Sitting Unsupported, Supported, Active Flashcards by Albert Pannone

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

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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

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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%

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A minimum of _______ between the pubic symphysis and the edge of the chair is optimal.

2-3 inches.

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The shape and tilt of the seat pan affects ____________ at the pelvis

Weight bearing

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A seat pan can cause excessive ___________ at the hips altering hip hinging

Internal and external rotation of the hips.

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These should be observed when evaluating a patient for sitting

Base of support
Alignment
Shoulder Girdle Position
Head position

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These should be tested when testing a patient for sitting

Vertical compression

Elbow flexion test.

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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

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The technique utilized to enhance the patient’s proprioceptive and kinesthetic awareness is ______ or ______

Kinesthetic Comparative Training or Proprioceptive Comparative Training (KCT or PCT)

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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

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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

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During the pre-training kinesthetic enhancement the therapists asks questions for the patient during command of _______

sit up tall

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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

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The sequence of stools for Pre-Training Kinesthetic Enhancement is:

Low, High, Low

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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.

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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

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Sitting on the pelvic floor causes a ______ of the ______ muscles causing a low level of activation of these muscles

loading, pelvic floor

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This is the most efficient height for the training of the patient in unsupported sitting

Functional Training Height

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The Functional Training Height is

The most efficient height for the training of the patient in unsupported sitting

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As training progresses - the patient is expected to transfer this proprioceptive knowledge to _______ ______ and ______ _______

variable heights and seating surfaces

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The patient is taken through pelvic forward and backward rocking after the ___________ lab

KCT/PCT

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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

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After rolling the pelvis at a new stool height the therapist should ________ test for ___________

Spring test for end feel

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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 _____

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

1. ask the patient to take a deep breath 2. ask the patient to sit up over your head 3. 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

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