Trunk control, balance/posture, & functional mobility Flashcards
what 4 main things keep the shoulder stable when its hanging?
- labrum (makes the socket deeper)
- joint capsule (fibrous sheath enclosing the point)
- joint cohesion
- ligamentous support (attach to the labrum)
what kind of joint is the shoulder?
synovial (fluid is holding the joint in place)
what does dynamic stability rely on?
- scapular alignment
- glenohumeral orientation
- muscles
what re the scapulohumeral muscles?
rotator cuff muscles and deltoid
what do the scapulohumeral muscles do?
hold thee humeral head din thee glenoid fossa
what are the scapulothoracic muscles?
serrates anterior
what is the scapulohumeral rhythm?
2:1
for every 2 degrees the arm goes up we have 1 degree of scapular movements
what muscles are the primer movers for shoulder flexion?
0-15 degrees= supraspinatus
15-90 degrees= deltoid
90 degrees= serrates anterior
when is scapular rotation the greatest?
between 80-140 degrees
what are agonists or prime movers?
produce a specific movement (elbow flexion prime movers= triceps, brachioradialis, etc)
what are antagonists?
must relax before agonist can more
they control gravity initiated movement by eccentric contraction
what is co-contraction?
stabilizes the joint (co contraction of surrounding muscles
what is synergy?
muscles acting together to produce specific movements
what 3 things do we need for full trunk control?
- contraction to move opposite gravity
- preventing movement occurring due to gravity
- control our speed of movement
functional independence requires all 3
what can insufficient trunk control lead to?
posterior pelvic tilt
extension of unaffected UE and LE to push off surface
change in head position in space for vision and swallowing concerns
what do we usually see with loss of co-activiation of the trunk flexor and extensor muscles?
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
what is the number one indicator for independence?
trunk control
what are common malalignmnets after stroke?
asymmetrical weight bearing
posterior pelvic tilt
unilateral retraction
what is a big problem with patients who have posterior pelvic tilt while sitting?
very high risk for pressure injuries
what are common issues for thee fit of wheelchair for stroke survivors?
seat height is too high
location of the rear wheels
what are the key factors to consider for fit and function with semi-propulsion?
seat depth
seat height
upper extremity support
what happens when the seat height is too high for a foot propellor?
cannot foot propel adequately
increased posterior pelvic tilt
what happens when thee seat width is too wide?
promotes pelvic obliquity
hard to reach weeks to propel with right arm
what is thee ideal seat width for a wheelchair user?
hip width/GT +1
what happens when the rear wheels are too far back for a wheelchair user?
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
what is an independent predictor of ADL independence post stroke?
balance
what does balance contribute to?
someones ability to mobilize and falls risk
what is a huge factor for quality of life after a stroke?
balance
its the number one indicator for satisfaction with community reintegration post stroke
what systems contribute to balance?
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)
in addition to posterior pelvic tilt, lateral trunk flexion, and thoracic spine flexion, what also changes post stroke?
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)
what is sensory re-weighing?
if we’re not getting as much info from our somatosensory system, we rely more on our visual system
what component assessments can we do for balance?
biomechanical- ROM, strength, alignment
sensory systems- Vision, somatosensory, vestibular
what are some balance assessments?
BERG
functional teach
TUG test
what balance observations should we look eat to assess OPI?
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?)
what re some compensations strategies for balance?
do tasks in the shower sitting down
wheelchair
4 wheeled walker
what are some remediation strategies for balance?
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
what does remediation need to focus on?
passive and active weight shifting
value added occupations specific to the client
