Hooklying, Bridging, Sidelying: Motor Control and Stability Techniques in Rehabilitation

Movements within position

bridging, scooting, and lower trunk rotation

Large base of support (BOS)

A stable foundation that enhances balance.

Low center of mass (COM)

Positioning that promotes stability.

Purpose of hooklying

To promote stability of the trunk and hips, dynamic postural control of the trunk and lower extremities.

Indication for hooklying in glute medius weakness

Used to activate hip adductors and extensors in a modified weight-bearing position.

Positive support reflex

Triggered by pressure to the ball of the foot, causing the lower extremity to extend.

Effect of reducing contact with the ball of the foot

Helps reduce the trigger of the positive support reflex.

Lower Trunk Rotation (LTR)

Moving the knees side to side to decrease hypertonicity in patients with Parkinson's, stroke, and SCI.

Indication for LTR

Poor or absent stability owing to hypotonia, hypertonia (spasticity, rigidity), pain, inability to initiate or control LTR.

Motor control goals in hooklying

Initiation of movement (mobility) and relaxation.

Why use hooklying

Good to initiate rolling, rigidity for PD patients, pelvic fracture.

Indication for stability in hooklying

Lower trunk instability, asymmetrical trunk control, inability to stabilize hips, inability to stabilize knees in flexion with the knee supported.

Compensatory strategies in hooklying

Lumbar extension, pelvic rotation, LE abduction, and/or external rotation.

Goal of Stabilizing Reversal (SR) in hooklying

Sustained isometric contraction, smooth reversal of contraction.

Resistance at ankles in hooklying

Hands closer to ankles increase the level of the arm, making it harder for athletes with ankle sprains.

Commands during Dynamic reversal

Commands and hands at the same time.

Stabilizing Reversal (SR) technique

3 directions: Medial/Lateral, Anterior/Posterior, Diagonal.

SR medial/lateral technique

Manual contact on that medial or lateral side of the knees, with commands to hold still.

SR anterior/posterior technique

Hands over knees, then hands below knees with commands to resist pulling and pushing.

SR diagonal technique

Therapist is in line of force, alternating manual contact between the distal medial side of one knee and the distal lateral side of the opposite knee.

Controlled Mobility for hooklying

Goal of DR in hooklying: make ataxic movements smaller, PD pt movements bigger.

Dynamic reversals (DR)

Patient is moving through the range with resistance from the therapist going in a medial-lateral direction.

Bridging

Movements: extending the hips and elevating the pelvis from the support surface with the lumbar spine in a stable neutral position.

Mobility with bridging

Why use: to help the pt initiate movement from hook-lying to bridging, promote weight-bearing.

Stability with bridging

Indicated for: patients with poor lower trunk and pelvis stability; weakness of the lower trunk, hip, ankle muscles, and impaired coordination between opposing lower trunk muscle groups.

Stabilizing reversals (SR)

MC heal of hand on ASIS 'hold do not let me push, do not let me pull' facilitates hip abductors and adductors.

Rhythmic Stabilization (RS)

One hand on top of pelvis, one under 'hold don't let me twist' - be careful with rotation with back injury patients.

Controlled Mobility with bridging

Scooting clinical note: moving the pelvis toward the more affected side stretches and elongates the trunk muscles on that side.

Scooting indications

Improve stability of trunk> upright antigravity activities such as standing and locomotion, weight shift.

Indication for Combination of Isotonics

Facilitate and strengthen the lateral weight shifts necessary for scooting.

Dynamic reversal (DR)

Can do anterior/posterior and medial/lateral 'lift hips and push away, go toward me.'

Combination of Isotonics (CoI)

A/P focus on eccentric contraction, bridge up against resistance, then slowly lower down.

Active mobility (AM)

Tapping to initiate left to right movement of hips to 'bridge and place.'

Sidelying

BOS large COM is low, making it a very stable posture for transitions into other functional positions.

Reflexes in sidelying

Tonic reflex (TLR) and tonic neck reflex (TNR), and muscle tone are REDUCED in the sidelying position.

Why Sidelying

Increase ROM of the trunk, scapula, and pelvis to promote the initiation of active movement of UE and LE.

Indication for sidelying

Increase stability of posture: hips and knees should be flexed 70-90 degrees, creating an anterior BOS.

Stability in sidelying

Hold.

Shorten held rhythmic contraction (SHRC)

Works postural extensor muscles, start head slight extensions and push forward, then move down to the shoulder and hip.

Reciprocal trunk pattern (SR)

Pt moving like they are running scapular go down down then up up, push hip up and forward.

Controlled mobility in sidelying

Ability to perform reciprocal patterns of pelvis and scapula necessary for many functional activities, including gait.

Reciprocal trunk pattern

Dynamic reversal (DR) and Combination of Isotonics (CoI).

Mobility in rolling

Weight-bearing occurs through large body segments with minimal antigravity control requirements.

Position for rolling

Supine.

Technique for rolling

Rhythmic initiation D2E, D1F.

UE D2F

Lead arm is opposite in direction pt is rolling, start hand up holding sword and put it in holster.

LE D1F

Lead leg opposite direction in which pt is rolling, ballerina to gum on bottom of shoe.