Gait Flashcards
decorticate system
dynamic stability
decerebrate system
improved coordination of activation patterns
>wt. support
>active propulsion
spinal prep
limb rhythm
modulates reflexes
executes rhythmic movements concurrently
motor control of gait
initiate a step steady state velocity change speed or stop recover from trip walk-run transition
HOAC II Model
hypothesis oriented algorithm for clinical decision making
>patient oriented, use exam findings (outcomes measures) to devel. hypothesis about cause, decide what the cause is and how to address it
impaired heel strike causes
PF contractures, tightness
DF weakness
knee- quad weakness or hamstring tightness
foot slap
no ecc. ant. tib
excessive inversion
synergy patterns
excessive eversion
hypotonicity
impaired midstance
knee hyperextension, or lack of full knee extension, lack of hip extension
causes of knee hyperextension
can’t DF, stuck in PF, weak quads so ur relying on ligaments and bony structure to keep u up
how much DF do u need for normal knee flexion during gait?
5 degrees
what is caused by an AFO that locks u into DF?
a knee flexion moment, ppl with weak hammys
causes of too much knee flexion (crouched gait posture)
hypertonic/contracted hammys, weak quads cuz they don’t counteract ur hammys pulling u into flexion
what does ur hip do to correct knee weakness?
flexes to stay upright during recurvatum, etc.
impaired terminal stance
not enough hip ext. due to flxn contracture or hypertonicity or weak extensors, OR lack of PF due to weak PFers or being stuck in DF
inadequate foot clearance
lack of hip flexion
knee causes- weak hammys, hypertonic quads
ankle cause-insuff. DF, weak DFers
proprioception cause- impaired sensation, dont know its dragging
Excessive ER at hip
use stronger adductors to medial whip
circumduction
use stronger abductors to circumduct and compensate for weak flexors
hip hiking
use strong abductors on one side and then adductors on the opp side to advance the leg
scissoring
hip adductor spasticity
causes of poor foot placement
coordination from cerebellum, proprioception issues
CVA gait disorders
dec. volocity due to weakness and synergy, inc. double support time, step asymmetry sue to dec. stance time on weak leg and short step length of strong leg
PD gait disorders
shuffling, festinating, dec. arm swing and trunk motion, poor momentum control
cerebellar gait disorders
slow, varied patterns, ataxic, WBOS, variable foot placement, high steppage (like a 1 year old walking)
spastic diplegic CP gait disorder
crouched, IR, hip and knee flexion, ant. pelvic tilt, ankle PF
level 4 outcomes measures
DGI
TUG
6 MWT
10 meter wt
whats the one test u should always do with a stroke pt?!
10 m walk test! - predicts community mobility
<0.4 m/sec
severe deficit, house bound
0.4-0.8m/sec
limited community (regina)
> 0.8 m/sec
full community
average gait speed
0.42 m/s
speed goal for household ambulation?
0.4 m/s
speed goal for community ambulation
1.3 m/s
distance goal for community ambulation?
1000 feet
other aspects of community ambulation?
obstacles, carrying a load, busy sidewalks, opening doors, uneven terrian, curbs, slopes, disractions, etc.
tx strategies for limb synergies or incoordination?
weight bearing, NDT of single joint, use of targets (start big and get small), timing and accuracy activities
what can be used as temporary orthotics in acute care inpatient?
ace wraps!
does weight shifting carry over to being better at walking?
NO!
what is part practice?
a way to break down gait. practice one portion at a time, for instance single leg stance, then practice swing phase with reps of hip flexion,then practice forward and backward rocking into and out of heel strike, etc.
what are the benefits of BWSTT in chronic, incomplete SCIs
increases walking speed and distance
improves limb coordination
improves strength and energy expenditure
what are the benefits of BWSTT in complete SCIs
timing and pattern of EMG activity improves, CV endurance, massed practice, decreased fear, LE strength gains–>however, gains are small and not functional
how does the BWSTT create change in complete SCI patients?
peripheral sensation input is processed by the CNS and the CPGs, residual connections in the damaged spinal cord are plastic and recover, this leads to LE strength gains.
