Ambulation Assessment and Training Flashcards
what are some gait recovery predictors
initial ASIA classification classification and age Lower Extremity Motor Score Quad Strength ( >3/5 indicates likelihood of ambulation) sparing of pin prick sensation
what ranges of motion do we want in the lower extremity joints for gait
ankle- need at least neutral but would like 10 degrees or more of DF
knee- full extension and flexion
hip- neutral or at least 10 degrees extension
what are some things we look at when evaluating gait potential
LEVEL OF INJURY- must have fair trunk strength. those with function in muscles crossing the hip do better
UPRIGHT TOLERANCE- tolerate upright with good hemodynamic response for 20 min before being cleared for locomotor training
ENDURACE- physical and mental
UE STRENGTH
PROM
BALANCE- trunk strength of at least a 3+
SPASTICITY- more difficult to ambulate and unsafe
At what level of injury is community ambulation a goal
L4 and below
at what levels of injury is household ambulation a goal
L1, L2 and L3
at what levels of injury is exercise ambulation a goal
above T2, T2-T6, T7-T10, T11-T12
What might you expect at T2 level of injury
partial UE function
tilt table, standing frames
goals: standing,exercise
what might you expect at T2-T6 level of injury
complete UE function
standing frame, RGO
goal:standing, exercise
what would you expect for T7-T12 level of injury
partial to complete trunk function standing and exercise ambulation RGO, KAFO bracing is usually recommended wheelchair is primary mode of locomotion
what would you expect for L1 level of injury
complete trunk function some hip flexion RGO, KAFO exercise and household ambulation bracing is recommended w/c is primary mode of locomotion
what would you expect for someone with L2 level of injury
stronger hip flexors KAFO exercise and household ambulation bracing is recommended wheelchair is primary mode
what would you expect for someone with L3 level of injury
quad strength-knee control combo of KAFO/AFO or just bilateral AFO household or community ambulation bracing recommended wheelchair is primary mode
what would you expect for someone with L4 and below level of injury
full quads partial hamstring AFO or SMO bracing recommended usually community ambulator
hip flexor strength requirement
2/5 is sufficient to advance the leg even with a KAFO
anything less than that would require trunk/pelvis stability or compensation to advance forward
quad strength requirement
score of 0,1or 2 requires a locked KAFO or stance control
score of 3 may unlock KAFO
score of 4 or 5 no bracing at knee; only AFO
hamstring strength requirements
3,4,5 will stabilize the knee in stance
strength of 0,1,2 may present with genu recurvatum, increased WB on UE, and uneven stance
dorsiflexion strength requirements
need an AFO if strength of 0,1,2 or 3
4,5 orthotic depends on PF strength and proprioception
what is the importance of strong plantarflexors
provides eccentric tibial control in stance
weight shifting
step length on contralateral side
what is the primary goal of locomotor training
provide sensory cues to retrain neural patterns that will result in effective locomotion
with what population is locomotor training evidence found the best in
best evidence is with incomplete SCI
How long must someone be able to tolerate standing with a good hemodynamic response as well to be allowed to locomotor train
for 20 minutes
what are contraindications for locomotor training
unstable fractures osteoporosis open wounds contact precautions contractures
what is the andago
a manually assisted treadmill training system that offers dynamic body weight support
what body weight gait training device can be used over a treadmill or the ground
the Lite Gait; it allows for some manual facilitation but may need more than one person to control the device
what is the lokomat
a driven robotic gait orthosis that guides the patients legs on a treadmill
progression of sit to stand
bilateral UE on parallel bar–>one on bar one on w/c–>bilateral UE on w/c
what is the guarding technique when someone is practicing trunk balance in standing
facilitate from behind or the side with one hand on their shoulder
tell them to hang on their Y ligaments for less muscle activation
what is it called when you hang on your Y ligaments for passive stability
parastance position
which gait pattern as the feet going past the hands
swing through
which gait pattern has the feet progressing forward to the hands
swing to
what is the sequence of a four point gait pattern
right crutch-left leg-left crutch-right leg
head follows the direction of the leading leg
