GAIT Flashcards
Gait training PROM screen: UE PROM needed
WNL, especially shoulders (sometimes need a ton of extension, need scapular movement too –> more likely to get GH injury)
LE PROM needed for Para stance
hip needs 0-10 extension, full flexion
hamstring: 0-110 for KAFOs or RGOs
knee extension: need full!
ankle: 0-10 DF
needed for PARA-STANCE
Need GRF to be ___ to hip for para-stance
posterior
*extensor moment to lean into Ys
For functional gait, patient needs to have __/5
throughout UEs
5/5 STRONG!
50 dip rule: 50 tricep dips and are fine
need to do __ not just rely on ASIA scores for LE functional gait strength/bracing specifications
MMT
especially for patients AISA C and D
What are other MSK conditions/considerations for standing/gait exam?
*may have other traumas!
- Lumbar flexibility to achieve para-stance
- Leg length discrepancy
- Scoliosis
- Orthopedic fixation –> poly trauma
- Body shape/size –> long arms for clearance can make it easier…
- Length of time since onset of injury
- May require osteoporosis screening (DEXA scan if someone has not been WB for 6 months)
sensory considerations for standing/gait examination
-body awareness (includes proprioception/kinesthesia)
-pain
-light touch
-deep pressure
NEED MORE THAN ASIA TESTING
trunk, legs in harness so you know where skin checks will be needed
Pros for SPASTICITY in standing/gait examination
- help to maintain muscle
bulk - assist in circulatory
function (MM PUMP) - postural control in trunk spasticity
- help prevent weight gain
- MAY indicative of recovery potential
- assist with mobility/standing/ambulation
CONS of SPASTICITY for standing/gait
- PROM changes
- interfere with orthosis use
–> cause areas of increased pressure
–> donning (can limit this) - interfere with mobility/stand/ambulation
What two mm groups will be tight/spastic that you need to be aware of
hip flexors
plantar flexors
other considerations for standing/gait exam:
___ for upright tolerance
___(attendance, compliance)
___sources
___ (other goals?)
- BP for upright tolerance
- motivation (attendance, compliance)
- cost/funding sources
- balancing gait with other goals (transfers, WC mobility, bed mobility, etc)
Patient must be able to stand in parallel bars for 60 min with stable BP/joints: measures what?
OTHN and
endurance
FIM/IRF-PAI: what is the distance required?
50-150 feet of locomotion, may not capture the change you are looking for…so SCIM III is good at capturing this!
-level surfaces, stairs for FIM
SCIM III captures gait/mobility in what four circumstances?
- indoor
Walking index for SCI: WISCI-II
specific to SCI
functional mobility and gait
amount of physical assistance needed as well as devices required
SCI-FAI
-assesses QUALITY of walking
(weight shift, step width, etc)
-good for arguing if patient needs to start wearing braces
functional walking ability in ambulatory individuals ith SCI
cardiopulmonary considerations
-autonomic dysreflexia (T6 and above)
-autonomic regulation in general
-orthostatic hypotension
-hyper or hypo tension before hand?
-smoking history? lung?
-diabetes? blood sugar? (hypoglycemia)
-CAD
integumentary considerations for SCI evaluation
WOUNDS
-need to keep eyes on it
-if something happens, you don’t know what the start point is
cognitive considerations for SCI
TBI (concussion or mild TBI)
psychological considerations for SCI
anxiety/depression –> impacts sleep and wake cycles! leads to fatigue
Diagnosis
ASIA neurologic classification
PT treating diagnosis: neuro classification system
Prognosis: how can you predict optimal level of improvement in function?
-prediction based on AISA levels
-ambulation.ca (age, L3, S1)
compensatory movement patterns for intervention route
head hips
using muscle sub
using momentum/gravity
risks to consider when choosing para-gait interventions
-prox femur, tibia fracture
-UE/LE overuse (especially shoulders and CTS with para-gait)
-cost/benefit ratio
-benefits (psycho, physio)
C1-C8 (cervical) ASIA A prognosis for walking
inadequate voluntary motor for ambulation BUT can do TOTAL ASSIST standing
T1-12 ASIA A prognosis for walking
-varying trunk/pelvis control
-abs are your lowest functioning mm group
-sensory deficits
supervision min assist: T1-T8
mod ind in parallel bars: T1-8
mod ind w/ KAFOs + AD: T9-12
L1 ASIA A
hip hike! QL control
KAFOs for ex/household amb + AD
WC
L2 ASIA A
hip flexor: iliopsoas
KAFOs for functional household ambulation with crutches
WC for other needed
L3 ASIA A
quad: knee control
AFO or KAFOs for household ambulation
*may use WC for community amb
L4/5 ASIA A
tib ant! knee and foot control
AFOs + cane/crutch
interventions for PROM
- self/assist PROM
- cruciate positioning for UE
- mobilizations
- standing program
- serial casting
interventions for spasticity management
- oral meds
- neurolytic injections
- botulism toxin injections
- intrathecal baclofen pump trial/placement
*gastrocs, hamstrings, hip flexors
KAFO pre-gait/functional training
what are klunkers?
training braces
*just a training tool, not customized and are heavy, but does allow assessment of patient’s ability to order their own
KAFO pre-gait/functional training:
what would you educate your patient on before starting?
worst outcomes:
shoulder injury
wound–> SKIN CHECKS
*educate patient! stop immediately at pain, pressure sores
donning/doffing of KAFO on own: what do they need?
trunk control esp in short/long sitting
hamstring length
Patients with complete SCIs need to practice what to strengthen?
push ups
jack knife
all patients need to be practicing
WC STS
WC frame and footrest type, arm rests*
KAFO pre-gait training: types of walking
Para-stance/tripod position
-Drag to
-Swing to
-swing through
4 point vs 2 point reciprocal
lofstrand vs walker considerations
lofstrand: more force on shoulder but faster, more mobile, less stable
What did Harkema find?
more mm activation with higher speed of stepping
*patients with ASIA A SCI can step 3-10 on treadmill
