Mobility, Positioning , Motor Development

manual wheelchair

self propel

light vs. ultra light for UE weakness

hemi-height using leg propulsion

casters

smaller = more difficult

minimum 5 in in diameter

fixed vs. swivel

COG forward

increased stability

decreased maneuverability

COG rearward

decrease stability

increased maneuverability

power chairs

UE weakness/paralysis

can't keep up with peers with manual propulsion

rear wheel drive

tracks straight

easier to steer

good on rough terrain

mid-wheel drive

greater maneuverability

small turn radius

rear extended hardware can get caught

front wheel drive

good on various terrains

powerful front wheel

fishtail at high speeds

recline and tilt-in-space

both used for postural instability, pressure relief, and orthostatic hypotension

recline chairs are good for

hip precautions

tilt in space chairs are good for

extensor tone

hip contracture

hand-held walkers

weight bearing LE

hands have to grip and steer

anterior: short-term, maneuverable

posterior: improve posture, lean when locked

alternative devices

prone scooters

caster carts

supine standers

prone standers

sit to stand

move from seated position to standing

reach various heights

bear weight and stretch

using a urinal

transportation

forward facing position

AAC and lap trays must be tied down separately

lap belt, shoulder belt, proper use of tie downs

hips don't lie

proximal stability before distal mobility

always start at the pelvis

90, neutral, or slight anterior tilt

wheelchair measurements

1 inch rule: seat to back of knee, hips to side of chair

seat height

ends at scapula but can change with poor postural stability

postural weakness intervention

recline

tilt in space

higher backrest

custom contoured

lateral trunk supports

lap tray

harness, dynamically stable

UE weakness intervention

lightweight/ultra light chair

power chair

power assist or 1 arm drive

walker with forearm trough

lap tray

u-shaped joystick that supports the palm

general weakness intervention

walker with forearm trough

lightweight/ ultra light wheelchair

increased tone intervention

tilt in space

decreased seat to back angle <90, hip flexion

seatbelt at 90 angle to thighs

hip guides

wedge downward, slope pointing back

foam cushion

poor envelopment, bottoms out

memory foam cushion

stable base, directs heat away, sliding

air cushion

good pressure distribution

bad for lack of sensation or poor posture

honeycomb cushion

pressure distribution

good ventilation

lightweight

poor envelopment

side-lying

useful for weakness

gravity eliminated

prone extension/prone on elbows

quadruped

predatory for crawling

build proximal stability

kneeling

tall kneel leads to half kneel

predatory for standing

unsupported sitting

long sit, ring sit, W sit

postural control needed/core stability

upright sitting

sitting in a chair

90-90-90

hypotonicity

low tone/weakness

slumped posture

hypermobile

facilitation techniques

hypertonicity

increased tone/tightness

extensor tone/posture

limited ROM

inhibitory techniques

dressing interventions

promote flexion

side-lying makes moving limbs and dressing easier

toileting interventions

reducer rings improve balance on toilet

bathing interventions

hammock chair fully supports

trunk support rings give trunk stability

inflatable bath collar used in supine and prone

NDT/Handling techniques

uses sensory input such as deep pressure and UE weight bearing with body in alignment

inhibit spasticity

inhibit primitive reflexes

facilitate normal movement patterns

positioning devices

promote weight bearing and weight shifting in the prone position to improve proximal stability, UE strength, and trunk stability

motor control

how one directs and regulates movement

motor learning

learning and refining motor skills over time

conditions with motor control deficits

CP

developmental coordination disorder

down syndrome

sensory integration disorders

acquired brain injury

intellectual disability

dysmetria

impaired ability to estimate distance

intention tremor

tremor with voluntary movement

limited force control

limited strength or energy

dysdiadokokinesis

difficulty with rapid change of motion

person

age

cognition

musculoskeletal

sensory systems

perception

social/emotional

task

nature of task

simple or complex

size, shape, weight, texture

environment

physical

social

cultural

temporal

virtual

personal

making the grade

finding just-right-challenge

challenging but possible

practice and failure makes perfect

failure is part of the learning process

whole learning

play activities, games, themed activities

variability

variety of tasks with same motor movement

vary objects or placement

vary requirements of the tasks

vary environmental context

problem solving

different degrees of difficulty and wait for child to figure it out

repeat movements for learning

problem solving is similar to error-based learning

meaningfulness

express interest

purposeful

shows pleasure

wants to demonstrate

transfer of learning

applying learning to new situations or generalizing in a natural context

grading and adapting

make tasks easier or harder to find the just right challenge

modeling or demonstration

showing how to perform a skill or task:

- before practicing

- after practicing

- throughout as needed

model slowly without verbal feedback

verbal instruction

used to teach motor skills

brief, simple statements

emphasizing key aspects of movement

whole vs. part practice

whole: better for simple skills

part: better for more complex skills and natural units

blocked practice

practice one skill by repeating similar movement over and over

downside of blocked practice

not best for novel or complex task

less transfer of learning

not as motivating

distributed practice

practice skill in a variety of ways by repetition of different but related skills

variable practice

practice actual task in natural context versus repeating one pattern of movement

considered best for transfer of learning

mental practice

prepare to perform task

basic imagery, combine with physical practice, short

key line

MC deficits make BLOCKing DIS VARY hard

blocked practice - distributed practice - variable practice