Week 7 (Standing Up)

Question 1

Kinematics: How do the shoulder, knee and feet move when standing up?

Answer 1

• Shoulder moves forwards, upwards and back slightly
• Knee moves forward slightly and back to start position
• Feet start in slight dorsiflexion
• Knee angle varies depending on height of chair

Question 2

What % is thighs off at?

Answer 2

30%

Question 3

What muscles turn on when standing up?

Answer 3

1. Tibialis anterior turns on before movement happens to dorsiflex to pull the shank forward and translate the knees
2. Hip and knee extensors help raise upwards
3. Gastrocnemius and soleus brake to pull you back to upright in final standing position

Question 4

Kinetics: Force

Answer 4

Have to be able to lift bodyweight off seat so there is more force through feet than bodyweight (150%)

Question 5

What are the important components of pre-extension phase during standing?

Answer 5

• Slight dorsiflexion so ankles are behind knees

- Inclination of trunk forward by hip flexion at hips with extended trunk

Question 6

What are the important components of extension phase during standing?

Answer 6

• Dorsiflexion at the ankle to move knees forward

- Extension at the hip and knees for final standing alignment

Question 7

How to clinically measure standing up?

Answer 7

• Timed 5 repetitions
• Maximum weight through affected leg (using scales)
• Lowest height they can stand from

Question 8

What are the adaptive behaviours people show when standing up during pre-extension?

Answer 8

• Wide BOS

- Weight bourne principally through intact side

Question 9

What are the adaptive behaviours people show when standing up during extension?

Answer 9

• Fall backwards
• Push through arms
• Weight bourne principally through intact side
• Final alignment flexed

Question 10

What does changing the foot placement do to standing?

Answer 10

Changes the leg loading

Question 11

Which foot do you want to place in front or behind to promote loading of the affected side?

Answer 11

Place the affected foot at the back and good foot in front

Question 12

What should the initial alignment of standing up be?

Answer 12

Upright

Encouraging rapid movement of shoulders forward and up

Question 13

Does increasing the seat height make it easier or harder?

Answer 13

Easier

Question 14

Does decreasing the seat height make it easier or harder?

Answer 14

Harder

Question 15

If a patient is standing to walk; and we want to load the R leg, what leg do we first step with?

Answer 15

Left

Question 16

How to promote flexibility of standing up?

Answer 16

• Dual task
• Different environments
• STS, STW

Question 17

Intervention of standing up?

Answer 17

Auditory force feedback during sit to stand
- Alarm goes on if they are not loading enough
- Powerful in training but not good for retention
- Continuous feedback so no self-evaluation
Training: 15 min, 3x daily, 5 days/week for 6 weeks

Question 18

What exercise to do if a patient places their affected too far forward for standing up?

Answer 18

Train moving the foot back in preparation for standing up (task-related)
- With skateboard and targets

Question 19

What exercise to do if a patient is weight bourne through their intact side?

Answer 19

Train loading the leg in preparation for standing up (task-related)
- With bathroom scales and a block

Question 20

What exercise to do if a patient tends to fall backwards?

Answer 20

Train inclining the trunk forward in preparation for standing up (task-related)
- With inclined table and a slide sheet

Question 21

Whole-task practise of standing up

Answer 21

Train standing up with flexibility encouraged

- Two physiotherapists provide manual guidance at the shoulders and knees