Submitted by: Jeremy Nelson PT
13.0 Standing Unsupported One Foot in Front
The goal of this component is to be “able to place foot tandem independently and hold 30 seconds test hip abductor control as now in relative adduction”. Although not typically part of the function of life (unless your occupation is a tight rope walker) component 13 does provide useful information to assist in developing the overall plan of care. This component is evaluating the capacity of the performer to weight shift, establish new bases of support and maintain the COG in relation to the new BOS. First task is to establish an asymmetrical base of support by stepping forward. In maintaining foot position 1 foot for the other so again was looking at weight shifting in the capacity to control that weight shift with the close kinetic chain lower extremity in addition once the asymmetrical base support is established were examining control the center of gravity over narrow base of support along and diagonal pattern
As the performer demonstrates “Loses balance while stepping or standing” there exists profound inability to control static balance. If the loss of balance comes when stepping then the weight shift did not happen and gravity won the day before the performer was able to establish a single limb BOS. As discussed in the previous articles, any time the performer demonstrates such a low score, the approach would be to step down to the lower level positions and critical tasks. With a review of these supportive tasks, the areas of inadequacies can be improved towards the desired level of the critical task. Having completed the lower level task, the performer will be on a firm foundation for advancement.
Even if the performer “needs help to step but can hold 15 seconds” an examination of the supportive critical tasks are in order. As organized in the hierarchy of movement, the asymmetrical and single limb positions would be supportive to this more complicated task. An inability to weight shift to single limb to establish a new BOS could be present for a number of reasons. What at first looks like a separate test are really the prior critical tasks revisited.
Similar to component 12, time is an element in the test as well as understanding what is required to accomplish the task. It takes time to position the advancing lower extremity into the position that is desired. The scores imply that time for the step to occur is adequate or not. For example when the performer is “able to take small step independently and hold 30 seconds” the weight shift was not likely adequate and the step is a quick step as the brain rapidly attempts to reestablish a BOS before a loss of balance occurs. The time is increased by the strength and power of the stance hip. When the performer has been “able to place foot ahead independently and hold 30 seconds “ an adequate weight shift to during the single limb position has occurred resulting in the establishment of a new BOS, and a capacity to demonstrate to maintain control of COG over BOS.