Test NDT Fall 2015 Flashcards
Initial Swing
Gait components
Anterior Elevation
Concentric by
- hip flexors
- abdominals
- contralateral extensors
Late swing to initial contact
Gait components
Anterior depression
eccentric by posterior elevators
Midstance to tow off
Gait components
Posterior Depression
Concentric/isometric
Very Initial Swing
Gait components
Posterior elevation
Plus anterior elevation
Cocontraction
What must be covered in advanced PNF for gait? (3)
- Pre-gait activities
- Individual Components
- Gait: whole skill training
Special techniques: why we use them in advanced PNF
- for insufficiently activated muscles
- for partially activated muscles
- For well-activated muscles
Using basic patterns: advanced PNF
for gait
3 things to do
1) Posterior depression with D1 Extension
2) Massed trunk extension using pelvis and scapula
3) Reciprocal trunk
Using Learning sequence pre-gait activities
3 positions to try
- Quadruped:
- early swing components - Backwards crawling:
- posterior depression with leg extension - Single limb support:
- resisted high step
- resisted anterior elevation of pelvis emphasizing knee control from flexed to extended positions
- resisted anterior elevation during push-off with hip extended
Why quadruped for pre-gait activities
early swing components
Why backwards crawling for pre-gait activities
posterior depression with leg extension
Why single limb support for pre-gait activities
- resisted high step
- resisted anterior elevation of pelvis emphasizing knee control from flexed to extended positions
- resisted anterior elevation during push-off with hip extended
Resisted Gait
what are the components
1) at the end of swing and heel strike
2) at the very end of stance and /initial swing transition
1) Eccentric posterior elevation/ depression at the end of swing and heel strike
2) isometric holding posterior elevation at the very end of stance/initial swing transition
Resisted Gait
what happens in backward walking
Resisted posterior elevation
Resisted gait
forward walking using dowel
Select one part of the cycle (weight transference, push-off and swing) and repeatedly resist it through the dowel
NDT Models of Care
Body Structure and Function
- -Functional Domain
- -Disability Domain
–Functional Domain
Structural and Functional Integrity
–Disability Domain
Primary and Secondary Impairments
NDT Models of Care
Motor Functions
- -Functional Domain
- -Disability Domain
–Functional Domain
Effective Posture and Movement
–Disability Domain
Ineffective posture and movement
NDT Models of Care
Individual Functions
- -Functional Domain
- -Disability Domain
–Functional Domain
Functional activities
–Disability Domain
Functional activity limitations
NDT Models of Care
Social Functions
- -Functional Domain
- -Disability Domain
–Functional Domain
Participation
–Disability Domain
Participation restriction
Primary impairments
what is it
2 examples
directly due to pathophysiology
related to pathophysiology:
- weakness
- hemiparesis related to stroke
Secondary Impairments:
what is it
2 examples
not directly due to pathophysiology, develop over time
- ROM
- learned disuse
Motor dimension
domain of posture and movement function / dysfunction :
how the motor status progresses or regresses over time
Domain of posture and movement dysfunction
The continue from effective to ineffective posture and movement in a dimension of motor function is unique in the NDT enablement model.
The NDT approach identifies and analyzes patterns of posture and movement that link functional abilities with underlying systems
Trunk control affects extremity movements
Proximal control: focus comes at trunk initially and then to extremities. Can treat distally if that is what is available to you but historically was more proximal then distal.
The continuum from effective to ineffective ____ and ____ in a dimension of motor function is unique in the NDT enablement model.
The continue from effective to ineffective posture and movement in a dimension of motor function is unique in the NDT enablement model.
Domain of posture and movement dysfunction
The NDT approach identifies and analyzes patterns of ____ and _____ that link functional abilities with underlying systems
The NDT approach identifies and analyzes patterns of posture and movement that link functional abilities with underlying systems
Why do we focus on trunk control in NDT
Trunk control affects extremity movements
Proximal control: focus comes at trunk initially and then to extremities. Can treat distally if that is what is available to you but historically was more proximal then distal.
Domain: Individual Functions:
Functional Activity limitations: range from simple tasks to complex skills
in an NDT approach it is the specific job of the clinician to identify functional limitations, then to theorize which motor dysfunctions and system impairments are responsible for limitations in the client’s behavior.
NDT examination focuses on difference in performance and capacity as it relates to function in various settings and uses this information to determine strategies for interventions that might bridge the gap between the two.
Functional Activity limitations:
in an NDT approach it is the specific job of the clinician to identify _______, then to theorize which ________ and _______ are responsible for limitations in the client’s behavior.
in an NDT approach it is the specific job of the clinician to identify functional limitations, then to theorize which motor dysfunctions and system impairments are responsible for limitations in the client’s behavior.
Functional Activity limitations:
NDT examination focuses on difference in _____ and ____ as it relates to function in various settings and uses this information to determine strategies for interventions that might bridge the gap between the two.
NDT examination focuses on difference in performance and capacity as it relates to function in various settings and uses this information to determine strategies for interventions that might bridge the gap between the two.
Functional Activity limitations:
NDT examination focuses on difference in performance and capacity as it relates to ______ in various settings and uses this information to determine strategies for interventions that might bridge the gap between the two.
NDT examination focuses on difference in performance and capacity as it relates to function in various settings and uses this information to determine strategies for interventions that might bridge the gap between the two.
Functional Activity limitations:
Takes primary impairment and secondary impairment and go forward to address the ______: a task analysis. Take a task they cannot do i.e. getting dressed in the morning. Break it into components-why cannot do it. Motor control to grab shirt, ROM in elbow or hand to grasp the shirt. Dysfunction in shoulder. Break it down and find the treatment accordingly.
Takes primary impairment and secondary impairment and go forward to address the functional limitation: a task analysis.
Take a task they cannot do i.e. getting dressed in the morning. Break it into components-why cannot do it. Motor control to grab shirt, ROM in elbow or hand to grasp the shirt. Dysfunction in shoulder. Break it down and find the treatment accordingly.
GIVE AN EXAMPLE
NDT: functional activity limitations
Takes primary impairment and secondary impairment and go forward to address the functional limitation: a task analysis.
Takes primary impairment and secondary impairment and go forward to address the functional limitation: a task analysis.
Take a task they cannot do i.e. getting dressed in the morning. Break it into components-why cannot do it. Motor control to grab shirt, ROM in elbow or hand to grasp the shirt. Dysfunction in shoulder. Break it down and find the treatment accordingly.
Social Dimension:
what is it the domain of?
Participation and Participation Restrictions
Social Dimension:
what does it take into account?
(3)
- Expected performance,
- activity, and
- roles within physical and social contexts
-What you would expect them to do in their home etc.
-It may be they don’t care about that task and any practice you give them isn’t going to help that task, choose to work on something they care about.
Not just reaching for cone but something that interests them. Do things that are important to them and they will be more engaged
Facilitators / Barriers or Hindrances:
Individual Factors
Services and systems
individual factors: Are elements in the immediate personal environment of the individual, including but not limited to settings such as home, workplace, community, and school.
Services and systems include formal and informal social structures and services in a community that affect an individual, such as organizations and services related to work environment, community activities, government agencies, communication, and transportation services.
Facilitators / Barriers or Hindrances:
Individual Factors
what are they?
Elements in immediate personal environment of the individual, including but not limited to
settings such as home, workplace, community, and school.
Facilitators / Barriers or Hindrances:
Services and systems
Services and systems include formal and informal social structures and services in a community that affect an individual, such as
organizations and services related to work environment, community activities, government agencies, communication, and transportation services.
Contextual Factors:
what are they?
give an example:
Use specific environmental context to shape patterns of movement.
-constraint induced therapy uses environment and little handling to shape the activity
—want someone to reach up and manipulate something on a shelf to get a hand to get the hand shape and reach you want rather than asking someone to do that.
Folding towels, set up child in a playground or outside or community setting.
Contextual Factors:
What is the NDT Focus:
what it helps with
Impact of the specific ENVIRONMENT in shaping the PATTERNS OF MOVEMENT
Additional avenues for intervention strategies.
This attention to the dynamic interactions between the individual and the environment reflects a change in NDT focus.
Constraint induced: uses the environment and little handling to shape the task—the context of the activity—reach up and manipulate something—automatically getting the motion you want
Atypical alignment and abnormal patterns of WB
3 possible causes
Examples:
- neuropathology (Pusher’s Syndrome)
- musculoskeletal impairments
- compensation for weakness.
Shoulder subluxation, or gradually increasing pronation in the foot.
If you can influence the patient’s alignment you can change the way they move. (Changing joint kinematics, muscle length/tension relationships, and sensory input)
Why do we care to influence the patient’s alignment?
If you can influence the patient’s alignment you can change the way they move.
(Changing joint kinematics, muscle length/tension relationships, and sensory input)
Abnormal Muscle Tone:
hypertonia and hypotonia
usually flaccidity or hypotonia in the beginning, and then progress to hypertonia
Causes of hypertonia
5
- spasticity
- Changes in muscle properties
- Changes in adaptability of muscles
- Stiffness (or muscle elasticity)
- Abnormal force production (hypotonia as well)
spasticity:
spasticity: velocity dependent reaction to stretch (only one component of increased muscle tone)
Hypertonia:
Changes in muscle properties:
3
hypoextensibility, contracture, and muscle atrophy
- can lose MU
- more connective tissue overlay
- weaker and stiffer
Hypertonia
Changes in adaptability of muscles:
3
Changes in adaptability of muscles:
- excessive co-activation
difficulty isolating biceps and triceps and turn on both at the same time - DF and PF kick in at the same time (try to position on side for different sensory input)
- if tight muscle this will also affect sensory input: changes proprioception in the area and feedback you get from the limb. Use a quieter voice. Change the activity if stuck in a pattern with a lot of co-activation. help them gain control over a different position.
Hypertonia
Stiffness
Stiffness (or muscle elasticity)
Hypertonia
Abnormal force production
Abnormal force production (hypotonia as well)
Kinesiological and Biomechanics Components of Movements:
What causes differences in postures and movements that occur between infancy and adulthood?
(3)
- kinesiological / biomechanics components of the musculoskeletal system
- anthropometric changes
- movement experiences in various gravitational contacts
(get swelling, and postural and gravitational responses affect how you move, practice under NDT: look at biomechanics, musculoskeletal factors of joint mobility)
NDT: Coordination Problems:
impaired coordination results from the disruption of the activation, sequencing, timing, and scaling of muscle activity, all of which have been discussed as primary impairments in CNS pathology.
impaired coordination results from the disruption of the activation, sequencing, timing, and scaling of muscle activity, all of which have been discussed as primary impairments in CNS pathology.
NDT: Coordination Problems:
What does impaired coordination results from?
The disruption of the activation, sequencing, timing, and scaling of muscle activity, all of which have been discussed as primary impairments in CNS pathology.
NDT: Coordination Problems:
What primary impairments in CNS pathology cause impaired coordination?
Disruption of___
(4)
1) Activation
2) sequencing
3) timing,
4) scaling of muscle activity
Ruskin:
CNS white matter
The largest amount of CNS white matter is used in:
feedback and feedforward communication
In redundant feedback loops and feedforward communication and interrelating of cells—> everything is intergraded and utilized
Implication of Ruskin on CNS white matter
- Associated problems: Motor planning and understanding of feedback confused: may take more time and repetition to understand an activity—need to try it more than one before you give up on the activity.
- Everything is integrated and both sides of the body are utilized
- Recovery after stroke as long as some sparing healthy tissue there is prospect that improvement will occur–> Patient can have problems in areas you did not think there would be problems
Implications of Ruskin on white matter
Motor planning and understanding of feedback can get confused:
So when set up a clear activity may take more time and set up and repetition. —may need to try it more than once and in different contexts before giving up on doing it.
Who said
there is no such thing as a single stroke with hemiplegia
Ruskin: Motor control integration—ruskin—there is no such thing as a single stroke with hemiplegia
Explicit and implicit motor learning:
Boyd and Winstein:
After MCA stroke:
explicit info was detrimental for implicit motor learning –a lot of VC will not be beneficial—environment, tactile, an be helpful to include
If medial temporal lobe damage had explicit learning deficits—a lot of verbal cues not help
use hand placements and guidance and context and environment
Implicit system is spread out and so it does not get completely disrupted: because it is so distributed: cerebellum, basal ganglia, SMC (sensory motor cortex)
What happened to explicit learning after stroke?
detrimental for implicit motor learning
–a lot of VC will not be beneficial
-environment, tactile, an be helpful to include
If medial temporal lobe damage had explicit learning deficits—a lot of verbal cues not help
use hand placements and guidance and context and environment
What damage caused explicit learning deficits
MEDIAL TEMPORAL LOBE damage had explicit learning deficits—a lot of verbal cues not help
What learning is messed up after MCA stroke?
explicit info was detrimental for implicit motor learning –a lot of VC will not be beneficial—environment, tactile, an be helpful to include
Will VC work after MCA stroke?
If medial temporal lobe damage had explicit learning deficits—a lot of verbal cues not help
use hand placements and guidance and context and environment
Will Implicit learning be messed up after stroke?
Implicit system is spread out and so it does not get completely disrupted: because it is so distributed: cerebellum, basal ganglia, SMC (sensory motor cortex)
Medial Temporal Lobe
- Implicit Learning Strategies
- Explicit Learning Strategies
Implicit Learning Strategies
UNIMPAIRED
Explicit Learning Strategies
IMPAIRED
Prefrontal Cortex
- Implicit Learning Strategies
- Explicit Learning Strategies
Implicit Learning Strategies
IMPAIRED: Visiomotor Sequencing Task
Explicit Learning Strategies
IMPAIRED: Visiomotor Sequencing Task
MCA: Sensorimotor Cortex
- Implicit Learning Strategies
- Explicit Learning Strategies
Implicit Learning Strategies
Unimpaired
Explicit Learning Strategies
Impaired
Cerebellum
- Implicit Learning Strategies
- Explicit Learning Strategies
-Implicit Learning Strategies
Unimpaired
-Explicit Learning Strategies
Impaired
Problems related to disturbed perception:
4
- Difficult to describe
- Must be observed
- Bilateral loss of discriminative sense in some modalities
- Dressing-Non motor aspects
Which specific sensory systems: do we need to evaluate?
3
- somatosensory
- Vestibular responses
- Vision, hearing, etc
Cortical or Discriminatory Sensations / Functions
4
- Kinesthesia:
- Passive position senses
- Passive motion sense - Point Localization
- Stereognosia, Graphesthesia etc
- Tactile Extinction
Lesions of the Association Cortices:
What happens (6)
Body image
- Hemineglect
- Body part identification
- Anosignosia
- Topographic Orientation, Figure–Ground Relationships
- Agnosia
Motor Planning Issues:
Lesions of the Association Cortices:
2 types
1) Apraxias: 1-construction apraxia, 2-dressing apraxia, 3-ideomotor apraxia, 4-ideational apraxia
2) Cognitive problems 1-attention 2-memory 3-problem solving 4-new learning ability
-Explicit motor learning strategies: following instructions of others
-Implicit motor learning strategies:
From within the learner, learning through repetition
More diffusely distributed throughout the brain
Lesion site may determine one’s ability to use explicit vs implicit strategies
4 types of apraxias with Lesions of the Association Cortices:
1-construction apraxia,
2-dressing apraxia,
3-ideomotor apraxia,
4-ideational apraxia
4 Cognitive problems with Lesions of the Association Cortices:
1-attention
2-memory
3-problem solving
4-new learning ability
What are Explicit motor learning strategies?
Explicit motor learning strategies:
following instructions of others
What are Implicit motor learning strategies?
-Implicit motor learning strategies:
From WITHIN THE LEARNER
learning through repetition
More diffusely distributed throughout the brain
Lesion site may determine one’s ability to use explicit vs implicit strategies
Patient may have sensory and perceptual problems-may come across as excuses for not doing something, poor carryover, not interested but may be aphasic, social behavior doesn’t match, difficulty adapting
Patient may have sensory and perceptual problems-may come across as excuses for not doing something, poor carryover, not interested but may be aphasic, social behavior doesn’t match, difficulty adapting
Medial Temporal Lobe
Implicit not impaired
Explicit impaired
Prefrontal Cortex
Implicit impaired (visiomotor sequencing task)
Explicit impaired (visiomotor sequencing task)
MCS: Sensorimotor cortex
implicit unimpaired
explicit impaired
Cerebellum
implicit unimpaired
explicit impaired
What do we need to evaluate in sensory motor therapy?
Specific sensory systems
- somatosensory
- vestibular responses
- vision, hearing, etc.
What are the somatosensory sensations?
6
- primary sensations (light and deep touch, pain and temperature, vibration sense)
- cortical or discriminatory sensations/functions
- Kinesthesia (passive position sense, passive motion sense)
- point localization
- stereognosia, graphesthessia, etc
- tactile extinction
What are perceptual problems?
Lesions of the association cortices
Body Image
a) Hemineglect
b) Body part Identification
c) Anosignosia
d) Topographic Orientation, figure-ground relationships
e) Agnosia
What are motor planning issues?
Apraxias:
- constructional apraxia
- dressing apraxia
- ideomotor apraxia
- ideational apraxia
cognitive problems
- attention
- memory
- problem-solving
- new learning ability
Explicit motor learning strategies:
following instructions of others
Implicit motor learning strategies:
From within the learner, learning through repetition
More diffusely distributed throughout the brain
Lesion site may determine one’s ability to use explicit vs implicit strategies
What are some common problems associated with disrupted perception?
Hypertonicity
Adopting end range Joint Positions
Hyperactivity, and Inordinately quick responses to commands
Pressing too hard against support surfaces
Hyperactivity, and indornitaly quick reps uses to commands
use of far too much effort when performing simple activities
inability to perform tasks despite adequate muscle activity
Inability to remember appointments, instructions, corrections which have been given previously
Failure to preserve stimuli on affected side
urinary incontinence
Non-valid explanations for failed task performance
Poor carryover
Apparent loss of initiative
Aphasia
Social behavior does not match situation
Difficulty adapting behavior
Disturbed perception and learning
Implications for learning
Guided movement therapy: intensive guiding
Right Fit Task Analysis
If the task is at the right level the patient will:
(4)
- Work quietly and is not moving restlessly
- Tone throughout his body will ‘normalize’ regardless of whether hypotonia or hypertonia is the predominate problem
- Intent facial expression
- Eye contact for task is appropriate
Poor Fit Task Analysis:
Too Complex
- Patient shows panic or fear
- Tone increases markedly
- He talks exaggeratedly about irrelevant matters
- Makes constant requests to visit the toilet
- Complains of other symptoms which could account for his lack of success
- Shows signs of aggression to the therapist or nurse
Right fit task analysis
Too Easy:
Too Easy:
1) Patient appears bored or disappointed
2) Chatters inconsequently or makes repetitive jokes
3) Is inattentive
4) Fiddles with clothing, scratches
Physical Factors Affecting Guiding
4
1) Size of patient - positioning
2) Mechanical factors
3) Patient’s stage of progress
4) Location
Things to pay attention to in a case study for adults with hemiplegia
participation restriction
functional limitation
postural and movement limitations
system impairments
musculoskeletal system
sensory systems
respiratory sustem
Documentation
What do goals need to address
3
1) FUNCTIONAL LIMITATIONS
2) and the IMPAIRMENTS that lead to them
3) (also ENVIRONMENTAL CONSTRAINTS)
why cant foot go onto the step
why cant stand up without fallling backwards
Documentation
How goals need to be constructed
Mini goals for the session assess and reassess, be persistent.
step back from the situation and try to analyze what you can improve on in the next session—PLACEMENT of the task, CHOICE of the task, MODIFICATION, HANDLING
Use of reliable and valid MEASURES -goniometry, berg balance scales, fugl meyer assessment
What needs to be in goals
Assess, reassess
Placement of task
Choice of task
Modification
Handling
Measures: goniometry, berg, fugl meyer
Address:
1) FUNCTIONAL LIMITATIONS
2) and the IMPAIRMENTS that lead to them
3) (also ENVIRONMENTAL CONSTRAINTS)
Factors important for patient prognosis
6
1) Medical history/stability
2) Social supports / family role and contribution
3) Management of depression, grieving process, acceptance
4) Severity of perceptual and cognitive deficits
5) First acute event vs chronic repeated events
6) Therapist attitude and ability to provide appropriate learning environment for patient
Umphred : 3 categories of human movement
1) normal and functional;
2) functional but limited in adaptability
3) dysfunctional and abnormal
Analysis leading to appropriate intervention
4 steps
- look at any movement pattern
- evaluate its components
- identify what is missing
- incorporate treatment strategies that help the client achieve the desired function outcome
Neuroplasticity: Implications for Neurorehabilitation
6 types of interventions that are used
6
1) Mirror therapy
2) Robotics
3) Body Weight Supported Treadmill Training
4) Constraint induced movement therapy
5) Virtual Reality
dual task cognitive training
6) Lesion site and dominance factors
Mirror Therapy–how many repetitions?
Able to achieve greater than or equal than or equal to 300 repetitions
session in the study high numbers of repetition have been shown to benefit patients post stroke
Cognitive Aspects of Intervention
4
1) Target FUNCTIONAL and COGNITIVE training
2) High REPETITIONS for high priority activities
(especially if memory and praxis issue, shorter task bouts if attention deficit)
3) focus on providing interesting and motivating activities to practice
4) language comprehension problems: greater focus on somatosensory, visual, thermal, and deep sensation for motor learning
How to incorporate
How is your role in society impacted by a mobility impairment?
Look at the whole person and what is meaningful to them functionally-this is where you will find your most effective tx –it is not an easy quick process
NDT handling and key points of control
OPEN HAND POSTURE
–not lumbrical grip and not on bony prominences
–Contact on MUSCLE BELLIES
–input GRADED not constant, and should be as LIGHT as possible achieve the desired results
What are you looking for in handling in NDT
Looking for a MUSCLE CONTRACTION under your hand
Examples of NDT handling
open hand posture on muscle bellies, look for a muscle contraction
-Ie gluteal muscles, quadriceps/hamstrings—not mixing muscle groups (not input to both hamstrings and quads unless you want them both to fire)
- Handling the foot
- Bottom of foot will make curl (if grip into the bottom of the foot)
LE impairments
3 things to assess
1) strength
(concentric/eccentric-task specific training and closed chain activities are usually best )
2) coordination
3) sensory impairments –provides sensory experiences, weight bearing appropriate handling,
ie appropriate key points, encouraging muscle activation for further feedback to the sensory system
Movement Analysis:
1) Joint kinematics are needed to complete the task, reliability
2) Strength (and muscle specifically concentric and eccentric) throughout body that make the movement possible
3) Feedback needed to improve timing and coordinated control
4) Targeted treatment and compensations that are necessary
What is the NDT approach
6
- Identify FUNCTIONAL TASK you want to improve
- Identify FUNCTIONAL IMPAIRMENTS that prevent the task from being accomplished
- Develop MINI GOALS to address each impairment individually and then as a whole
- Plan TREATMENT accordingly
- PRE-TEST / POST-TEST
- ANALYZE RESULTS
LE impairments
NDT: what to address
1) IMPAIRMENTS are a place to start
2) Remember that the ALIGNMENT of the PROXIMAL SEGMENTS (especially trunk) will impact ability of patient to use LE
3) MUSCLE TONE: too high/too low management strategies
4) ROM: specific joint ranges need to be available – stretching , joint mobilizations
5) STRENGTH: concentric/eccentric
6) COORDINATION
7) SENSORY IMPAIRMENTS
LE Function in Sitting
ALIGNMENT Hips: Knees: Ankle: Foot: Trunk:
Hips: abducted to neutral, flexed to 90 degrees
Knees: flexed to 90 degrees
Ankle: DF to neutral
Foot: able to rest on surface with neutral supination/pronation, toes in neutral abduction/extension, balance of muscle activity
Remember trunk is assumed to be in good alignment as well: neutral lumbar spine, thoracic extension
Something to do to aid in LE function in sitting
Soft tissue mobilization of talus to improve DF, metatarsal spread, toes
Standing
ALIGNMENT
HIPS
KNEES
ANKLES
FOOT
HIPS: extended to neutral, feet hip width apart
KNEES: extended, not resting on ligaments
ANKLES: DF to at least neutral (ideally more should be able to allow for efficient postural sway)
FOOT able to rest on the surface, arches are maintained.
Toes extended, not over or under active
For standing:
when is it good to have UE supported? (3)
when do we not want UE supported? (2)
WANT
1) safety
2) balance
3) good for the arm —appropriate postural responses is good for the CNS and can encourage active control
DON’T WANT
1) working on balance
2) to add complexity to the task cognitively
- —–if painful: if still want support can have the elbow flexed and leaning through forearms
LE facilitation
key points:
Trunk, quadriceps/hamstrings for weight shifting laterally and anterior/lateral
Sit to Stand:
- Weight shift (anterior)
- Muscle activity
- Facilitation: Key Points:
- –Trunk (abdominals and lumbar extensors)
- –Lower Extremities: Hip extensors/ knee extensors (from anterior position)
- –From lateral position
Sit to Stand:
what muscle activity needed
TRUNK: Balance of flexion/ extension
HIPS: flex to 110 degrees (depends on height of surface) then extend,
KNEES: may move towards increased flexion with anterior weight shift/ scoot forward,
ANKLES: dorsiflexed, then plantarflexed
How much do hips need to be flexed in sit to stand?
110 degrees (depends on height of surface) then extend
Facilitation needed in sit to stand
Key points (3)
1) Trunk (abdominals and lumbar extensors)
2) Lower Extremities: Hip extensors/ knee extensors (from anterior position)
3) From lateral position
Weight Bearing Sequence in Standing:
4
1) Bilateral Knee Bends
2) Shift to involve LE with “release” of uninvolved knee
3) Shift to involved LE, toe in/ toe out with uninvolved foot
4) Shift to involved LE, step forward with uninvolved LE
Walking/Gait Initiation
Components
Components:
single limb support, double limb support
Walking/Gait Initiation
Key points
Gluteus medius, quadriceps/hamstrings (in stance on stance limb)
Walking/Gait Initiation
- components
- foundations: key points
- activity to do for WS
Components: single limb support, double limb support
Foundation: Key Points: Gluteus medius, quadriceps/hamstrings (in stance on stance limb)
What to do with the UEs?
Stance Standing
Step ons to work on weight shifting and single limb stance (sensory implications?)
Facilitation of Gait: Group exercise
-key points of control
–what to consider about the input
Group exercise: following
Key Points of control: trunk laterally, gluteus medius, quadriceps/hamstrings, UE
Now without talking try to direct/ influence partner
Timing of input, intensity of input, withdrawing input (moving distally, less intense, less frequent)
Common Gait Impairments Following Stroke
STANCE (2)
SWING (2)
STANCE
- Decreased hip extension at end of stance
- Decreased DF at foot contact and during stance associated with hyperextended knee
SWING
- Decreased knee flexion at toe off and mid swing
- Decreased hip flexion mid swing
Common Gait Impairments Following Stroke
STANCE (2)
- Decreased HIP EXTENSION at end of stance
2. Decreased DF at foot contact and during stance associated with hyperextended knee
Common Gait Impairments Following Stroke
SWING (2)
- Decreased KNEE FLEXION at toe off and mid swing
2. Decreased HIP FLEXION mid swing
