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Chapter Outline
Kneeling
General Characteristics
Prerequisite Requirements
Interventions to Improve Intermediate Trunk and Hip Control in Kneeling
Movement Transitions: Heel-Sitting or Side-Sitting and Kneeling
Kneel-Stepping and Kneel-Walking
Strategies to Improve Balance Control in Kneeling
Practice and Feedback
Half-Kneeling
General Characteristics
Interventions to Improve Intermediate Trunk and Hip Control in Half-Kneeling
Half-Kneeling: Diagonal Weight Shifting
Movement Transitions: Half-Kneeling to Standing
Summary
Student Practice Activities
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This chapter focuses on interventions to improve intermediate trunk and hip control using kneeling postures. Kneeling offers the benefit of improving trunk and hip control without the demands of controlling the knee and ankle that are required during standing. Inherent to these upright, antigravity postures are important prerequisite requirements for standing. For example, kneeling postures are particularly useful for developing initial upright postural control and for promoting hip extension and abduction stabilization control required for standing. By eliminating the demands of upright standing, patient anxiety and fear of falling are typically diminished. Kneeling activities are also important lead-up skills for independent floor-to-standing transfers.
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The postures addressed in this chapter are kneeling (Fig. 7.1A) and half-kneeling (Fig. 7.1B). In kneeling, both hips are extended with bilateral weight-bearing occurring primarily at the knees and upper tibia, with the legs and feet resting on the support surface. This creates a wider base of support (BOS) than standing, but not as wide as seen in half-kneeling. In half-kneeling, one hip remains extended, with weight-bearing at the knee and upper tibia with the opposite hip and knee flexed to approximately 90 degrees. Weight-bearing occurs at the foot placed forward on the supporting surface. In kneeling and half-kneeling postures, height of the center of mass (COM) is intermediate.
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Clinical Note:
Patients with significant cerebellar dysfunction and ataxia (e.g., those with traumatic brain injury [TBI], multiple sclerosis [MS], or cerebellar degeneration) benefit from practice in these more stable postures. For these patients, kneeling and half-kneeling are functionally important as transitional activities in preparation for upright standing.
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General Characteristics
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In kneeling, the COM is intermediate; it is higher than in supine or prone positions and lower than in standing. In kneeling, control of the knee is decreased and foot and ankle control is not required to maintain upright trunk and hip control. This reduces the degrees of freedom compared ...