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Neuromuscular Practice 3.1 > 3 Standing > Flashcards

3 Standing Flashcards

1
Q

What type of questions would you ask for standing during the history intake?

A
  • Do you have:
    • Difficulty standing equally?
    • When trying to reach or stand on one foot?
    • When being bumped
    • Uneven surface?
    • Lights dimmed?
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2
Q

What are some standing training intervention principles?

A
  • Prepare activites that increase cortical excitability
  • select meaningful task: (active, alert, motivated, understood)
  • Forces use of impaired system
  • Facilitate movement through assistnce, stim, extrinisck or error signals
  • Use LIGHT touch (1 NEWTON)
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3
Q

What do you do when the task is too challenging?

A
  • Simplify
  • limit degrees of freedom
  • utilizing part practice
  • manipulate control parameter
    • (BOS, sensory conditions, speed, surface, RPA, amplitude, task, somatosensory/,motor demands)
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4
Q

What are preparation techniques for stand training?

A
  • transcutaneous estim of foot and leg (redues sway with and without vision)
  • Motor Imagery of movement and task
  • Aerobic exercise (increase BNDF)
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5
Q

What is the training dosage in Acute state?

A
  • 2-3 sessions/week
    • 40 to 120 min/session

OR

  • 5 sessions/ week
    • 45-60min/session

(too intense programs have high drop out rates)

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6
Q

What interventions DO NOT WORK for standing?

A
  • Sitting balance (lateral shifts)
  • Task oriented circuit training (without emphasis on standing)
  • BWSTT
  • Untargeted fall prevention programs
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7
Q

What are the 2 thing that occur with poor static alignment?

A
  • Asymmetry between limbs with excessive large interfoot distance
  • Knee hyperext with excessive PF
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8
Q

What are the issues with Asymmetry?

A
  • medial lateral sway in sanding = more visual dominance
  • More weight on unaffected leg
    • good to know for intervention stragegies
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9
Q

What impairments do you see with impaired standing?

A
  • reduced glute med
  • poor oritentaion of long axis
  • ankle clonus
  • reduce cutaneous sensation of the foot
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10
Q

What are ways to activate glute med?

A
  • Forced use: weight shift to affected limb
    • Shoe wedge on non affected
    • Small step
  • Center of pressure
    • COP feedback of weight bearing
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11
Q

How do you improve poor oritentation to longitude body axis?

A
  • Visual feedback with volitional weight shifts
    • use mirror and align trunk
    • Short term
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12
Q

What interventions for gastroc clonus?

A
  • EMG biofeedback to gastroc (gold standard)
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13
Q

What interventions for reduced foot sensation?

A
  • Sensory threshold and detection
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14
Q

What are the 2 impariments for lower extremity alignment?

A
  • Reduced Quadriceps force production
  • Excessive activation of gastroc soleus
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15
Q

What interventions for Impaired reduced for production of quads?

A
  • Sit to stand movements with mirror biofeedback improves postual stability
  • MUST BE STANDING
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16
Q

What are interventions for impaired gastroc soleus for excessive activation/spasticity?

A
  • Biofeedback to reduce activity
17
Q

What are signs of excessive postural sway in quiet standing?

A
  • Too much sway at the ankle (head and hips moving at the same direction)
  • Excessive sway in dim lighting
  • Falls or requries BOS on uneven/compliant surface
18
Q

What impairments do you see in Excessive sway in quiet standing?

A
  • Reduced cutanous sensation of foot
  • reduced ankle proprioception
  • inability to reweight sensory systems
  • poor timing and sequencing of gastroc/sol/TA
  • Preceptual deficiet/hemineglect
  • impaired vestibvular spinal funciton
19
Q

What are interventions for reduced cutaneous sensation of the foot?

A
  • Tactile sensory input (differnt surfaces)
  • Mental imagery
20
Q

What interventions for reduced ankle proprioception?

A
  • Standing on level surface with blond fold
  • STanding on unstable surface and changing ankle degrees (target)
21
Q

What interventions for inability to reweight sensory systems?

A
  • Progression of balance exercises
    • 4 weeks 50 min a day
  • Dim light: visual to proprioception shift dominance
    • firm surface with eyes closed
    • progress to eyes open and visual information does not orient
    • DOME OVER HEAD
22
Q

Interventions for gastroc soleus TA timing?

A
  • Biofeedback/EMG for gastrpc TA
  • Mirror Visual Feedback
    • detect sway and push down toes to ground
23
Q

Interventionfor preceptual deficit and hemineglect?

A
  • posutal instabilty
  • increase cues and awareness
24
Q

What DOES NOT WORK with standing interventions

A
  • Sitting
  • Task oriented circuit training
  • BWSTT
  • Fall prevention programs
25
Q

General prinicaples for APA intervention

A
  • Fast/rapid movement
  • whole task in standing control
  • Reaching/grasping
26
Q

What is observed with Ineffective APAs

A
  • Falls w/ fast forward reach
  • Pelvic drop or instabilty to assume single limb stance
27
Q

What is observed for ineffective RPAs?

A
  • Small perturbation leads to sway at the hips (moving in opposite directions)
  • Large perturbation leads to falls
28
Q

What are general intervention priniciples for RPA?

A
  • appropriate level of perturbation
  • alternating environment
    • firm to compliant surfaces
    • large BOS to small BOS
  • Change velocity of sway
  • Random pertu
29
Q

Pertubations

A
  • Should be ANKLE not hip
  • LArge should be step/hip not fall

Neuromuscular Practice 3.1 (15 decks)

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