Elaboration and assessment of clinical protocols to support the evaluation of stand-to-sit activity / Elaboração e Avaliação dos Protocolos para auxílio na avaliação da atividade de sentar

Introduction Evaluation of sit-to-stand and stand-to-sit activities is used by physical therapists in patients with neurological and musculoskeletal disorders. Sit-to-stand activity presents different descriptions of phases and movements; however the phases of stand-to-sit activity have not been established yet.Objectives To describe the movements during stand-to-sit activity and create an evaluation protocol.Materials and methods Stand-to-sit activity was described on anterior and lateral views based on the observation of 27 healthy subjects. The body segments chosen to analyze were feet, ankles, knees, hips, pelvis, trunk, spine, upper limbs, head and cervical spine. The movements of body segments were described as adduction and abduction, eversion and inversion, valgus and varus, neutral position and asymmetry. The protocol was assessed with questionnaires answered by 12 physiotherapists experts in the area.Results Stand-to-sit activity was divided in 4 phases: 1- "Neutral position", 2- "Pre-squat", 3- "Squat" and 4- "Stabilization". Two models of protocols were developed considering 5 body segments to the anterior view and 7 segments for the lateral view.Conclusion Stand-to-sit activity was described in 4 phases with sequential movements of each body segment. These protocols allow physiotherapists to identify unusual movements of body segments during the stand-to-sit activity.

Introdução Levantar e sentar são movimentos comuns da vida diária, e sua avaliação é utilizada frequentemente por fisioterapeutas em pacientes com disfunções neurológicas e musculoesqueléticas. A atividade de levantar apresenta diferentes descrições quanto às fases e movimentos, enquanto a atividade de sentar ainda não apresenta suas fases estabelecidas.Objetivos Descrever os movimentos durante a atividade de sentar e elaborar protocolos de auxílio à avaliação.Materiais e métodos Esta atividade foi descrita nas vistas anterior e lateral com base nos achados de um levantamento bibliográfico e na observação das filmagens de 27 indivíduos funcionalmente independentes. Os segmentos corporais analisados foram pés, tornozelos, joelhos, quadris, pelve, tronco, coluna lombar, membros superiores, coluna cervical e cabeça. Seus movimentos e condições foram descritos: adução e abdução, eversão e inversão, valgismo e varismo, posição neutra e assimetria. Os protocolos foram avaliados por meio de questionários de avaliação, respondidos por 12 fisioterapeutas especialistas na área.Resultados A atividade de sentar foi descrita de acordo com o estabelecimento de 4 fases. 1- “Posição inicial”, 2- “Pré-agachamento”, 3- “Agachamento” e 4- “Estabilização”. Foram elaborados 2 modelos de protocolos, sendo considerados 5 segmentos corporais para a vista anterior e 7 segmentos para a vista lateral.Conclusão A atividade de sentar foi descrita em 4 fases, e em cada uma ocorrem movimentos sequenciais de cada segmento corporal. Estes protocolos permitem identificar as alterações de segmentos corporais durante a atividade de sentar por meio da comparação dos movimentos descritos. A classificação do grau de inadequação corresponde ao número de segmentos corporais com movimentos alterados.

Postural control under visual and proprioceptive perturbations during double and single limb stances: insights for balance training.

Single Limb Stance under visual and proprioceptive disturbances is largely used in clinical settings in order to improve balance in a wide range of functional disabilities. However, the proper role of vision and proprioception in SLS is not completely understood. The objectives of this study were to test the hypotheses that when ankle proprioception is perturbed, the role of vision in postural control increases according to the difficulty of the standing task. And to test the effect of vision during postural adaptation after withdrawal of the somesthetic perturbation during double and single limb stance Eleven males were submitted to double (DLS) and single limb (SLS) stances under conditions of normal or reduced vision, both with normal and perturbed proprioception. Center of pressure parameters were analyzed across conditions. Vision had a main effect in SLS, whereas proprioception perturbation showed effects only during DLS. Baseline stability was promptly achieved independently of visual input after proprioception reintegration. In conclusion, the role of vision increases in SLS. After proprioception reintegration, vision does not affect postural recovery. Balance training programs must take that into account.

Misalignment of the knees: does it affect human stance stability.

INTRODUCTION: Data describing the relationships between postural alignment and stance stability are scarce and controversial. OBJECTIVE: The aim of this study was to evaluate the effects of sensory disturbances on knee alignment in upright stance and the effects of knee hyperextension on stance stability. METHOD: Kinetic and kinematic data of 23 healthy adult women were collected while quietly standing in four sensory conditions. Kinematic data: knee angle (dependent variables) variations were analyzed across sensory conditions. Kinetic data: as subjects with hyperextended knees showed a clear tendency to flex their knees as balance challenge increased, center of pressure (COP) parameters (dependent variables) were analyzed in each sensory condition among trial sub-groups: Aligned-Trials (knee angle<180°), Hyperextended-Trials (>180°) and Adjusted-Trials (>180° initially, turned <180° under challenging conditions). RESULTS: Differences were found in mean velocity of COP in two conditions showing that knee alignment can affect stance stability. CONCLUSION: Knee hyperextension is a transient condition changing under postural challenges. Knee hyperextension affected postural control as mean velocity was the highest in the hyperextended group in natural standing sensory condition and lowest with sensory disturbance.

Can quiet standing posture predict compensatory postural adjustment?

OBJECTIVE: The aim of this study was to analyze whether quiet standing posture is related to compensatory postural adjustment. INTRODUCTION: The latest data in clinical practice suggests that static posture may play a significant role in musculoskeletal function, even in dynamic activities. However, no evidence exists regarding whether static posture during quiet standing is related to postural adjustment. METHODS: Twenty healthy participants standing on a movable surface underwent unexpected, standardized backward and forward postural perturbations while kinematic data were acquired; ankle, knee, pelvis and trunk positions were then calculated. An initial and a final video frame representing quiet standing posture and the end of the postural perturbation were selected in such a way that postural adjustments had occurred between these frames. The positions of the body segments were calculated in these initial and final frames, together with the displacement of body segments during postural adjustments between the initial and final frames. The relationship between the positions of body segments in the initial and final frames and their displacements over this time period was analyzed using multiple regressions with a significance level of p < or = 0.05. RESULTS: We failed to identify a relationship between the position of the body segments in the initial and final frames and the associated displacement of the body segments. DISCUSSION: The motion pattern during compensatory postural adjustment is not related to quiet standing posture or to the final posture of compensatory postural adjustment. This fact should be considered when treating balance disturbances and musculoskeletal abnormalities. CONCLUSION: Static posture cannot predict how body segments will behave during compensatory postural adjustment.

Can quiet standing posture predict compensatory postural adjustment?

OBJECTIVE: The aim of this study was to analyze whether quiet standing posture is related to compensatory postural adjustment. INTRODUCTION: The latest data in clinical practice suggests that static posture may play a significant role in musculoskeletal function, even in dynamic activities. However, no evidence exists regarding whether static posture during quiet standing is related to postural adjustment. METHODS: Twenty healthy participants standing on a movable surface underwent unexpected, standardized backward and forward postural perturbations while kinematic data were acquired; ankle, knee, pelvis and trunk positions were then calculated. An initial and a final video frame representing quiet standing posture and the end of the postural perturbation were selected in such a way that postural adjustments had occurred between these frames. The positions of the body segments were calculated in these initial and final frames, together with the displacement of body segments during postural adjustments between the initial and final frames. The relationship between the positions of body segments in the initial and final frames and their displacements over this time period was analyzed using multiple regressions with a significance level of p < 0.05. RESULTS: We failed to identify a relationship between the position of the body segments in the initial and final frames and the associated displacement of the body segments. DISCUSSION: The motion pattern during compensatory postural adjustment is not related to quiet standing posture or to the final posture of compensatory postural adjustment. This fact should be considered when treating balance disturbances and musculoskeletal abnormalities. CONCLUSION: Static posture cannot predict how body segments will behave during compensatory postural adjustment.

Isokinetic dynamometry of knee flexors and extensors: comparative study among non-athletes, jumper athletes and runner athletes.

UNLABELLED: Participation in intensive sports activities leads to muscular specializations that may generate alterations in involved articular forces and cause static (posture) and dynamic changes (alterations of articular stability, coordination, etc.). Prevention of injury requires specific functional muscular evaluation in all athletes and for any kind of sport. OBJECTIVE: To dynamically evaluate, through isokinetic tests, the peak torque, total work, and average power of the knee flexor and extensor muscles of jumper and runner athletes and compare them to those of a non-athletic population, evaluating dominance and balance between agonistic and antagonistic muscle groups. RESULTS: In the non-athlete group, we noted a higher asymmetry between the dominant and nondominant members. The jumpers had the highest values of the evaluated parameters of all groups, whereas parameters for the runners were intermediate between non-athletes and jumpers.

Isokinetic dynamometry of knee flexors and extensors: comparative study among non-athletes, jumper athletes and runner athletes

Participation in intensive sports activities leads to muscular specializations that may generate alterations in involved articular forces and cause static (posture) and dynamic changes (alterations of articular stability, coordination, etc.). Prevention of injury requires specific functional muscular evaluation in all athletes and for any kind of sport. OBJECTIVE: To dynamically evaluate, through isokinetic tests, the peak torque, total work, and average power of the knee flexor and extensor muscles of jumper and runner athletes and compare them to those of a non-athletic population, evaluating dominance and balance between agonistic and antagonistic muscle groups. RESULTS: In the non-athlete group, we noted a higher asymmetry between the dominant and nondominant members. The jumpers had the highest values of the evaluated parameters of all groups, whereas parameters for the runners were intermediate between non-athletes and jumpers