Sitting Unsupported, Supported, Active Flashcards
It is imperative to teach the patient these three keys for seating surfaces during the course of unsupported sitting training
Height of the seating surface
AP depth of the seating surface
Shape and tilt of the seat pan
The height of the seating surface affects the distribution of ________ into the pelvis and into the feet by affecting the ________ angle
Weight
Thigh torso angle
More than ________ percent of the thigh must be off of the chair seat in order to achieve a proper effect from the chair height while keeping the pelvis off the chair
50%
A minimum of _______ between the pubic symphysis and the edge of the chair is optimal.
2-3 inches.
The shape and tilt of the seat pan affects ____________ at the pelvis
Weight bearing
A seat pan can cause excessive ___________ at the hips altering hip hinging
Internal and external rotation of the hips.
These should be observed when evaluating a patient for sitting
Base of support
Alignment
Shoulder Girdle Position
Head position
These should be tested when testing a patient for sitting
Vertical compression
Elbow flexion test.
The purpose of the pre-training kinesthetic enhancement is to enhance the patients awareness of ___________ by emphasizing the effect on the position and function of the body by changing the height of the chair.
his/her body
The technique utilized to enhance the patient’s proprioceptive and kinesthetic awareness is ______ or ______
Kinesthetic Comparative Training or Proprioceptive Comparative Training (KCT or PCT)
During Pre-Training Kinesthetic Enhancement the high stool is placed from 90-100 degrees of hip angle depending on the __________ of the patient
Posterior compartment tightness
During the Pre-Training Kinesthetic Enhancement the therapist gives the patient permission to slump by using the verbal cue _______ and then asks the patient to ________ in whatever way the patient feels is appropriate at least 2 times
slump, sit up tall
During the pre-training kinesthetic enhancement the therapists asks questions for the patient during command of _______
sit up tall
The three questions asked during pre training kinesthetic enhancement are:
- Please note how much excursion you have on this surface
- Please note how much effort it is to sit up on this surface
- Please note exactly where the effort is occurring to sit up on this surface
The sequence of stools for Pre-Training Kinesthetic Enhancement is:
Low, High, Low
During the awareness lab for efficient base of support, individuals are asked to find their happy place and then slump at two individual times, these are
When sitting normally and then when asked to sit forward on their pelvic floor.
Using the pelvic floor as your base of support biomechanically provides a base that allows the patient’s center of mass to be supported without excessive ______ ________ (state of balance)
Phasic Effort
Sitting on the pelvic floor causes a ______ of the ______ muscles causing a low level of activation of these muscles
loading, pelvic floor
This is the most efficient height for the training of the patient in unsupported sitting
Functional Training Height
The Functional Training Height is
The most efficient height for the training of the patient in unsupported sitting
As training progresses - the patient is expected to transfer this proprioceptive knowledge to _______ ______ and ______ _______
variable heights and seating surfaces
The patient is taken through pelvic forward and backward rocking after the ___________ lab
KCT/PCT
The patients pelvis is rolled forward and backward as if it were a ball since this creates a more functional motion at both the ________ angle and the ________ junction
pelvic femoral angle and the lumbopelvic junction
After rolling the pelvis at a new stool height the therapist should ________ test for ___________
Spring test for end feel
When spring testing during functional training height training there should be a springy end feel in both the ______ and the ________
hips and lumbar spine
An appropriate chair height allows the patient to position the _______ vertically over the __________
pelvis, pelvic floor
When the pelvis is positioned appropriately over the pelvic floor weight is felt on the ________ and the _____________
Front edge of the ischial tuberosities and the posterior aspect of the pubic symphysis
If the stool is too high for a functional training height, the first end feel will be in the ________
Lumbar Spine. (extension block)
If the stool is too low you will feel the end feel first in the _________
Hips
After identifying the Functional Training Height you assist the patient in finding the ________
pelvic floor
The therapist’s first step in finding the pelvic floor is to correct the _______ and _______
lumbopelvic and pelvic-femoral angle.
The “happy place” should be a relatively ______ _____ position. Use of the ________ confirms this position
Loose packed, VCT
To position a patient to find their pelvic floor a __________ is used after finding their happy place
piano grip
The vertical compression when finding the pelvic floor both confirms the ______ of the _______ and _______ _______ the patient as to the sensation of sitting on the pelvic floor
Accuracy of the position and kinesthetically educates
The therapist should use vertical compression to kinesthetically compare _____ sitting to _______ sitting to _____ _______ sitting when finding the pelvic floor
sacral, ischial, pelvic floor
A common mistake with finding the pelvic floor is to allow further _______ of the _______ ______ or to _______ the patient too far ________ when attempting to move onto the pelvic floor
extension of the lumbar spine, hinge the patient too far forward.
If the patient hinges too far forward or extensd while hinging forward the therapists will note a shearing at ______ when applying the vertical compression. This is avoided by stabilizing the lumbar position with the ______ grip
L5/S1, Piano
The steps in training a patient in unsupported sitting are:
Pre Training Kinesthetic Enhancement, Lab for Efficient Base of Support, Identification of Functional Training Height, Finding the Pelvic Floor, Mechanical and Motor Control Analysis of Lumbopelvic Hip movement, The Training Sequences, Shoulder Girdle Position, Head and Neck Position, Post-Test with EFT, Motor Control Training
The passive movements used to determine the FTH assist the therapist in determining the ________ of training
Sequence
The therapists looks for two things when rolling the pelvis to find the sequence of movement, they are:
The biomechanical motion of the lumbar and thoracic spine
The existing movement pattern used to sit up straight
When examining the mechanical mobility of the patient’s spine when sitting up for lumbopelvic sitting movement, the spine should extend up to approximately _____
T6
A normal movement pattern for sitting up straight includes the dissociation pattern in which the _____ _____ elevates away from the ________
rib cage, abdomen
In a compensated pattern when rolling the pelvis forward the patient will not get full ________
Excursion
You choose training sequence 1 if the patient performs ______ _____ of motion while the therapist is rolling the pelvis forward and the ____ ______ ________ away from the abdomen
Full excursion, sternum fully elevates.
If the patient fails to perform a full excursion of motion while the therapist is rolling the pelvis forward, the therapist must determine is the cause ________ or ______ _______
mechanical, motor control
To determine if a patient is unable to dissociate in sitting, the therapists performs these three steps to find if it is mechanical or motor control
- ask the patient to take a deep breath
- ask the patient to sit up over your head
- perform a specific segmental mobility assessment
Before the patient is trained in a new sitting posture through the dissociative and non-dissociative sequences, the patient is asked to sit normally and in what he/she believes to be an efficient posture and the _____ and _____ test is performed in each position
EFT
VCT
In the dissociating sequence the patient is allowed to find _________ on their own
POC or happy place
The only angle corrected by the therapist in the dissociating sequence is the _________ angle
pelvic femoral
The most frequent mistake for the dissociating sequence is th
Over correct the lumbar spine/allow to much lumbar extension
If the patient has a hard time disassociating relaxation of the rib cage from relaxation of the ______, then the therapist holds the patient’s ribcage while the patient places a hand on the ______ to allow for relaxation of the ________ and the lumbar spine
Stomach
If the patient has difficulty relaxing the ribcage when teaching dissociating sitting the therapist can use these three techqiues
Resisted lateral breathing to exhale,
Pushing down on sternum
Pushing down on lateral ribcage
When teaching sitting the xiphoid must sit ________
posterior
If a patient presents with an elevated sternum they will feel like they are slouching because of the pre-set kinesthetic influence of the_________ system
vestibular
The most common dysfunction in teaching non-dissociated sitting is the inefficient separation of the ________ from the ________ region which prevents correct positioning of the pelvis under the thoracic
Thoracic, lumbar region.
When teaching dissociated sitting, the ribcage is elevated through _________
A tissue lock just below the ribcage
Once the patient has gained a proprioceptive concept of the proper position in sitting, train the patient to self-correct using _________ to lift the rib cage up off the lumbar spine and abdomen region
Inhalation
It is important to note that a patient can be in a neutral T/L position and still have a depressed _________. A patient can also present with an efficient rib cage, but be limited at the ______ junction
sternum, TL junction.
Patients can adapt to chairs of different heights by ______ _____ _______ _______ to anchor the pelvis
dropping one foot back
When training a patient in sitting you are training the shoulder girdle to rest in the groove of the PNF __ pattern
PD
If the patient cannot perform PD in sitting, with proper dissociation, it is necessary to train the movement in _______ using the principles and procedures of ____ and immediately assign a home program of __________ in supine or against a wall
Sidelying, PNF, Pivot Prone
When training the head and neck position, it is trained in relationship to the _______ as the base of support
Shoulder girdle
When teaching appropriate head position for sitting, the emphasis is on ________ of the posterior aspect of the neck while allowing the relaxation of the ______ which allows the chin to drop in a neutral position.
elongation,
extensors
When teaching a patient head and neck position for sitting you do not want to ask for an ________ ________ _______
Active Dorsal Glide
When training motor control for a new sitting posture, the therapist may use the PNF techniques initially of __________ and progress toward movements of ________ on a stable trunk with and without resistance
isometric reversals, extremities
The evaluation for hip hinging involves observing the patient ____ ______ forwards and backwards in a chair
hip hinging
When observing hip hinging for active sitting the patient’s arms should be ______ across their chest
crossed
When looking at hip hinging for active sitting you want to note compensation secondary to tightness in the ______
hips
The following are the three primary dysfunctions that can be observed in active sitting
Inappropriate initiation,
Inappropriate weight acceptance, inappropriate timing
Inappropriate initiation in active sitting is manifested by ______ or _______ in the trunk and at the ______ ______ Junction
fleixon, extension, lumbo-pelvic
Inappropriate weight acceptance is manifested in active sitting by extension of the ____ and _____
neck and back
Inappropriate timing in active sitting is manifested by the patient allowing movement to continue with end range of the ______ has been reached. Trunk _____ and Lumbo-Pelvic _______ is observed at the end range of motion
hips, flexion, flexion
All training in sitting must begin with the patient in an efficient ______ ______ with weight bearing into the _____ _____
sitting posture, pelvic floor
To have appropriate active sitting occur the patient must be seated on a surface that allows sufficient ROM in the __________ ______ of the ______ and _____ to allow for forward motion of the trunk at the hips
posterolateral compartment of the hips and thighs
When the patient is being taught efficient weight acceptance in active sitting they are asked to keep their LE in a _______ seated position with the forward knee at ____ degrees or slightly less. The ______ to ______ ______ must be under the knee of the forward leg
stride, 90, mid to fore foot
Once the patient is hinged forward for testing weight acceptance, they are asked these three questions:
Where do you feel you are working?
How much effort is there in your back?
Is there any pain or discomfort and if so, please rate on a scale of 1-5.
When assessing seated weight acceptance a - lb weight is used and the patient hinges forward - ttimes
5-7, 3-4
When training weight acceptance, as the patient is hip hinged forward it is very important to ____ your transition from therapist to patient support. If the therapist keeps contact for to long it will disrupt ______
timing, ace
To train the patient to become aware of appropriate timing, _______ is used along the paraspinal region
taping
A balanced alignment is maintained during movement by initiating the movement from the _____ ___ ________, Allowing the axis of motion to occur at the _______, and allowing the ______ ___ _______ to accept weight acn inversely facilitate the automatic activation of the _____
base of support, hips, base of support, core
When teaching active sitting, lumbar flexion is a sign that the patient lacks _____ and effective ______ with appropriate hip hinging
LPM, timing
When teaching active sitting, lumba extension is a sign that the patient lacks ______
weight acceptance
A common dysfunction of the head and neck in active sitting is to lift it into _______ to counter momentum
extension
When teaching someone to prevent cervical extension in active sitting the patient is instructed to _____ the chin and keep the neck in a _____ ______ throughout the movement
relax, neutral position
If the patient lifts or drops the thoracic spine during active sitting they should focus on feeling the _______ of the thoracic spine immediately ______ into the forward base of support as the weight shift begins
weight, accepted
In weight shifting for active sitting the patient should continue to bear the weight of the thoracic spine through the _____ ______ to keep the thoracic spine neutral
abdominal wall
Any sitting position in which the BOS is NOT the _____ ______ is reclined sitting and requires support
pelvic floor
Once postural or unsupported sitting is trained, some patient may need to utilize ______ or _______ to maintain a balanced posture
supports, alterations
Assistive devices for sitting should support the _____ ______ not force the patient into this ________
learned position, position
When teaching reclined or supported sitting, you should utilize the ______ ___ _______ and use ___ to determine which supports work best.
principles of positioning,
KCT
Supported sitting should focus on the concept of ________
unloading
In sitting as the trunk reclines, ______ maintains the lumbo-pelvic and thoraco-lumbar position
supports
In reclined sitting, the base of support is the feet, pelvis, and ______
spine
A _________ in supported sitting alters the weight distribution more anteriorly and support the pelvis in a manner than allows the pelvic floor to accept the weight as well as the feet
Seat wedge
A _______ in supported sitting gives a more direct support to the pelvis, enforcing the use of support as the key component in correcting postures
sacral support
Arm supports in supported sitting affects the ______ alignment and allows for decompression of the ______ region which can increase the longevity of sitting
cervical, lumbar
