Alteração de marcha Flashcards
O que perguntar na história de uma queixa de alteração de marcha?
When reviewing the history, it is helpful to inquire about (1) the onset and progression of disability. Initial awareness of an unsteady gait often follows (2) a fall. It is always important to (3) review the use of alcohol and medications that affect gait and balance.
O que avaliar na marcha desses pacientes?
Gait observation provides an immediate sense of the patient’s degree of disability. Characteristic patterns of abnormality are sometimes observed, though failing gaits often look fundamentally similar. Cadence (steps/ min), velocity, and stride length can be recorded by timing a patient over a fixed distance. Watching the patient get out of a chair provides a good functional assessment of balance.
Qual o exame de escolha na investigação de alteração de marcha a/e?
Brain imaging studies may be informative in patients with an undiagnosed disorder of gait
O que eu posso fazer para reduzir quedas?
Standing blood pressure should be recorded.
A home visit to look for environmental hazards can be helpful. A variety of modifications may be recommended to improve safety, including improved lighting and the installation of grab bars and nonslip surfaces.
Rehabilitation interventions attempt to improve muscle strength and balance stability and to make the patient more resistant to injury.
Sensory balance training is another approach to improve balance stability. Measurable gains can be achieved in a few weeks of training, and benefits can be maintained over 6 months by a 10- to 20-min home exercise program. This strategy is particularly successful in patients with vestibular and somatosensory balance disorders. The Yale Health and Aging study used a strategy of targeted, multiple risk factor abatement to reduce falls in the elderly. Prescription medications were adjusted, and home-based exercise programs were tailored to the patients’ needs, based on an initial geriatric assessment. The program realized a 44% reduction in falls, compared with a control group of patients who had periodic social visits.
