NM II unit II: Intro to bed mobility and static sitting

what is a key prerequisite to regaining independence and ADLS after a neurologic injury

sitting function

what individual tasks are part of bed mobility as a whole (5)

bridging

scooting

rolling

prone on elbows

quadruped

what are individual components of static sitting as a whole (5)

long sitting

short sitting

ring sitting

side sitting

sitting with upright posture

what should be determined when considering intervention selection with bed mobility and statis sitting (3)

pts goals

current ability

prognosis

what do PTs do when performing interventions for bed mobility and sitting balance (3)

have the pt work at the optimal level

intentionally progress the intervention

assist the pt towards their maximal potential

what does UE strength assist with

maintaining sitting position and facilitates postural control in the upright position

what does LE strength assist in

scooting and moving in bed allowing the pt to have better control of the task

what should strength exercises in PT focus on for bed mobility and static sitting

emphasize repetition of different activities to enhance progression by mastering bed mobility and seating activities

if a pt cannot perform a bed mobility task how should the approach to intervention change

a task oriented approach separating the mobility into components

when performing rolling side to side what muscles are used (5)

abdominals to rotate and perform dynamic stability

hip muscles for hip flexion

back muscles to control the turn

leg muscles

shoulder muscles

what interventions can be done to improve rolling side to side (3)

PNF D1 flexion UE and LE

use momentum

segmental rolling

how does D1 PNF flexion improve rolling side to side

it facilitates the motion of rolling using the momentum and using the UE across the pts body to initiate and finish the movement

what side should a pt roll to

both sides to normalize task

what side is harder to roll to

the stronger side

what can be facilitated when performing rolling side to side

moving the weaker UE forward across the trunk and ask the pt to push with the LE in hooklying

what does bridging allow for (3)

facilitates sit to stand transfers

relieves pressure

allows the pt to have more mobility in bed

what can be facilitated when performing a bridge

supporting the foot or the weaker LE

what muscles are involved when performing bridging (7)

gluteus maximum

hamstrings

erector spinae

quadriceps

core

hip adductors

calf muscles

what interventions can be used to improve bridging (7)

verbal/tactile cues

manual assistance

glute sets/posterior pelvic tilt

partial bridges

bridging with support/resistance

unilateral bridging/marching bridge

bed mobility training

what muscles are used when performing a supine to sit (5)

core for trunk control

neck flexors to lift head

hip flexors to assist trunk movement and swing leg

UE muscles if pushing

postural and stabilizing muscles

what interventions should be done to improve supine to sit transfers (4)

UE/LE strengthening

segmental rolling; sidelying to sitting

leg swing practice

PNF

what are some examples of strength exercises to improve a supine to sit (6)

tricep press

wt bearing

SLR

sidelying hip flexion with band

manual resistance

quick stretch

what is required to maintain a seated position

static postural control

what muscles are used with static sitting (4)

core

glutes

back

neck

what are the modifiable components of static sitting that can be adjusted to progress/regress the activity (6)

BOS

support surface

sensory input

UE support

UE movements

resistance

what is the initial treatment BOS for static sitting

LEs uncrossed

what is the progression treatment BOS for static sitting

LEs crossed

what is the initial treatment support surface for static sitting

sitting on a mat

what is the progression of treatment support surface for static sitting

sitting on therapy ball

what is the initial treatment sensory input for static sitting

eyes open

what is the progression of treatment sensory input for static sitting

eyes clsoed

what is the initial treatment UE position for static sitting

UEs extended out to the side

what is the progression of treatment UE position for static sitting

UEs folded across chest

what is the initial treatment UE movements for static sitting

single UE raises

what is the progression of treatment UE movements for static sitting

Bilateral UE raises

what parts of the UE are affected by tone abnormalities (6)

scapula

trunk

shoulder

elbow

wrist

hand

what parts of the LE are impacted by tone abnormalities (5)

pelvis

hip

knee

ankle

foot

what is impacted in the LE in a prolonged sitting position if tone is present

the hip and knee directly

what interventions are used with bed mobility and static sitting with hypotonicity (3)

facilitation techniques

manual support

assistive tools

what facilitation techniques are used to help bed mobility and static sitting with hypotonicity (2)

quick stretch, tapping, brushing to simulate weak muscles

rhythmic initiation (PNF) for rolling and bridging

what manual support techniques are used to help bed mobility and static sitting with hypotonicity

providing trunk and extremity support

use of bolters/pillows for joint alignment

what assistive tools can assist with bed mobility and static sitting with hypotonicity

bed rails or sheet to initiate

bed ladder or trapeze bar

what can be used in postural alignment training with hypotonicity

external support (wedges, high-back chairs)

use of visual cues and proprioceptive input

what activation strategies can be used to assist with bed mobility with hypotonicity

tapping or quick stretch to trunk and pelvic stabilizers

anterior pelvic tolt to activate trunk extensors

what weight bearing activities can be used with hypotonicity to improve bed mobility

UE wt bearing on table or lap tray to activate the scapular stabilizers

what interventions are done to help hypertonicity (4)

bed mobility

tone inhibition strategies

proper positioning

task breakdown

what tone inhibition strategies can be used to decrease hypertonicity (3)

prolonged stretch to hypertonic muscles

rhythmic rotation to reduce tone before rolling

neutral warmth, slow rocking to calmm excessive tone

what positional strategies can be used to decrease hypertonicity (2)

side-lying to inhibit extensor strategy

abduction pillows

if a pt has a LE extensor synergy with static sitting how can they be positioned

use posterior pelvic tilt to support

feet flat with hips/knees and 90 degrees to inhibit LE tone

what tone inhibition interventions can be used for static sitting with hypertonicity (3)

wt bearing through UE to reduce UE flexor tone

rhythmic stabilization (PNF) of trunk

Slow vestibular input (rocking)

what are the general interventions that can be used to manage muscle tone (11)

strength

ROM

wt bearing

neuromuscular re-ed

positioning

task specific training

simultaneous bilateral training

electrical stimulation

supportive devices

motor imagery

postural training

what is ataxia

the inability to perform smooth, coordinated movements that may lack sufficient force production and/or have limitations in ROM

what are the primary impairments associated with ataxia (7)

dysmetria

decomposition of movement

rebound phenomenon

dysdiadochokinesia

asthenia

intention tremor

hypermetria

how can hand eye and or eye foot coordination be impacted with ataxia

eye movements can become effected

what is rehabilitation focused on with ataxia

motor learning approaches to enhance neuroplasticity

what should interventions be based on with ataxia (6)

patients impairments

postural control

compensatory strategies

advance from simple to complex tasks

self selected speeds -> normal -> fast movements with accuracy

control in symmetric postures -> control in assymetrical postures

how should postural control be developed with ataxia

start centrally, then move proximal to distal

what do coordination exercises address (5)

static balance

dynamic balance

trunk limb coordination with functional movements

prevention of falls and injuries

improving general mobility

what PNF techniques are used to treat ataxia

rhythmic initiation

combination of isotonics (agonist reversals)

isotonic reversals (slow reversals)

rhythmic stabilization (stabilizing reversal)

what do verbal/visual cues in coordination training do

guide and enhance movement

what do antagonist coordination techniques do for coordination training

ensure that opposing muscle groups are working together smoothly

what does incorporating reciprocal or reversing movements with resistance do

builds strength and control

what is the natural sequence of most movement that should be emphasized during intervention of ataxia

typically progresses from distal to proximal patterns

what techniques are used to reduce incoordination with sensory input

manual contacts

what are interventions aimed to do for movement effort for coordination

decreased the effort to make tasks more efficient and sustainable

what is the goal on Frenkels coordination exercise

exercises used to treat ataxia due to MS and cerebellar lesions

what is the focus on Frenkels exercises

use vision as a principal source of feedback in guiding the adaptation to sensory perturbations such as loss or diminished proprioception

what should be done with interventions if there is loss of proprioception

substitute vision to het feedback for adapting to sensory perturbations

what techniques can be used to incorporate Frenkels exercises in care

visualize limbs with mirrors

use a semi fowler or sitting position

progress f

how are interventions progressed with Frenkel's coordination exercises

progress from limb supported to anti-gravity

progress from unilateral to bilateral, symmetrical, and bilateral reciprocal movements

progress from stable to postures that challenge stability

when are Cawthorne-cooksey exercises inicated

for pts with impairments of the vestibular system or vestibular labyrinth impairment

what is the goal of cawthorne-cooksey exercises

to help the pt learn to compensate or habitually ignore the abnormal vestibular signals

what does cawthorne-cooksey exercises prepare pts for

complex visuomotor exercises during treatment

how should may exercises and balance training be performed with pts with ataxia

in functional positions beginning at the pts current functioning level

what is the first goal of interventions with pts with ataxia

establish central trunk stability to allow for development of proximal and distal control

how should interventions progress after establishing stabilization of the trunk in ataxic pts

progress proximally to structures such as shoulder and pelvic girdles followed by distal limb control

how should bed mobility exercises be progressed

to more advanced positions like sitting maintaining focus on functional relevance

what are some examples of bed mobility exercises (6)

isometric trunk contraction

limb movements for trunk stability

use of vison to perform smooth limb movements

unilateral bridging

bilateral bridging with posterior pelvic tilt

rolling to one side

what are examples of interventions for functional activities in sitting (3)

wt shifts (lateral, anterior, posterior)

sitting to supine; supine to sitting

sitting reaches

what are precautions to consider during interventions with ataxic pts (6)

limit resistance/tasks against gravity

limit compensatory strategies

avoid overexertion

allow frequent rest

headache can indicate overexertion of oculomotor muscles

use task variability based on pts ability to adapt and anticipate movements/activities

what is the purpose of the tactile sensory system

protection and discrimination

what do mechanoreceptors in the skin respond to

touch and can distinguish different textures or contours, shapes, sizes, and location of touch

what do vestibular receptors detect

hand eye movements crucial for balance and orientation

what is normal sensory function

the ability to take in, process, organize, and plan a motor response to sensory stimuli, which comes from tactile, proprioceptive, and vestibular receptors

what is impaired sensory function

breakdown of body's ability to appropriately and efficiently register and process sensory information , resulting in disruption in all motor activities

what are the types of hyposensitivity (4)

anesthesia

partial or poor registration of sensation

reduced sensory discrimination

sensory neglect

what is anesthesia

total loss hyposensitivity

what are the types of hypersensitivity (3)

sensory defensiveness

sensory avoidance

paresthesia

what is paresthesia

numbness, tingling, impaired sensation

what interventions are used for recovery with hyposensitivity (7)

Sensory integration therapy

sensory retraining

functional training and motor learning

intermittent pneumatic compression

thermal modalities

electrophysical agents

monochromatic infrared photo energy

what is sensory integration therapy for hyposensitivity recovery

therapeutic activities that are meaningful to the pt including enhances sensation, tactile, vestibular, and proprioceptive with active participation to elicit adaptive responses

what is sensory retraining for hyposensitivity recovery

active exercises to improve localizing, increasing awareness to, and interpretation of sensory input

what is functional training and motor learning for hyposensitivity recovery

performing ADLs or functional activities repeatedly to improve motor control and sensory impairments via neuroplasticity

how can IPC help hyposensitivity recovery

it improves circulation and sensation

how can thermal modalities help hyposensitivity hyposensitivity

application of alternating cold and hot modalities can improve sensory function with improvement in tactile sensation

how do electrophysical agents help hyposensitivity (NMES, TENS)

it increases activity in the sensory motor cortex

how can monochromatic infrared photon energy improve hyposensitivity

increased dilation of veins leading to improved circulation and new function

what are compensatory interventions for hyposensitivity (3)

alternating or adjusting sensory environment

pt education

use of adaptive equipment

what interventions are used for recovery of hypersensitivity (3)

Sensory integration therapy

Wilbarger brushing protocol

Vibration

what does Wilbargers brushing protocol do for hypersensitivity recovery

it decreases tactile defensiveness using deep touch pressure and joint compression providing proprioceptive input to decrease hypersensitivity to tactile input