Evidence Based Management of Lower Limb Dysfunctions

Question 1

What is Treadmill training and partial body weight support.

Answer 1

• Whole task practice of gait.
• supportive harness to off-load body weight from the legs.
• As gait improves, support is decreased as patient required to control a greater percentage of body weight.
• research; Cochrane review Merholz et al 2017 mixed, not massively supportive, no significant benefits long-term. SEE LC FOR MORE.

Question 2

How can Strength training help in the management of lower limb dysfunctions?

Answer 2

• Evidence suggests that strengthening does not increase spasticity and does improve strength and activity such as walking, stairs etc.

SO… its a great thing to do and strong evidence that higher doses of practice is better for muscle strength of paretic leg, and there is carry over to functional tasks like sit-stand etc.

Question 3

Cardiovascular diseases (and stroke)
- leading prospective cause of death on chronic stroke.

How can aerobic exercise help?

Answer 3

• Aerobic exercise can help;
• reduce resting BP
• improve; lipid profiles
• improve glucose tolerance and insulin profiles.
• reducing systolic resting BP by 10mmHg an lead a 1/3 reduced risk of stroke.

Question 4

Treatment plan;

• starting position
• dosage
• ways to progress/regress treatment.

For a patient with right sided weakness, includes Footdrop, vaulting, has an AFO on right leg which helps prevent Footdrop (google it). Also has right hip hitching as well.

Answer 4

• Appears to have a issue with knee flexion,

Question 5

Treatment plan;

• starting position
• dosage
• ways to progress/regress treatment.

For a patient with right sided weakness, includes Footdrop, vaulting, has an AFO on right leg which helps prevent Footdrop (google it). Also has right hip hitching as well.

• Appears to have a issue with knee flexion during swing phase.
• Possible plantar flexion spasticity and or tightness, reduced ROM. Might be due to denervation of common peroneal nerve.
• weak abductors, tight adductors may be sensory loss.

Answer 5

Starting position;
- There is no right answer, so best approach is to test her power (0-5) if around grade 2-3, then side-lying might be a good place to start. But standing is the most functional but requires more power, so best to see what she can do, if you can get her in standing but otherwise start in side-lying. In standing give her something to support her like a walking stick or a wall to help support herself.

Focus on getting her to keep her hip level.

Just see LC…

Question 6

What are the 2 different treatment approaches?

Answer 6

• Task orientated

- Treat underline impairments