Trunk Flashcards
how can we set our patients up for success in sitting posture?
lumbosacral push, raising the height of the chair, increase forward seat slope to activate trunk control
A R hemiplegic patient is in short sit in a chair. You ask them to move each of their limbs, what happens?
RUE/RLE - synergy
LUE/LLE - hesitancy due to it providing stability
If you want to isolate a limb movement on a hemiplegic patient to analyze its movement, what would you need to do?
stabilize the trunk
define balance
maintaining COG over BOS
what are the four main righting reactions
labryinthine, optical, neck, and body righting
what is labyrinthine righting
righting driven by the inner ear - regardless of position in space, the head finds vertical in the absence of visual information
what is optical righting
eyes finding upright
which righting reaction is most important in log rolling
neck righting
which righting reaction is most important in segmental rolling
body righting
what are equilibrium reactions
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
what are two protective reactions seen in the stroke population
parachute response in UE and stepping response in LE
what happens if a patient does not have equilibrium or protective reactions
they lose balance easily/fall, they move slowly, the lose movement strategies
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)
- use functioning extremities to stabilize
- become rigid in posture (i.e. co-contract)
- stop moving/move less
Dissociate between the upper and lower trunk
upper trunk - head, C1-T10, rib cage, and scapulae
lower trunk - T11-sacrum and pelvis
how does the position and responsiveness of the pelvis change with body position
the pelvis is a component of the lower trunk in sitting, but kinematically linked to the LE in standing
6 early trunk activation positions/activities
hooklying bridging sidelying PoE rolling and supine to sit PNF
what is the ideal set up for observation of static sitting balance
low mat, feet on the floor, back unsupported
T/F: static sitting posture is a record of trunk control specifically
false - static sitting posture analysis should observe all aspects of the kinematic chain
If you have a patient in short sit, what is one of the first things you can do to fix their posture?
Get the trunk activated - Ask them to mirror you, breathe in, and reach up towards the ceiling
Ryerson and Levit consider what important function a “precursor for trunk control and vital for function”
ability to perform trunk weight shifting
In order to use the UE functionally, what needs to happen at the trunk? what about to use the LE functionally?
to use the UE functionally, we need lower trunk stability
to use the LE functionally, we need upper trunk stability
how might you integrate PNF of the pelvis and scapulae into stroke patient care?
Perform PNF on their strong side first to get them familiar with the movement as well as weightbearing on their weak side
Describe the progression of treatment to challenge trunk control and sitting balance
task modification should be easy enough to allow success/reward but hard enough to challenge
what are three trunk assessment scales?
Postural Assessment Scale for Stroke (PASS), Trunk Impairment Scale (TIS), and Function in Sitting Test (FIST)
what is the difference between the PASS and TIS
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.
What three things predict ADLs at 6 months?
PASS, TIS, and unsupported sitting
Impaired static sitting balance acutely predicts poor prognosis for ambulation and ADLs after a stroke
T/F: trunk position sense is spared in individuals post stroke
false: trunk position sense is impaired
T/F: trunk impairments are long lasting and present in patients with chronic hemiplegia (>1 year)
true
T/F: adding specific core strengthening/trunk exercises improves dynamic sitting balance, standing balance, gait, and mobility after stroek
true
