Ambulation Assessment and Training

Question 1

what are some gait recovery predictors

Answer 1

initial ASIA classification
classification and age
Lower Extremity Motor Score
Quad Strength ( >3/5 indicates likelihood of ambulation)
sparing of pin prick sensation

Question 2

what ranges of motion do we want in the lower extremity joints for gait

Answer 2

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

Question 3

what are some things we look at when evaluating gait potential

Answer 3

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

Question 4

At what level of injury is community ambulation a goal

Answer 4

L4 and below

Question 5

at what levels of injury is household ambulation a goal

Answer 5

L1, L2 and L3

Question 6

at what levels of injury is exercise ambulation a goal

Answer 6

above T2, T2-T6, T7-T10, T11-T12

Question 7

What might you expect at T2 level of injury

Answer 7

partial UE function
tilt table, standing frames
goals: standing,exercise

Question 8

what might you expect at T2-T6 level of injury

Answer 8

complete UE function
standing frame, RGO
goal:standing, exercise

Question 9

what would you expect for T7-T12 level of injury

Answer 9

partial to complete trunk function
standing and exercise ambulation
RGO, KAFO
bracing is usually recommended
wheelchair is primary mode of locomotion

Question 10

what would you expect for L1 level of injury

Answer 10

complete trunk function
some hip flexion
RGO, KAFO
exercise and household ambulation
bracing is recommended
w/c is primary mode of locomotion

Question 11

what would you expect for someone with L2 level of injury

Answer 11

stronger hip flexors
KAFO
exercise and household ambulation
bracing is recommended
wheelchair is primary mode

Question 12

what would you expect for someone with L3 level of injury

Answer 12

quad strength-knee control
combo of KAFO/AFO or just bilateral AFO
household or community ambulation
bracing recommended
wheelchair is primary mode

Question 13

what would you expect for someone with L4 and below level of injury

Answer 13

full quads
partial hamstring
AFO or SMO
bracing recommended
usually community ambulator

Question 14

hip flexor strength requirement

Answer 14

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

Question 15

quad strength requirement

Answer 15

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

Question 16

hamstring strength requirements

Answer 16

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

Question 17

dorsiflexion strength requirements

Answer 17

need an AFO if strength of 0,1,2 or 3

4,5 orthotic depends on PF strength and proprioception

Question 18

what is the importance of strong plantarflexors

Answer 18

provides eccentric tibial control in stance
weight shifting
step length on contralateral side

Question 19

what is the primary goal of locomotor training

Answer 19

provide sensory cues to retrain neural patterns that will result in effective locomotion

Question 20

with what population is locomotor training evidence found the best in

Answer 20

best evidence is with incomplete SCI

Question 21

How long must someone be able to tolerate standing with a good hemodynamic response as well to be allowed to locomotor train

Answer 21

for 20 minutes

Question 22

what are contraindications for locomotor training

Answer 22

unstable fractures
osteoporosis
open wounds
contact precautions
contractures

Question 23

what is the andago

Answer 23

a manually assisted treadmill training system that offers dynamic body weight support

Question 24

what body weight gait training device can be used over a treadmill or the ground

Answer 24

the Lite Gait; it allows for some manual facilitation but may need more than one person to control the device

Question 25

what is the lokomat

Answer 25

a driven robotic gait orthosis that guides the patients legs on a treadmill

Question 26

progression of sit to stand

Answer 26

bilateral UE on parallel bar–>one on bar one on w/c–>bilateral UE on w/c

Question 27

what is the guarding technique when someone is practicing trunk balance in standing

Answer 27

facilitate from behind or the side with one hand on their shoulder
tell them to hang on their Y ligaments for less muscle activation

Question 28

what is it called when you hang on your Y ligaments for passive stability

Answer 28

parastance position

Question 29

which gait pattern as the feet going past the hands

Answer 29

swing through

Question 30

which gait pattern has the feet progressing forward to the hands

Answer 30

swing to

Question 31

what is the sequence of a four point gait pattern

Answer 31

right crutch-left leg-left crutch-right leg

head follows the direction of the leading leg