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jessiekate22
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What does training functional movements follow?
- - a thorough assessment of mm length, strength, spasticity
- - obs determine what is over active and what is underactive and functional task analysis allows us to determine the missing compnents of the task
- - these comp are retrained concurrently withany specific mm or jt treatments
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What are common adaptive behaviours for rolling?
- - wriggling instead of turning
- - pulling with intact arm
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What are the components to activate and retrain for the shoulder and arm to reach across the body?
- - protraction, horizontal adduction of shoulder and arm to reach across body
- - active practice in supine or sidelying
- - for added awareness, activation and control use vision to attend to affected body parts, handle more firmly, counter- pressure at shoulder
- - an air- splint may be used for awareness and support during early practice of activities
- - if neglect is severe may need to remind pt and teach pt to lift arm across body if motor return is poor
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What are the components to activate and retrain lower limb?
- 1) bend ur leg using hip and knee flexors- active practice of hipflex, using vision
- 2) place foot on bed and push through foot to extend hip and roll pelvis forward- practice hip ext (sidelying), pushing into the therapist thigh, use compression, mirror for added awareness
- 3) other techniques for activation, awareness and control include- sweep tapping/ finger stretch gluteals
- - tactile/ stretch stimlation abs for stabilisation (supine lying)
- 4) flex and add leg across body using momentum to finally roll with whole body
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What are the componenets to activate and retrain with bridging?
- 1) practice hip ext as above
- 2) bend up both legs using hip and knee flexors (assist affected side if necessary)
- - may need to support feet on bed for stable base and compression from knee towards heel for soleus activation (bridging)
- 3) push down through both feet, extend hips and lift bottom off bed
- 4) bridge and move sideways across bed
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What are the common adaptive behaviours for sit up over edge of bed?
- - rotation and flexion of neck forward
- - excessive pushing up on intact arm
- - hooking intact leg under affected leg
- - falls backwards
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What are the components of lateral neck flexion you can retrain for sit up over edge of bed?
- - manually lift head and then eccentric lowering of head
- - practice active lateral flexion
- (progress to forward flexion and rot from supine)
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What are the components you can retrain for sidelying to sit over edge of bed?
- - lift head, shoulders (lateral flexors), and lean up on unaffected elbow, lower to bed
- - repeat and push through hand
- - position flexed legs close to edge before starting, then guide and lower legs over edge of bed
- - actively flex and lower legs over edge during sitting up
- - actively assist with affected arm or position limb and assist pt to through arm (elbow extensors, scapular and G/H stability required)
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What are common adaptive behaviours of sitting?
- - shifting onto the unaffected/ less affected buttock in sitting
- - wide BOS ie both hips externally rotated or feet/ knees too far apart in sitting
- - voluntary restriction of movement ie pt holds himself stiffly and holds breath
- - pt leans forward or backwards when the task requires the body weight should be shifted sideways
- - use of arms ie grabbing for support, holding arms out of sideways or forward, on minimal shift in COG
- - avoiding threat to balance ie reducing movement, speed, minimising distance reached
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What practices can you use to help pt with alignment and holding for sitting?
- - handling for safety/ correction of posture/ place feet on stool
- - practice active holding of correct posture
- - positioning for arm (pillow, extended arm etc)
- - weight bearing through forearm, or hand (scap, GH and elbow stabilisers progressively activated) to maintain length of mm ( may apply air splint at elbow if required)
- - eliciting mm activity: ext for upright posture, abs for stabilization, lower limb stabiliser (load affected leg)
- - for added activation of abs practice bracing, add hip/ knee flexion, then bracing plus bridging (supine lying)
- Use mirror for active correction
- - if pushing pt use a more structured envt
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What postural adjustemnts and reactions can you use to help train a pt in sitting?
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- Internal perturbations:- turn head, body
- - reaching forward and up (hip flexion, trunk ext)
- - reaching forward and down (controlled flexion- eccentric activity)
- - reaching laterally (lengthen and shorten sides)
- - reaching backwards (rot and ext)
- - practve functional tasks in sitting
- - reach with two hands for objects on stool or floor
- External perturbations:- for writing, placing and equilibrium responses
- - manual displacement
- - use of equipment for surface instability
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What are common adaptive behavious for standing and sitting down?
- Pre-extension phase:- weight bearing particularly through intact side- due to loss of strength, dexterity of trunk and leg mm of affected side as well as intact foot nback, affected foot forward because of weak hamstrings on affected side
- - Wide BOS- at knees and/or feet due to poor balance
- Extension phase:- falls backwards- due to shoulders not moved far enough forward and or moved forward slowly as well as knees not mved forward
- - pushes through arms- to compensate for weak leg mm and loss of momentum
- - weight bearing through intact side- due to loss of stenght/ dexterity of hip/ knes, ankle mm of affected side, as well as intact footback, affected foot forward because of weak hamstrings on affeted side
- - final alignment flexed- due to hips and knees not extended around 0 degrees when standing
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How can we improve hip ext, abduction and trunk stabilisation for standing up and sitting down?
- - sidelying and brige over edge of bed for more selective activation of gluteals, pushing through foot on stool to practice inner range control
- - bridgingg with rhythmical stabilisation
- - theraball work
- - remove hand in sidelying, for added abduction control
- - add compression, knee to foot for awareness
- - sweep tap, finger stretches etc along verbal cuing for added activation
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How can we improve knee ext for standing up and sitting down?
- - elicit active contraction in quads in supine or sitting
- - eccentric/ concentric contraction of quads with compression through heel (mimicking stance phase of gait) in half lying and sitting
- - add sweep tapping, FES to activate and enhance feedback in extension
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What do you need when preparing to stand from sitting?
- - approproate sitting position and control of sitng balance
- - practise foot placement
- - practise forward lean (flexion at hip) with eret trunk
- should try mental and verbal rehearsal of task
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What can you use when practising sit to stand?
- Practise part stand
- - stand fom higher chair (progress to lower)
- - even weight distribution (limb load monitor, scales)
- - add compression for awareness
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What are some common adaptive behaviours in balance standing?
- - wide BOS- feet to far apart or one or both hips externally rot
- - voluntary restriction of movement ie pt holds himself stiffly and holds breath
- = pt shuffles feet instead of making adjustments with appropriate body segments
- - pt takes a step prematurally ie as soon as COG moves
- - pt flexes at hips instead of DF at ankles in reaching forward and moves trunk instead of hips and feet when reaching sideways
- - pt lean forwards or backwards when the task requires the body weight should be shifted sideways
- - use of arms ie grabbing for support, holding arms out to sideways or forward, on minimal shift in COG
- - shifting on the unaffected leg
- - avoiding threat to balance eg reduced movement speed, minimising distance reached
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How can you help a pt with alignment and postural holding in balanced standing?
- - correct alignment, practice holds
- - practice weight shift, lateral pelvic shift and even weight bearing (hip abductors)
- - practice inner range holds hip ext (may use splint on knee)
- - practice inner range holds knee ext without locking knee
- - practice small knee bends/ ext for inner range control
- - progress to stpe standing, narrow base
- - use table,rail etc as required to minimse pushing
- - use vdeo feedback for increase awarenes of problems
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Internal/ external perturbation used in standing (balance)
- - use verbal cues, then more automatic responses
- - turn head, trunk
- - reach in all directions, including overhead and to floor as more stable
- - facilitate ankle strategy form wall, then open space
- - facilitate hip strategy
- - facilitate stepping reactions in all directions
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