Lab 1- Positioning and Passive Ranging

Purpose of positioning neuro patients (side lying, supine, sitting)

Comfort

Reduce muscle tone

Let muscle relax and lengthen to avoid contractures

Support and stabilize body segments

To prevent damage in affected limb

Enhance normal sensory feed back, body symmetry and spatial awareness

Facilitate functional activity

Support resp function

Which side should hemiplegic patient be positioned?

Intact side

Components of lying on intact side

Head in neutral

Top scapula (unaffected) protracted

affected arm supported by pillow

affected leg supported by pillow

When is passive exercise contraindicated?

When it increased the patient's symptoms of intensifies their condition

do NOT _______ weak muscles

overstretch

Parameters for PROM exercise

not set in stone/ patient dependent

Typically 5-10 sets x 1-3 reps daily

Benefits of PROM exercises

Maintains muscle elasticity

Maintains ROM

Promotes circulation

Minimizes contracture formation

Minimizes adhesion formation

Promotes sensory awareness

Inhibits and reduces pain

Increases collagen nutrition

Evaluates joint integrity and motion

Difference between passive stretching and PROM exercise

Passive stretching - goal to increase joint range

Passive Range - maintain joint range

Which muscles are involved in tenodesis grip?

Which extends most distally?

Why is it important NOT to overstretch these muscles?

flexor pollicis longus, flexor digitorum profundus and superficialis

Flexor digitorum profundus extends most distally

It is important not to over stretch these because they won't be able to grip as they cannot contract.

A person should be able to stand and transfer with AX1 if they are able to :

Extend one 1 and hold for 10 seconds

Sit unsupported for 10 1 minute

Follow simple instructions

Why is it important to NOT block the knee when pt is moving from sitting to standing ? Where should the therapist be to avoid this?

pt may need to sit down and bend the knees forward

will reduce the need for them to engage their own muscles : quads

PT should provide lateral support to avoid this happening

Which is the preferred EOB to wheel chair transfer method? Why is it not ideal for everyone

Sit to stand is ideal but requires more control than squat pivot

Which pts is a squat pivot transfer ideal for?

Pt who cannot fully stand due to balance issues, LE weakness or truncal ataxia

Why is it important to not slide on a transfer board?

skin damage

Which FIM score indicates pt no longer needs assistance (helper)?

6 (modified independence) and 7 (complete independence) W

What are tilt tables referred to in paediatrics?

Standers

When using a tilt table when should we take vital signs?

Once they are strapped in but in horizontal position

When table is elevated to a tolerable level by pt

When table has been lowered back to horizontal and straps are removed

What should be monitored/ logged after a tilt table intervention?

Vitals, observe and palpate LE for edema or circulatory responses (colour, temp, pulse), general observation of patient

How long does someone need to be in a tilt table to help with bone density?

at least 7.5 hours

contraindications for tilt table use

severe low BP

tendency to faint

cardiovascular issues

acute DVT

fractures

joint instabilities

Signs/ symptoms of intolerance to being tilted upright

Signs: dangerous drop in BP

tachycardia

Symptoms: dizziness, lightheadedness that doesn't improve

benefits of tilt table

socialization

increase tolerance to be upright

minimize acute muscle weakness

increase muscle recovery when implemented early in PT

cognition