3 Standing Flashcards
What type of questions would you ask for standing during the history intake?
- Do you have:
- Difficulty standing equally?
- When trying to reach or stand on one foot?
- When being bumped
- Uneven surface?
- Lights dimmed?
What are some standing training intervention principles?
- 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)
What do you do when the task is too challenging?
- Simplify
- limit degrees of freedom
- utilizing part practice
- manipulate control parameter
- (BOS, sensory conditions, speed, surface, RPA, amplitude, task, somatosensory/,motor demands)
What are preparation techniques for stand training?
- transcutaneous estim of foot and leg (redues sway with and without vision)
- Motor Imagery of movement and task
- Aerobic exercise (increase BNDF)
What is the training dosage in Acute state?
- 2-3 sessions/week
- 40 to 120 min/session
OR
- 5 sessions/ week
- 45-60min/session
(too intense programs have high drop out rates)
What interventions DO NOT WORK for standing?
- Sitting balance (lateral shifts)
- Task oriented circuit training (without emphasis on standing)
- BWSTT
- Untargeted fall prevention programs
What are the 2 thing that occur with poor static alignment?
- Asymmetry between limbs with excessive large interfoot distance
- Knee hyperext with excessive PF
What are the issues with Asymmetry?
- medial lateral sway in sanding = more visual dominance
- More weight on unaffected leg
- good to know for intervention stragegies
What impairments do you see with impaired standing?
- reduced glute med
- poor oritentaion of long axis
- ankle clonus
- reduce cutaneous sensation of the foot
What are ways to activate glute med?
- Forced use: weight shift to affected limb
- Shoe wedge on non affected
- Small step
- Center of pressure
- COP feedback of weight bearing
How do you improve poor oritentation to longitude body axis?
- Visual feedback with volitional weight shifts
- use mirror and align trunk
- Short term
What interventions for gastroc clonus?
- EMG biofeedback to gastroc (gold standard)
What interventions for reduced foot sensation?
- Sensory threshold and detection
What are the 2 impariments for lower extremity alignment?
- Reduced Quadriceps force production
- Excessive activation of gastroc soleus
What interventions for Impaired reduced for production of quads?
- Sit to stand movements with mirror biofeedback improves postual stability
- MUST BE STANDING
What are interventions for impaired gastroc soleus for excessive activation/spasticity?
- Biofeedback to reduce activity
What are signs of excessive postural sway in quiet standing?
- 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
What impairments do you see in Excessive sway in quiet standing?
- 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
What are interventions for reduced cutaneous sensation of the foot?
- Tactile sensory input (differnt surfaces)
- Mental imagery
What interventions for reduced ankle proprioception?
- Standing on level surface with blond fold
- STanding on unstable surface and changing ankle degrees (target)
What interventions for inability to reweight sensory systems?
- 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
Interventions for gastroc soleus TA timing?
- Biofeedback/EMG for gastrpc TA
- Mirror Visual Feedback
- detect sway and push down toes to ground
Interventionfor preceptual deficit and hemineglect?
- posutal instabilty
- increase cues and awareness
What DOES NOT WORK with standing interventions
- Sitting
- Task oriented circuit training
- BWSTT
- Fall prevention programs
General prinicaples for APA intervention
- Fast/rapid movement
- whole task in standing control
- Reaching/grasping
What is observed with Ineffective APAs
- Falls w/ fast forward reach
- Pelvic drop or instabilty to assume single limb stance
What is observed for ineffective RPAs?
- Small perturbation leads to sway at the hips (moving in opposite directions)
- Large perturbation leads to falls
What are general intervention priniciples for RPA?
- appropriate level of perturbation
- alternating environment
- firm to compliant surfaces
- large BOS to small BOS
- Change velocity of sway
- Random pertu
Pertubations
- Should be ANKLE not hip
- LArge should be step/hip not fall