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NI1 > Standing > Flashcards

Standing Flashcards

1
Q

What does standing involve?

A

Standing alignment & ability to balance

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2
Q

What is balance?

A
  • Ability to control the COM over the BOS
  • Results from interaction between sensory & musculoskeletal systems
  • Integrated & modified by CNS
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3
Q

What are the main sensory systems involved in balance?

A
  • Vestibular: Info about head position & movement
  • Kinaesthetic: Info about movement of body relative to BOS & limbs relative to each other
  • Visual: Info about environment & orientation/movement of body
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4
Q

What are postural adjustments?

A
  • Muscle activations that maintain balance (COM over BOS)
  • Support head & body against gravity
  • Stabilise body parts while others are moved
  • Anticipatory or reactive
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5
Q

What is postural control important for?

A
  • Independence
  • Falls prevention
  • Gait
  • Predictor for achieving independent living after stroke
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6
Q

What are the important components of standing?

A
  • Feet few cms apart
  • Head balanced on level shoulders
  • Weight evenly distributed
  • Hips in front of ankles
  • Hip, knee & ankle extension
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7
Q

What are the important components of reaching in standing?

A
  • Shift head, arm, trunk & legs towards object by moving at ankles
  • Load foot ipsilateral to direction of reach
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8
Q

What evidence is there for muscle activation in pushing & pulling?

A
  • Compared normal activation of leg muscles during pulling & pushing on a handle in standing
  • Pushing: Anterior leg muscles activated
  • Pulling: Posterior leg muscles activated
  • Muscles activated distal to proximal
  • Clinical implications: Train in various directions
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9
Q

What evidence is there for lower limb activation during reaching in standing?

A
  • Examined EMG patterns of lower limb during reaching tasks in normal participants
  • EMG patterns varied with the task
  • Muscle activity anticipatory & ongoing
  • When holding on with hands, hand muscles turned on (not leg)
  • Clinical implications: Train lots of different tasks, avoid holding on to ensure activation of leg muscles
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10
Q

What are the clinical implications of the research regarding muscle activation in standing?

A

Postural adjustments are:

  • Anticipatory & ongoing
  • Task & context specific
  • Train balance as part of daily tasks
  • Consider nature of external support (e.g. rails vs harness)
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11
Q

How is standing assessed?

A
  • Observe standing alignment
  • Observe balance in standing which reaching/looking in various directions
  • Look for missing important components & adaptive strategies
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12
Q

How is standing measured?

A
  • Functional reach test
  • Step test
  • Berg balance scale (may be too easy for some patients)
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13
Q

What are the common observable deviations in standing?

A
  • Decreased hip & knee extension
  • Excessive lateral pelvic shift to affected side
  • Inability to make preparatory & ongoing postural adjustments during reaching
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14
Q

What are the common adaptive strategies in standing?

A
  • Increased BOS
  • Weight shifted to intact side
  • Flexion at hips instead of DF at ankles when reaching forward
  • Movement at trunk instead of hips & ankles when reaching sideways
  • Shuffling & premature stepping
  • Use of arms
  • Voluntary restriction of movement
  • Holding breath
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15
Q

What evidence is there for balance impairment after stroke?

A
  • Balance impairment is common after stroke (83%)

- Correlated with severity of stroke, impairment & disability

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16
Q

What are the main research findings regarding stroke & standing balance?

A
  • Greater postural sway
  • Reduced weight through affected leg
  • Smaller excursions of weight movement in direction of affected leg
  • Effects seen in static & dynamic balance & in responses to external perturbations
17
Q

What evidence is there for lateral shift in standing after stroke?

A
  • Compared accuracy & speed of lateral shift over 12 weeks
  • Stroke patients & healthy aged-match controls
  • After 12 weeks, stroke patients had attained normal precision, but speed still reduced in both directions
18
Q

What are the clinical implications of the research regarding lateral shift in standing after stroke?

A
  • Hip abductors are main muscle group involved in lateral weight shift
  • If abductors don’t turn on quickly, weight shift is too late & patient is at risk of falling
  • Train hip abductors in strength & speed
  • Train weight shift using cues
19
Q

What interventions can be used for difficulty in standing?

A
  • Impairments: Address impairments found in assessment

- Activity training: Improve standing alignment & ability to move COM over BOS

20
Q

What are some activities that can be used as activity training for standing?

A
  • Looking up at ceiling/behind shoulders
  • Reaching in different directions
  • Progress: Change BOS, increase reaching distance/speed, vary size/weight of target object, alter direction of reach
21
Q

What evidence is there for balance training?

A
  • Systematic review examining effects of balance training on standing balance after stroke
  • One-on-one/group balance training effective in improving standing balance in all stages of stroke
22
Q

What evidence is there for activity training for standing?

A
  • Looked at effect of virtual reality in improving standing balance
  • 40 mins PT 4 days/week for 4 weeks plus 30 mins virtual reality therapy
  • Improved Berg balance, weight shift control, increase gait velocity & spatiotemporal factors
  • But small study, further research needed (may be effective)
23
Q

What evidence is there for use of biofeedback in standing training?

A
  • Systematic review comparing biofeedback & usual physio in lower limb training after stroke
  • Biofeedback more effective than usual physio in improving standing balance
24
Q

What are the key points regarding standing balance?

A
  • Important for function
  • Impaired after stroke
  • Normal standing balance is context specific
  • Improves after stroke with training

NI1 (10 decks)

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