INTERVENTIONS TO IMPROVE LOCOMOTOR SKILLS Flashcards Preview

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Flashcards in INTERVENTIONS TO IMPROVE LOCOMOTOR SKILLS Deck (34):
1

Objectives

  • Collect responses to positional changes and observed balance strategies (Tues & Thur)
  • Describe interventions to improve locomotor skills

fyi

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important is Antigravity muscles
tactile cueing and approximation

Postural Tone- 

3

Amount or excursion in one direction without losing balance

Limits of Stability

4

Path of bodies movement during normal standing

Sway envelope

5

Static postural control

Stability

6

Dynamic postural control

have to have stability first

Controlled mobility

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knowing what adjustments of posture you wil have to make to keep balance

Anticipatory postural control

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Vestibular, tactile, proprioceptive, visual with postural stability.

Sensory component

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Normal Postural Synergies

Stay within LOS

these kick in first to adjust for balance loss

 

Ankle strategy

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Normal Postural Synergies

Approach LOS

adjustment of balance to not take a step when ankles don't kick in.

Hip Strategy

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Normal Postural Synergies

Stepping

Grasp

 

ankle and hip strategy is not enought to keep balance

Change of support strategy

:you got pushed beyond BOS and you have to take a step or fall grabbing something.

12

Common Impairments in Standing?

Box 7.1

Alignment
Weight bearing
Muscle Weakness
 

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Strategies to improve standing control for 

  • Flexibility and strengthening
  • Postural stabilization

     

     

this is were neuro meets ortho Dr C said

Table 7.1 and Table 7.2

 

Flexibility and strengthening

  • Core stability
  • Extremity strength and flexibility
  • Allow pt to use minimal touch down support


Postural stabilization

  • Modify BOS, sensory input, etc
  • Duel tasking- walking and carrying something
     

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  • Encourage awareness of correct position
  • Focus augmented feedback on key errors

picking out one or two key things you think will make a difference for your pt.

Verbal Cueing

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  • WB on all four limbs
  • Provides for early upright activities with wide BOS and high COM

What would initial position look like?
How can you progress this?

Modified Plantigrade

standing place both hands on hip height surface instead of paralell bars

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Stabilizing reversals
Rhythmic stabilization
Weight shifts
Dynamic reversals
Where would we progress from here?

Modified Plantigrade

 

do them in standing 

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Standing…how do we get more control

 

What other activities?

 

What PNF activities 

Do an entire body exercise involvement-  ex use theraband in standing pt holds and PTA stands in front pulling. 

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Now you are stepping…

What activities are you going to do to improve this?

How do  you improve balance?

How can you change sensory input to challenge the patient?

What activities are you going to do to improve this?
weight shifts, quick stretch

How do  you improve balance?

change surface with purturbations

 

How can you change sensory input to challenge the patient?

use med bal for approximation for proprioception 

19

Review Gait terminology

Table 8.1
Traditional
STANCE PHASE: Heel, Foot, Mid, Heel & Toe
SWING PHASE: Acceleration, Mid & Deceleration
Rancho Los Amigos
STANCE PHASE: Initial, Loading, Mid, Terminal & Preswing
SWING PHASE: Initial, Mid & Terminal
*Note mistake at top of 196- should read Swing Phase at top of table

Stance Phase- what percent 

 

Swing Phase- what percent

Stance Phase- 60% of gait cycle

Swing Phase- 40% of gait cycle

20

go over

What is the difference between the following terms?
Stance time
Step length
Step width
Stride length
Stride width

go over table 8.2

21

how does a PT gather Data Collection from Gait Analysis?

 

  • Identify gait deviations and possibly the cause
  • Establish PT diagnosis and prognosis
  • Developing a POC
  • “Determining need for assistive device, protective equipment or prosthetic or orthotic devices”
  • Analyzing the use of an assistive device or fit of a device
  • Promote patient learning and improved function of the patient

22

Group Activity (30 min)- Review Box 8.1- Common Gait Deviations
Review and physically mimic gait deviations
Be prepared to discuss and demo 

lateral trunk bend

trendelenburg gait

backward trunk lean

forward tunk lean

excessive hip flexion

limited hip extension

antalgic gait 

23

Walking Interventions

what are the Prerequisites?

  • “appropriate weightbearing status-may improve with assistive device.
  • Postural alignment- if we can correct may not be as bad as thought
  • ROM- work on to fix
  • Muscle performance- meaning is it kicking in properly 
  • Motor function -is itfucntioning correctly
  • Balance- 
  • Static and dynamic standing control”

24

Walking Interventions

Walking Forward and Backward

  • Progression from stepping in place
  • Therapist is looking for…
    • Timing and sequencing
    • Pelvic rotation
    • Knee extension w/hip flexion and knee flexion w/hip extension

25

Clinical Decision Making/Critical Thinking:

What manual contacts can be used with a patient displaying decreased pelvic rotation during the swing phase?  What about decreased hip extension with backward walking? 

the quick stretch

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Walking Interventions

Progressing walking forward and backward

  • Level of assistance
  • Step length
  • Walking speed
  • Modify BOS
  • Acceleration/decelaration- can they do when they need to
  • Dual-task walking- walk and carrying something/younger-walking and tossing a ball
  • Environment- change to outside maybe hallways with people walking by

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Walking Forward and Backward

Techniques and Verbal Cues

Resisted Progression
Fig 8.1

  • Resistance should be light
  • Approximation can be used over the pelvic of the stance leg
  • Quick stretch can be used to elicit pelvic rotation-low level parkinsons
  • What about verbal cues- keep simple
  • T-Band…. Fig 8.2- assists with resistance for strength and endurance
  • Wood poles (dowels)…. Fig 8.3- assists with reciprocal arm swing, pelvic rotation and trunk rotation

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what we did in class

In groups, discuss the other activities located in the chapter
Procedure
Verbal or tactile cues?

Walking, Side-stepping
Walking, Side-stepping and Crossed-Stepping
Walking, Braiding
Stair Climbing
20-25 minutes

fyi

29

Strategies for Varying Locomotor Task Demands

take a look at 

Box 8.2
Box 8.3- Varying Environmental Demands

fyi

30

Body Weight Support and Treadmill Training

  • Body weight is supported through a trunk harness
  • Can be used over the treadmill and over ground

31

Whole-task practice versus parts-to-whole

Whole-task practice - doing all together

parts-to-whole- breaking exerxise down

32

Sensory Stimulation Techniques are used how?
 

Manual contact from therapists

33

another thing we did

LAB ACTIVITY:
Box 8.6
Complete in pairs and/or small groups
Take notes for yourself
Nothing required to turn in

 

Continued practice of PNF and techniques if time allows

fyi

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