presented by Kay Wing
This course is part of our GCS Prep-Program. Learn more about the full prep-program here: MedBridge GCS Prep-Program.
When treating geriatric patients with neurological impairments, it is helpful to have a consistent, yet flexible approach. In this course Dr. Kay Wing continues with the remaining layers of facilitation which, when used in conjunction with each other, enhance the response of the patient to the therapist's intervention regardless of their diagnosis or deficits. Using these principles of effective intervention within each treatment session will maximize benefit to the patient throughout all stages of recovery. This is the second part in a two-part lecture series on the layers of facilitation and provides the theoretical foundation for interventions in three demonstration-based courses.
Kay Wing, PT, DPT, NCS is the owner of Southwest Advanced Neurological Rehabilitation (SWAN Rehab), an outpatient rehabilitation facility specializing in the treatment of stroke, traumatic brain injury, and other neurological diseases. She received her physical therapy degree at Northwestern University and her doctorate of physical therapy from Northern Arizona University. She is a board certified specialist in neurological physical therapy. Dr. Wing has taught courses in neurological rehabilitation and mobility training as well as instructed PNF workshops throughout the United States and internationally for many years. Dr. Wing has collaborated with A.T. Still University, Northern Arizona University, and Arizona State University in clinical research to incorporate research into clinical practice and is an adjunct faculty member at Northern Arizona University and A.T. Still University. Dr. Wing is the recipient of the Section on Administration Outstanding Service Award, the Arizona Physical Therapy Association Outstanding Physical Therapist of the Year award, the Neurology Section Award for Clinical Excellence in Neurology, and the Henry O. and Florence P. Kendall Practice Award. She was also a finalist for the 2016 Phoenix Chamber of Commerce Athena award.
Both the therapist's body position, and the position of the patient affect the quality of the patient’s response. There are a multitude of various positions in which to treat a patient and it’s important to alternate these treatment positions and postures during treatment. Join Dr. Wing as she discusses the importance of patient and therapist body positioning in this chapter.
Early motor function is dominated by reflex activity while mature motor function is spontaneous. However, reflexes are programmed into the neuromuscular system and mature movement is reinforced by reflexes. After a stroke or other neurologic deficit, reflex activity may increase and influence the response of the patient.
The placement of the therapist’s hands is a powerful layer of facilitation. Whenever possible the therapist should place manual contacts over the skin, muscles, and tendons of the agonist. In this chapter Dr. Wing will identify the correct and incorrect contact placements and describe how these contacts on the body affect patient response to treatment.
There are three forms of stretch to facilitate movement. The correct use of these three forms can initiate movement, increase the strength of the movement throughout the full range of motion, and improve the patient’s mobility overall.
The use of vision and visual cues as a layer of facilitation will virtually always improve performance. In addition to discussing the benefits of using visual cues, this chapter will discuss vision as an external focus of attention to improve performance. We'll also identify three neuromuscular mechanisms that describe the value of using visual cues and know how to effectively instruct patients using external cues.
Therapists often make the mistake of using too many words (verbal cues) when treating patients with neurological deficits. This can actually degrade performance rather than improve it. This chapter will present research that describes how to effectively use verbal instructions to enhance rather than worsen performance.
The effective use of appropriate resistance in the hands of a skilled therapist can do more than just increase strength. This chapter will teach how the neuromuscular works in a unified manner, and correct neuromuscular concepts of resistance, and present these concepts with video examples for better understanding.
All patients have strengths. An effective therapist will be able to analyze a patient's movement patterns, identify strengths and weaknesses, and develop a treatment plan to utilize these strengths during therapy. In addition, the therapist will know how to apply appropriate layers of facilitation to enhance the patient's response.