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normal movement- sit to stand Flashcards

1
Q

how is normal movement defined ?
SLGEI

A

some lions greet elephants intensely

  • skill
  • acquired through learning
  • goal/task specific
  • efficient and economic
  • individual
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2
Q

what does normal movement look like ?
GGCES

A

good girls can exercise smoothly

  • goal directed
  • graded
  • coordinated
  • efficient
  • smooth
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3
Q

neuromuscular system to achieve normal movement

A
  1. receive sensory input
  2. integrate/ central processors
  3. respond appropriately to multiple intrinsic and extrinsic stimuli/ motor output
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4
Q

normal muscle tone

A

constant state of mild muscle tension, readiness of a muscle to contract/move

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5
Q

normal postural tone

A

maintain body upright against gravity. allows selective movement to attain functional skills (stabilise some parts and allow others to move)

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6
Q

reciprocal innervation

A

graded and synchronous interaction of agonists, antagonists and synergists

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7
Q

sensory/ motor feedback

A

required for refining quality of movement and learning

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8
Q

balance/ equilibrium reactions

A

automatic, slight changes in tone to maintain/ restore balance

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9
Q

systems approach to motor control

A

movement is organised around a behavioural goal/function and results from an interaction between
1. environment
2. task
3. individual

to go to the
1. musculoskeletal system
2. sensory-motor control system
3. cognitive processes

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10
Q

core tasks for movement observation

A

supine, side lying, prone
sitting
standing
sit to stand/ stand to sit
walking
step up/ step down
reach, grasp and manipulation

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11
Q

movement continuum

A
  1. initial conditions
  2. preparation
  3. initiation
  4. execution
  5. termination
    6 expected out achieved?
  6. repeat task with progression/ or regression
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12
Q

initial conditions - movement continuum

A

set the initial conditions for first task performance. initial conditions can be systematically varied in subsequent repetitions

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13
Q

preparation - movement continuum

A

evaluate is performer understood the instructions and task required

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14
Q

initiation - movement continuum

A

timing
direction
smoothness

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15
Q

execution - movement continuum

A

amplitude
direction
speed
smoothness

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16
Q

termination - movement continuum

A

timing
stability
accuracy

17
Q

base of support pro, reg

A

pro- narrower BoS- feet closer together
reg- increase BoS to improve stability- widen feet

18
Q

speed of perturbation progression

A

encourage faster completion of task, add internal perturbation
eg. head turns (walking), marching (sitting and standing)

19
Q

cognitive demand progression

A

add dual tasks =
addition/subtraction problems: reciting every other letter of the alphabet (cognitive-motor)

additional motor tasks eg. walking and carrying water (motor-motor)

20
Q

surface type or height pro, reg

A

PRO

raise step height (step up/down)
lower seat height (sit to stand)

Alter surface type
- standing on foam
- walking on grass

REG
lower step height (step up/down)
raise seat height (sit to stand)

21
Q

cueing physical assistance regression

A

verbal cueing or physical prompts, provide physical assistance (therapist or other) to enable completion of task

22
Q

external support regression

A

orthotics, assistive device, upper extremity support

23
Q

environmental support pro, reg

A

pro
alter auditory and visual environment
- louder environment
- motion in environment - walking in crowds

add external perturbations
nudge, push (sit, stand, walking)

Reg
- quiet environment, brighten lights

24
Q

sit to stand phases
FMES

A
  1. flexion momentum (start)
  2. movement transfer (lift off)
  3. extension (max dorsiflexion)
  4. stabilisation (end hip extension)
25
analysis sit to stand- initial
- observation sitting - can they perform the task without modifications
26
analysis sit to stand- preparation
- did they understand the instructions? is demonstration needed
27
analysis sit to stand- initiation
- appropriate timing and direction? - pelvic tilt anteriorly - trunk accelerates forward via hip flexion
28
analysis sit to stand- execution
- are body segments aligned - lift off to max dorsiflexion= buttocks lift off as weight transfer fully onto feet with hip, knee ankle flexion - appropriate deceleration and control- max DF to end hip ext= trunk, hips, knees extend simultaneously
29
analysis sit to stand- termination
- is CoM maintained over BoS - postural stability? - (erect trunk, full hip and knee extension, **minimal postural sway)**
30
# 7 how can strokes affect normal weakness?
1. loss of joint range, muscle length & altered tone 2. limb weakness 3. altered sensation 4. movement patterns may require more effort & be uncoordinated 5. normal balance reactions can be slower 6. falls or fear of falling 7. pain/ particularly shoulder pain
31
# 6 supine observation ## Footnote BoS, position, motor tone, postural tone, mass, CoM,
- large BoS - position of extension - low motor tone - mass spread out - CoM is closer to BoS more stable - low postural tone - alignment - neutral - accepting/rejecting BoS - symetrical ? - lordosis, kyphosis normal/excessive? - protracted/retracted shoulders - pelvic tilt - leg, foot, arm hand rotation
32
motor tone
the amount of tension (or resistance to movement) in muscles
33
postural tone
the steady contraction of muscles that are necessary to hold different parts of the skeleton in proper relation to the various and constantly changing attitudes and postures of the body. can be assessed by looking at muscle bulk, postural adjustments when they move
34
observation in sitting
bed heights can create difference - BoS - muscle tone increased - head side flexion, rotation, upper cervical flex/ext - shoulder girdle- symetry, protract, retract - arms & elbows flexed or rotated- for protraction - hands- deviation, flex/ext, pro/sup, fingers - pelvis- tilt- palpate iliac crest and tilt opposite direction to ammend - chest thoracic area - hips- rotation, abd, add - ankle- df, pf, inv, ev - accepting bos in feet? arches?
35
observation in standing
1. BoS smaller than supine 2. position of extension 3. increased postural tone 4. COG- higher and more centeral . * position of head- lat flex, rot, flex/ext, upper cervical flex/ext * shoulder girdle- pro/retr/elevation/depression * scapula - angle of spine, position of inferior angle, winging?, muscle creases/armpit creases * trunk - natural curve? lateral tilt? * knees- hyperextension, valgus/varus, rotation (hips knee or ankle origniate) * ankles- acceptance of bos, clawing toes, weigth distribution, in,ev, * equal weight bearning?- test by gripping and trying to move a foot to see if one mores more freely
36
lying to sitting (cant move one side of body)
* bed height important to help patient to touch the floor * therapist at the front is the person talking through the motion as they are face to face with patient * ready steady roll/sit * let patient move what they are able to move * talk them through what your going to move step by step so they can process and try think about the movement 1. get patients knees into flexion (they can move their good side) front physio stabilising knees 2. fold bad arm over their stomach 3. reach good arm to grip the side of the bed 4. turn head to face the way they are rolling 5. ready steady roll - behind therapist one hand under shoulder and other on the hip, front physio rolls knees and stabilises knees onto the physios knee 1. back physio supports- heel of hand on pelvis and other under the lowest scapula to support shoulder, this hand then supports under the elbow. physios body behind incase patient falls back 2. front physio rotates legs round and then adjusts the bos
37
sit to stand with 1 therapist
1. therapist sits next to patient 2. hands on patients pelvis 3. support alongside with whole body and hand on the opposite pelvis- good with patients with loss of sensation down one side
38
sit to stand 2 therapists
1. one therapist supporting behind, pelvic tilting posterior to anterior 2. therapist infront, locks patients weaker leg inbetween their knees, preventing knee from giving way 3. hands under glutes to stand, hands under quads to sit- encourgaes posterior translation 4. can also promote pelvic tilt additionally by tilting through the chest one hand anterior/posterior

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