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Neuro Rehab 2 > CVA - 5a Stroke Rehab Gait > Flashcards

CVA - 5a Stroke Rehab Gait Flashcards

1
Q

primary vs secondary LE impairments

A

primary:
- motor control/activation
- altered ms tone
- loss of sensation
- coordination problems

secondary:
- weakness, atrophy
- ms length, ROM
- edema
- pain

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2
Q

what is the emphasis of LE neurorehab and why

A

gait training

amb is key functional activity for participation and quality of life

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3
Q

what are 3 interventions of LE neurorehab

A

functional retraining
gait training*
strength training

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4
Q

what functional retraining interventions are included in LE neurorehab

A

bed mobility
bridging
balanced sitting/standing
sit to stand transfers

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5
Q

what context is strength training often utilized for LE neurorehab

A

more functional and get them on programs to be doing outside PT

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6
Q

what does evidence say ab the use of PNF and NDT in LE neurorehab

A

lack of evidence to support use in gait/amb training

may be beneficial for pre-gait activities and bed mobility

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7
Q

what is the majority of stroke survivors ambulation status 6mo post

A

independent but most have gait abnormalities

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8
Q

majority of stroke survivors are dc to where after rehab and what is their functional abilities at this point

A

home

but not functional community amb

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9
Q

stance phase: normal hip movement and why

A

flex -> ext

flex - proper heel strike
ext - facilitate push off position to trigger hip flex to step

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10
Q

stance phase: normal pelvis and trunk motion and why

A

(tiny) lateral horizontal shift of pelvis and trunk

critical for loading and unweighting contralateral limb

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11
Q

stance phase: normal knee movement

A

10-15deg flex at IC
ext
flex in terminal stance

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12
Q

6 common gait deviations in stance phase

A
  1. poorly aligned trunk/pelvis
  2. dec peak hip ext
  3. knee hyper ext
  4. lack of knee ext
  5. dec PF at toe off
  6. WTB on MT heads
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13
Q

HCF for knee hyper ext in stance and what problems can knee hyper ext lead to

A

dec quad strength (eccentric)

can lead to issues w joint capsule and overstretching structures on post aspect of knee
- leading to inc instability of knee

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14
Q

HCFs for lack of knee ext in stance

A

knee flex tone
knee/quad weakness

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15
Q

HCF for dec PF at toe off in stance

A

strength deficits

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16
Q

what leads to pts WTB on MT heads in stance and what problems can this lead to

A

for pt unable to maintain DF while amb

can lead to skin breakdown and injure integrity of ankle/foot

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17
Q

hip and knee movement from initial to mid to terminal swing

A

initial - knee flex w hip ext
mid - hip flex w knee ext
terminal - knee full ext and ankle DF before heel strike

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18
Q

pelvis motion in swing phase

A

lateral pelvic tilt downward direction 5deg

forward rotation of ipsilateral pelvis

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19
Q

6 common gait deviations in swing phase

A
  1. dec peak hip flex
  2. no UE swing on hemi side
  3. inc hip and knee flex (ataxic)
  4. dec peak knee flex in early swing
  5. dec knee ext in late swng
  6. lack of DF/toe clearance
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20
Q

what impact does dec hip flex have on the swing phase

A

dec step length

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21
Q

what impact does no UE swing have in the swing phase

A

impacts balance, posture, speed

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22
Q

what impact does inc hip/knee flex have in swing phase and what type of CVA is this commonly seen in

A

affects stepping, balance

cerebellar strokes

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23
Q

what impact does dec peak knee flex have in early swing

A

affect momentum to swing leg through
- impacts step length

24
Q

what impact does dec knee ext have in late swing

A

IC w flex knee -> make leg unstable
dec step length

25
Q

what impact does a lack of DF have in the swing phase and what are likely HCFs

A

impacts toe clearance

d/t weakness, spasticity in PFs

26
Q

general spatial and temporal characteristics of gait post stroke (4)

A
  1. dec walking speed
  2. dec stride length and cadence
  3. shorter stance time and longer swing time of affected leg
  4. shorter step length of unaffected limb (caused by dec affected limb stance time)
27
Q

how should gait training start in post stroke and how do you progress from there

A

start w postural alignment and static/stand phase control

progress to dynamic control and swing phase

28
Q

when do you see the most recovery post stroke

A

first 6mo, but can continue past

29
Q

what are the key ms to focus on for gait training

A

paretic limb:
- PF
- hip flex
- knee ext and flex

non-paretic limb:
- PF
- knee flex

30
Q

what does evidence say ab the use of ms strengthening in gait training

A

graded ms strengthening improves strength but doesn’t lead to improved walking ability w/o functional training

31
Q

how and when is intensive mobility training utilized post stroke

A

focuses on strength, balance, and aerobic exercises on a variety of walking tasks

improves gait in sub-acute and chronic stroke

32
Q

what are pre-gait (part-task) activities for stance phase control (5)

A

paretic limb loading
sit to stand - quad control
unilateral stance
side stepping
standing wt shifting activities

33
Q

what are pre-gait (part-task) activities for swing phase control (4)

A

step to and step thru
toe clearance
heel strike
wt transference to hemi side w contra swing

34
Q

what motor learning principles can be applied to overground whole-task gait training

A

quickly move out of || bars

dec manual assistance, facilitation, verbal cues, feedback asap to prevent PT dependence

specificity of training:
- HEP
- environmental factors

35
Q

what are 3 things to think ab when working on whole-task gait training

A

apply motor learning principles

eval need for orthotics/ADs

focus on trunk/UE as well as LE

36
Q

why do you want to move out of || bars as soon as possible when doing whole task gait training

A

want to unweight UE and onto LE

often pt is pulling on bars and that isn’t functional or a normal gait pattern

37
Q

what is the goal of dec the feedback you give the pt during whole task gait training

A

want them to focus on their internal feedback

38
Q

what are environmental factors to consider with whole-task gait training

A

open vs closed environment
- amt of stim
terrain/slope/even-ness

39
Q

what is the main goal of LE orthosis

A

walking aids to promote early mobility in non-ambulators after strokes

40
Q

what gait deviations can an AFO prevent and how

A

foot drop and knee hyper ext

gastroc crosses 2 joints, the position of the ankle prevents knee hyper ext

41
Q

how does the use of a LE fit into the approaches to rehab

A

want to do restorative approach first, don’t want to do compensatory strategy too soon

but if only can progress forward with AD then use orthotic

42
Q

what can AFOs improve in gait (5)

A

ankle/knee kinematics
kinetic/energy cost of amb
walking activity
walking impairment
balance

43
Q

what is the goal of using FES in amb

A

activate/strengthen DF to prevent foot drop

44
Q

what does the evidence say about the use of FES for amb

A

similar outcomes to orthotics but higher quality studies are needed

45
Q

when is an appropriate time to implement body wt support treadmill training

A

early gait retraining - high reps
- initiate gait

46
Q

what are the pros of using body wt support treadmill training compared to overground

A

less risk of falls
safe manual facilitation of normal kinematics w fewer PTs

47
Q

what is the locomotor training protocol as applied to body wt support treadmill training

A

20-30min
3x/wk
12 wks

48
Q

what are the guidelines for the use of body wt support treadmill training

A

maximize wt bearing thru LE
- start w 30% of wt supported
- wean down from there

want to normalize kinematics while minimizing compensation

49
Q

what does evidence say about body wt support treadmill training vs what anecdotal says

A

insufficient evidence that improves (I) walking ability
- no evidence of persisting beneficial effects

anecdotal evidence in clinics of quicker progress via inc walking speed and endurance
- so still used

50
Q

what needs to be better understood about body wt support treadmill training

A

effects of different frequencies, durations, intensities

51
Q

what did evidence say about robotic assisted gait training

A

improved outcomes as compared to conventional gait training

52
Q

what are the 3 functional walking categories

A

physiological
household walker
community walker

53
Q

what interventions are appropriate for a physiological walker and what are these walkers limited by

A

exercise only: || bars, BSWTT, robotic

unable to walk otherwise

54
Q

what interventions are appropriate for a household walker and what are these walkers limited by

A

short distances, ADs

difficulty w stairs and uneven surfaces

55
Q

what interventions are appropriate for a community walker and what are these walkers limited by

A

faster gait speed, (I) on uneven surfaces and in crowds
- enter and leave home (I)
- manage stairs and curbs (I)

limited by:
slower gait speed and/or unable to (I) negotiate crowded areas

Neuro Rehab 2 (48 decks)

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