PRONE ON ELBOWS

mobility

Getting a patient into prone on elbows is working on which stage of motor control?

Holding

What is the goal/activity when working on stability in PoE?

medial/lateral, anterior/posterior

Two directions you can do stabilizng reversals in PoE

axillary boarder (of scapula), vertebral boarder (of scapula) using heel of hand

Manual contacts for SR medial/ lateral in PoE

winging

When looking at a patient doing PoE, look for this happening in the scapula.

round the back

How can a patient correct winging?

stop activity and correct

What should you do if a patient starts winging during PoE techniques?

a little above their hands

where should the patient look for proper head position in PoE?

neurtral

In PoE, the cervical spine should be:

webspace in inferior angle of scapula, over top of shoulder

Manual contacts for SR posterior/anterior in PoE

half kneeling over patient (posteriorly)

Therapist body position for SR posterior/anterior in PoE

at the patients side

Therapist body position for SR medial/lateral in PoE

3

How many holds should a patient do before moving your hands to the next direction for stabilizing reversals?

directly under the shoulders

where should elbows be in PoE?

isometric

What type of contraction happens with all stability techniques?

neutral

In PoE, wrists should be in: (no supination or pronation or clasped together)

serratus anterior

Weakness in what muscle causes scapular winging?

long thoracic nerve

Innervation for the serratus anterior

medial/lateral, rotational

Two ways you can do DR in PoE when doing weight shifting activities

dynamic reversal (DR) PNF patterns UE (D1F, D2F)

When doing reaching activities in the static-dynamic phase in PoE, what technique is used?

UE D1F, D2F

PNF patterns used for reaching activities in PoE

axillary boarder (of scapula), vertebral boarder (of scapula) using heel of hand

manual contacts for DR medial/lateral in PoE

“push and pull”

Verbal cues for DR medial/lateral PoE

point of weakness, loading hemiperetic side

Where would you put a hold in DRH medial/lateral? (2, 1 has to do with stroke)

at the patients side

Therapist body position when doing medial/lateral DR in PoE

right elbow

when the patient is rotating to the right in DR with a rotational direction in PoE, where should the look?

Hand on right shoulder, and webspace of left scapula

If the patient is starting DR rotational direction rotated and looking at the right elbow, where should resistance be put when they move to the left?

“look to the left, look to the right.”

Verbal cues used for DR rotational direction

the side they are moving towards

Webspace on inferior angle of Scapula hand placement for DR rotational direction should be put on which scapula: the the side they are moving towards or the opposite of the side they are moving towards?

the opposite of the side they are moving towards

hand placement over the shoulder for DR rotational direction should be put on which shoulder: the the side they are moving towards or the opposite of the side they are moving towards?

proximal stability (stabilizing arm) with distal mobility (reaching arm)

Why is DR with reaching using PNF patterns static-dynamic instead of controlled mobility?

approximation on stabilizing shoulder, top of first and at wrist reaching arm

Manual contacts for DR with reaching

yes

Resistance for DR with reaching should be given given through out the entire range of of D2F and D1F?

up and over

Hold DRH with reaching activities should be where on D1F? Up and over, or down and in?

"“push up and out, pull down and in”

Verbal commands for D2F DR with reaching

“push up and over, pull down and in”

Verbal commands for D1F DR with reaching

serratus anterior, rotator cuff

what muscles does SR in PoE is being worked on?

SR in PoE

what is a good technique and position in the stability stage for should surgery patients with no WB restrictions?

supraspinatus, infraspinatus, teres minor, subscapularis

The rotator cuff muscles

half kneeling over patient (posteriorly)

therapist body position for DR rotational compoentn

in front of patient

therapist body position for DR reaching activities

one side at a time

SR in medial/lateral Poe challenges one side or both side at a time?

both sides at a time

SR in anterior/posterior PoE challenges one side or both side at a time?

anterior/posterior

If the patient has stability issues in both shoulders, what direction of SR might be better?

shoulder surgery (stability), recent amputees (stability), stroke (static dynamic), ataxic (controlled mobility)

PoE is a great postion for these patients:

isometric exercise

What type of exercises do you do with shoulder surgery patients in the maximum protection phase (first few weeks after surgery?

get in the floor often

PoE is a great functional position for populations who: (to read books, play play with kids, ect.)

weight bearing, approximation, stability, postioning for extensor synergy, and awareness for neglect

How does PoE help stroke patients? (5) (3 things and what synergy it helps and awareness of what)

large, low

PoE had a ___ BOS, and ___ COM (very stable if positioned correcly)

directly under the shoulders

In PoE, elbows should be:

UE extensor synergy, ATNR, STLR

Reflexes that may interfer with prone on elbows

supine

What position promotes extensor tone in STLR?

flexor

Prone promote what tone for STLR patients?

STLR

If a patient in PoE wants to flex the LE while in that position, what abnormal reflex is probably present?

resent abdominal/ thoracic surgery (gallbladder removal small bowel obstruction), respiratory pathologies (COPD)

Precautions for PoE (2)

elbow pathology (no WB through elbows), resent surgery or trauma (CABG, PEG tube), cardiopulmonary impairments, pregnant, anterior THA

contraindications for PoE (5)

Obese, hip flexor contractions, back issues/ instrumentation

Patient who may be uncomfortable or have issues getting in PoE

they should be encouraged to lay prone anyway and they can do things here (read books, plays video games, scroll on phone, ect.)

why is PoE a great functional position for amputees?

It could place the patient in too much extension

why is it a bad idea to put a patient with a recent anterior THA in a PoE position?

it promotes lumbar extension

why would a patient with back issues might have trouble/ be uncomfortable in PoE?

stabilize the shoulders

What do the rotator cuff muscles (SITS) do?

head control

Getting into PoE might not be benefical for patients who have poor:

build up chest (pillow, wedge), add a theraband around forearms (recruit rotator cuff)

If the patient cannot maintain PoE, how man the postiion be modified?

it recruits the rotator cuff muscles (SITS)

Why would adding a theraband to forearms in PoE help a patient maintain the position?

shoulder weakness, general weakness (TBI, develpmentally delayed, spinal cord injury)

People who may have issues maintaining PoE

weight shifting

what activity are you working on when doing DR in a medial/lateral or rotational direction in PoE?

No

when weight shifting from the right elbow to the left elbow in medial/lateral DR, are the elbows leaving the mat?

little

Is the weight shift in medial/lateral DR in PoE big or little?

make movements smaller (controlled mobility)

The ultimate goal when doing weight shifts with an ataxic patient?

DR medial/lateral PoE

Technique and position great for weight shifting activities for ataxic patients

DR rotational PoE

What controlled mobility technique (direction of technique) and position should you use to facilitate scapular motion?

put it closer to the wrists

What could make resistance from a theraband more difficult in PoE

put closer to elbow

What could make resistance from a theraband less difficult in PoE

No

does PoE put weight bearing through upper arm and wrist?

elbow, shoulder, humerus

where in the UE does PoE put weight bearing? (3)

DR rotational in PoE

Is a lead up activity for scapular motion in reaching activities (DR reaching using flexion PNF in static-dynamic phase)

DR rotation

How would you regress DR reaching?

1. weight shift.

2. DR medial/lateral

1. If a patient cannot do this in PoE they probably cannot do reaching activities.

2. What can be done to improve this? (activity, technique with specific direction)

concentric for both direction

What kind of contraction in DR reaching using PNF? include what direction

right. Stabilizing left shoulder strengthens it

To promote stability in the shoulder for a left shoulder surgery patient, which arm should do the reaching in DR PoE for static-dynamic phase? Why?

left. Scapular motion is needed for reaching

If the left arm has limited scapular motion, which arm should do the reaching in PoE for static-dynamic phase? Why?

D1F. crosses midline.

What specific pattern for DR reaching is good for stroke patients with neglect? Why?

the arm on neglectful side

What arm needs to be the stabilizing arm for stoke patients with neglect doing DR reaching?