Activities - Important components

Question 1

Bed mobility - Rolling over in bed
Important components & Adaptive strategies

Answer 1

Important components
- Rotation and flexion of the neck
- Flexion and protraction of shoulder
- Rotation with the trunk
- Hip and knee flexion

Adaptive strategies
- Wriggling instead of turning
- Pulling with intact arm

Question 2

Bed mobility - Sitting on side of the edge of bed from side lying
Important components & Adaptive strategies

Answer 2

Important components
- Lateral flexion of neck
- Lateral flexion of trunk and abduction of lower arm
- Legs lifted & lowered over side of bed

Adaptive Strategies
- Rotation & flexion of neck forward
- Excessive pushing with intact arm
- Hooking intact leg under affected leg
- Weight kept too far back

Question 3

Bed Mobility - Sitting on side of the edge of bed from supine
Important components & Adaptive strategies

Answer 3

Important components
- Flexion and rotation of trunk and head
- Flexion of hips & knees to swing legs & clear bed
- Push up with hand closest to the side of the bed you are moving towards

Adaptive strategies
- Excessive pushing up on intact arm
- Hooking intact leg under affected leg
- Weight kept too far back

Question 4

Sitting
Important Components (sitting & reaching in sitting) & Adaptive strategies

Answer 4

Important components
Sitting
- Head balanced on level shoulders
- Flexion of hips with extension of trunk (ie, shoulder over hips)
- Feet and knees close together
- Weight evenly distributed
Reaching in sitting
- Shift head, arm(s) and trunk toward the object, by moving at the hips
- Load foot or feet which is/are ipsilateral to the direction of the reach

Adaptive Strategies
- Widen base of support, ie, feet and/or knees too far apart, one or both hips externally rotated, uses arms for support
- Shifts weight onto the intact foot/buttock
- Flexes forward when the task requires the body weight should be shifted sideways
- Shuffles feet
- Uses arms for balance prematurely
- Avoids threats to balance by reducing movement speed and amplitude, and/or holding stiffly, and/or holding breath

Question 5

Sit to Stand

Answer 5

Initial Alignment (reduce thigh support)
Important components
- Feet placement (feet apart and pointing forward, knees directly over feet, ankles dorsiflexion)

Pre-extension phase
Important components
- Inclination of trunk forward by flexion at the hips with an extended trunk
- Movement of the knees forward
Adaptive Strategies
- Weight borne principally through the intact side
- Wide base of support

Extension phase
Important components
- Extension of hips and knees for final standing alignment
- Weight evenly distributed
Adaptive strategies
- Weight kept too far back
- Pushes through arms
- Use of swinging arm to bring weight forward
- Weight borne principally through intact side
- Final alignment flexed

Question 6

Standing

Answer 6

Important components
Standing
- Head balanced on level shoulders
- Shoulders over hips
- Erect trunk
- Hips in front of ankles
- Feet a few inches apart and pointing forward
- Weight evenly distributed
Reaching in standing
- Shift head, arm(s) and trunk toward the object, by moving at the ankles
- Load foot or feet which is/are ipsilateral to the direction of the reach

Adaptive Strategies
- Avoid threats to balance by reducing movement speed and amplitude, and/or holding stiffly, and/or holding breath
- Widens base of support, i.e., feet too far apart or one or both hips externally rotated
- Shifts weight onto the intact foot
- Takes a step prematurely
- Uses arms for balance prematurely
- Flexes at hips and/or protects at shoulder instead of dorsiflexing at ankles in reaching forward and moves trunk instead of moving at hips and ankles when reaching sideways

Question 7

Walking

Answer 7

Stance Phase
Important Components
- Lateral horizontal shift of the pelvis and trunk
- Extension of the hip throughout
- Flexion of the knee (0-10deg) on initial contact, then extension through midstance and flexion prior to toe-off
- Plantargrade of the ankle on initial contact, then plantar flexion followed by dorsiflexion of the ankle until the end of stance, and then fast plantarflexion
Adaptive Strategies
- Trunk inclined forward during stance
- Hyperextended knee during stance
- Short step length(s)
- Wide base of support
- Walking very slowly and increased time spent in double support

Swing Phase
Important components
- Slight lateral pelvic tilt downwards
- Rotation of pelvic forward
- Flexion of knee with hip in extension followed by hip flexion
- Extension of knee prior to heel strike
- Dorsiflexion of ankle throughout
Adaptive strategies
- Trunk inclined backward at end of swing
- Elevation of the pelvis and abduction of the leg