Functional Mobility and Gait Flashcards
How much ankle dorsiflexion ROM is necessary during the swing phase to clear the foot?
0 Degrees
What is the knee maximal amount of flexion during the Gait Cycle?
60 Degrees
What ARM do you want to (START) going towards when training supine to sit towards the involved side?
Start Movement using the STRONGER arm
- allows for overflow to weaker side
When coming from supine to sit towards the involved side; how should we retrain breathing?
Cue patient to BLOW OUT when they come into sitting
How long should we hold at end range to increase isometric contraction?
Hold for 6 SECONDS
What are two general phases to consider when performing a sit to stands?
Pre-Extension Phase
and
Extension Phase
Ways to increase LE activation while in supine?
Progress to FAST concentric contraction
and
Slow Eccentrics
During a sit to stand what are things to consider the impact of:
Different Height Chairs
Not Using Hands
Feet in stride
Position of Spine and Pelvis
During the Pre-Extension Phase of sit to stands; the trunk needs what type of alignment?
Stay Neutral with slight THORACIC EXTENSION
During the Pre-Extension Phase of sit to stands; the pelvis needs what type of alignment?
Neutral Pelvis Progressing to Anterior Pelvic Tilt
(and hip flexion)
Slight Thoracic Extension and pelvis progressing to anterior tilt allows for what motion during the Pre-Extension Phase of Sit - Stands.
Shift the weight forward and provide weight bearing through the LEs.
During the Pre-Extension Phase the tibias need to do what (during sit to stands)
Translate forward with knees flexed until hips lift off the mat
What 3 things can limit forward progression of the Tibia?
- Blocking the when standing
- AFO preventing dorsiflexion
- Tight Soleus
During the extension phase of sit to stands what type of firing must occur and of what muscles?
Symmetrical firing of extensor muscles to provide the extension moment of hip/trunk and knee
What types of compensation may be seen during the Extension Phase of Sit to Stands? (3 things)
- Leaning onto the Less Impaired (good side)
- Rotating in Trunk
- Pushing heavily through the UEs
Ways to adjust interventions for sit to stands based on the following impairment:
Decreased ROM of Ankle DF (soleus) and hip flexion
Put the ankle and hip on stretch in standing on steps
Ways to adjust interventions for sit to stands based on the following impairment:
Decreased power of hip abductors/extensors and knee extensors
Add resistance and perform fast concentric and slow eccentrics with theraband when standing
Ways to adjust interventions for sit to stands based on the following impairment: Hypotonia in trunk and lower extremity
Pushing the therapist to increase activity
Using what sitting position can increase activation of the Lower Extremities?
High Perch
Ways to adjust interventions for sit to stands based on the following impairment:
Decreased Somatosensory
Stay on firm surface and do with eyes closed
When training for strength deterioration of form should occur during the last (BLANK) REPS
LAST 2 REPS
For Strength 60% threshold REPs and RPE?
15 REPS at RPE 12-13
For Strength 80% threshold REPs and RPE?
10 REPS at RPE 15 - 17
Ways to increase anterior pelvic tilt in sitting? (2 things)
Sitting backwards in a chair
or
Corner of mat
[also increasing Thoracic Extension)
Phases during the Stance Phase of Gait
Initial Contact
Loading Response
Mid Stance
Terminal Stance
Pre-Swing
What phase of gait does “double support” occur in?
Pre Swing
What phases occur during the swing phase of gait
Initial Swing
Mid Swing
Terminal Swing
What occurs during the at the hip during stance phase?
Frontal Plane and Sagittal Plane (Muscle Activation)
Frontal = Glute Medius
Sagittal = Glute Max
Which is more of a priority? Stance or Swing Phase
Stance phase is the priority
Majority of patients do not achieve what phases during the stance phase of Gait?
Do not get Mid to Terminal Stance
What stepping pattern do we want to promote?
Step through gait pattern
What are possible impairments limiting the stance phase of gait?
Strength of hip extensor and abductors
PROM of hip extension
PROM of hip extension and ankle DF with knee extended
Position of the pelvis
Control of forward progression of the tibia is from what muscle and activation
Eccentric Plantar Flexion Contraction
Which phases do we need to be careful blocking during gait?
Midstance to terminal stance
- need to cage the knee and move with the tibia
What is the key component of pre-swing?
Hip Position in terminal stance is the key component of pre-swing
What MMT grade is required of the hip flexors during the swing phase?
2+ of the Hip Flexors
(2/3 of flexion for swing happens passively from quick stretch)
MAX: PROM Required:
Hip Extension
Extension 10-20 degrees Terminal Stance
MAX: PROM Required:
Knee Flexion
Flexion: 40 - 60 Midswing
MAX: PROM Required:
Ankle Flexion (DF):
Flexion: 10 degrees DF midstance to terminal stance
MAX: PROM Required:
MTP Extension
60 degrees hyperextension during preswing
Muscle Activation:
Stance-Hip
Glute Max (ECCENTRIC)
Glute Med (ECCENTRIC)
Hamstrings (ECCENTRIC)
Muscle Activation:
Stance-Knee
Eccentric Activation of:
Hamstrings and Quads
Muscle Activation:
Stance-Ankle
Eccentric Activation of Plantar Flexors: Midstance
Concentric Activation of Plantar Flexors: Terminal
Muscle Activation:
Swing-Hip
Concentric contraction of the iliopsoas
Muscle Activation:
Swing-Knee
Eccentric Contraction of the Hamstrings
Muscle Activation:
Swing-Ankle
Anterior tibialis
Peroneal’s
Major activation occurs in the hip extensors during what phase of gait?
Loading Response
Weakness of what muscles is the most common cause of falls during turning?
Hip Abductors
Weakness of the quads leads to instability during what phase of gait?
Instability during loading response (and midstance)
Loading response may be the more plausible answer
Muscle activation of the plantar flexors is the major source of propulsive power
Eccentric control during stance
AND
Concentric control in pre-swing
How far should a community ambulator be able to walk?
> 1000 ft
1200-1800 ft for one errand
