WEEK 7 - PHYSIOTHERAPY MANAGEMENT FOR WALKING AFTER ABI

Question 1

Common impairments that can impact gait in people with hemiparesis (5)

Answer 1

• verticality mismatch / contraversive pushing / body in space deficits
• motor impairments
  
  • mixed tone - spasticity and hypotonia
  • weakness
    
    • insufficient activation of extensors - trunk / hip / knee
    • changes from fast to super slow twitch, loss of motor units
  • loss of fractionation
    
    • influence of abnormal synergies/loss of selective muscle activation; loss of selective ankle control
  • loss of dexterity / speed of movement / coordination
• sensory deficits / kinaesthesia / proprioceptive properties
• loss of PROM - dorsiflexion ROM particularly
• HCD, awareness, judgement, anticipation

Question 2

Initial contact to mid stance - hemiparetic analysis (3)

Answer 2

• hip retraction, knee hyperextension, plantarflexion
• insufficient motor activity causes hip retraction or limp collapse
• spasticity prevents eccentric muscle activity - knee hyperextension
• ankle impairments prevent heel strike / heel rocker / efficiency

Question 3

midstance to terminal stance - hemiparetic analysis (3)

Answer 3

• lack of tibial advancement, lack of trailing limb
• plantarflexion spasticity
• lack of activation of dorsiflexors
• insufficient PROM dorsi
• lack of momentum carried from loading response
• backward trunk rotation
• insufficient stance time for step with non-paretic leg (weakness)

Question 4

terminal stance to pre-swing - hemiparetic analysis (2)

Answer 4

lack of passive knee flexion
- slow weight transfer on to non-paretic leg
- lack of lateral translation of the pelvis

• absence of push off
• lack of prepositioning (dorsi)
• lack of rapid activation / strength of plantarflexors

Question 5

swing - hemiparetic analysis (2)

Answer 5

• inadequate preparation for swing
• compensatory swing
• effortful high stepping flexion
• hip hitching and circumduction begins in pre swing

Question 6

gait analysis documentation

Answer 6

Statement of ability / assistance required

• Physio assistance, distance travelled, cadence, surface, external aids used

Measurement (or quantifying description)

Description of key features of movement

Question 7

Observation / documentation of gait (6)

Answer 7

Look for key features

1. general parameters
   - level of assistance
   - distance / speed
   - step length
   - step width
2. weight acceptance
3. stance ability
4. foot clearance
5. shock absorption - transition from swing to stance
6. propulsion