Postural Control and the Trunk Flashcards
Anterior pelvic tilt
- ASIS migrate forward
- lumbar curve is accented
- increased hip flexion
Posterior Pelvic tilt
- ASIS migrate backwards
- Fattening of lumbar curve
- increased hip extension
Lateral Pelvic tilt
- height discrepancy of iliac crests
- lateral spine flexion
- lateral ribcage displacement
Vertebral Column Rotation
one side of ribcage moves anteriorly, the other side moves posteriorly in the transverse plane.
Abdominal Muscles
1.rectus abdominus
2. oblique’s: internal and external
3. transverse abdominus
Assess in sitting with shoulders swaying behind hips, trunk moving away from support surface and rotation activities.
Posterior trunk muscles
- quadratus lumborum
- erector spinae
- latissimus dorsi
Good TX for these is bridging for bed mobility!
Trunk control Predictor ( assessments) - Which measures of trunk control have been strong predictors of ADL function.
- PASS- TC score and age
- Fugl-Meyer motor test score
- Barthel index score
Trunk ( test question)
- Center of control for distal movements
- Dynamic stability: is the ability of part of the body to remain stable but active while allowing other parts of the body to move.
Trunk facts
1.represents greater than half of the body mass class notes: regain trunk muscles by breaking it down, supine, sitting,sidelying on red matt, isolate and focus pelvic and abd motions when strength in antigravity then go to sitting and bowel movements. Squat pivot transfer instead of full stand.
Requirements for normal movement of trunk
- normal tone
- reciprocal innervation: balanced firing b/w agonist and antagonist = good control over all muscle groups of the trunk.
- normal sensation= proprioceptive sense, body in space.
- righting and equilibrium
- normal joint range
Consequences of poor trunk control
- UE and LE dysfunction
- fall risk
- spinal deformity and contracture ( bone on bone)
- interaction with environmental hard to adapt
- VISUAL dysfunction( core control)
- DYSPHAGIA = difficulty swallowing, ( core control and good alignment)
- decrease balance and decrease tolerance sitting and standing.
Principles of normal movement applied to trunk
- Normal control demands dissociation: rotation trunk and extension and rotation obliques.
- Rotation is essential for midline control
- postural control of trunk relies on multiple factors ( Tone, AROM, PROM, pain, strength, perception)
Common trunk & postural problems
- Posterior pelvic tilt, lumbar spine flexion
- pelvic obliquity with unequal weight bearing on ischial tuberosities
- KYPHOSIS
- lateral trunk flexion
- Rib cage rotation( usually towards stroke side, tx go to non stroke side.
- head and neck mal-alignment. ( rotation toward hemi side).
General evaluation strategies for addressing trunk problems
Evaluation:
- observation of patients movement during daily tasks.
- Pt. should be shirtless to inspect scapula alignment, check winging
- compare quadrants of trunk upper R and L, lower R and L, check muscle waste.
- Trunk should be evaluated in variety of positions of occupational performance: best assessment is observation of bathing, grooming,transfers off toilet and bed, are they moving as unit? Log rolling? Can they bend down and reach feet?
- subjective
- tone
- ROM ( on/off shoes: look at rotation, arms on therapist sh. side to side and up and down passively check for tightness.
- alignment/ malalignment (kyphosis)
- functional movement observation ( can u get that box of tissues for me?)
- balance reactions ( can u reach for my finger?)
- patterns of movement ( can u pick up comb?)
General treatment strategies for addressing trunk problems
- lateral flexion : activate reaching, sitting, get elbow on matt table and WB, then try again on R.
- reach to floor and assess
- therapy ball under arm , roll ball activate muscles
- support affected arm and move arm forward
- sidelying PNF: move arm above head.
