GAIT Flashcards
(41 cards)
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
- moderate distance (10-100 meters)
- outdoor (>100 meters)
- stair management
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)
