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NI1 > Sitting Up, Sitting & Standing Up > Flashcards

Sitting Up, Sitting & Standing Up Flashcards

1
Q

What is bed mobility important for?

A
  • Pressure relief
  • Comfort & rest
  • Encourages self care & participation
  • Progression to independent mobility
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2
Q

What are the two components of sitting up from supine?

A
  • Rolling over

- Sitting up over the side of the bed

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3
Q

What does rolling include?

A

Movement from supine to prone, prone to supine or as part of a task

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4
Q

What is the difference between rolling & turning in bed?

A
  • Rolling: Includes lateral displacement of the body

- Turning: Rolling on the spot (no lateral displacement)

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5
Q

What are the difficulties of rolling & turning?

A
  • Rotation of low, flat, wide base

- Considerable force required to shift & stabilise COM

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6
Q

What are the important components of rolling over?

A
  • Rotation & flexion of neck
  • Hip & knee flexion
  • Flexion & protraction of shoulder
  • Rotation of trunk
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7
Q

What are the important components of sitting up over the side of the bed?

A
  • Lateral flexion of neck
  • Lateral flexion of trunk & abduction of lower arm
  • Legs lifted & lowered over side of bed
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8
Q

How is sitting up measured?

A
  • Time taken to complete task
  • Item 1 of MAS (supine to lying on intact side)
  • Item 2 of MAS (supine to siting over side of bed)
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9
Q

What are the important components of sitting?

A
  • Feet & knees close together
  • Head balanced on level shoulders
  • Weight evenly distributed
  • Flexion of hips with extension of trunk (shoulders over hips)
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10
Q

What are the important components of reaching in sitting?

A
  • Shifting head, arms & trunk towards object by moving at hips
  • Loading the foot ipsilateral to the direction of the reach
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11
Q

What evidence is there for foot positioning during reaching in sitting?

A
  • Compared reaching distance between both feet on floor, one foot off floor, both feet off floor in stroke patients
  • Furthest reach achieved with both feet on floor
  • Clinical implications: Train reaching with both feet on the floor
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12
Q

What evidence is there for arm positioning during reaching in sitting?

A
  • Study looked at movement of normal healthy adults during reaching
  • Observed that head, arms & trunk move towards object by movement at the hips
  • Movement duration approx 1s
  • Arm never completely straightens to reach the object
  • Clinical implications: Look for arm position when assessing reaching in sitting (straight arm may be adaptive strategy)
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13
Q

What evidence is there for loading through the feet during reaching in sitting?

A
  • Examined ground reaction force through feet when performing reaches of varying distances/tasks
  • Further reach = greater loading
  • Leg muscles activated when reaching beyond arm’s length esp at 140% of arm’s length
  • Faster grasp required = greater ground reaction force
  • Clinical implications: Train speed & reaching outside arm’s length to improve loading through the feet
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14
Q

What evidence is there for direction of reaching during reaching in sitting?

A
  • Location of target influences amount of force through the feet
  • Feet in the direction of the reach have greatest load
  • Older subjects activated tib ant, soleus & vastus lateralis bilaterally in all reaches
  • Clinical implications: To train loading the foot reach on the same side, for older adults may want to start training on unaffected side to make it easier
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15
Q

What evidence is there for thigh support in reaching in sitting?

A
  • Compared reaching forward, ipsilaterally & across the body with 25%, 50% & 75% thigh support
  • Less thigh support = greater load through leg when reaching
  • Clinical implications: To progress loading training reduce thigh support
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16
Q

What evidence is there for reaching in sitting after stroke?

A
  • When reaching forwards & sideways:
  • Lack of loading of affected foot in all directions & slowness of movement
  • Clinical implications: Train speed & loading affected foot
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17
Q

How can you promote loading & muscle activation of the affected side after stroke?

A
  • Reach beyond arm’s length, progress by increasing reaching distance
  • Progress reaching to direction of affected leg
  • Increase speed & endpoint of reaching
  • Reduce thigh support
18
Q

What does assessment of sitting & reaching in sitting include?

A
  • Observation of sitting alignment & missing important components
  • Assessment of patient’s capacity to make preparatory & ongoing postural adjustments e.g. balance
  • Observation of adaptive strategies
19
Q

What are the common observable deviations in sitting?

A
  • ER & abduction of hip
  • IR & adduction of hip
  • Lack of foot placement on floor
  • Inability to reach beyond arm’s length
  • Inability to load affected leg
20
Q

What are the common adaptive behaviours during sitting & reaching in sitting?

A
  • Increased BOS
  • Weight shift to intact side
  • Forward flexion when task requires sideways shift
  • Shuffling feet
  • Use of arms
  • Minimising challenges of balance by restricting speed & amplitude of movement
  • Laterally flexing
  • Full elbow extension (voluntary restriction of movement)
  • Holding breath
21
Q

How is sitting & reaching in sitting measured?

A
  • Item 3 of MAS (balanced sitting)
  • Amount of thigh support
  • Distance reaching without bending
  • Speed of reaching to standardised point
22
Q

What evidence is there for sitting balance training in chronic stroke?

A
  • RCT: sitting balance training vs placebo for stroke patients
  • Standardised training protocol: Reaching beyond arm’s length varying distance, direction, speed, thigh support, task & seat height
  • Significant improvement in leg loading in all directions (almost normal) & movement speed
23
Q

What evidence is there for sitting balance training in subacute stroke?

A
  • Same standardised training protocol used for sitting balance training for chronic stroke
  • Increased max reach distance & peak vertical force through affected foot (maintained at 6 months)
  • Decreased movement time
24
Q

What are the important components of standing up?

A
  • Feet placed back so ankles are behind knees (approx 15 deg DF)
  • Forward translation of trunk by flexion at hip with extension of trunk
  • DF of ankles to bring knees forward (approx 27-28 deg DF)
  • Sequence of lower limb extension at knees, hips & ankles
25
Q

What are the common observable deviations in standing up?

A
  • Difficulty generating/timing sufficient force in lower limb extensors to propel body vertically
  • Failure to place feet far enough back
  • Failure to move body far enough forward for thighs off
  • Poor balance
26
Q

What are the common adaptive behaviours in standing up?

A
  • Increase BOS
  • Use of hands
  • Falls backwards
  • Weight shift laterally to intact side
  • Flexion of trunk
  • Intact foot placed posterior to affected foot
  • Adduction &/or IR of affected leg (locking joints together to increase stability)
  • Final alignment flexed
27
Q

What evidence is there for the kinematics of sit to stand?

A
  • Looked at healthy population STS kinematics
  • Movement duration 1.5s
  • COM moves in 2 phases, horizontal & vertical
  • Ankle at 15 deg DF
  • Thighs off occurs at 30% movement duration
  • Knees move forward then back to start position
28
Q

What evidence is there for loading the legs in sit to stand?

A
  • At thighs off force through the feet is 150% BW
  • Allows body to be propelled upward to standing
  • Clinical implications: Loading the legs is important, need to aim for 75% BW for each leg when training standing up
29
Q

What evidence is there for muscle activity during standing up?

A
  • Ankle DF active before movement begins
  • Muscles that propel body upwards are active just before thighs off
  • Clinical implications: Need to train whole movement, not just components otherwise preparatory activation won’t happen
30
Q

What evidence is there for foot placement during standing up?

A
  • Study examined 3 foot positions
  • Feet further forward
    = > distance BM needs to move
    = > movement time
    = > hip movement
    = < knee/ankle movement
  • Clinical implications: Need to train bringing the feet back for STS
31
Q

What evidence is there for elevation of feet during standing up?

A
  • Examined effects of 3 different foot positions (normal, unaffected extended, unaffected elevated) in stroke patients
  • Peak vertical force & rate of development of peak force greater in affected foot when unaffected foot was forward or elevated
  • Affected tib ant & quads require greater force production when unaffected foot placed forward
  • Clinical implications: Train both feet back initially, progress by putting unaffected foot forwards or elevated
32
Q

What evidence is there for initial alignment during standing up?

A
  • Compared active trunk inclination with no inclination in horizontal phase of STS (healthy young adults)
  • Max force in all muscles sustained for longer when no forward trunk inclination
  • Peak acceleration of forward trunk inclination coincides with onset of hip & knee extension
  • Clinical implications: Need to train forward translation of trunk, ensure you’re not blocking patient’s forward translation
33
Q

What evidence is there for seat height & standing up?

A
  • Compared effects of standing up with seat at knee height: alone; plus use of arms; plus 1/3 thigh length; plus 2/3 thigh length
  • Joint movements around hip & knee decreased as seat height increased
  • Amount of muscle activity decreased as seat height increased
  • Muscle activity in lower limbs reduced by 50% when arms used
  • Clinical implications: No arm use in training, have seat at correct height
34
Q

What assessment is used for standing up?

A
  • Observation
  • Note deviations from important components & adaptive behaviours
  • Determine impairments most likely contributing to deviations
35
Q

What measurement is used for standing up?

A
  • Item 4 MAS (sitting to standing)
  • Time taken to perform 5 reps STS
  • Seat height
  • Weight taken through affected foot
36
Q

What are the principles of training standing up?

A
  • Address underlying impairments
  • Do not use upper limbs
  • Use demonstration & feedback
  • Use manual guidance
  • Repetitive practice (5x20 reps daily)
37
Q

What evidence is there for standing up interventions?

A
  • Cochrane systematic review of standing up interventions for sub-acute & chronic stroke patients
  • Interventions included repetitive STS practice alone; exercise programs; augmented feedback during STS training
  • Moderate quality evidence that STS interventions may improve speed & lateral symmetry of STS
  • Improvement maintained at follow-up
38
Q

What evidence is there for training STS with auditory feedback?

A
  • Compared to STS training with no feedback
  • Trained 45 mins, 5 days/week for 6 weeks
  • Significant improvement in weight distribution in standing up
  • Clinical implications: Need to use feedback in training
39
Q

What evidence is there for biofeedback in lower limb activities after stroke?
**Use in viva

A
  • Systematic review of effects of biofeedback in LL activities
  • Activities included sitting, STS, standing & walking
  • Biofeedback & physio tended to improve standing up more than physio alone
40
Q

What evidence is there for using feedback for foot position in standing up?

A
  • Pilot study (no control)
  • Used a square rule to provide feedback on foot position (no verbal)
  • Increased speed & quality of standing up
  • Improved performance outside of therapy (foot position correct 2/3 of the time)
41
Q

What are the common adaptive strategies of rolling over in bed?

A
  • Wriggling instead of turning
  • Pulling over with intact hand
  • Failure to move affected arm (may indicate inattention or neglect)
42
Q

What are the common adaptive strategies of sitting up over the side of the bed?

A
  • Rotation & flexion of neck forward
  • Excessive pushing through intact arm to compensate for lack of trunk side flexion
  • Hooking intact leg under affected leg
  • Falling backwards

NI1 (10 decks)

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