Rolling, Coming to Sit Flashcards
What two activities were highly related to being discharged to home for post stroke patients?
Gait and Rolling to intact side
What are the common movement patterns of the upper extremity during rolling?
lift-reach above shoulder
push and reach
lift-reach below shoulder
push
What are the common movement patterns of the trunk during rolling?
shoulder girdle leads
relationship b/w pelvis and shoulder girdle changes
pelvis leads
aligned pelvis and shoulder girdle
What are the common movement patterns of the lower extremity during rolling?
unilateral push
bilateral push
unilateral lift
bilateral lift
What are some common Patient identified problems with rolling?
“I get stuck when I try to roll”
“My arms get caught”
“I cannot reach across”
“my legs are too heavy”
What four muscles are mostly activated during rolling activities?
SCM
Pec major
Ext. Oblique
Rectus Femoris
How does muscle activation of rolling change in hemiplegia patients?
SCM muscles fire regularly but the Pec Maj., Ext. Oblique and Rectus Femoris are have reduced activation on the paretic side of the body
What interventions help address weaknesses of the 4 major rolling muscles?
- Over activate the muscles (emphasize activation of involved muscles)
- Rhythmic initiation (progress from passive to AAROM to AROM to resisted movement)
- Manual contact of involved muscles
- Verbal commands
How should you initiate rolling movements using the momentum generation intervention?
How should you transition the momentum?
with lift of head and neck
move head and arms quickly in the direction of the roll and with the head and trunk moving into slight flexion
How should you initiate rolling movements using the forced control intervention?
How should you transition the momentum?
push one foot into the support surface, lift head; reach with UE
continue rolling to side by pushing with the LE and reaching with the UE
What are common patterns of the UE during coming to sit movements?
Lateral lift and push Push double push lift and push left and reach
What are common patterns of the head and trunk during coming to sit movements?
pelvis leading
lateral roll
roll off
come to sit
What are common patterns of the LE during coming to sit movements?
Step off
asynchronous w/ leg extension
asynchronous
synchronous
What are some common Patient identified problems with coming to sit?
“I get stuck”
“I will fall”
“I move soooo slowly”
“I don’t have the strength”
What interventions are appropriate for patients the have poor LE sequencing or weakness of hip abductors/flexors?
-lateral leg movement, single leg b y moving one LE toward the side of exit and the other LE (helps with initial portion of rise)
What interventions are appropriate for patients the have poor sequencing of trunk/UE/LE’s?
Sidelying to sit-on preferred side with hips and knees flexed and heels supported on bed, push down with preferred side elbow and the opposite hand. Come to sit with LE;s off edge of bed (alternate way to rise after a roll onto side)
Trunk Elevation by UE extension-from supine, extend UE, push off, and extend the elbow to achieve trunk elevation (elevating trunk using shoulder and elbow extension)
What interventions are appropriate for patients the have poor sequencing of trunk/UE/LE’s and reduced somatosensation around ischial tuberosities?
Weight on hip and Hold- from sitting on edge of bed and arms crossed across chest, place all WB on one hip, lean as far as possible to one side, hold position for 3 seconds. repeat on opposite side
What are some environmental contextual factors to consider for rolling/coming to sit activities?
- arm support
- size of support surface
- distance of object if reaching
- feet on floor vs off the floor
What interventions can help promote orientation to vertical when maintaining posture in sitting?
- Visual Feedback using mirrors and tape lines
- Somatosensory feedback (kinesiotape)
- Customized seating systems
What interventions can help promote orientation to support surface when maintaining posture in sitting?
- active weight shifting w/ approximation through iliac crests
- exaggerated pelvis movements to align in all planes
- seat surface of different compliances
- mirror feedback
- customized seat cushion
True or False: With APAs while sitting the postural muscle activation occurs after the primer mover for the activity
False, it occurs before in order to prepare body for the movement
usually the neck extensors are activated in order to stabilize the head before movement
What is muscle patterns are impaired in hemiplegia patients as far as APAs?
the ability to properly sequence muscle activation for APAs
What is sensory patterns are impaired in hemiplegia patients as far as APAs?
problems with lateral stabilization and issues with sitting on compliant surfaces
True or False: Post-stroke patients have significant issues with trunk proprioception
True
What intervention guidelines are appropriate for training seated APAs in hemiplegia patients?
reaching beyond the arm’s length while focusing on:
- smooth coordinate motion of the trunk and arm to get the hand to the object
- Appropriate loading of the affected foot
- Preventing the use of maladaptive strategies such as widening of the BoS
Where does movement primarily occur for RPA movements?
at the hip
What interventions are appropriate to address slow activation of postural muscles during RPA movements while sitting?
- manual perturbations in sitting
- platform perturbations in sitting
- weighted ball activities (catching, kicking, etc.)-ONLY works on first few attempts then it becomes an APA
