Motor Control Deficits Flashcards
8 points of focus to correct seated position
- pelvis in neutral-anterior tilt
- equal WB on both ischial tuberosities
- trunk erect and midline with 3 natural curves in back
- shoulders symmetrical and over hips
- head/neck neutral
- hips slightly above level of knees
- knees in line with hips
- feet equally WB and underneath knees
impact of posterior pelvic tilt
adverse affect on swallowing
impedes normal/proper alignment of scapula & humerus
encourages flexion synergy of UE
benefits of neutral pelvis
- preferred for pts with hemiplegia
- inhibits extension synergy of LE
- promotes WB equally through LE
- permits gravity assistance in bringing both scapulae into forward protraction
- facilitates thoracic and neck extension for pts who fall fwd in a sitting postion
- helps decrease the fear factor of coming forward
NDT technique to help client maintain 3 natural curves of back
place fingertips on clavicles and other hand on low back
- verbally cue client to “sit up”
- simultaneously sweep hand up back
trunk rotation exercises in supine
- flex hips and knees as if to bridge. keep shoulders flat on bed. let knees rotate from one side to the other
- legs straight, cradle affected UE, rotates upper trunk without moving pelvis
trunk rotation exercies seated
- cradle affected UE against chest; rotate upper body while keeping pelvis stationary
- move from upright posture to lateral flexion on one side, WB on forearm if necessary
- pt holds affected wrist and reaches to floor between feet; client is encouraged to drop head and dangle
position of UE with pt with increased tone
scapula: retraction and depression and/or downward rotation
humerus: internal rotation
elbow: flexion with either supination or pronation
wrist and finger flexion, ulnar deviation (?)
how to position UE for functional activities (high UE tone)
- bring scapula into forward protraction- gently cradle arm while placing other hand along medial border of scapula to bring scapula forward
- abduct shoulder with towel or pillow if needed
- bring elbow into extension and place forearm into neutral (use circular motion to move elbow a little bit at a time)
- correct wrist deviation
- add flexion at wrist to open up fingers so you can get thumb out
- use hand shake position to extend MP
- switch to lateral side of hand to correct wrist flexion
essential components to functional arm use
- reaching
- grasping
- holding
- manipulating
phases of standing
- pre-extension phase (forward phase): hips flex to move center of mass fwd
- extension phase (upward phase): hips and knees extend to move the center of mass upward to final standing alignment
technique for training sit to stand
- position foot with knee and ankle greater than 90
- forward motion of upper body (trunk maintains good posture)
- sequential extension of knee hip and ankle
- equal WB on both limbs
environmental mods to facilitate sit to stand
- raise seat
- use chair without arms (if client is overusing arms)
- select chair that allows for placing feet back so knees and ankles can be appropriately flexed
treatment for balance and walking during occupational performance
(in addition to posture training, sit to stand, reaching training)
- present pt with functional activity graded to challenge ability to shift center of mass over base of support
-grade by changing:
+position of person
+object placement
+object characteristics (weight)
+temporal demands
