(2) Gait Interventions HEMI POP Flashcards

1
Q

What are the 4 main reasons to work on Gait?

A
  1. its the primary goal (salience)
  2. independent ambulation leads to lower burden of care and improved ability to participate in meaningful social roles
  3. transference (indirect improvement in other functional tasks)
  4. gait speed correlates with fear of falling, fall risk, strength, balance, community mobility, QOL
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2
Q

to improve walking function in abulatory chronic CVA, iSCI, TBI, Clinicians SHOULD perform…

A

walking training at moderate to high aerobic intensities, walking training with VR

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3
Q

(when gait at high int is not possible….)
to improve walking function in ambulatory chronic CVA, iSCI, TBI, clinicians MAY consider:

A

strength training at > 70% 1RM
Circuit training, cycling, or recumbent stepping at 75-85% HR max
Balance training w/ VR

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4
Q

Dont think you are improving gait with

A

balance interventions, BWSTT w manual assist
robotic walking

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5
Q

Why is VR good?

A

Neuroplasticity: Salience! (they can choose if they are on the beach or street…)
Autonomy (pts who have a choice do better)
External focus of control

WHEN VR ISN’T AVAILABLE apply these concepts!

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6
Q

are there CPG for gait in subacute stroke?

A

NO but current evidence strongly points to the same treatment principles as chronic stroke

(high rep, high intensity training to improve gait, leap-frog principle, no need to facilitate normal movements)

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7
Q

Evidence for HIGT: in GAIT

A

significant improvements in 6MWT and 10MWT

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8
Q

Evidence for HIGT: in balance and function

A

same or greater improvements in berg and functional measures (trandfers and 5xSTS)

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9
Q

Evidence for HIGT: in kinematics

A

sig improvements in speed, gait symmetry (stance time, step length)
general improvement in sagittal plane kinematics
compensatory patterns noted in frontal plane (increased gait speed in pts who are low level to start with)

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10
Q

How do you assess gait prior to intervention

A

follow movement task analysis framework (movement constructs, progressions, regressions)
intervene as little as possible by minimizing verbal, tactile cues and devices
KEEP THEM SAFE

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11
Q

assessing gait: if pt is independent ambulator…

A

walk down hall with usual devices and self selected speed.
add progressions as needed

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12
Q

assessing gait: if pt is not independent

A

focus on safety
good options: rail, hemi rail, parallel bars, bilateral hand held
add task progressions or regressions as indicated

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13
Q

4 variables HIGT

A

specificity repetition intensity and variability/error

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14
Q

specificity:

A

task specific
primary goal is to improve gait then prim intervention should be gait!
eliminate non gait interventions if time is limited

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15
Q

repetition

A

as many steps as possible in a session! minimize rest breaks, pedometer if possible
conventional therapy is 1000 steps/day
high rep therapy is 2000-6000 steps/day feasible in IPR

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16
Q

intensity

A

high HR! 70-80 HRR = HIT
use RPE as sub

17
Q

Variability and error

A

allow and even encourage errors!
perfect practice DOES NOT equal perfect performance or motor learning!!!!
contributes to improvements in performance not just capacity
encourages improvement in non gait parameters – balance, transitional movement ect

18
Q

what are the 4 biomechanical subcomponents of gait

A

propulsion, limb swing, postural stability, stance control

19
Q

success and energy cost for propulsion

A

moving in a defined direction
42-48

20
Q

success and energy cost limb swing

A

moving past CL limb
10-20

21
Q

success and energy cost of postural stability

A

not falling (maintaining stability)
6

22
Q

success and energy cost for stance

A

limb not collapsing
25-28

23
Q

assist as needed and error augmentation for propulsion

A

AAN: manual assistance (walker, tech moving device forward), bands with ANT resistance
EA: verbal cues walk faster, increase treadmill speed, incline walking, resisted walking

24
Q

assist as needed and error augmentation for limb swing

A

AAN: band ant assist, manual assistance
EA: weights, post band resist, vary direction, reciprocal stairs

25
Q

assist as needed and error augmentation for postural stability

A

AAN: physical assist, UE support, BW support
EA: take away support, change BOS, change gait surface

26
Q

assist as needed and error augmentation for stance

A

AAN: BW support, hand held assist
EA: weighted vests, recip. stairs

27
Q

assist as needed and error augmentation for ST

A