Submitted by: Jeremy Nelson PT
10.0 Turning Look Behind Over Left and Right Shoulders While Standing.
This component is the first times that the test is examining the ability of the core musculature to control the center of gravity in a rotational pattern. Rotation is critical to functional movement. This test specifically looks at rotation in a symmetrical stance around a midsagittal axis. Function happens in three dimensions and rotation is a motion used when performing diagonal movements. Without diagonal movements necessary weight shifts would be difficult to produce. The goal of this component is “looks behind from both sides and weight shifts well”.
Starting from the end, the weight shift is the first element of the structure to consider. For only after the weight shift is successful can the performer complete the looking over the shoulder. Controlling the rotation motion so that the COG can move towards the rotation foot and the hip extensors and hip abductor’s are able to control the weight shift to the ipsilateral extremity is the domain of the hip joint and requires good core stability.
Not only is the motor system on display but also is the vestibular system and its ability to control balance while the head is rotating. In order to successfully perform the looking over the shoulder their needs to be an adequate weight shift towards that side of that the patient is looking towards. Adequate vestibular input is a key to this weight shift and maintaining the COG over the BOS during the rotation.
As in many of the berg tests it is advisable to comment on what is seen in terms of strategy. The movement strategies that are being employed are important to identify as they will provide a place to start with the change effort. Recognizing if the rotation is occurring at the pelvis, trunk or neck and to what degree these body segments are contributing will explain the causes implied in the scores. When there is motion around the hip joint and control through the hip extensors and hip abductor’s then the body is good position to turn around the axis. When rotation is occurring at the lumbar spine this is due to inadequate mobility at the hip or thoracic spine or both.
When the performer “needs assist to keep from losing balance or falling” there is more to explore in terms of why the performer is falling. Is there a sense of vertigo present that would provide cause for an examination of the vestibular system? Is weight shifting adequate in the frontal plane? If so how does it different from the addition of rotation? All of these questions will be useful in organizing the change effort to focus on the causative factors. Moving to the “needs supervision when turning” score is a sign of progress; however this score still indicates that body segment contribution is not adequate. Something is limiting the crucial weight shift to the ipsilateral lower extremity.
As the performer is able to “turn sideways only but maintains balance” the weight shift that was absent before is present. Only if the weight shift occurred would balance be maintained with turn sideways. In addition the contribution of the hip would be deemed adequate in this position. Without adequate hip mobility, reaching the sideways position would be likely impossible. Adequate weight shift to the ipsilateral side will promote the necessary internal rotation required as well as the external rotation of the contra lateral hip. Without the weight shift the rotation promotes a posterior lateral shift, causing the performer to lean back.
In deed the next score of “looks behind one side only other side shows less weight shift” could indicate a lack of ROM at the hip joints. Range of motion will also be required of the thoracic spine and cervical spine to complete the looking over the shoulder maneuver. By limiting the hip rotation by placing the performer in the seated position, and continuing the motion, the clinician can identify the contribution of the thoracic spine to the rotation. Lumbar spine rotation occurs if the performer does not first attain the upright posture with a slight anterior pelvis tilt. A posterior rotation of the pelvis will cause the lumbar spine to flex, providing emphasis for lumbar spine rotation. This can give the appearance of limited thoracic spine mobility. Finally cervical spine mobility is assessed as the thorax is restricted.