CVA - 5a Stroke Rehab Gait

Question 1

primary vs secondary LE impairments

Answer 1

primary:
- motor control/activation
- altered ms tone
- loss of sensation
- coordination problems

secondary:
- weakness, atrophy
- ms length, ROM
- edema
- pain

Question 2

what is the emphasis of LE neurorehab and why

Answer 2

gait training

amb is key functional activity for participation and quality of life

Question 3

what are 3 interventions of LE neurorehab

Answer 3

functional retraining
gait training*
strength training

Question 4

what functional retraining interventions are included in LE neurorehab

Answer 4

bed mobility
bridging
balanced sitting/standing
sit to stand transfers

Question 5

what context is strength training often utilized for LE neurorehab

Answer 5

more functional and get them on programs to be doing outside PT

Question 6

what does evidence say ab the use of PNF and NDT in LE neurorehab

Answer 6

lack of evidence to support use in gait/amb training

may be beneficial for pre-gait activities and bed mobility

Question 7

what is the majority of stroke survivors ambulation status 6mo post

Answer 7

independent but most have gait abnormalities

Question 8

majority of stroke survivors are dc to where after rehab and what is their functional abilities at this point

Answer 8

home

but not functional community amb

Question 9

stance phase: normal hip movement and why

Answer 9

flex -> ext

flex - proper heel strike
ext - facilitate push off position to trigger hip flex to step

Question 10

stance phase: normal pelvis and trunk motion and why

Answer 10

(tiny) lateral horizontal shift of pelvis and trunk

critical for loading and unweighting contralateral limb

Question 11

stance phase: normal knee movement

Answer 11

10-15deg flex at IC
ext
flex in terminal stance

Question 12

6 common gait deviations in stance phase

Answer 12

1. poorly aligned trunk/pelvis
2. dec peak hip ext
3. knee hyper ext
4. lack of knee ext
5. dec PF at toe off
6. WTB on MT heads

Question 13

HCF for knee hyper ext in stance and what problems can knee hyper ext lead to

Answer 13

dec quad strength (eccentric)

can lead to issues w joint capsule and overstretching structures on post aspect of knee
- leading to inc instability of knee

Question 14

HCFs for lack of knee ext in stance

Answer 14

knee flex tone
knee/quad weakness

Question 15

HCF for dec PF at toe off in stance

Answer 15

strength deficits

Question 16

what leads to pts WTB on MT heads in stance and what problems can this lead to

Answer 16

for pt unable to maintain DF while amb

can lead to skin breakdown and injure integrity of ankle/foot

Question 17

hip and knee movement from initial to mid to terminal swing

Answer 17

initial - knee flex w hip ext
mid - hip flex w knee ext
terminal - knee full ext and ankle DF before heel strike

Question 18

pelvis motion in swing phase

Answer 18

lateral pelvic tilt downward direction 5deg

forward rotation of ipsilateral pelvis

Question 19

6 common gait deviations in swing phase

Answer 19

1. dec peak hip flex
2. no UE swing on hemi side
3. inc hip and knee flex (ataxic)
4. dec peak knee flex in early swing
5. dec knee ext in late swng
6. lack of DF/toe clearance

Question 20

what impact does dec hip flex have on the swing phase

Answer 20

dec step length

Question 21

what impact does no UE swing have in the swing phase

Answer 21

impacts balance, posture, speed

Question 22

what impact does inc hip/knee flex have in swing phase and what type of CVA is this commonly seen in

Answer 22

affects stepping, balance

cerebellar strokes

Question 23

what impact does dec peak knee flex have in early swing

Answer 23

affect momentum to swing leg through
- impacts step length

Question 24

what impact does dec knee ext have in late swing

Answer 24

IC w flex knee -> make leg unstable
dec step length

Question 25

what impact does a lack of DF have in the swing phase and what are likely HCFs

Answer 25

impacts toe clearance d/t weakness, spasticity in PFs

Question 26

general spatial and temporal characteristics of gait post stroke (4)

Answer 26

1. dec walking speed 2. dec stride length and cadence 3. shorter stance time and longer swing time of affected leg 4. shorter step length of unaffected limb (caused by dec affected limb stance time)

Question 27

how should gait training start in post stroke and how do you progress from there

Answer 27

start w postural alignment and static/stand phase control progress to dynamic control and swing phase

Question 28

when do you see the most recovery post stroke

Answer 28

first 6mo, but can continue past

Question 29

what are the key ms to focus on for gait training

Answer 29

paretic limb: - PF - hip flex - knee ext and flex non-paretic limb: - PF - knee flex

Question 30

what does evidence say ab the use of ms strengthening in gait training

Answer 30

graded ms strengthening improves strength but doesn't lead to improved walking ability w/o functional training

Question 31

how and when is intensive mobility training utilized post stroke

Answer 31

focuses on strength, balance, and aerobic exercises on a variety of walking tasks improves gait in sub-acute and chronic stroke

Question 32

what are pre-gait (part-task) activities for stance phase control (5)

Answer 32

paretic limb loading sit to stand - quad control unilateral stance side stepping standing wt shifting activities

Question 33

what are pre-gait (part-task) activities for swing phase control (4)

Answer 33

step to and step thru toe clearance heel strike wt transference to hemi side w contra swing

Question 34

what motor learning principles can be applied to overground whole-task gait training

Answer 34

quickly move out of || bars dec manual assistance, facilitation, verbal cues, feedback asap to prevent PT dependence specificity of training: - HEP - environmental factors

Question 35

what are 3 things to think ab when working on whole-task gait training

Answer 35

apply motor learning principles eval need for orthotics/ADs focus on trunk/UE as well as LE

Question 36

why do you want to move out of || bars as soon as possible when doing whole task gait training

Answer 36

want to unweight UE and onto LE often pt is pulling on bars and that isn't functional or a normal gait pattern

Question 37

what is the goal of dec the feedback you give the pt during whole task gait training

Answer 37

want them to focus on their internal feedback

Question 38

what are environmental factors to consider with whole-task gait training

Answer 38

open vs closed environment - amt of stim terrain/slope/even-ness

Question 39

what is the main goal of LE orthosis

Answer 39

walking aids to promote early mobility in non-ambulators after strokes

Question 40

what gait deviations can an AFO prevent and how

Answer 40

foot drop and knee hyper ext gastroc crosses 2 joints, the position of the ankle prevents knee hyper ext

Question 41

how does the use of a LE fit into the approaches to rehab

Answer 41

want to do restorative approach first, don't want to do compensatory strategy too soon but if only can progress forward with AD then use orthotic

Question 42

what can AFOs improve in gait (5)

Answer 42

ankle/knee kinematics kinetic/energy cost of amb walking activity walking impairment balance

Question 43

what is the goal of using FES in amb

Answer 43

activate/strengthen DF to prevent foot drop

Question 44

what does the evidence say about the use of FES for amb

Answer 44

similar outcomes to orthotics but higher quality studies are needed

Question 45

when is an appropriate time to implement body wt support treadmill training

Answer 45

early gait retraining - high reps - initiate gait

Question 46

what are the pros of using body wt support treadmill training compared to overground

Answer 46

less risk of falls safe manual facilitation of normal kinematics w fewer PTs

Question 47

what is the locomotor training protocol as applied to body wt support treadmill training

Answer 47

20-30min 3x/wk 12 wks

Question 48

what are the guidelines for the use of body wt support treadmill training

Answer 48

maximize wt bearing thru LE - start w 30% of wt supported - wean down from there want to normalize kinematics while minimizing compensation

Question 49

what does evidence say about body wt support treadmill training vs what anecdotal says

Answer 49

insufficient evidence that improves (I) walking ability - no evidence of persisting beneficial effects anecdotal evidence in clinics of quicker progress via inc walking speed and endurance - so still used

Question 50

what needs to be better understood about body wt support treadmill training

Answer 50

effects of different frequencies, durations, intensities

Question 51

what did evidence say about robotic assisted gait training

Answer 51

improved outcomes as compared to conventional gait training

Question 52

what are the 3 functional walking categories

Answer 52

physiological household walker community walker

Question 53

what interventions are appropriate for a physiological walker and what are these walkers limited by

Answer 53

exercise only: || bars, BSWTT, robotic unable to walk otherwise

Question 54

what interventions are appropriate for a household walker and what are these walkers limited by

Answer 54

short distances, ADs difficulty w stairs and uneven surfaces

Question 55

what interventions are appropriate for a community walker and what are these walkers limited by

Answer 55

faster gait speed, (I) on uneven surfaces and in crowds - enter and leave home (I) - manage stairs and curbs (I) limited by: slower gait speed and/or unable to (I) negotiate crowded areas