INTERVENTIONS TO IMPROVE SITTING BALANCE AND BALANCE SKILLS

Question 1

Objectives
Collect responses to positional changes and observed balance strategies (Tues & Thur)
Describe interventions to improve sitting and sitting balance

Answer 1

fyi

Question 2

Treatment Strategies-how do you progress

Box 4.2- descriptions

Answer 2

Progress by varying the level of difficulty and postural stabilization requirements

Question 3

Improving Sitting Control

How Do You Know Where to Start?

Answer 3

• Information from PT exam and eval
• Current patient condition (orientation, cognition, endurance, etc.)
• Trial and Error (with safety always being considered)

Question 4

Verbal and Tactile Feedback

Augmented Feedback
Verbal
Box 4.3

what is Tactile cueing?

Answer 4

Tapping, light resistance, pressure, approximation

Question 5

Improving Stability Control

Sitting, Active Holding

Answer 5

Good sitting w/one or both UEs used for support
Fig 4.5

Thin of what neuromuscular techniques would be good to use to support this activity?

Question 6

Improving Stability Control

Active Sitting in Long Sitting

Who is it used for and what are some examples?

Answer 6

• Typically used with patients who have spinal cord lesions

Fig 4.6

• Alteration of hand positioning to assist and progress

Behind
Forward
To the side

Question 7

Improving Stability Control

Side Sitting, Active Holding

Who is used for and what are some examples?

Answer 7

• Typically used with patients who exhibit spastic lateral trunk muscles (often seen in CVA)
• Fig 4.7
• Posture elongates the weightbearing side of the trunk

Question 8

Improving Stability Control

Sitting, Resisted Holding

Who is this good for and what are some examples?

Answer 8

• Light resistance applied to head and trunk to elicit/facilitate extensor contraction
• Patient “holds” against resistance
• Resistance is gradually released as the patient actively holds the posture

Question 9

Improving Stability Control

Sitting, Holding, Stabilizing Reversals

Answer 9

Patient holds a sitting posture while therapist completes stabilizing reversals, medial/lateral and anterior/posterior

Question 10

Improving Stability Control

Sitting, Holding, Rhythmic Stabilization

Answer 10

Patient holds a sitting posture while the therapist completes rhythmic stabilization; applying rotational resistance

Question 11

Improving Controlled Mobility

Dynamic postural control……..explain what it is

Answer 11

• Controlled mobility on postural stability
  
  • Movements result in disturbances of the COM

Question 12

Improving Controlled Mobility

give some examples of how to work on seated

Answer 12

Sitting, Active Weight Shifts with Extended Arm Support
Fig 4.10
Sitting, Active Weight Shifts with Hands on a Large ball
Fig 4.11
Provides UE support, may inhibit spasticity, may reduce patient anxiety of falling forward and assists with shoulder PROM.

Sitting, Active Weight Shifts with Upper Trunk Rotation
Fig 4.12
Sitting, Active Weight Shifts with Voluntary Limb Movements
Fig 4.13
Benefits
Examples
Fig 4.14

Question 13

Improving Controlled Mobility

Sitting, Resisted UE Movements

Fig 4.16 & 4.17

Answer 13

Use of PNF patterns to challenge dynamic control
Level of resistance is determined by the patient’s ability to stabilize the trunk

Question 14

Improving Controlled Mobility

Sitting, PNF Chop/Reverse Chop, Dynamic Reversals

Fig 4.18 & 4.19

Answer 14

• Use of UE D1 PNF flex/ext patterns (pick an apple…) to challenge dynamic control
• Affected arm moves in the pattern with other arm serving as assist.

Chop (place the apple in the bucket)- movement into the D1 extension pattern
 Reverse chop (pick the apple)- movement into the D1 flexion pattern

Question 15

Improving Controlled Mobility

Sitting, PNF Lift/Reverse Lift, Dynamic Reversals
Fig 4.20 & 4.21

Answer 15

• Use of UE D2 PNF flex/ext patterns (grab the sword…) to challenge dynamic control
• Affected arm moves in the pattern with other arm serving as assist.

Lift (Ta-Da…)- movement into the D2 flexion pattern
 Reverse chop (reach for the sword)- movement into the D2 extension pattern

Question 16

Improving Controlled Mobility

Sitting, Bilateral Symmetrical PNF D1 Thrust and Withdrawl, Dynamic Reversals
Fig 4.22

Thrust pattern
What is occurring with the UEs?

Reverse thrust
What is occurring with the UEs?

Answer 16

Thrust pattern
What is occurring with the UEs?

• jab with fingers open palm down

Reverse thrust
What is occurring with the UEs?

• pull back into side fist palm up

benefits- very functional - work c people c shoulder probs and balance (work with resistance) or lung conditions,

Question 17

Improving Controlled Mobility

Sitting, Bilateral Symmetrical PNF D2, Dynamic Reversals
Fig 4.23

Answer 17

Pattern
Begin with UEs in extension, adduction and internal rotation

What is occurring with the UEs?standing behind resisting them in sitting coming up to Y

Question 18

Improving Adaptive Balance Control

“The ability to maintain or recover balance when subjected to unexpected challenges”

definition

Answer 18

Reactive Balance Control

Question 19

Training Activities

Sitting, Manual Perturbations: give examples

what are some Key Points to Remember?

Answer 19

• Backward Displacement
• Forward Displacement

Key Points to Remember

• Therapist may need to guide responses physically or verbally
• Perturbations should be at trunk, not shoulders
• Perturbations should be appropriate for patient condition

Question 20

Training Activities

Sitting on a Moveable Surface
Fig 4.24 & Fig 4.25

Key Points to Remember?

Answer 20

• Therapist may need to guide responses physically or verbally; hands-off is expected once patient moves correctly
• While on the therapy ball: Therapist can sit behind the patient or in front
• Choosing the right size ball is important- Box 4.4

Question 21

Training Activities

Sitting on the Ball, Static Activities
Fig 4.26

Key Points to Remember?

Answer 21

• Therapist may need to guide responses physically or verbally; hands-off is expected once patient moves correctly
• Patient is asked to “hold steady”
• With progression, the patient is asked to hold the UEs in a static position

Question 22

Training Activities

Sitting on the Ball, Dynamic Activities
P114-116
Many activities………..
Will practice in lab

Key Points to Remember?

Answer 22

• Therapist may need to guide responses physically or verbally; hands-off is expected once patient moves correctly
• Activity is dynamic; patient is demonstrating mobility on stability

Question 23

Training Activities

Scooting
Fig 4.34 & 4.35
From long-sitting, short-sitting and off a high table
Will practice in lab

Key Points to Remember?

Answer 23

• Therapist may need to guide responses physically or verbally; hands-off is expected once patient moves correctly
• Activity is dynamic; patient is demonstrating mobility on stability
• Activity utilizes weight shifting to allow moving the opposite limb forward
• With scooting off high table, pelvis on dynamic side is rotated forward with hip and knee extension (coming to a modified standing)

Question 24

what we did in lab

Lab Procedures for Tuesday
Student Practice Activities
Please read this- p118

Box 4.5
Box 4.6
Be prepared to complete these activities in lab. Complete all instructions. Be prepared with paper to take notes- no lab handout.

Answer 24

fyi