Posture monitoring feedback

Presentation
Presentation

By means of this exercise the patient must achieve gradual perfecting of movements, from the complexity required for shoulder, arm, forearm, and elbow movements, to fine movements at the wrist distal, hand and fingers. To make a stable position possible for the arm for which fine use of the hand is activated, proximal control of the trunk is fundamentally important. Attention must not be focussed solely on interaction with the aid, but must also take the way the patient uses the various areas of their body into account.

 

The use of position feedback instruments makes it possible to draw the patient’s attention to the motorial behaviour of areas of their body, of which the patient is not always fully aware, providing information on performance, and focussing attention on important aspects of the gesture. Also adding Feedback has a motivating effect and produces an immediate increase in performance.

More info
More info

Posture Monitoring feedback

Evaluating the strategy used by the patient in completing the gesture required is of fundamental importance, in order to choose the feedback instruments to be used and where they must be positioned. Often the patient uses compensation strategies to complete the task in the most simple, economic manner. Therefore we want to ensure that, by means of the exercised proposed, the patient gradually perceives and learns the correct motorial behaviour strategy.


Motorial learning phases include an initial phase during which feedback is constant and acts on an afferent channel, looking for selective monitoring of the movement and posture. In the second and third phases the information on details of the movement is gradually reduced. Here summary feedback is important for getting to an automatism phase, with open exercises in variable contexts. This is the line taken when seeking to provide the patient with the information required to do a task with the correct Posturel alignment, reducing compensation to a minimum.


For explanatory purposes, let’s analyse the compensations used by patients more often on various planes and how to position the feedback devices to allow them to perceive their error and complete the functional task in the best possible way.

COMPENSATION 1 - Elevating the Scapula

In this task involving reaching the handle, there is a need to avoid the patient compensating by using the scapula-thoracic joint, to make a movement that must physiologically mainly be carried out by the scapulohumeral joint.

The proximal part of the protractor is positioned using double-sided tape at the scapular spine and the velcro strip is used to connect the lower part to the thoracic strap. By adjusting the wire the range of elevation for the scapula is defined, beyond which the circuit is closed and the FB signal is activated.

 

INCORRECT POSITION CORRECT POSITION
 

Plane

Posture

Task

Compensation

Tool

Type of FB

 Frontal

 Standing 

Reaching the handle

 Elevating the scapula

 Protractor

 Negative Feedback

COMPENSATION 2 - Counter sideways inclination of the trunk

Another compensation mechanism that a patient can use is to bend the trunk to avoid abducting the arm or flexing the elbow.

What is being sought is monitoring of the trunk on the frontal plane while the hand reaches the handle.

The inclinometer is positioned on the velcro strip on the thoracic viewer, with the antenna facing in the opposite direction to inclination of the trunk.

The system is activated when the antenna goes beyond the horizontal. The more the antenna is pointed downwards, the greater the range left to the patient for using inclination compensation before getting the signal to stop.

 

INCORRECT POSITION CORRECT POSITION
 

Plane

Posture

Task

Compensation

Tool

Tipo FB

 Frontal 

 Standing 

Reaching the handle

 Counter bending of the side of the trunk

 Inclinometer 

 Negative Feedback

COMPENSATION 3 - Homolateral inclination of the trunk

When making the gesture of turning the handle, the patient can use the trunk to “reinforce” the movement, which should be done exclusively by the upper limb. Compared to the previous situation the inclination is opposite, that is on the same side as the limb working. The antenna will therefore be aligned in the opposite direction and the patient will receive <0 FB as soon as they move the trunk on the frontal plane.

 

INCORRECT POSITION  CORRECT POSITION

 

Plane

Posture

Task

Compensation

Tool

Type of FB

Frontal

Standing

Reaching the handle

Homolateral inclination of the trunk

Inclinometer

Negative Feedback

COMPENSATION 4 - Counter sideways inclination of the trunk

This exercise involves turning the handle anticlockwise. This movement is done mainly due to abduction of the arm. The patient will probably be able to do the task at a certain height, but will have difficulty if the handle is positioned higher up. The inclinometer on the trunk makes it possible to precisely determine the point at which the patient begins to have difficulty and use the trunk to compensate to a possible joint deficit of the shoulder. Being able to monitor the trunk on the frontal plane and to move the handle to a known height makes it possible to highlight a patient’s improvement during a single session or over a number of sessions.

 

INCORRECT POSITION CORRECT POSITION
 

Plane

Posture

Task

Compensation

Tool

Type of FB

 Frontale

 Standing 

 Turning the handle anticlockwise

 Counter sideways inclination of the trunk

 Inclinometer

 Negative Feedback

COMPENSATION 5 - Extension of the trunk

For this exercise, the patient’s difficulty may be linked to a flexing deficit for the arm. Applying the inclinometer to the back immediately indicates any compensation by extending the trunk during the task of positioning an
item in the support. Below an arm flexion of 120°-150° in fact, the trunk should not be involved. In this case too, as in the previous case, being able to adjust the support to the required height, allows the therapist to work on
the specific nature of the functional task. As for all the exercises with FB, the task can be made easier or more difficult by adjusting the inclination of the antenna.

 

 

Plane

Posture

Task

Compensation

Tool

Type of FB

 Sagittal

 Standing 

 Putting an item on a shelf

 Extension of the trunk

 Inclinometer

 Negative Feedback

COMPENSATION 6 - Flexion of the trunk

For patients with a hunchback posture that is difficult to correct, providing positive FB when correct extension of the trunk is achieved is more effective and less frustrating. Positioning the inclinometer on the front at the sternum, the inclination of the same is regulated so that the sound sensor is activated at the range set.

 

INCORRECT POSITION CORRECT POSITION

 

Plane

Posture

Task

Compensation

Tool

Type of FB

 Sagittal

 Seated

 Filling a cup

 Flexion of the trunk

 Inclinometer

 Positive Feedback

COMPENSATION 7 - Flexion of the trunk

This task and its context are similar to the previous case, but differ in that the patient manages to keep the trunk aligned more easily. The FB is activated when the patient loses control of the correct posture and calls on them to regain the initial position.

 

INCORRECT POSITION CORRECT POSITION
 

Piane

Posture

Task

Compensation

Tool

Type of FB

Sagittal

Seated

Filling a cup

Flexion of the trunk

Inclinometer

Negative Feedback

Documents
Documents

Insights - Manual Leonardo

Esempi applicativi - Examples of application
Video
Video

inclinometer 1/10

inclinometer 1/10

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