Chapter 3: Activity limitation (bed mobility)

Question 1

what are the essential components of rolling in bed?

Answer 1

1. neck lateral rotation
2. shoulder flexion + protraction
3. hip and knee flexion
4. trunk rotation

Question 2

What are the essential components of side-lying to sitting

Answer 2

1. neck lateral flexion
2. trunk shortening
3. elbow extension
4. shoulder abduction

Question 3

What is the importance of proper bed positioning?

Answer 3

1. helps prevent abnormal muscle tone
2. help to prevent muscle tightness by maintaining muscle length
3. helps patient to lead the correct posture

Question 4

what is the proper bed positioning for lying supine?

Answer 4

1. patient lying straight
2. affected shoulder supported by pillow
3. affected elbow supported on pillow, slightly bent
4. affected hand supported on pillow, palms downwards, fingers open

Question 5

what is the proper bed positioning for side lying on affected side?

Answer 5

1. lie the patient slightly on their back, with pillow behind
2. affected arm is placed stretched out, elbows slightly bent, palms upwards
3. affected shoulder is protracted
4. unaffected arm is rested on a pillow placed in front of the patient
5. unaffected leg places on top of the pillow, hips and knees are bent
6. affected leg is just behind the pillow, hips and knees bent

Question 6

what is the proper bed positioning for side lying on unaffected side?

Answer 6

1. Position the patient on the unaffected side
2. Position the affected shoulder and arm forwards, supported with pillow
3. Bend the affected elbow slightly and keep the palm facing down with fingers straight
4. Bend the affected hip and knee and support them on a pillow in front of the unaffected leg

Question 7

what is the proper bed positioning for sitting?

Answer 7

1. Sit upright in chair with weight through both buttocks
2. Position the affected shoulder and arm forwards and supported on a pillow with fingers straight
3. Tuck part of the pillow underneath the affected shoulder
4. Position both feet flat on the floor or foot rest

Question 8

what disabilities are associated with poor sitting

Answer 8

1. Muscle weakness
2. Poor coordination
3. Frequency to adapt behaviour to avoid threats to balance (overuse of non-affected side)

Question 9

what are the biomechanics of normal sitting?

Answer 9

1. CoG is moderately high
2. buttocks, thighs and feet are on supporting surfaces
3. even weightbearing on ischial tuberosity (ASIS balanced in frontal view, PSIS slightly higher than ASIS)
4. natural lumbar lordosis
5. head and trunk are vertically aligned in line with the pelvis, “chin in” position

Question 10

stroke patients typically demonstrate what sort of misalignments when sitting?

Answer 10

Spinal alignment:

1. Flattened lumbar spine
2. Increased thoracic kyphosis
3. increased shoulder protraction
4. increased forward head protraction
5. weightbearing on sacrum (patient sits back)

Pelvis position:

1. uneven weightbearing on ischial tuberosity - results of asymmetrical strength, muscle tone, change in hip mobility
2. lateral tilt of the pelvis - one ASIS higher than the other

Question 11

importance of trunk control

Answer 11

1. To maintain upright posture - vital predictor of functional outcomes, balance, gait, coordination, UL function
2. perform weight shifting in sitting and standing
3. dissociate upper and lower extremities for function - stabilization of trunk muscle enables improved ability to use UL function

Question 12

what is the definition of facilitating an intervention?

Answer 12

therapeutic handling of the patient’s key point of control to enable the individual to experience the movement that is not passive

Question 13

what are the aims of facilitation?

Answer 13

enable successful and efficient movement when performing tasks

1. postural orientation
2. components of the movement
3. functional sequence of movement
4. specific muscle activity
5. recognition of the task
6. motivate the patient

Question 14

What is the definition of inhibition?

Answer 14

Technique that aims in reduction of components of posture and movement that are atypical

Question 15

what are the aims of inhibition?

Answer 15

1. Constrain degree of freedom of body segments to decrease the amount of force the patient uses to stabilise posture
2. Balance activity of antagonist muscle groups
3. Reduce spasticity that interferes with moving specific body segments

Question 16

what are the central key points of control?

Answer 16

Sternum (anterior)

T7-T8 (posterior)

Question 17

What are the proximal key points of control?

Answer 17

Pelvis
head
shoulders

Question 18

What are the distal key points of control?

Answer 18

Knees
ankles
elbows
wrist and hands

Question 19

Importance of key points of control?

Answer 19

1. enable therapist to control and guide the movement of the body
2. Body parts from which abnormal patterns could be controlled (inhibited) and the strength and distribution of postural tone could be influenced
3. normal movements patterns could be facilitated or a specific technique of stimulation could be used

Question 20

side lying to sitting on which side is easier?

Answer 20

weaker side

Question 21

why is it important for patients to be independent in bed mobility?

Answer 21

avoid chest complications, bed sores and discomfort

Question 22

1) what assessments are done to evaluate sitting ability in stroke patients?
2) What are the components
3) what is the MCID

Answer 22

1. Trunk impairment scale (max 23 points)
2. static sitting balance, dynamic sitting balance , coordination
3. 4 points