Week 13 PP Posture, Alignment, Gait, Devices(1) (2) (1)

Stability and Mobility

• Importance of positioning, postural alignment, and functional mobility in occupational performance.

• Description of bed mobility, wheelchair propulsion, transfers, and gait.

Learning Objectives

• Connect concepts of positioning, postural alignment, and functional mobility.

• Understand the human gait pattern as part of functional mobility.

• Analyze atypical posture and gait patterns impacting occupational performance.

• Recognize the role of mobility devices in occupational therapy.

Interconnected Body Segments

• Body segments are interrelated; the function and position of one impact others.

• Movements can be analyzed through open-link and closed-link chains.

Stability Defined

• Stability: Control over body position/movement.

• Base of Support (BOS): Area created by body parts in contact with surfaces.

  • Larger distance between points of contact increases stability.

  • Application in activities of daily living (ADLs).

• Dynamic stability changes during walking or running as base of support shifts.

Use of Gait Devices

• Gait Devices: Increase points of contact, enhance stability.

  • Types: walkers, canes, crutches.

  • Consider how devices affect posture.

Cane Usage

• Cane Selection: Factors include minor weakness or balance impairment.

• Proper cane height for optimal use.

• Cane Sequencing While Walking: Start with the cane opposite the affected side, step with affected leg, then advance the stronger leg.

Special Features of Canes

• Ergonomic handles, seats, collapsible shafts, and LED lights can enhance usability.

• Consider aesthetics for compliance.

Safety Precautions for Cane Use

• Ensure cane tip is in good condition (replace if worn).

• Keep walking paths clear of hazards.

• Use proper footwear.

Mobility Devices Overview

• Mobility Devices can extend base of support and stability.

  • Walker: Offers multiple points of contact; suitable for weight bearing.

  • Crutches: Provides alternative support through additional points.

Center of Gravity (COG)

• COG: Balance point, stability increases as the COG lowers.

• Movement alters COG, affecting balance and support.

Line of Gravity (LOG)

• LOG is a vertical line from COG to the ground; if in BOS, increases stability.

Functional Stability

• Essential for performing tasks in various contexts.

• Methods to enhance stability include increasing the BOS and weight distribution.

Posture and Postural Alignment

• Posture: Relative position of body segments during activity.

• Postural Control: Ability to maintain balance; involves both voluntary and involuntary adjustments.

Functional Mobility

• Involves moving from one place to another, including bed mobility, wheelchair mobility, transfers, ambulation.

• Good posture enhances functional mobility.

High Pressure Areas in Positioning

• Positioning needs to address pressure sores associated with bony prominences.

Wheelchair Mobility

• Proper positioning is crucial; consider neutral pelvic tilt, degree of elbow flexion.

Understanding Gait

• Gait Cycle: Alternate phases of stance and swing allow forward movement.

• Each leg alternates between weight acceptance, single leg support, and double leg support.

Abnormal Gait Patterns

1. Antalgic Gait: Avoids pain; shortened stance phase.

2. Ataxic Gait: Lack of coordination, not due to strength compromise.

3. Trendelenburg Gait: Pelvic drop during swing leg advancement; weak gluteus medius.

4. Circumduction Gait: Leg moves outward due to difficulties with hip/knee/ankle movement.

5. Foot Drop: Toes drag due to loss of ankle dorsiflexion.

6. Hemiplegic Gait: Weakness/paralysis on one side from neurological conditions.

7. Scissor Gait: Legs cross during ambulation; tight hip adductors.

8. Parkinsonian Gait: Shuffling with trunk flexion and weight on toes.

Transfers Review

• Key steps for sit-to-stand and stand-to-sit transfers, ensuring proper body mechanics.

References

• Short, N., Vilensky, J., Suarez-Quian, C.A. (2021). Functional anatomy for occupational therapy. Bools of Discovery.