3 Standing

Question 1

What type of questions would you ask for standing during the history intake?

Answer 1

• Do you have:
  
  • Difficulty standing equally?
  • When trying to reach or stand on one foot?
  • When being bumped
  • Uneven surface?
  • Lights dimmed?

Question 2

What are some standing training intervention principles?

Answer 2

• Prepare activites that increase cortical excitability
• select meaningful task: (active, alert, motivated, understood)
• Forces use of impaired system
• Facilitate movement through assistnce, stim, extrinisck or error signals
• Use LIGHT touch (1 NEWTON)

Question 3

What do you do when the task is too challenging?

Answer 3

• Simplify
• limit degrees of freedom
• utilizing part practice
• manipulate control parameter
  
  • (BOS, sensory conditions, speed, surface, RPA, amplitude, task, somatosensory/,motor demands)

Question 4

What are preparation techniques for stand training?

Answer 4

• transcutaneous estim of foot and leg (redues sway with and without vision)
• Motor Imagery of movement and task
• Aerobic exercise (increase BNDF)

Question 5

What is the training dosage in Acute state?

Answer 5

• 2-3 sessions/week
  
  • 40 to 120 min/session

OR

• 5 sessions/ week
  
  • 45-60min/session

(too intense programs have high drop out rates)

Question 6

What interventions DO NOT WORK for standing?

Answer 6

• Sitting balance (lateral shifts)
• Task oriented circuit training (without emphasis on standing)
• BWSTT
• Untargeted fall prevention programs

Question 7

What are the 2 thing that occur with poor static alignment?

Answer 7

• Asymmetry between limbs with excessive large interfoot distance
• Knee hyperext with excessive PF

Question 8

What are the issues with Asymmetry?

Answer 8

• medial lateral sway in sanding = more visual dominance
• More weight on unaffected leg
  
  • good to know for intervention stragegies

Question 9

What impairments do you see with impaired standing?

Answer 9

• reduced glute med
• poor oritentaion of long axis
• ankle clonus
• reduce cutaneous sensation of the foot

Question 10

What are ways to activate glute med?

Answer 10

• Forced use: weight shift to affected limb
  
  • Shoe wedge on non affected
  • Small step
• Center of pressure
  
  • COP feedback of weight bearing

Question 11

How do you improve poor oritentation to longitude body axis?

Answer 11

• Visual feedback with volitional weight shifts
  
  • use mirror and align trunk
  • Short term

Question 12

What interventions for gastroc clonus?

Answer 12

• EMG biofeedback to gastroc (gold standard)

Question 13

What interventions for reduced foot sensation?

Answer 13

• Sensory threshold and detection

Question 14

What are the 2 impariments for lower extremity alignment?

Answer 14

• Reduced Quadriceps force production
• Excessive activation of gastroc soleus

Question 15

What interventions for Impaired reduced for production of quads?

Answer 15

• Sit to stand movements with mirror biofeedback improves postual stability
• MUST BE STANDING

Question 16

What are interventions for impaired gastroc soleus for excessive activation/spasticity?

Answer 16

• Biofeedback to reduce activity

Question 17

What are signs of excessive postural sway in quiet standing?

Answer 17

• Too much sway at the ankle (head and hips moving at the same direction)
• Excessive sway in dim lighting
• Falls or requries BOS on uneven/compliant surface

Question 18

What impairments do you see in Excessive sway in quiet standing?

Answer 18

• Reduced cutanous sensation of foot
• reduced ankle proprioception
• inability to reweight sensory systems
• poor timing and sequencing of gastroc/sol/TA
• Preceptual deficiet/hemineglect
• impaired vestibvular spinal funciton

Question 19

What are interventions for reduced cutaneous sensation of the foot?

Answer 19

• Tactile sensory input (differnt surfaces)
• Mental imagery

Question 20

What interventions for reduced ankle proprioception?

Answer 20

• Standing on level surface with blond fold
• STanding on unstable surface and changing ankle degrees (target)

Question 21

What interventions for inability to reweight sensory systems?

Answer 21

• Progression of balance exercises
  
  • 4 weeks 50 min a day
• Dim light: visual to proprioception shift dominance
  
  • firm surface with eyes closed
  • progress to eyes open and visual information does not orient
  • DOME OVER HEAD

Question 22

Interventions for gastroc soleus TA timing?

Answer 22

• Biofeedback/EMG for gastrpc TA
• Mirror Visual Feedback
  
  • detect sway and push down toes to ground

Question 23

Interventionfor preceptual deficit and hemineglect?

Answer 23

• posutal instabilty
• increase cues and awareness

Question 24

What DOES NOT WORK with standing interventions

Answer 24

• Sitting
• Task oriented circuit training
• BWSTT
• Fall prevention programs

Question 25

General prinicaples for APA intervention

Answer 25

* Fast/rapid movement * whole task in standing control * Reaching/grasping

Question 26

What is observed with Ineffective APAs

Answer 26

* Falls w/ fast forward reach * Pelvic drop or instabilty to assume single limb stance

Question 27

What is observed for ineffective RPAs?

Answer 27

* Small perturbation leads to sway at the hips (moving in opposite directions) * Large perturbation leads to falls

Question 28

What are general intervention priniciples for RPA?

Answer 28

* appropriate level of perturbation * alternating environment * firm to compliant surfaces * large BOS to small BOS * Change velocity of sway * Random pertu

Question 29

Pertubations

Answer 29

* Should be ANKLE not hip * LArge should be step/hip not fall