Neuro Rehab techniques: Prone on Elbows, Quadruped and Kneeling

Question 1

What are the objectives for Prone on Elbows?

Answer 1

Improve control at head/neck/upper trunk and UE shoulder stability, trunk mobility and stability, hip extension ROM, lead up for independent position changes, quadruped activities, and floor to stand transfers.

Question 2

What are the objectives for Quadruped?

Answer 2

Provide a stable position for weight shifting, preparation for standing and walking, relax tone, and engage in UE and LE movements.

Question 3

What are the objectives for Kneeling?

Answer 3

Use for stability with isometric reversals and rhythmic stabilization, transitional mobility, heel sitting to kneeling, kneel walking, and advanced exercises.

Question 4

What are the objectives for Half-Kneeling?

Answer 4

Use for stability, greater weight-bearing and stability demands, transitional mobility from kneeling to half-kneeling, and advanced kneeling exercises.

Question 5

What are the general benefits of Prone on Elbows?

Answer 5

Very stable with a large base of support and low center of mass, opportunity for early weight bearing, and lead up to independent position changes.

Question 6

What are the general benefits of Quadruped?

Answer 6

Useful for relaxation of tone, weight shifting, and as a lead-up activity to standing and walking or hand and finger activities.

Question 7

What are the general benefits of Kneeling?

Answer 7

Develops initial upright position, less demanding than standing, reduces fear of falling, and can be a precursor for upright positions and floor transfers.

Question 8

What are the general benefits of Half-Kneeling?

Answer 8

More stable than kneeling, with a wider base of support, useful for developing upright postural control and as a precursor for standing.

Question 9

Describe the position for Prone on Elbows.

Answer 9

The patient is prone with the head and upper trunk elevated off the supporting surface, bearing weight on the elbows. UEs are in a bilateral symmetrical position with elbows flexed to 90 degrees under the shoulders.

Question 10

Describe the technique to assist a patient into Prone on Elbows.

Answer 10

Assist the patient to roll onto their stomach and bring their elbows under them. Support under each arm below the axilla and cup around the anterior aspect of the rib cage.

Question 11

Describe the position for Quadruped.

Answer 11

The patient is on hands and knees with hips and knees flexed to 90 degrees. Weight is evenly distributed between the hands and knees.

Question 12

Describe the technique to assist a patient into Quadruped from side-sitting.

Answer 12

From side-sitting, the patient rotates the lower trunk, moving the hips over the knees to assume the quadruped position with assistance or resistance from the therapist.

Question 13

Describe the technique to assist a patient into Quadruped from Prone on Elbows.

Answer 13

From prone on elbows, the patient ‘walks’ backward on elbows, lifting the hips until over the knees, then weight shifts to one side, straightening the opposite elbow and repeating on the contralateral side.

Question 14

Describe the position for Kneeling.

Answer 14

The patient is upright with head, trunk, and hips in alignment, weight bearing through hips, knees, and legs. Hips are extended and knees are flexed.

Question 15

Describe the technique to assist a patient into Kneeling from Heel-Sitting.

Answer 15

From heel-sitting, the patient moves forward into kneeling with support from the therapist on the ischial tuberosities, guiding the patient into an upright position.

Question 16

Describe the position for Half-Kneeling.

Answer 16

The patient is upright with one hip extended and weight bearing on the stance limb, the opposite hip and knee flexed to 90 degrees with foot flat on the support surface.

Question 17

Describe the technique to assist a patient into Half-Kneeling from Kneeling.

Answer 17

Shift weight onto one knee and bring the opposite knee up, placing the foot flat on the mat. Elastic bands can be used to assist ankle dorsiflexion and hip/knee flexion.

Question 18

What are the contraindications for Prone on Elbows?

Answer 18

Elbow pathology, recent chest surgery or trauma, winging of scapula, inability to assume the position due to cardiac precautions, increased tone, or limited mobility.

Question 19

What are the considerations for Prone on Elbows?

Answer 19

Limited hip extension ROM, shoulder pain or ROM impairments, scapular/shoulder weakness, UE hypertonia. Supports can be used to reduce UE loading.

Question 20

What are the contraindications for Quadruped?

Answer 20

Presence of wrist, shoulder, or knee pathology that limits weight bearing on those joints.

Question 21

What are the considerations for Quadruped?

Answer 21

Ensuring even weight distribution, using supports if necessary, and monitoring for excessive tone or pain in the supporting joints.

Question 22

What are the contraindications for Kneeling?

Answer 22

Rheumatoid arthritis or osteoarthritis affecting the knee, knee joint instability, apophysitis of the tibial tubercle, or recent knee surgery.

Question 23

What are the considerations for Kneeling?

Answer 23

Monitoring for discomfort or pain, using padding to reduce pressure on patellar tendons, and ensuring adequate strength of trunk and hip extensors.

Question 24

What are the contraindications for Half-Kneeling?

Answer 24

Similar to kneeling, with additional caution for any instability or pain in the weight-bearing leg.

Question 25

What are the considerations for Half-Kneeling?

Answer 25

Monitoring for balance and stability, using supports as needed, and ensuring even weight distribution between the knee and foot.

Question 26

Describe the stabilization techniques for Prone on Elbows.

Answer 26

Stabilizing reversals, rhythmic stabilization with resistance applied to shoulder external rotation to promote scapular stability.

Question 27

Describe the weight shifting techniques for Prone on Elbows.

Answer 27

Isotonic reversals with lateral weight shifts, facilitating weight shift towards the therapist, and adding isometric holds.

Question 28

Describe the stabilization techniques for Quadruped.

Answer 28

Isometric reversals and rhythmic stabilization to promote stability in the quadruped position.

Question 29

Describe the weight shifting techniques for Quadruped.

Answer 29

Forward/backward and side-to-side weight shifts to increase stability demands and prepare for reaching activities.

Question 30

Describe the stabilization techniques for Kneeling.

Answer 30

Isometric reversals and rhythmic stabilization, maintaining upright posture against resistance.

Question 31

Describe the weight shifting techniques for Kneeling.

Answer 31

Forward/backward, medial/lateral, and diagonal weight shifts, promoting pelvic motion needed for normal gait.

Question 32

Describe the stabilization techniques for Half-Kneeling.

Answer 32

Isometric reversals and rhythmic stabilization, holding head and trunk upright with even weight distribution.

Question 33

Describe the weight shifting techniques for Half-Kneeling.

Answer 33

Isotonic reversals in different directions, facilitating reaching activities while maintaining postural stability.

Question 34

Describe the movement transition from Quadruped to Heel-Sitting.

Answer 34

From quadruped, move shoulders, hips, and knees into further flexion until buttocks contact heels, with therapist providing resistance on ischial tuberosities.

Question 35

Describe the movement transition from Heel-Sitting to Kneeling.

Answer 35

From heel-sitting, move forward into kneeling with support on ischial tuberosities, guiding the patient into an upright position.

Question 36

Describe advanced techniques and progressions for Kneeling.

Answer 36

Weight shifting, reaching, anticipatory balance control, reactive postural control, and activities on compliant surfaces or with therapy balls.

Question 37

Describe the movement transition from Kneeling to Half-Kneeling.

Answer 37

Shift weight onto one knee and bring the opposite knee up, placing the foot flat on the mat, using elastic bands for assistance if needed.

Question 38

Describe the movement transition from Half-Kneeling to Standing.

Answer 38

Shift weight onto the foot in front, extend the hips and knees to stand up, using supports as needed for stability and balance.

Question 39

Describe advanced techniques and progressions for Half-Kneeling.

Answer 39

Weight shifting, reaching activities with weighted balls, anticipatory and reactive balance control exercises.