Test 3: Gait Interventions Flashcards
statistics of walking deficits with stroke pts
2/3 of people w/ stroke cannot walk/require assist
3 months post stroke, 1/3 still require assistance
what stage of parkinsons are postural deficits common
stage 3
affects walking
statistics for those with MS who need walk assist
50% require assistance within 15 years of dx
locomotion definition
ability to move from one place to another
walking, wheelchair, etc
importance of locomotor training
decreased burden of care
better participation in social roles and work
higher QOL
better aerobic capacity
improved overall health
signs that gait is safe to begin training
trunk control (HAT- head, arm, trunk)
weight shift/acceptance on affected limb
attention to task
ROM at LE joints
stability at ankle
static/dynamic standing control
what to consider before initiating gait training
has pt done it before?
if so, how much assistance?
use any orthotics/ADs?
how to analyze gait prior to starting training
observational gait analysis (continuous task- cant use hedman model)
RLA gait analysis form (foot clearance, weight acceptance, stance vs swing, etc)
gait assessment objective measure examples
TUG
10 MWT
FGA/DGI
6MWT
community balance and mobility scale
mini Best
examples of reasons a pt may have short step length
decreased strength in stance limb
weakness of hip flexors in swing
tight hip flexors
fatigue/endurance deficits
knee buckling/poor quad recruitment
interventions you may do prior to gait to address body structure and function impairments
hip stability
hip flexion strength
quad control
ankle stability
power training
ROM/spasticity reduction
PT considerations for functional strengthening of LEs for gait training
resistance training should be at intensities lower than 60% 1RM
perform for time rather than reps
improve oxidative capacity of muscles for power/endurance
perform both concentric and eccentric
what may cause insufficient DF ROM
muscle tightness
loss of control
edema
what may cause inappropriate foot contact during gait
weakness at foot/ankle
muscle tightness
foot posturing
purpose of an aircast at the ankle
improve ankle stability to improve weight acceptance and decrease fear of re-injury
correct supination often seen in neurologic gait
ways to facilitate foot clearance
ace wrap around ankle and foot to facilitate DF
tape on toe/plastic sliders to reduce toe friction
theraband to facilitate knee flex; need 60 deg of flexion in swing for foot clearance
general intervention goals
improve functional skills/motor learning
make interventions intense enough to promotr behavioral change and neural organization
final goal = adaptability of learned skill for independent function
what is pregait training
for lower lvl pts to emphasize stance stability
acute phase
b/c stance = 60% gait
why is a good stance phase key to successful swing
quick stretch on hip flexors
swing is momentum
what do you look for when observing gait and choosing interventions for pre gait training
dynamic standing posture control while executing
ability to weight shift at initiation
ability to accept weight
stability/ROM of ankle
overshooting step length in termination
how to initiate overground training
pregait therapy - i.e. weight shift
lead up exercises - affected limb in ext; work to lead up to reciprocal stepping
encourage larger steps; hip flexors stretched activates gait pattern generator
Examples of early gait activities in the acute stage
equal WBing in LEs
equal WBing in UEs
trunk cintrol
facilitated fwd progression
use it and improve it
examples of functional task specific progressions in gait training
walking in all directions
different surfaces
stair climbing
step over
walking in simulated home environment
walking in community
activities with coincident timing
dual task activities
advanced gait challenges/progressions
step over with affected or unaffected LE - facilitate swing or WBing
walking on slope- increase DF/control knee hyperext
walking down slope- eccentric activation
walk wiht paretic side by wall- reduce circumdiction
walking on unlevel surface - promote stability
