PHYSIOHEALER.

ESSENTIAL COMPONENTS OF STANDING UP:

Foot placement.
Forward trunk inclination by hip flexion with the neck and spine extended.
Hip extension (for final standing adjustment)

ESSENTIAL COMPONENTS OF SITTING DOWN:

Forward trunk inclination by hip flexion with the neck and spine extended.
Knee flexion

Common Problems:

Inability to shift the center of gravity forward sufficiently during the early stages of
standing up and the late stages of sitting down.
Failure to place the affected foot.

Common Compensatory Responses:

Weight borne primarily on the intact side which becomes accentuated when the
intact foot is positioned posterior to the affected foot.

Forward neck and trunk flexion or wriggling forward to the edge of the chair to shift
the weight forward.

SPECIFIC TECHNIQUES:

To Stimulate Trunk Inclination Forward at the Hips
Practice Standing Up
Practice Sitting Down.

BALANCED STANDING:

Appropriate body alignment
Correct adjustments made to changes in body alignment (with shifts in the center of gravity).

Increases awareness of bilaterality,position in space and positioning of body parts; may minimize the development of spasticity.

BALANCE:

Constant accurately balanced movement of the center of gravity on a stationary base to keep the line of gravity just in front of the ankles.

Standing without using undue muscle activity, to move about in standing, to move in and out of the standing position, and to walk without arm support.

Description of Normal Function:

ESSENTIAL COMPONENTS OF STANDING ALIGNMENT:

Feet a few inches apart
Symmetrical weight-bearing.
Extended knees and hips
Hips over feet
Erect trunk.
Shoulders over hips
Head balanced on level shoulders.

ESSENTIAL COMPONENTS OF BALANCE REACTIONS:

Lateral shift in the center of gravity
Lateral neck flexion.
Lateral trunk flexion (pelvic elevation, shoulder depression)
Backward shift in the center of gravity.
Neck extension
Forward trunk inclination at the hips.
Ankle dorsiflexion.

WHAT TO DO…

Observe standing alignment
Test the ability to adjust to self-initiated movement of head, trunk and limbs.
Looking behind, up Grasping an object from the floor.
Standing on one leg Reaching in various directions.
Test the displacement of weight sideways and backward (equilibrium reactions) with feet a few inches apart.

Common Compensatory Responses:

Wide base of support (placement of the feet and knees apart)
Voluntary restriction of movement (holding the breath or maintaining a stiff body
posture)
Shuffling of the feet instead of adjusting using appropriate body segments.
Stepping sideways or backward as soon as the center of gravity moves.
Leaning backwards when the center of gravity shifts sideways
Proximal (instead of distal) movement of parts when shifting the center of gravity.

Use of protective support by the upper limbs (grabbing for support, holding arms
out sideways or forward) with minimal shifts in the center of gravity.

SPECIFIC TECHNIQUES:

To Stimulate Hip Extension
To Maintain Knee Extension
To Stimulate Adjustments to Shifts in Center of Gravity.

To Stimulate Essential Aspects of Balanced Standing Alignment.
To Stimulate Protective Support through the Arm.

(AMBULATION WILL BE DISCUSSED AND COMPARED WITH PERIPHERAL NEURO-MUSCULAR FACILITATION AND THE NEURODEVELOPMENTAL TECHNIQUES)

Following are the mentioned Essential Components -MRP of Upper Limb:

1.SITTING UP FROM SUPINE:

Rolling over to and sitting up from the intact side in the early stages of stroke,is given minimum period for practice.

Description of Normal function:

Essential components of Rolling:

Onto the side
Neck flexion and rotation
Shoulder flexion and protraction
Trunk rotation
Hip and knee flexion
Other components: posterior hip shifting; foot pushing on the bed

Essential components of Sitting:

Up over the side of the bed
Lateral neck flexion
Lateral trunk flexion
Lowering of the legs over the side of the bed

Other component: Shoulder abduction of the lower arm

Common compensatory responses:

Forward neck flexion and rotation
Pulling self over using the intact hand; wriggling
Hooking of the intact leg under the affected leg to dangle over the side of the bed
Specific techniques
To stimulate shoulder girdle protraction for rolling over

To stimulate hip extension for rolling onto the side
To stimulate lateral neck flexion.

2.BALANCED SITTING:

Appropriate body alignment
Correct adjustments made to changes in body alignment (with shifts in the center of gravity).

BALANCE:

Sitting without using undue muscle activity, to move about in sitting, to move in and out of the sitting position, without arm support.

BALANCE REACTIONS:

Head trunk and limb movement in response to any shift in the center of gravity to maintain balance.

Protective extension only occurs when the center of gravity is moved so far that balance is lost.

Description of Normal Function:

3.ESSENTIAL COMPONENTS OF SITTING ALIGNMENT:

Feet and knees close together
Symmetrical weight-bearing / sitting
Hip flexion with trunk extension
Head balanced on level shoulders

ESSENTIAL COMPONENTS OF BALANCE REACTIONS:

Lateral shift in the center of gravity.
Lateral neck flexion
Lateral trunk flexion (pelvic elevation, shoulder depression)
Backward shift in the center of gravity.
Forward neck and trunk flexion.

WHAT TO DO…

Observe sitting alignment
Sitting on a firm base with feet flat on the floor, knees and feet a few inches apart and hands on the lap.

Test the ability to adjust to self-initiated movement of head, trunk and limbs.

Looking behind, up Grasping an object from the floor.

Lifting the intact leg and foot.

Reaching in various directions
Test the displacement of weight sideways and backward (equilibrium reactions) .

Common Compensatory Responses:

Wide base of support (placement of the feet and / or knees apart)
Voluntary restriction of movement (holding the breath or maintaining a stiff body
posture)
Shuffling of the feet instead of adjusting using appropriate body segments
Leaning forward or backward when the center of gravity shifts sideways
Use of protective support by the upper limbs (grabbing for support, holding arms
out sideways or forward) with minimal shifts in the center of gravity.

SPECIFIC TECHNIQUES :

To Stimulate Adjustments to Shifts in Center of Gravity.

To Stimulate Essential Aspects of Balanced Sitting Alignment.

4.STANDING UP AND SITTING DOWN:

Placement of the feet and shifting of the body such that the center of gravity moves forward or backwards
Good sitting balance is not a prerequisite to standing up; the patient, however, needs good sitting alignment.

The terms “Lasegue test” and “straight leg raise test” are synonyms or  being used interchangeably for the same physical examination maneuver used to assess nerve root irritation in the lower back.

It involves passively lifting a patient’s leg with the knee straight to see if it causes pain that radiates down the leg, which can indicate conditions like a herniated disc.

There are no differences between the two names.

Lasegue Test /Straight Leg Raise (SLR) Test:

Purpose:

To check for nerve root irritation in the lumbosacral area, often caused by a herniated disc or other nerve compression.

Procedure:

The patient lies down while the examiner lifts their straight leg to flex the hip.

Positive sign:

The test is considered positive if pain radiates down the leg, particularly between (35 degree and 70 degree) of hip flexion, which suggests nerve root tension.

Additional Assessment:

The examiner may then have the patient flex or point their foot (dorsiflexion) to see if the pain worsens, which can help confirm the diagnosis.

Historical context:

The test is named after Dr. Charles Lasegue, but it is believed that Dr. Lazar Lazarevic was the first to describe it. 

1. ANALYSIS OF TASK:

Observation as the patient performs (or anticipates to perform) the activity.

Note: Any missing components
Incorrect timing of components within a movement pattern.
Absence of specific muscle activity.

Presence of any excessive or inappropriate muscle activity.

Compensatory motor behaviour,selection of essential movements upon which the activity depends:

Selection of the most essential components if many components are missing (i.e., the patient is barely able to move)

2. PRACTICE OF MISSING COMPONENTS:

Practice at peak performance for at least 30-60 minutes or more twice daily; progression when some form of control is seen.

Switching from verbal instruction to visual demonstration or vice versa if a person does not respond.

3. PRACTICE OF TASK:

Transition from cognitive to automatic phase of learning (overlaps with Step 2)

4. TRANSFERENCE OF LEARNING:

Carry-over of learning into task performance during daily routines.

Strategies for instructing the patient:

Verbal instruction is kept to a minimum.The therapist identifies the most important aspect of the movement on which the patient will concentrate.

Visual demonstration is provided by the therapist’s performance of the task, focusing on one or two most important components.

Manual guidance helps to clarify the model of action by passively guiding the patient through the path of movement or by physically constraining inappropriate components.

Accurate,timely feedback about the quality of performance helps the patient to learn which strategies to repeat and which ones to avoid.

Consistency of practice facilitates development of skill in task performance.

The programme is composed of guidelines for evaluating and improving 7 daily functions:

Upper limb function.

Oro-facial function.

Sitting up from supine.

Sitting.

Standing up and sitting down.

Standing.

Walking.

Each section is composed of a description of normal activity (essential movement components).

Mastery of a section is not necessary before going onto another section.

There is no intent of progressing from one section to the next; the order of sections is not important.

The patient must always be actively participating in the activity (without resistance) and given some opportunity to make mistakes.

Intervention

The Four Steps of the Motor Relearning Programme:

1. ANALYSIS OF TASK:
Observation
Comparison
Analysis

2. PRACTICE OF MISSING COMPONENTS:
Explanation – Identification of goal
Instruction
Practice plus verbal and visual feedback plus manual guidance

3. PRACTICE OF TASK:
Explanation – Identification of goal
Instruction
Practice plus verbal and visual feedback plus manual guidance
Progression:
Increase complexity
Add variety
Decrease feedback and guidance
Re-evaluation
Encourage flexibility

4. TRANSFERENCE OF LEARNING:
Opportunity to practice in context
Consistency of practice and positive reinforcement
Organization of self-monitored practice
Structured and stimulating learning environment
Involvement of relatives and staff