Postures, Positioning, and Muscle Tone

1
Postures, Positioning, and Muscle Tone

• Development, Assessment, and Abnormalities

2
Participation

• Physical Disability and Participation
• Physical disability can negatively affect a
  students participation in curricular, extra
  curricular, and major life activities
• Two Types of Important Information -
• Circumstances that give children difficulty
  when they try to participate
• Modifications that might present helpful
  solutions

3
Postures

• Positioning to provide the physical foundation
  for participation in functional activities in
  school and other life activities
• Mobility for moving from place to place to
  participate as fully as possible in major life
  activities

4
Positioning

• The need varies depending on age, disability, and
  intended use
• Proximal Support of Body
• Affective use of Upper Body
• Security and Safety
• Reduction of Deformity
• Frequency of Change
• Seating
• Posture and Muscle Tone

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Seating

• Directly influences posture, muscle tone, and
  coordination
• Pelvic Position
• Foot Support
• Shoulder/upper Trunk Support if needed
• Inadequate Positions
• Devices

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Postures

• Relationship to appearance and socialization
• Studies on appearance
• Awareness
• Postures Plural (Rathbone, 1965)
• Good postures equal a balance of Strength and
  Flexibility
• Gravity
• Anti gravity muscles

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Postures Assessment

• Alignment
• Minimizing muscle imbalance
• Spinal column curves
• C 1-7 concave
• T 1-12 convex
• L 1-5 concave
• S 1-5 convex
• Analysis of muscle imbalance
• Questions
• too tight?
• too loose?
• role of gravity?
• Reciprocal Innervation

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Normal Postural Development

• Single C - curve at birth
• 4 to 5 months Cervical curve
• When extensors of the neck and back are
  strengthened by head lifting
• 12 to 16 months Lumbar curve
• When extensors of the lower back are strengthened
  by walking
• Lordosis - week abs/tight hip flexors

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Posture Training Guidelines

• Brief History
• For years individual prescribed exercises were
  the accepted practice in posture training and
  body mechanics
• Boring
• Not effective if not adhered to
• Incorrect movements could cause injury
• Todays Trend
• Game like activities that utilize muscle groups
  in therapeutically sound ways
• Class activity to come up with activities
• Contraindicated Activities
• Straight leg lift/hold
• Straight leg sit ups
• Push ups
• Squats

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Postural Abnormalities

• Functional or Structural?
• Forward Head and Neck
• When earlobe is not in alignment with tip of
  shoulder (acromion process)
• Ameliorative exercises
• Contraindications
• Excessive Head Tilt
• RT or LT
• Ameliorative Exercises

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Postural Abnormalities

• Kyphosis - (Humpback, Hunchback, or Potts
  curvature or rounded upper back)
• Ameliorative Exercises
• Contraindications
• Lordosis - (Swayback or Hollow back)
• Ameliorative Exercises
• Contraindications
• Abdominal Weakness
• Low ab
• Upper ab
• Visceroptosis
• Ameliorative Exercises
• Contraindications

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Postural Abnormalities

• Scoliosis lateral curvature of the spine
• Begins with single curve (primary) then a
  compensatory curve in opposite direction
• Keynote positions are diagnostic devices or
  corrective exercises specifically for scoliosis
• 1. Adams position
• 2. Hanging position
• 3. Standing position
• Ameliorative Exercises
• Uneven Shoulders/Hips
• May be normal unless scoliosis
• Left H or Right H

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Balance and Postural Control

• Four main etiologies of balance and postural
  control deficiencies
• Central Sensory Impairments
• Central Motor Impairments
• Peripheral Sensory Impairments
• Peripheral Motor Impairments

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Balance and Postural Control

• What can be done?
• Depends on.
• Suggestions
• Determine etiology and intervene
• Firm surfaces to move on / practice or training
  on soft surfaces (if somatosensory)
• Increase in room illumination (if visual)
• Strength training/Range of motion activities (if
  peripheral motor)

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Falls

• Factors -
• Tripping over hazardous objects (peripheral
  motor)
• Improper vestibular system (peripheral sensory)
• Slower RT to catch balance (central motor)
• Uneven surfaces (central or peripheral motor)

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Gaits

• Characteristics of Older Adult
• Decreased walking speed
• Decreased stride length
• Increased double support period
• Reduction in toe-floor clearance

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Gait Analysis

• Scissors Gait
• Hemiplegic Gait
• Ataxic / Cerebellar gait
• Shuffling gait
• Festination gait
• Steppage gait
• Waddling gait
• Muscular Dystrophy gait