing
Izometric activity of arms
Izometric activity of legs
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=?A87%2%97(52* =5#?%2%97(52*Postural Tasks
Loading, Exercise, Weightlifting.. Viscera are pressurized by diaphragm, pelvic floor and abdominal wall Intra-abdominal pressure increases Posture = Initial position (axis) – diaphragm and pelvic floor – Essential Quality of stabilization pattern
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2nd phase of development un subcortical level: Between 5-12 months:
Stepping forward and supporting function of the extremities
Ipsilateral pattern Contralateral pattern
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Ipsilateral pattern Contralateral pattern
•! Opened kinetic chain •! Fixing point: proximal •! Moving point: distal •! Distal segment moves against the
proximal •! Proximal direction of muscle pull
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•! Closed kinetic chain •! Fixing point: distal •! Moving point: proximal •! Proximal segment moves against the
distal •! Distal direction of muscle pull
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CONTRALATERAL GLOBAL PATTERN
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All patterns based on the same principles: Stabilization & stepping forward and supporting extremities function Ipsi or contralateral pattern
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•! Synthesis •! Selection •! Integration
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Of all sensoric information into postural – locomotion function •! eyesight •! touch •! hearing •! proprioception •! vestibular perception
Newborn: grasp reflex No sensation – No stereognosis No body image Primitive reflex positive
4 ! months old: active grasp from midline Stereognosis on hand matured Primitive grasp reflex inhibited
42.&"%-VS"+"%'D3.)7".nn' Optimal Postural - Locomotor Function Can be evoked as a global reflex
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Athletic Performance Automatic utilization of all the principles described •! Automatic integration of postural –locomotion function with
afferent information •! Orofacial muscles – also fulfil stabilization function •! Integration of eyesight – eyes are leading, move (proceed) in
the direction of stepping forward = throwing hand •! Reciprocal position/movement of the extremities.
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4 MAIN REASONS WHY THE BASIC PATTERN OF STABILIZATION/RESPIRATION IS DISTURBED
4 MAIN REASONS WHY THE BASIC PATTERN OF STABILIZATION/RESPIRATION IS DISTURBED
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HOW DO WE NORMALIZE MUSCLE ACTIVITY IN POSTURAL FUNCTION?
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OPTIMAL MUSCLE COORDINATION CAN BE ACTIVATED USING EXERCISES IN DEVELOPMENTAL POSITION
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E.G. EXERCISE IN TRIPOD
DEVELOPMENTAL PRINCIPLES IN THERAPY AND TRAINING:
•! SUPPORTING SEGMENTS CENTRATION •! SPINAL ELONGATION AND CENTRATION
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HIGH KNEELING
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THREE COMPONENTS
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DISTURBED IDEOMOTOR FUNCTION
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Patient is instructed: a&1;("-+,(*"*.('/-.*C(1;*(.&3*(-I("-+,(I--1((H,(C,$:(1;*(.&3*(-I("-+,(I--1(((
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The left side neglect
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SScciieennttiiffiicc ppaappeerr:: SSuubbjjeeccttiivvee vviissuuaall vveerrttiiccaall iinn ppaattiieennttss
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EE..gg.. SSeelleeccttiivvee hhiipp mmoovveemmeenntt Patient is asked to perform movement in the hip joint only while keeping the rest of the body stabilized, without any additional movement
EE..gg.. SSeelleeccttiivvee eeyyee mmoovveemmeenntt Patient is asked to watch moving object with his/her eyes only while keeping head and neck in neutral position
PPoossttuurraall aaddaappttaattiioonn,, aabbiilliittyy ttoo rreellaaxx Patient is in a posturally challenging situation. Can she/he relax e.g. one arm?
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Ideal pattern of stabilization Poor pattern of stabilization
Do you see any difference in posture & muscle function?
Just compare !!
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"Every exercise is a test" NNNO25&74P$*Q5"&5*
Every developmental position is an exercise position
NNN=5102*6%2ef*
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