Posture/Balance/Transfers/Gait Motor Control - E1 Flashcards
Define balance
The ability to control one’s COM w/respect to the BOS
Define BOS
The area of the body in contact w/the support surface
What is postural stability?
Balance!
What is Center of Pressure
The center of the distribution of total forces applied to the support surface
Define “cone of stability”
The boundaries w/in which the body can maintain stability w/o changing the BOS
What is another word for “cone of stability”
Stability limits
Define 0 balance
Unable to maintain balance or no attempt made
Define poor balance
Able to balance w/ or w/o UE support for 5 seconds or less
Define fair balance
Able to balance w/ or w/o UE support for 15-60s and/or able to hold against slight resistance
Define good balance
Able to hold balance against moderate resistance
List the 4 types of balance
Static
Dynamic
Protective
Functional
List the types of static balance
Static - time as measure (T)
Static - resistance as measure (R)
Static - anticipatory, feed-forward (AFF)
List the types of dynamic balance
Dynamic - reactive, feedback (RFB)
Dynamic - anticipatory, feedforward (AFF)
Static Balance T
A) objective or subjective?
B) what are you doing?
A) Time is an objective measure
B) maintain a position over time
How do you test Static Balance R
A) objective or subjective?
B) what are you doing?
A) Can be subjective or objective
B) Attempt to assume near-normal posture w/w/o BUE support and maintain position against gradual matched manual resistance
What are the Static Balance Basic Procedures - w/Pt in sitting
1) Height-adjustable table
2) Feet flat on floor
3) Hips & knees at 90
4) Max thigh contact on support surface
5) UE supported or unsupported
What is PT force application….
a) positions
b) instructions
c) duration
d) end?
a) anterior - mid sternum posterior - mid upper back R/L - acromion b) Hold, don't let me move you c) Gradual build up 3-4 sec d) End when displaced approx 1 inch
Is the (a/b) reliability high for sitting strength tests
a) Intra-rater
b) inter-rater
Yes & yes - both are fairly high of ICCs
What is Static Balance AFF
The individual is anticipating or predicting what trunk and proximal mm actions or motor control is necessary to prevent falling due to the progressively increasing weight of the arm during reaching
What is the goal of Static AFF balance?
Stability
What are you doing with Dynamic Balance - RFB
Manually displace the COM toward the edges of BOS to elicit the equilibrium or balance rxns
How do you describe a perturbation?
Based on the direction the patient is moving
What occurs w/lateral displacement?
a) head/neck
b) trunk
c) arms
d) legs
a) CL (to displacement) lat flexion
b) CL (to displacement) lat flexion, ipsi elongation
c) CL (to displacement)
d) CL IR (to displacement) and IPSI ER
What are you doing in dynamic balance - AFF
Reach in various directions beyond arm’s length to elicit trunk and arm (sitting) and whole body (standing) balance reaction
What is an objective test of dynamic sitting and standing AFF balance
The Multi-Directional Reach test (MDRT): using a meterstick
What type of reactions are protective reactions?
Reactive, feedback reactions
How do you test protective reactions?
PT uses manual perturbations to move PT beyond BOS, 1st slow and then 2nd relatively faster
What are some examples of functional balance tests?
BERG
Tinetti
Mini-BEST test
What is functional balance?
The utilization of effective balance strategies while performing a set of functional tasks which progress in difficulty
What is the momentum strategy for rolling?
Generates momentum by initiating motion by head, lead shldr, and trunk w/either simultaneous or immediately followed by lead UE reaching
What is the first common form of rolling?
a) arm
b) HT
c) Leg
It is the momentum strategy where
A) arms lift and reach above shldr pattern
B) shldr girdle leads
C) Unilateral lift
What is the 3rd common form of rolling?
a) arm
b) HT
c) Leg
It is a momentum pattern where
A) Lift and reach above shldr level
B) Shldr girdle leads
C) Bilateral lift
What is the Force-control strategy of rolling?
Pt pushes w/LE either in a flexed or semi-flexed position which propels the body to SL w/flexion of shldr, head, trunk, and lead UE assists in the motion
What is the second common form of rolling?
a) arm
b) HT
c) Leg
It is a force control strategy with
A) Lift and reach above shldr level
B) Shoulder girdle leads
C) Unilateral push
T or F: Supine to erect stance is not variable for adults 20-35 years old
False - there is lots of variability
What is the first common form of supine to standing?
A) UE
B) Axial
C) LE
A symmetrical Force strategy
A) UE: symmetrical push
B) Axial: symmetrical
C) LE: symmetrical squat
What is the 2nd common form of supine to standing?
A) UE
B) Axial
C) LE
Symmetrical except for LEGS
A) UE: symmetrical push
B) Axial: symmetrical
C) LE: asymmetric squat
What is the 3rd common form of standing?
A) UE
B) Axial
C) LE
Rotation Strategy
A) UE: asymmetrical push and reach
B) Axial: partial rotation
C) LE: half kneel
What form of supine to erect stance requires the greatest force production?
Symmetrical form of rising requires greatest control of direction and force production
What factors can influence a movement pattern
- Taller and lighter = more symmetrical
- Shorter and heavier = asymmetrical
What is included in the task of STS
Move the COM from BOS defined by buttock to the BOS defined by the feet
What type of curve is present at the tragus during sit to stand?
C curve
What kind of curve is present at the acromion during STS?
C curve
What kind of curve is present at the top of the pelvis during STS?
S curve
What kind of curve is present at the bottom of the pelvis during STS?
S curve
What kind of curve is present at the knee during STS?
Anterior translation 1st
What major movements occur during STS at…
a) neck
b) trunk
c) pelvis
d) hip
e) knee
f) ankle
A) Flex --> extension B) Flex --> extension C) APT --> PPT D) Flex --> extension E) Extension throughout F) Flex --> extension
Define STS Momentum Strategy
Requires at least a certain amount of speed and no breaks in motion - accel then decel the COM
Define STS Force Strategy
Trunk generates F to bring COM over the BOS - stop or nearly stop - then LE forces lift the body to the vertical position
What occurs at each phase in the Neck during STS?
A) total movement
B) each phase
A) 8 degrees B) 0% 2 flex below horizontal 30% 4 flexed, begin extension 100% +4 exten above horizontal
What occurs at each phase in the Trunk during STS?
A) total movement
B) each phase
A) 32 total degrees B) 0% 10 deg flexed from vertical --> RAPID FLEXION 45% 42 flexion --> RAPID EXTENSION 100% extended to vertical
What occurs at each phase in the pelvis during STS?
A) total movement
B) each phase
A) 38 deg total
B)
0% 26 deg behind vert in PPT, moving toward flexion
50% 12 deg fwd vert in APT, now move toward PPT
100% 1 deg fwd of vertical
What occurs at each phase in the Hip during STS?
A) each phase
A)
Flexion first 40%
Extension second 60%
What occurs at each phase in the Knee during STS?
A) Total movement
B) each phase
A) 70 deg
B)
Very little ext 1st 40% (6 deg)
Rapid extension 2nd 60% of movement (76 deg)
List the 4 phases of the Momentum Strategy STS
Phase 1 - Flexion-Momentum Phase
Phase 2- Momentum-Transfer Phase
Phase 3 - Extension Phase
Phase 4 - Stabilization phase
A) What occurs in STS Phase 1: Flexion-Momentum
B) mm?
A) Begins w/mvmt initiation and ends b4 butt lift-off w/horiz WS of COM
B) Ecc control of fwd momentum by ES
A) What occurs in STS Phase 2: Momentum- Transfer Phase
B) mm?
A) Begins as butt lifts and ends w/max ankle DF w/transfer of momentum from upper body to total body (lift)
B) Co-activation of hip and knee extensors
A) What occurs in STS Phase 3: Extension Phase
B) What direction do you moev
A) Begins just after max DF and ends when hips first cease to extend w/lift or extension phase - ext of hips and knees
B) Moves body vertical
A) What occurs in STS Phase 4: Stabilization Phase
Begins after hip ext is reached and ends when all motion assoc w/stabilization is completed
What is required of the Momentum Strategy for STS?
- Concentric to propel the body
- Eccentric to control the motion of the body
What are some safety concerns of momentum strategy for STS?
- bkwd fall if try to transfer momentum from trunk to legs b4 COM is over feet
- fwd fall if Pt unable to control horiz F @ end of STS movement
What Pts might not be good for utilizing the momentum strategy?
- Orthostatic hypotension
- Vestibular problems
- Dizziness
What occurs in Phase 1 of the Force Control Strategy STS?
Trunk flexion and APT to bring COM over feet
What occurs in Phase 2 of the Force Control Strategy STS?
Extension of trunk, hips and knees w/sufficient force to bring the body to the vertical position
What occurs in Phase 3 of the Force Control Strategy STS?
Stabilization
What can you strengthen to augment Force-control Strategy for STS?
Trunk, hip, and knee extensors can be strengthened
What considerations should be made for both the Momentum and Force STS Strategies?
- manually assist @ knee
- Progress from high to low seat
- P downward thru knee to increase WB sensation of the foot on the contact surface
- P thru dorsum of foot to facilitate WB on that LE
What are the rules of STS
1) Feet shldr width apart
2) Symmetrical alignment anterior view
3) Aligned altho feet can be staggered
4) W or w/o arms
STS Variability
A) Intra-subject
B) Inter-subject
A) intra-subj is variable w/same start position, and even more variable w/o standard start position
B) High variability
What occurs in Stand to Sit?
- Eccentric control of body weight as lowered
- Ecc. paraspinals, quads, and GS
- Relies on some passive tension
