3 Sit to Stand Flashcards
What are prognostic indicators for sit to stand with hemiplegia?
- Knee extension force
- Standing balance
- Symmetry in standing
What are the critical events for STS?
- Flexion Momentum
- Momentum Transfer
- Extension
- Stabilization
What is the requirement for flexion momentum?
Initial foot placement backwards (10cm behind knee)
Momentum generation at the trunk
What is the requirement for momentum transfer?
Continued flexion of the hips with ankle dorsiflexion
What is the requirement for extension in STS?
Sequence lower limb extension (hip, knee, ankle)
- ankle PF
What is the requirement for stabilization?
Ankle strategy
Which activity measures require efficiency in movement?
- 5 times STS (poor efficiency if more than 12sec)
- Timed Sit to Stand (poor efficiency if more than 4.5 sec)
- 30 second sit to stand
What activity measures alllow for AD during transtion?
TUG
What measure examines ability to transition?
Berg Balance
Functional Independence (FIM)
Gross motor function measure, Dimension D (children and peds)
What is proper intensity for STS practice? What are some ways to prepare the system for STS?
- 50-100 reps
- Aerobic exercise/Mental imagery
What are some feedback priniciples you should use in STS?
- Can use assitance, Extrinsic and intrinsic feedback
- Must Fade feedback
- Visual feedback can improve kinematics
- Moving feet back improves symmetry of movement
- EMG can be used with spasticity
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What are atypical patterns of flexion momentum?
- Insufficient ankle DF (get feet back)
- Insufficient Trunk momentum (speed/flexion)
- Reliance on arms
How far is foot placement in flexion momentum?
around 10cm behind the knee
What are interventions for poor timing of the TA?
- Rhythmic auditory stimulation
- FES to TA
- EMG biofeedback
What are the intervetions for reduced RA activation/Force production?
- Decrease friction (trash bag/socks on tile)
- Target training
- FES to TA
- Seated stool walking
What are interventions for reduced Gastroc-soleus flexibility?
- whole practice with active dynamic stretching
- HEP for stretching
What are interventions for reduced ankle propioception?
- Visual or joint position feedback
- Target training with eyes open and closed
- can used tactile cure as target with eles closed
- Approximation
What are interventiosn for excessive Gastroc/soleus activation/spasticity?
- EMG biofeedback while moving feet backwards
What are atypical pattersns for inability to generate trunk momentum?
- poor amplitude
- poor speed
What many degrees of flexion is needed for trunk momentum?
60
What are interventions for cognitive fear of falling in trunk momentum?
- STS exercises
- PT position in front of patient
- Part practice
- postural control off seat at different speeds
- trunk target training forward trunk momentum change
- Mental imagery
What are interventions for impaired ankle proprioception for trunk momentum?
Visual or joint position feedback
Mental imagery pushing through on floor and pulling up the toes
approximation through joint
What are interventions for impaired force production of the Rectus femoris and paraspinals in trunk momentum?
- add resistance to increase motor unit recruitment
- manual or weighted
- C curve tracking (marking on wall)
- backwards C
What are interventions for impaired fractionation for trunk momentum?
- impaired sequencing of gastric TA
- Impaired Timing and sequencing of rectus femoris and paraspinals
Intervention
- Rhythmic auditory stimulation
- Target training and visual feedback
- forced use
- lowering seat height, increase the need for momentum
What are atypical movements in momentum transfer?
- Insufficnet flexion of the hip knee ankle
- Asymmetry in loading
How many ROM is needed for the hip knee and ankle in momentum transfer?
- hip 90
- knee 90
- ankle 23
What interventions are used for reduced force/power of the TA in momentum transfer?
- manual facilitation and approximation to drive knees forward
- target training to drive knees forward
- pulling forward on rolling stool with affected limb
What interventions would you use for gastroc soleus spasticity for momentum transfer?
- EMG biofeedback
- FES to TA
- inhibit gastroc muscle
What interventions would you use for reduced limb loading for symmetry in momentum transfer?
- Mental practice (task specific)
- Forward reach training in sitting for increasedload through affected leg
- Destabilize stronger LE
- Place stronger foot FORWARD or on a small step
What atypical patterns do you see in extension phase?
insufficnet extension of trunk hip knee and ankle
asymmetry in extension
What impairments do you see with the extension phase?
- reduced power of glute max, quad femoris and gastoc soleus
- reduced flexibility of iliopsoas, rectus fem, and hamstrings
What are interventions for reduced flexibility of Gastroc Soleus for symmetry in extension?
Joint mobs did not improve STS even though it increased ROM
MORE RELATED TO POWER and how fast you can get through ROM
What are the impairments for symmetry in extension?
- poor orientation to longitudinal axis of body
- reduced limb loading
- gastroc soleus spasticity
- reduced flexibility of gastroc soleus
What is the atypical movement in stabilization?
- Excessive Sway
What are the impairments for ankle strategy?
- impaired proprioception (use target AP tib movement EO and EC, approximation of weight shifts, cues to push down into floor, weighted belt, mental imagery)
- Impaired TA activation
- Reduced Gastroc Flexibility (mini squats + ankle DF on floor)
- Impaired timing/sequencing of TA and gastroc (wall sways + vary amplitude)
- Spasticity
