Trunk control, balance/posture, & functional mobility

Question 1

what 4 main things keep the shoulder stable when its hanging?

Answer 1

1. labrum (makes the socket deeper)
2. joint capsule (fibrous sheath enclosing the point)
3. joint cohesion
4. ligamentous support (attach to the labrum)

Question 2

what kind of joint is the shoulder?

Answer 2

synovial (fluid is holding the joint in place)

Question 3

what does dynamic stability rely on?

Answer 3

1. scapular alignment
2. glenohumeral orientation
3. muscles

Question 4

what re the scapulohumeral muscles?

Answer 4

rotator cuff muscles and deltoid

Question 5

what do the scapulohumeral muscles do?

Answer 5

hold thee humeral head din thee glenoid fossa

Question 6

what are the scapulothoracic muscles?

Answer 6

serrates anterior

Question 7

what is the scapulohumeral rhythm?

Answer 7

2:1

for every 2 degrees the arm goes up we have 1 degree of scapular movements

Question 8

what muscles are the primer movers for shoulder flexion?

Answer 8

0-15 degrees= supraspinatus
15-90 degrees= deltoid
90 degrees= serrates anterior

Question 9

when is scapular rotation the greatest?

Answer 9

between 80-140 degrees

Question 10

what are agonists or prime movers?

Answer 10

produce a specific movement (elbow flexion prime movers= triceps, brachioradialis, etc)

Question 11

what are antagonists?

Answer 11

must relax before agonist can more

they control gravity initiated movement by eccentric contraction

Question 12

what is co-contraction?

Answer 12

stabilizes the joint (co contraction of surrounding muscles

Question 13

what is synergy?

Answer 13

muscles acting together to produce specific movements

Question 14

what 3 things do we need for full trunk control?

Answer 14

1. contraction to move opposite gravity
2. preventing movement occurring due to gravity
3. control our speed of movement

functional independence requires all 3

Question 15

what can insufficient trunk control lead to?

Answer 15

posterior pelvic tilt

extension of unaffected UE and LE to push off surface

change in head position in space for vision and swallowing concerns

Question 16

what do we usually see with loss of co-activiation of the trunk flexor and extensor muscles?

Answer 16

an inability to shift weight over pelvis and results in collapsing laterally over trunk

overuse of shoulder elevation and lateral flexion

unilateral increased trunk flexion or extension

Question 17

what is the number one indicator for independence?

Answer 17

trunk control

Question 18

what are common malalignmnets after stroke?

Answer 18

asymmetrical weight bearing
posterior pelvic tilt
unilateral retraction

Question 19

what is a big problem with patients who have posterior pelvic tilt while sitting?

Answer 19

very high risk for pressure injuries

Question 20

what are common issues for thee fit of wheelchair for stroke survivors?

Answer 20

seat height is too high
location of the rear wheels

Question 21

what are the key factors to consider for fit and function with semi-propulsion?

Answer 21

seat depth
seat height
upper extremity support

Question 22

what happens when the seat height is too high for a foot propellor?

Answer 22

cannot foot propel adequately
increased posterior pelvic tilt

Question 23

what happens when thee seat width is too wide?

Answer 23

promotes pelvic obliquity

hard to reach weeks to propel with right arm

Question 24

what is thee ideal seat width for a wheelchair user?

Answer 24

hip width/GT +1

Question 25

what happens when the rear wheels are too far back for a wheelchair user?

Answer 25

it makes it very difficult to self-propel the chair

most of their weight is distributed in front of the rear axels making the chair feel very heavy

Question 26

what is an independent predictor of ADL independence post stroke?

Answer 26

balance

Question 27

what does balance contribute to?

Answer 27

someones ability to mobilize and falls risk

Question 28

what is a huge factor for quality of life after a stroke?

Answer 28

balance

its the number one indicator for satisfaction with community reintegration post stroke

Question 29

what systems contribute to balance?

Answer 29

vision (provides info about what’s going on around us)

somatosensory (what we feel under our feet when we are standing)

vestibular (our head position and head motion in space)

Question 30

in addition to posterior pelvic tilt, lateral trunk flexion, and thoracic spine flexion, what also changes post stroke?

Answer 30

perceptual dysfunction due to fear of shifting weight to affected side (lateral bias to unaffected side)

(even if they can withstand weight and do things, people tend not to do it)

Question 31

what is sensory re-weighing?

Answer 31

if we’re not getting as much info from our somatosensory system, we rely more on our visual system

Question 32

what component assessments can we do for balance?

Answer 32

biomechanical- ROM, strength, alignment

sensory systems- Vision, somatosensory, vestibular

Question 33

what are some balance assessments?

Answer 33

BERG
functional teach
TUG test

Question 34

what balance observations should we look eat to assess OPI?

Answer 34

postural alignment
BOS (narrow or wide)
movement strategies (are they able to do static balance?)
presence or absence of anticipatory postural adjustments (do they know when they are going to lose their balance?)

Question 35

what re some compensations strategies for balance?

Answer 35

do tasks in the shower sitting down
wheelchair
4 wheeled walker

Question 36

what are some remediation strategies for balance?

Answer 36

use UE to increase BOS

retrain sensory organization (have them work on different surfaces, practice weight shifting forward/backward)

ex. open fridge grab something from top shelf, grab something from bottom shelf

Question 37

what does remediation need to focus on?

Answer 37

passive and active weight shifting

value added occupations specific to the client