Trunk

Question 1

how can we set our patients up for success in sitting posture?

Answer 1

lumbosacral push, raising the height of the chair, increase forward seat slope to activate trunk control

Question 2

A R hemiplegic patient is in short sit in a chair. You ask them to move each of their limbs, what happens?

Answer 2

RUE/RLE - synergy

LUE/LLE - hesitancy due to it providing stability

Question 3

If you want to isolate a limb movement on a hemiplegic patient to analyze its movement, what would you need to do?

Answer 3

stabilize the trunk

Question 4

define balance

Answer 4

maintaining COG over BOS

Question 5

what are the four main righting reactions

Answer 5

labryinthine, optical, neck, and body righting

Question 6

what is labyrinthine righting

Answer 6

righting driven by the inner ear - regardless of position in space, the head finds vertical in the absence of visual information

Question 7

what is optical righting

Answer 7

eyes finding upright

Question 8

which righting reaction is most important in log rolling

Answer 8

neck righting

Question 9

which righting reaction is most important in segmental rolling

Answer 9

body righting

Question 10

what are equilibrium reactions

Answer 10

body’s first line defense to loss of balance in all positions - e.g. arms and legs shoot in the opposite direction of the tilt

Question 11

what are two protective reactions seen in the stroke population

Answer 11

parachute response in UE and stepping response in LE

Question 12

what happens if a patient does not have equilibrium or protective reactions

Answer 12

they lose balance easily/fall, they move slowly, the lose movement strategies

Question 13

what do our patients with hemiplegia do when their trunk doesn’t provide stability? (hint: what do you do when you’re walking on ice) (3)

Answer 13

1. use functioning extremities to stabilize
2. become rigid in posture (i.e. co-contract)
3. stop moving/move less

Question 14

Dissociate between the upper and lower trunk

Answer 14

upper trunk - head, C1-T10, rib cage, and scapulae

lower trunk - T11-sacrum and pelvis

Question 15

how does the position and responsiveness of the pelvis change with body position

Answer 15

the pelvis is a component of the lower trunk in sitting, but kinematically linked to the LE in standing

Question 16

6 early trunk activation positions/activities

Answer 16

hooklying
bridging
sidelying
PoE
rolling and supine to sit
PNF

Question 17

what is the ideal set up for observation of static sitting balance

Answer 17

low mat, feet on the floor, back unsupported

Question 18

T/F: static sitting posture is a record of trunk control specifically

Answer 18

false - static sitting posture analysis should observe all aspects of the kinematic chain

Question 19

If you have a patient in short sit, what is one of the first things you can do to fix their posture?

Answer 19

Get the trunk activated - Ask them to mirror you, breathe in, and reach up towards the ceiling

Question 20

Ryerson and Levit consider what important function a “precursor for trunk control and vital for function”

Answer 20

ability to perform trunk weight shifting

Question 21

In order to use the UE functionally, what needs to happen at the trunk? what about to use the LE functionally?

Answer 21

to use the UE functionally, we need lower trunk stability

to use the LE functionally, we need upper trunk stability

Question 22

how might you integrate PNF of the pelvis and scapulae into stroke patient care?

Answer 22

Perform PNF on their strong side first to get them familiar with the movement as well as weightbearing on their weak side

Question 23

Describe the progression of treatment to challenge trunk control and sitting balance

Answer 23

task modification should be easy enough to allow success/reward but hard enough to challenge

Question 24

what are three trunk assessment scales?

Answer 24

Postural Assessment Scale for Stroke (PASS), Trunk Impairment Scale (TIS), and Function in Sitting Test (FIST)

Question 25

what is the difference between the PASS and TIS

Answer 25

They both assess the trunk, though the TIS tells you a lot about the quality of movement and will likely be used in lower functioning patients and the PASS tells you a lot about function.

Question 26

What three things predict ADLs at 6 months?

Answer 26

PASS, TIS, and unsupported sitting

Question 27

Answer 27

Impaired static sitting balance acutely predicts poor prognosis for ambulation and ADLs after a stroke

Question 28

T/F: trunk position sense is spared in individuals post stroke

Answer 28

false: trunk position sense is impaired

Question 29

T/F: trunk impairments are long lasting and present in patients with chronic hemiplegia (>1 year)

Answer 29

true

Question 30

T/F: adding specific core strengthening/trunk exercises improves dynamic sitting balance, standing balance, gait, and mobility after stroek

Answer 30

true