INTERVENTIONS TO IMPROVE SITTING BALANCE AND BALANCE SKILLS Flashcards
Objectives
Collect responses to positional changes and observed balance strategies (Tues & Thur)
Describe interventions to improve sitting and sitting balance
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Treatment Strategies-how do you progress
Box 4.2- descriptions
Progress by varying the level of difficulty and postural stabilization requirements
Improving Sitting Control
How Do You Know Where to Start?
- Information from PT exam and eval
- Current patient condition (orientation, cognition, endurance, etc.)
- Trial and Error (with safety always being considered)
Verbal and Tactile Feedback
Augmented Feedback
Verbal
Box 4.3
what is Tactile cueing?
Tapping, light resistance, pressure, approximation
Improving Stability Control
Sitting, Active Holding
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?
Improving Stability Control
Active Sitting in Long Sitting
Who is it used for and what are some examples?
- 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
Improving Stability Control
Side Sitting, Active Holding
Who is used for and what are some examples?
- 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
Improving Stability Control
Sitting, Resisted Holding
Who is this good for and what are some examples?
- 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
Improving Stability Control
Sitting, Holding, Stabilizing Reversals
Patient holds a sitting posture while therapist completes stabilizing reversals, medial/lateral and anterior/posterior
Improving Stability Control
Sitting, Holding, Rhythmic Stabilization
Patient holds a sitting posture while the therapist completes rhythmic stabilization; applying rotational resistance
Improving Controlled Mobility
Dynamic postural control……..explain what it is
- Controlled mobility on postural stability
- Movements result in disturbances of the COM
Improving Controlled Mobility
give some examples of how to work on seated
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
Improving Controlled Mobility
Sitting, Resisted UE Movements
Fig 4.16 & 4.17
Use of PNF patterns to challenge dynamic control
Level of resistance is determined by the patient’s ability to stabilize the trunk
Improving Controlled Mobility
Sitting, PNF Chop/Reverse Chop, Dynamic Reversals
Fig 4.18 & 4.19
- 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
Improving Controlled Mobility
Sitting, PNF Lift/Reverse Lift, Dynamic Reversals
Fig 4.20 & 4.21
- 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
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?
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,
Improving Controlled Mobility
Sitting, Bilateral Symmetrical PNF D2, Dynamic Reversals
Fig 4.23
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
Improving Adaptive Balance Control
“The ability to maintain or recover balance when subjected to unexpected challenges”
definition
Reactive Balance Control
Training Activities
Sitting, Manual Perturbations: give examples
what are some Key Points to Remember?
- 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
Training Activities
Sitting on a Moveable Surface
Fig 4.24 & Fig 4.25
Key Points to Remember?
- 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
Training Activities
Sitting on the Ball, Static Activities
Fig 4.26
Key Points to Remember?
- 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
Training Activities
Sitting on the Ball, Dynamic Activities
P114-116
Many activities………..
Will practice in lab
Key Points to Remember?
- 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
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?
- 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)
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.
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