Trunk Control Flashcards
Postural control
Ability to maintain balance and stability in a given position or movement
Essential for efficient and effective performance of activities of daily living
Orientation
Stability
Postural control: orientation
Ability to maintain an appropriate relationship between body segments and between the body and gravity
Postural control: stability
Ability to control the centre of mass relative to the base of support
Trunk control
Stabilisation - ability of the trunk muscles to allow the body to remain stable during head and limb movements
Selective movements of the trunk
Capacity if the body to maintain or resume a relative position (static) or trajectory (dynamic) of the trunk following perturbation
Anticipatory postural adjustments (APAs) - automatic muscle contractions which occur 100ms prior to the voluntary movement
Selective movements
Controlled, specific and coordinated movements of a joint of body part in relation to other segments, which are the result of precisely graded neuromuscular activities
Trunk during sit to stand
Start, lift off, max dorsiflexion, end hip extension
Phase 1 - flexion momentum
Phase 2 - momentum transfer
Phase 3 - extension
Phase 4 - stabilisation
Trunk in gait
Dynamic stabilisation of trunk allows orientation of head and efficient limb movement
Graded selective and coordinated activation and stabilisation of trunk on both sides of body during transfer of weight to stance side and advancement of stepping limb
Trunk is fundamental to limb progression by clearing a pathway and reducing the displacement of the centre of mass
Trunk impairments in CNS lesions
Weakness - altered muscle activation/ control, disuse atrophy
Altered tone - spasticity, hypotonia
Changes to muscle architecture - stiffness, shortening
Ataxia
Spinal deformity impairment on other body segments
Decreased trunk position sense
Visio-perceptual impairments - altered vertical perception, pusher syndrome
Trunk weakness post-stroke
Bilateral but more on the contralesional side
Trunk control and core muscle strength
Trunk extensions more week than flexors
Anticipatory postural adjustment of trunk muscles are impaired in patients
Trunk control is an important early predictor of overall functional outcome, balance and gait
Trunk assessment
Observation
Functional assessment
Active movements
Passive movements
Trunk impairment scale
Trunk assessment: observation
Resting posture
Muscle activation
Trunk assessment: functional assessment
Bed mobility - bridging, crook-lying (bilateral/ single leg), rolling
Sitting - static, dynamic +/- movement of limb, head
Sit to stand
Consider impact of specific components making up the trunk e.g. pelvis, rib cage
Trunk assessment: active movements
Likely to assess most through function
Flexion
Extension
Side flexion
Rotation
Pelvic tilt
Trunk assessment: passive movements
Assessing for alterations in muscle length, tone and stiffness
Flexion
Extension
Side flexion
Rotation
Pelvic tilt
Trunk assessment: trunk impairment scale
Assesses static and dynamic sitting balance and trunk coordination in a sitting position
Static subscale
Dynamic subscale
Coordination subscale
Trunk assessment: trunk impairment scale - static subscale
Ability to maintain a sitting position
With feet supported
While the legs are passively crossed
When the subject crosses the legs actively
Trunk assessment: trunk impairment scale - dynamic subscale
Lateral flexion of the trunk
Unilateral lifting of the pelvis
Trunk assessment: trunk impairment scale - coordination subscale
Rotate upper (shoulder girdle) and then lower (pelvis) part of trunk 6 times
Treatment
Preparation - for movement, stretching/ lengthening muscles for better segment alignment and activation
Facilitation - of movement to activate muscles, trunk extensors, side flexors, rotators, arm placing/ reaching, stable and unstable surface
Functional strengthening
Repetitive goal-orientated task practice
