CVA Impairments 4: Gait/Assistance/Orthotics

Question 1

0-0.4 m/s gait speed is associated with

Answer 1

household ambulation
(0-0.2 = d/c to SNF)

Question 2

0.4-0.8 m/s gait speed is associated with

Answer 2

limited community ambulator

Question 3

0.8 - 1/2 m/s gait speed is associated with

Answer 3

community ambulation

Question 4

1.2 - 1.4 m/s gait speed is associated with

Answer 4

crossing street, normal walking speed

Question 5

Preferred gait speed of chronic stroke patients is

Answer 5

0.10 m/s to 0.76 m/s

Question 6

_______ weakness could result in compensation at the trunk seen as an ipsilateral trunk lean

Answer 6

glute med

Question 7

Pelvis/Hip at IC - MSt

Answer 7

↓ pelvic rotation/hip flexion
↑ hip IR/ adduction (Trendelenburg)

Question 8

3 Common Knee Patterns IC –> MSt

Answer 8

1. ↑ flexion (IC)
2. ↓ flexion early stance > hyperext mid-late stance
3. Excessive hyperext throughout most of stance phase

Question 9

Common foot/ankle patterns IC –> Mst

Answer 9

↓ TIBIAL PROGRESSION
↓ ankle DF
Lack of heel strike
Flat foot contact
Instability at foot ankle contact > inversion, supination
Pes Planus

Question 10

Pelvis/Hip at MSt > TSt

Answer 10

↓ pelvic rotation
↓ hip EXT/TSt
Hip flex (forward progression)

Question 11

Knee at MSt > TSt

Answer 11

↓ knee EXT
Knee buckling
Delayed movement into knee flex (prep for swing)

Question 12

Foot/ankle at MSt > TSt

Answer 12

↓ tibial progression (step-to)
↓ heel off at terminal stance

Question 13

Pelvis/Hip in swing

Answer 13

↓ hip flex
hip hiking
circumduction
↑ compensatory ER

Question 14

Knee in swing

Answer 14

↓ knee flex

Question 15

Foot/ankle is swing

Answer 15

↓ DF (poor foot clearance, toe drag)
↑ inversion

Question 16

You note your patient is tripping over obstacles on the floor and appears to have a decreased awareness of obstacles during ambulation. You hypothesize this could be due to?

Answer 16

visual deficits (dysconjugate gaze!!)

Question 17

Your patient has significant veering and ambulates in a curved path. You have ruled out visual impairments, what do you suspect is wrong?

Answer 17

visuospatial inattention

Question 18

T/F Foot orthoses are beneficial to stabilize the foot thereby giving ankle stability.

Answer 18

False (NO ankle support)

Question 19

Foot orthoses

Answer 19

orthotics used to redistribute forces on the foot (transfer WB stresses to pressure-tolerant sites, correct alignment, protect painful areas from contact, etc.)

Question 20

3 Most common indications for AFO:

Answer 20

Weakness, impaired proprioception, spasticity

Question 21

Describe what observations in swing and stance would warrant an AFO

Answer 21

Swing: poor foot clearance, foot drop
Stance: ankle instability, knee buckling, hyperextension

Question 22

Contraindications for any LE Orthoses

Answer 22

• Ankle clonus
• LE swelling
• Significant or poor healing/skin breakdown

Question 23

Precautions for any LE orthoses

Answer 23

• Decreased ROM in joints to be braces
• Sensory Impairments
• Cognition, communication +/- perceptual deficits

Question 24

List the AFO from most supportive to least supportive

Answer 24

Stirrup/Double upright
Solid
Pre-hinged
Hinged/articulated
Ground reaction
Posterior Leaf spring

Question 25

Your patient has CHF with bilateral LE edema that varies throughout the day. They have had a stroke leaving them with R foot drop. What AFO would be appropriate for this patient? What do you need to consider when choosing this type of AFO?

Answer 25

STIRRUP/DOUBLE UPRIGHT AFO
-Permanently attached to shoe
-HEAVY
-Can be unlocked to allow DF