Final - Sitting/ Sitting Balance Flashcards
4 Major Goals for Siting
- Stable static sitting balance (be aware of initial conditions, optimize)
- Trunk postural adjustments for maintenance of balance
- Trunk postural adjustments for restoration of balance
- Combining trunk and extremity movement to accomplish seated tasks or for transitional movements such as transfers and preparation for sit to stand
Stable sitting position
- LOS greater than in standing
- COG is lower, BOS is higher
What is sitting LOS affected by?
thigh support, feet support, UE support
48% of patients following CVA cannot do what at the start of rehab?
sit independently
the greater the sitting deficit…
the lower the functional scores at discharge are likely to be
What we want for initial conditions of sitting?
- normal postural alignment
- normal behavioral arousal
What should you do if the patient has decreased attention (depression)
provide verbal support, positive goal setting, referral
what should you do if the patient has decreased attention (disinhibition)
redirect, ignore, reinforce positive behavior
How can neglect present?
- Failure to report, respond, or orient to stimuli
- Failure is not due to sensory or motor deficits
What should you do for decreased body orientation?
Reorient/recalibrate sensory system, provide movement, provide cues for
midline/vertical
How can alignment/posture affect sitting?
- Spasticity/Tone in extremities and trunk may cause poor sitting posture
- Flaccid UE may pull body forward or to the side resulting in flexion or lateral flexion
What should you do for weakness/insufficient muscle tone?
- Weightbearing, weight shifting
- Tactile/Proprioceptive cues, Tapping
- Isometric holds in sitting posture
What should you do for too much muscle tone
Slow stretch
Prolonged traction
What should you do if the initiation is too fast
alter your instructions
what should you do if initiation is slowed due to delayed postural adjustments?
Practice tasks of increasing difficulty
Maximize BOS to start; provide tactile cues to start
Provide feedback
What should you do if initiation is slowed due to behavioral/cognitive deficits?
Break down task
Decreased amount of instructions
Automatic activities
What should you do if execution has reduced speed/amplitude
Weakness- consider type of contraction; weightbearing, strengthen functionally,
facilitation
what should you do if execution has altered direction
- Abnormal synergies- consider where patient is and work to isolate
- Closed chain activities
- Bilateral activities
Missing components in termination
- typically delayed breaking
- motor planning
- use of sensory feedback/information during task
what should you do for motor planning deficits in termination
practice slow, controlled and less challenging activities
what should you do for deficits in termination due to lack of sensory feedback/information during task?
Mirror, sensation
Augment, substitute, and predict
task requirements for seated reaching
- proactive control: forward weight shifting, lateral weight shifting, scooting
- reactive control: surface stability
Considerations for sitting balance:
- intrinsic and extrinsic factors that influence seated postural control
-environment, person, and task - Consider ability to maintain postural control and make ongoing postural adjustments
Normal Postural Alignment starts with good initial conditions:
- Pelvic Position- Weight symmetrically distributed, Pelvis in a neutral position (not retracted),
Pelvis in neutral or slight anterior tilt - Hips and knees flexed in approximately 90 degrees
- Thigh supported
- Feet flat on floor (or if unable to reach floor step stool)
- Upright/midline trunk position
- Head in upright midline position
- Behavior/Attention- Consideration of alertness, attentional deficits, agitation
anticipatory sitting postural control activities
- anterior weight shifting
- Lateral weight shifting
- sitting down to elbow transitions
- scooting
- reaching activities
- addition of tasks
