Don't Just Sit There

DontJustSitThere:EvidenceBasedSittingBalanceExamination&Intervention 2/5/2015
CSM2015
DontJustSitThere:
EvidenceBasedSittingBalance
Examination&Intervention
CombinedSectionsMeeting2015
February47,2015
SharonLGorman,PT,DPTSc,GCS,FNAP
SamuelMerrittUniversity,OaklandCA
CathyCHarro,PT,MS,NCS
GrandValleyStateUniversity,GrandRapidsMI
ChristinaPlatko,PT,DPT
MaryFreeBedRehabilitationHospital,GrandRapids,MI
DisclosureStatement
Dr.GormanisthecreatoroftheFIST.Shehas
noconflictofinteresttoreport.
Ms.Harro isaninterprofessional team

memberfordevelopmentandtestingofthe
PocketPT .Shehasnoconflictofinterestto
report.
Dr.Platko hasnoconflictofinteresttoreport.
PropertyofSLGorman,CCHarro,CPlatko
Nottobereproducedwithoutpermission 1
CSM2015
SessionObjectives
Atthecompletionofthiscourse,youwillbeableto:
1. Applytheoreticalmodelsofposturalcontrolandfunction
insittingtopatientcases.
2. Selectfromreliableandvalidmeasuresofsittingbalance
atboththeimpairmentandactivitylevelofthe
InternationalClassificationofFunctioning,Disability,and
Healthmodel.
3. Utilizeresultsfromsittingbalancemeasurestodevelop
interventionstrategiesspecifictoposturalcontrol
problemsinsitting.
4. Usingcurrentevidence,relatesittingbalancedysfunction
topatientprognosisinselectpatientpopulations.
Whosheretoday?
CSM2015
BalanceModelsAppliedtoSitting
Systems
Biomechanical
Model Constraints
Sensory Cognitive
Modalities Processing
Balance
Sensory
Strategies Perceptionof
Verticality
Integration
Movement
Strategies
KeyConstructsofBalanceControl
Voluntary MidlineStability
Postural Limitsof
Control Stability
ProactivePostural
Anticipatory
Strategies
Postural
Control
Feedforward
Control
Reactive AutomaticPostural
Postural Adjustments
Control FeedbackControl
CSM2015
manyscientistsbelievethatconceptsimportantfor
stanceposturalcontrolwillbeshowntobeequally
validforposturalcontrolinsitting.
(ShumwayCook,2011,p192)
ComparisontoStandingBalance
CONSTRUCT STANDING SITTING
Postural control Static, proactive,reactive Static, proactive,reactive
Stabletrunkforlimbmotion To allowforgait Toallowforstanding&gait
Directionofcontrol Anterior/posterior Lateral&anterior/posterior
Baseofsupport Feet Feet,thighs,buttocks
Somatosensoryinput Feet Feet, thighs,buttocks
LEcontribution Multipledegreesoffreedom Less degreesoffreedom
CSM2015
PosturalControlDeficitsinSitting
CommonNeurologicImpairments
AbnormalposturalalignmentforstableBOS
Impairedperceptionofmidline&orientationin
space
Poorposturalstability,dynamicstabilization
Reduced&delayedanticipatorystrategies
Slowed&limitedrangeofvoluntaryweightshifts,
poorLOScontrol
Poorlimbcontrolwithoutstabletrunkposture
Delayedorabsentautomaticposturalreactions
ClinicalPopulationsw/SittingBalance
Impairment
CSM2015
AcuteStroke
EarlySittingBalanceRecovery
StrokeHelpSeries:TeachingIndependenceATherapeuticApproachtoStrokeRehabilitation
InternationalClinicalEducators,Inc.
PatientwithTBI:
ImpairedSittingBalance
CSM2015
AgingwithTBI
DeclineinSittingStability
SittingBalance&Function
SittingbalanceatadmissionpredictedbothBBS&FIM
(Feld2001,KatzLeurer 2008,Gorman2014)
TrunkImpairmentScale&PASSpredictedFIMscores
(DiMonaco 2010)
FIMscoreimprovementpredictedbysittingbalance
s/pCVA(CarodArtal 2007)
Sittingbalancepredictiveofdepressives/s&ADL
outcomess/pCVA(Hama2007)
Poorprognosisforindependenceforpersonswith
limitedsittingbalanceafteracuteCVA(Tyson2007)
Dualtaskchallengesdisruptedsittingbalanceafter
acuteCVA(Harley2006)
CSM2015
SittingBalance&Locomotor
Outcomes
MobilityOutcomes
Mobilityat1yr s/pCVApredictedinpartbysitting
balance(vandePort2006)
Walking
Balance(sit&stand)strongestpredictorof
recoveryofwalking(Tyson2007)
Sittingbalanceat2wk s/pCVApredictedwalking
abilityat6mo (Feigin 1996)
s/pCVATISscorewashighlyrelatedtowalking
ability(Verheyden 2006)
SittingBalance&DischargeDisposition
TrunkImpairmentScale&PASSpredictedDC
destination(DiMonaco 2010)
Sittingbalance1of4predictorsofDCtohome
s/pCVA(Frank2010)
Sittingbalance1of5predictorsofDCtohome
s/pCVA(Meijer2005)
FunctionInSittingTestatadmissionpredicted
homeDCfromIPR(Gormaninpress)
CSM2015
SittingBalance&TBIPrognosis
FunctionalIndependence
Recoveryofsittingbalancepredictiveoffunctional
recoveryupto5yearsafterBI(Black2000)
Dynamicsittingbalancedeficitsrelatedtofunctional
limitations1yr s/pTBI(Duong2004)
Productiveactivity(Brown2005)
Sittingbalancepredictedrecovery1yr s/pBI
TBIseverity(Greenwald2001)
SingleglobalsittingbalanceratingatIPRadmission
associatedwith
InitialGCS
AcutecareLOS&medicalcomplications
LengthofPTA
SittingBalance&SCI
Complexityofthefunctionaltaskmatters
MASsitbalanceitems+SittingBalanceScorehadgood
reliabilitybutlittletomodvaliditycomparedtoFIM
(Jorgensen2011)
Functionalreachinsittingcorrelatedwithdressing(LB>UB)
butnottransfersorw/cpropulsion(Jaskirat 2008)
Func onalbalancenormalbalance
Paraplegiashoweddecreasedstaticsitting&LOScompared
tonormalcontrols(SerraAo 2013)
Sitting&standingbalancenothighlycorrelated(Forrest2012)
Sittingbalancetaskscandifferentiatehigh(C6T7)vs.
low(T8L2)levelofSCI&acutevs.chronicSCI
(BoswellRuys 2009)
CSM2015
SittingBalance&FallRisk
Mediolateralsway&rateofrise(sittostand)
relatedtofalls
CVAw/fall medlat sway& rateofrise
comparedtoCVAw/ofall&controls(Cheng1998)
Fearoffalling medlat swayduringsittowalk
(Aberg2010)
SittingdowntaskassociatedwithfallsinLTC
12%ofallrecordedfalls(Robinovitch 2013)
Gapintheliterature!
CSM2015
ClinicalExamination:SittingBalance
Importanceofsensitiveoutcomemeasures
Diagnosesittingbalancedeficits
Possiblyfallrisk
Providebaselinemeasureofsittingfunction
Serveasprognosticindicatorforfunctional
outcomes
Guideinterventionstoremediatebalancedeficits
Documentrecoveryordeclineinsittingfunction
Assesseffectivenessoftargetedinterventions
PsychometricPropertiesofMeasures
Reliability Validity
Inter &Intrarater Contentvalidity
reliability Concurrentvalidity
Test/Retestreliability Discriminativevalidity
MinimalDetectable Predictivevalidity
Change
Responsiveness Sensitivity
Torecoveryoffunction Todetectfallrisk
Todeclineinfunction Todetectfunctionally
Clinicallymeaningful relevantchange
change
CSM2015
ICFModel
Health Condition
(disorder/disease)
Body function & structure Activities Participation

(Impairment) (Limitation) (Restriction)
Environmental Personal
Factors Factors
ClinicalExamination
SittingBalanceTests/Measures
BodyStructure& Activities
Function(Impairment) FunctioninSittingTest
PosturalAlignment SittingBalanceScale
TrunkImpairmentScale OttawaSittingScale
TrunkControlTest
ClinicalScalefor
Contraversive Pushing
Multidirectional
FunctionalReachtest
CSM2015
PosturalStability&Alignment
ICFlevel:BodyStructure/Function
Anatomicalalignment
Photographicrecords
Frontal&Sagittalplanes
Videographic records
Stability&dynamictasks
Objectivemeasure
Headalignment
Spinalalignment
ConstraintsonPhoto/Video
Photorelease
Methodtoattachto
EHR
Departmentvs.
personaldevice
Dealingwiththe
original
Infectioncontrol
Knowpolicies&
procedures!
CSM2015
TrunkImpairmentScale
Verheyden2007
Trunkcontrolimpairmentsinsitting
TISExamines
Staticsittingbalance
Isolatedtrunkmovements
Shortening&elongationoftrunk
Rotationofuppertrunkonfixedlowertrunk
Rotationoflowertrunkonfixeduppertrunk
KeyLimitation
Doesnotevaluatefunctionaltasksinsitting
CSM2015
Verheyden2004,2006,2007,2010
ExcellentReliabilityinsubacute stroke
Interrater(ICC=.99)
Test/Retest(ICC=.96)
Excellentinternalconsistency
Cronbach alpha=.89
Goodconcurrentvaliditywith
TrunkControlTest(r=0.83)
Barthel Index(r=0.86)
PASS(r=0.84)
Lackofceilingeffect
TrunkControlTest
Collin1990
Trunkmotorcontrolimpairments
TCTExamines
Rolling(bothsides)
Transfersupinetositting
Staticsitting(unsupported,w/outfeetonfloor)
KeyLimitation
Only1itemspecifictosittingbalance
Doesnotevaluatefunctionaltasksinsitting
CSM2015
TrunkControlTest
ITEMS SCORING
Rolltoweakside 0=Unabletodoonown
Rolltostrongside
12=Abletodobutonly
Sittingupfromlying withnonmuscularhelp
down (i.e.,usingarmstopull,
Balanceinsitting usingbedrail)
position
Onsideofbed 25=Normal
Feetnotonfloor
Notusingarms
TrunkControlTest
Collin1990
PredictiveValidity
TCTaddedtoFIMatadmissionimproved
predictionofDCFIMmorethanadmissionFIM
alone(RR.66to.75)
Quick,impairmentbasedtest
Testlimitations
CSM2015
PusherSyndrome:DiagnosticCriteria
a) SpontaneousBodyPosture
b) Abduction/ExtensionofNonpareticExtremities
c) ResistancetoPassiveCorrection
Karnath HO,Broetz D.Understandingandtreatingpushersyndrome.PhysTher.2003;83:11191125.
ClinicalScaleforContraversive Pushing
Babyar 2009
Bodypostureunderdifferentconditions
Contraversive PushingScaleexamines
Bothinsitting&standing
Spontaneousbodyposture
Abduction&extensionofnonpareticlimbs
Resistancetopassivecorrection
KeyLimitation
DoesnotevaluatePSduringdynamic/functionalactivities
CSM2015
ClinicalScale forContraversive Pushing
Sitting Standing
Spontaneousbodyposture .75 1.0
Sumtotal(max=2) 1.75
Abductionandextensionofnonparetic
1.0 1.0
extremities
Sumtotal(max=2) 2.0
Resistance topassivecorrection
1.0 1.0
Sum total(max=2) 2.0
TotalScore 5.75/6.0
SampleScoringSheetfrompatientwithAcuteStrokewithPusherSyndrome
Babyar 2009
TestPsychometrics
Excellentinterraterreliability(ICC=.92)
GoodconcurrentvaliditywithBarthel Index(r=.66)
Adequatesensitivity(64.7%)andspecificity(100%)to
detectPSbasedondiagnosticcriteria
Strongertestpsychometricsthan
BurkeLateropulsion Scale
ModifiedScaleforContraversive Pushing
CSM2015
MultidirectionalFunctionalReachTest
Newton2001
ICFlevel:BodyFunction/Structure
WeightshiftwithUEreachinmultipledirections
MDFRTestExamines
Canbeadaptedtositting
Abilitytomaintainbalancewhileweightshifting
andreaching
Alldirections(anterior*,posterior,right,left)
KeyLimitation
Measuresonlyasingleconstruct
Clinicallychallengingforreliabletestadministration
MultidirectionalFunctionalReachTest
Newton2001,Lynch1998
ReliabilityinSCI
Test/Retest(ICC=.85.94)
Concurrentvaliditywith
BBS(r=.48),butbestinforwarddirection
TUG(r=.44)
Pronetomeasurementerrors
Notcomprehensiveforsittingfunction
CSM2015
ClinicalExamination
SittingBalanceTests/Measures
BodyStructure& Activities
Function(Impairment) FunctioninSittingTest
PosturalAlignment SittingBalanceScale
TrunkImpairmentScale OttawaSittingScale
TrunkControlTest
ClinicalScalefor
Contraversive Pushing
Multidirectional
FunctionalReachtest
FunctionInSittingTest
Gorman2010
ICFlevel:Activity
Performancebasedtestoffunctionaltasks
FISTExamines
StaticSitting
Static,eyesclosed,turnhead,liftfoot
DynamicSitting
Forwardreach,lateralreach,itemofffloor,itemfrombehind
ReactiveSitting
Nudgesinanterior,lateral,posterior
KeyLimitation
Limitedtositting
CSM2015
Gorman2014
Prospective,multicenter
study
4inpatientrehabcenters
acrossUS
N=125participants
Varietyofdx(CVA&TBI
mostcommon)
RelationshipofFISTat
admission&d/c
FIM(bothmotor&total)
BBS
ResponsivenessofFIST
MCIDofFIST
CSM2015
Gorman2010,2013,2014
ExcellentReliability Responsiveness
Inter &Intra rater(ICC=.99) ES=.83
Test/Retest(ICC=.97) SRM=1.04
Excellentinternal MCD=5.5points
consistency MCID=6.5points
Cronbach alpha=.98 Predicativevalidity
Excellent/goodconcurrent DCtohome
validity Noflooreffect,butceiling
mRS (r=.76) affectbyDCinIPR
BBS(r=.85) Freeonlinetraining
FIM(r=.71) www.samuelmerritt.edu/fist
SittingBalanceScale
Medley2011
ICFlevel:Activity
Abilitytomaintainsittingw/andw/odisplacements
SittingBalanceScaleExamines
Staticsittingbalance(3items)
Sittingbalancew/trunkdisplacement(6items)
Sittingbalancew/UEdisplacement(2items)
KeyLimitations
Unknownresponsivenessorconcurrentvalidity
CSM2015
SittingBalanceScale
Situnsupported(60s) Alternatefoottouch
Situnsupported,eyes (33.5inchht)
closed(30s) Lateralreach
Sitw/armsaslevers Turntolookoverboth
(90 shld flexw/2lbcuff shoulders
wt) Lateralbendtoelbow
Forwardreach Sittostand
Pickupobjectfrom Pickupobjectfrom
floor floor
Scoring:ordinalscale(04)foreachindividualitem
SittingBalanceScale
Medley2011,Thompson2013
GoodtoExcellentReliability
Intrarater(ICC=.96.99)
Interrater(ICC=.87)
GoodInternalConsistency
Cronbach alpha=.76
Moderateconcurrentvalidity
TIS(r=.60to.92,variedbysetting)
Ambulatorystatus(r=.67)
Equipmentrequired&2itemsrequirebilateralLEs
1studysampleincludedpersonsw/osittingbalance
dysfunction
CSM2015
OttawaSittingScale
Thornton2010
ICFlevel:Activity
Movementwithin&outsideBOSinsitting
OttawaSittingScaleExamines
Staticsitting
Weightshiftsofsmall&longerdistance
Lifthips
Walkhipsforward&back
KeyLimitations
Lackofvaliditystudies
OttawaSittingScale
Items 6 itemsscoredtwice
Maintainstaticsitting Feetsupported
position Feetunsupported
Movesshortdistance Scoring
(12cm)
Anterior,right,left
04pointordinalscale
Moveslongerdistance Differentscaleforeach
(25cm) item
Anterior,right,left
Trunkrotationability
Sittingon1hip
Walkingonhips
Forward&back
CSM2015
OttawaSittingScale
Thornton2010
ExcellentReliability
Intrarater(ICC=.99)
Interrater(ICC=.96.98)
Ceilingeffectnoted
CorrespondedtoBBSscoresof~10
Lackofvaliditystudies
ComparedtoBBS&PFMP,noanalysis
Lackofstudiesonresponsivenessoftest
OtherActivitylevelMeasures
(withlimitations)
GlobalRatingScales(N,G,F,P)
Subjective
Pooroperationaldefinitionsthatvary
KansasSittingBalanceScale(Kluding 2006)
Singlestudy,limitedresearch
Limitedtestpsychometrics
BergBalanceScale(Berg1995)
Singleitemstaticsittingx30seconds
CSM2015
OtherActivitylevelMeasures
(withlimitations)
MotorAssessmentScale(Carr1985)
Singleitembalancedsitting
PosturalAssessmentScale(PASS)(Benaim 1999)
Staticsitting&supine sittransfers
StrokeImpairmentAssessmentSet(Liu2002)
Trunksubsection:2items(verticality &abd MMT)
BrunelBalanceAssessment(Tyson2004)
3items(static,armlift,forwardreach)
ParticipationlevelMeasures
(withlimitations)
ActivitiesspecificBalanceConfidenceScale
(Botner 2005)
Nosittingitems,allitemsinstanding
FallsEfficacyScale(Delbaere 2010)
Nosittingitems,sittostandonly
StrokeImpactScale(Guidetti 2014)
1sittingitem:sittingwithoutlosingbalance
GAP Participationlevelmeasuresrelevantto
sittingfunction
CSM2015
EmergingTechnologies
Forceplatformsystems
Pressurematsensorsdevices
Accelerometers&movementsensors
Videographic movementanalysis(eg.Dartfish)
Clinicalutility?
Affordability
Portability?
EmergingQuantitativeMeasures
PocketPTTrunkMovementBattery
MovementSensorAssessmentTechnology
CSM2015
PocketPT TrunkMovementBattery
TrunkMovementBattery
BeelBates2011,Englesma 2014
AssessmentcomponentofPocketPT
QuantitativeLimitsofStabilitytest
Anterior,Posterior,Lateralmaximaltrunklean
Initialposition,maximalCOMexcursion&average
movementvelocity
ExcellenttoModerateReliability(adultsw/BI)
IntraraterReliability(ICC=.70.91)
InterraterReliability(ICC=.75.99)
Goodtoexcellentconcurrentvalidity(adultsw/BI)
FIST,MultidirectionalFRT,globalratingscale
Excellentdiscriminativevalidity
CSM2015
TotalMaximumExcursion
DesigningInterventionstoPromote
RecoveryofSittingFunction
CSM2015
ExaminationFindings
GuideDirectedInterventions
Clinicaldecisionmaking
Whatbalancecomponentsneedremediation?
Voluntary,Proactive,Reactive,SensoryorMotorStrategies
Whataretheactivitylimitations?Whatfunctional
tasksareinefficientorineffective?
Taskdemands,transitionalmovements,dualtasks
Whatenvironmentalconditionsarechallengingor
posefallrisk?
With/withouttrunksupport,UEsupport,feetonground
Surfaceconditions,baseofsupport,visualcontext
ExaminationFindings
GuideDirectedInterventions
ClinicalDecisionmaking
Whataretheprimarysystemimpairments
contributingtosittingbalancedeficits?
Trunkweakness,dynamictrunkcontrol
LEweaknessaffectingstableBOS
Impairedperceptionofvertical/midline
SensoryorPerceptualdeficits
Musculoskeletallimitations
Abnormaltone/alignmentissues
Impairedposturalstrategies;motorcontrolissues
Attention/cognition
CSM2015
TreatmentPrinciples
PromoteNeuroplasticity
Applymotorlearningconceptstofacilitate
recoveryofsittingbalanceskills
Applytaskspecifictrainingconcepts
Practicemeaningfultasks,saliency
Practiceinfunctionallyrelevantenvironments
Buildinrepetition&intensityofpractice
Learningfromerrors
YES!Errors=lossofbalancesoCNSlearns
TaskOrientedBalanceTraining
Practicebalanceskillsincontextofspecifictask
goalsvs.balanceexercises
Embedbalancedemandsintotaskdesign
Beexplicitregardingtaskgoal&FBonsuccess
Encourageactiveproblemsolvingandmotor
learning
Promoteselfevaluationoftaskdemands
Highlightcriticalaspectsofenvironment
Encouragepatienttoevaluatetheirperformance
Addressunderlyingimpairmentsaffecting
balanceinthecontextofTObalancetraining
CSM2015
BalanceTrainingInterventions
ApplicationofEcologicalModel
CustomizedInterventionsfor
BalanceTraining
TaskDemands ForceduseofPCsystem
Reaching SingleUEorbothUEs
Loadorunloaded
Tasks Distance,speed,timingdemands
Trunk LimitsofStabilitydemands
Segmentaltrunkmotions/rotation
Movement Transitionalmovementdemands
DualTask Balance+motordemands
Balance+cognitivedemands
Demands Environmentaldistraction/attn.
CSM2015
CustomizedInterventionsfor
BalanceTraining
EnvironmentalConditionsProgressivechallenge
Support Stable/unstable/moving
Level/unlevel,surfaceareasupport
Surface Bed,w/c,mattable,couch
LevelofExternal Thighandfeetsupport
Back/trunksupport&supportlocation
Support UEsupport&locationofsupport
External Lightingconditions,eyesopen/closed
Attentiondemands
Environment Cognitiveprocessingload
TargetedBalanceTreatmentDesign
Whataspectsofbalanceis
Rxfocus?
Posturalstability&
Voluntaryposturalcontrol
Proactiveposturalcontrol
Reactiveposturalcontrol
Effectivemotorstrategies
Functionaltaskdemands
CSM2015
Sitting:VoluntaryPosturalControl
Addressposturalalignment&createstableBOS
Retrainmidlineforstaticanddynamictasks
Useofexternalcues,internalrecalibration
Expandlimitsofstability(perceptualworkspace)
A/P,Lateral,Functionalrotationalplanes
Embedtaskdemandsthatrequire LOS
Challengestabilityonmovingbaseofsupport
Exerciseball,equilibriumboard,dynadisc
Environmentalfeedbackre:stablecenter
Sitting:ProactiveBalanceStrategies
Practiceselfgeneratedmovements
Initiallyinmidlinewithmin.displacementofCOM
ProgresstoincreasingdynamicCOMexcursion
ProgressdemandsforUE,LE,&trunkmotions
Addamplitude,speed,load,timingdemands
Reaching,leaning,lifting,hitting,kicking,turning
Practicetransitionalmovements
Sit/sidelying,scooting,sittostanding,s/ptransfers
CSM2015
Sitting:ReactiveBalanceStrategies
Promotetimely&effectiveposturalresponses
toperturbationsoranylossofbalance
Manualperturbations
Firstinmidline,thenduringdynamictasks
Progressfromexpectedtounexpected
Challengeinunstable/movingsurfaceconditions
Inclines,foam,balanceboard,ball
Progressfrommidlinetodynamictasks
SafepracticeatedgeofLOSwherefallriskzone
Workingonsaferecoveryfromlossofbalance
WhatistheEvidenceforSitting
BalanceInterventions?
TaskSpecificTraining(Deanetal2007)
Sittingreachingtrainingbeyondarmslength
Varieddistance,direction,thighsupport,loads
RCTdemonstratedsignificantlyimprovedreach
distance,pareticLEloading,&speedofreach
Nocarryovertowalkingfunction
EarlyIntensiveForcedUse(Tangetal2014)
Comparisonofearlysitting,standing,walkingtask
trainingwithcontemporaryBobath approach
Patientswithseveremotordeficitspoststroke
SignificantlyhigherSTREAMandBergscoresat4&8wk
inEarlyTaskspecifictraininggroup
CSM2015
MentalPracticeaddedtoTaskSpecificTraining
Combiningphysicalwithmentalpracticeprimessystemfor
motorstrategy,enhanceslimbloadingduringSTStask
(Malouin 2009)
Mentalimageryofsittostandandreachtasksresultedin
taskspecificincreasesinspeed(Guttman 2012)
Combiningvisualimagewithmental&physicalpracticeof
sittingtrunkleantask(anteriorandlateral)enhanced
loadingonpareticside(Saito2013)
Patientsabilitytousemotorimageryvaries;evaluatewith
publishedmeasures
Useofexternalimageryvs.internalimagery(kinesthetic
feelofmovement)intraining
WeaklevelsofevidenceofMPinsittingbalancerecovery
Efficacyoftrunkexercises(Verheyden etal2009)
Rx:selectivetrunkexercisesinsupineandsitting(CVA)
Dosing 4xweekfor5weeksvscontrolgroupconventionalPT/OT
RCTFindings:Significantgainsonlyindynamicbalance
subscaleofTrunkImpairmentScale(TIS)forexercisegroup
Nodifferencesinfunctionaloutcomes
Trunkexerciseseffectonbalance&function(Saeys 2012)
Additional16hrs (8wks)oftrunkexerciseinacuteCVA
Focusofexercises:strength,coordination,selectivemotion
SignificanthighergainsinTISforexercisegroup
CarryovertohigherBergandDGIscoresinexercisegroup
CSM2015
UseofEmergingTechnology
inBalanceInterventions
AugmentedvisualBFBenhancessitting
symmetry(Mudie etal2002)
Balanceperformancemonitor,carryovertofunction?
Videogamingeffectondynamicsittingbalance
SonyPlayStationIIEyeToy (s/pstroke)(Rand2008)
CaseSeriesx3(SCIandTBI)(Betker 2007)
Advantages:motivational,increasedpracticetime
Limitationsofcommercialvideogamingtechnology
Highleveloftaskdemandsandcomplexity
Limitedabilityfortherapisttocustomizetrainingfor
patient
PocketPT Technology Englesma etal2014
3dSensortransmitsdatatoipad,wirelesstechnology
PocketPTappinterprets&storestestresultsforeachpatienton
backenddashboardportalforPTonlineaccess
PocketPTisapersonalized,therapeuticgamingplatformfor
retrainingdynamicbalance
AssessmentfindingsdrivePTdirectedgameparametersandgoals
CSM2015
PocketPT
InteractiveGamingSystem
forBalanceRetraining
PocketPT
PTDirectedGoalsSetforTrunkMotion
CSM2015
PuttingItAllTogether
Cases
Case#1:
Patientwithacutestroke
Case#2:
ICUpatientpneumoniawhodevelopedcritical
illnesspolyneuropathy
Case#3:
PatientwithTBI
CSM2015
TakeHome:SummaryPoints
Selectionof
rightmeasure Usemeasurementto
forright driveinterventions
patientat systematically;
righttime Reexamineperiodically
Selectionofboth
measure&
interventionfor
tasks,environment,
needs
2014 by American Physical Therapy Association
Questions?
CSM2015
Othercollaborators: Contactus:
MatthewMiller SharonGorman
EricaLorie sgorman@samuelmerritt.edu
CaraGreenwald @criticalipt
StephanieDickerson CathyHarro
LeslieWolf harroc@gvsu.edu
KathleenCampbell ChristinaPlatko
christina.platko@maryfreebed.com
DontJustSitThere!EvidencebasedSittingBalanceExamination&Intervention
CSM2015 SLGorman,CCHarro,CPlatko
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