abnormal mobility Flashcards
paresis/weakness reduces the ability to?
generate force; huge contributor to disordered gait
true or false: paresis is a primary neuromuscular impairment
true
what does pauses affect?
number, type, and disagree frequency of motor neurons needed for force production in gait
true or false: paresis does not affect both neural and non neural components of force prooudction
false: it does affect both
what does paresis do to gait speed?
slows it down
true or false: paresis causes the loss of eccentric and concentric control
true
paresis/weakness of the ankle and knee causes (4)
- reduced PF activation
- reduced DF activation
- knee hyperextension in stance phase
- lack of knee flexion in swing phase
true or false: PF paresis is one of the factors leading to knee hyperextension in stance post stroke
true - PF are a 2 joint muscle where the plantar flexors should be able to help stabilize the knee and prevent hyperextension
paresis of the quadriceps leads to?
- knee hyperextends during mid stance (gene recurvatum)
- forward trunk lean (creates extensor moment at knee)
hyperextension compensation of the knee leads to
- diminished knee flexion in swim
- knee trauma over time
paresis of the hip flexors leads to
- diminished knee flexion during swim
- to clearance
- shortened step length (impacts foot position at IC)
- compensatory strategies
compensatory strategies of paresis of the hip flexors
- hip hike (posterior pelvic tilt/abdominal contraction)
- circumduction
-vaulting - lateral lean
paresis of the hip extensors lead to
- difficulty holding trunk erected (threatens stability)
- causes. backward leaning to bring COM behind the hips
paresis of hip abductors leads to
- drop of the pelvis on the contralateral side to the weakness (trendelenburg gait)
- compensation
- lateral shift of COM and lateral trunk lean over the stance leg
spasticity and its effects on gait
- results in appropriate activation of the muscle at points during the gait cycle when it is being rapidly lengthened
- it alters the technical properties of a muscle, producing increased stiffness
when in the gait cycle is the quad rapidly lengthened?
- early stance phase during loading response
- when the knee flexes during initial swing
when in the gait cycle does the hamstring is rapidly lengthened?
terminal swing
spasticity of the plantarflexor includes
-abnormal activation of the triceps sure during early stance phase (knee hyperextension)
- TS activation/stiffness in swig (toe drag)
- TS and posterior tibalis (equinovarus positioning)
spasticity of the quadriceps include
- excessive knee extension in stance
- quad spasticity leads to stiff-knee gait during swing phase (decrease knee flexion and hip circumduction during swing phase of gait)
spasticity of hamstrings include
- excessive activation prevents knee from fully extending (knee flexion at IC)
- excessive knee flexion persists throughout stance (couched gait pattern)
spasticity of the adductors include
- adductor spasticity produces contralateral drop of pelvis and stance (femur drawn medially)
- scissoring gait
loss of selective control and emergence of abnormal synergies
- inability to recruit muscles selectively (associated with abnormal coupling of muscles)
- sterotypical movement strategies ( abnormal synergies or synkinesia)
- manifested in gait as total extension or total flexion patterns
coordination problems
- non-stretch related muscle overactivity
- poor segmental and intersegmental coordination (poor timing and scaling of muscle activity and coordination between the 2 LE or between the LEs and UEs)
- coactivation of agonists/antagonists
musculoskeletal impairments
- weakest
- loss of ROM and contractures
- changes in alignment
proprioceptive loss include
CVA and controls had vibration to the TA
visual deficits
- vision critical to proactive balance (anticipation of obstacles)
- leads to reduced gait speed
- in the blind, increases reliance on auditory cues
- obvious impairments in route finding
vestibular deficits
- gait ataxia
- impair gaze stabilization during gait
- lead to reduce gait speed
oscillopsia
world moving when it is not
perceptual deficits
- impaired body image or scheme (ipsilateral trunk lean towards stance leg)
- unilateral spatial neglect (R CVA/L hemis)
perceptual problems may include
- spatial relations disorder
topographical disorientation
antalgic gait
what is spatial relations disorder
affects the ability to negotiate the environment, without bumping into obstacles (both walking and in wheelchair)
what is topographical disorientation
inability to remember the relationship of one place to another
what is antalgic gait
gait pattern that results from pain
antalgic gait may include what kind of results
- reduced weight bearing time on a painful limb
- avoidance of impact loads
- reduced joint excursion
- minimized muscle activation across a joint
impaired cogitation –> impaired dual task may include
- posture, balance, and gait require attentional resources
- attentional demands for postural control in stance and gait are greater in individuals with impaired balance compared to norms
- important to evaluate walking function under more complex conditions, especially in neurological clients
what factors limi participation in the mobility domain?
- depression
- fatigue
balance/fall self efficacy - usual gait velocity
- hemiparetic limb strength
disorders of mobility (other than gait)
- gait initiation
ability to maintain balance while COM shifts Post?lat towards swing limb, then to stance limb and forward beyond BOS - anticipatory balance that control dynamic stability are critical to the complex process of gait initiation
disorders of mobility continue pt2…. other than gait
- stair walking (ascend, descend)
- reduced anticipatory PF activation for energy absorption when descending
- instability during longer periods of single limb stance
disorders of mobility continue pt3… other than gait
-transfers and bed mobility
- STS
- Rise to walk
true or false: use force control strategy or zero momentum strategy for those with cardiovascular problems (orthostatic hypotension), episodes of dizziness
true
other mobility tasks - limitations with bed mobility may include
- difficulty rolling away from a weak side
- difficulty pushing from side lying to sitting on a weak side
- difficulty lifting legs into bed moving from sitting to lying
Functional Gait Assessment (FGA) fall risk score
less than or equal to 22 out of 30
<22/30
cut off score for 5xSTS
12 seconds (roughly)
cut off score for Gait velocity
1.13m/s (0.8 for community ambulatory)
cut off scores for 6MWT
527meters =1,729 feet
cicumduciton impairment may present as? treatment>
- plantar flexion tightness
- calf stretches
genuine recurvatum impairment may present as? treatment
- hamstring weakness
- eccentric knee extension
forward trunk lean imparment may present as
- quad weakness
- step ups/downs, quad strengthening
scissoring gait impairment may present as? treatment?
- adductor spasticity
- stretch add, straddle line/central divider
coactivation of muscles impariemtn may present as? treatment?
- cerebellar ataxia
- reverse walking downstairs
lateral lean impairment may present as? treatment?
- hip abductor weakness
- standing hip abduction ex (monster walk)
loss of balance turning impairment may present as? treatment?
anticipatory balance
- walking with lots of direction changes
excessive knee flexion in stance impairment may present as? treatment?
- LE proprioceptive loss
- mirror for feedback, walk down hills
foot drag impairments may present as? treatment?
- DF weakness
- seated toe taps
poor endurance impairment may present as? treatment?
- decreased conditioning
- HIIT with limited resting, vital signs monitoring
