Gait Interventions Flashcards
Factors affecting gait intervention
- Developmental considerations
- Child has never walked
- Child walks with abnormal gait pattern –usually due to compensatory strategies acquired to accommodate for neuromuscular and musculoskeletal impairments
- Child lost ability to walk due to illness, surgery, etc.
“Why can’t my child walk?”
- Neuromuscular impairments
- Musculoskeletal impairments
- Sensory impairments
- Compensatory Strategies
Limitations in Ambulatory Capacity
- Absence of basic locomotor patterns for progression
- Inability to maintain appropriate posture for orientation and stability
- Inability to adapt posture and movement
Together –affect long-term viability
Neuromuscular Impairments
- atypical tone
- paralysis/weakness
- decreased coordination
Musculoskeletal impairments
- weakness
- loss of ROM
- contractures
- changes in alignment: torsional malalignment - “lever arm dysfunction”
Hip flexors MMT < 2+ compensatory patterns
- posterior pelvic tilt
- circumduction
- contralateral vaulting
- abduction of hip
hip abductor weakness affect on gait
trendelenburg
hip extensor weakness affect on gait
forward trunk lean
knee extensors 3+ to 4 affect on gait
difficulty controlling knee flexion during loading results in hyperextension of knee
- can result in toe drag
knee flexor weakness affect on gait
lack of control of knee in swing
decreased stability of knee in stance
plantar flexor weakness affect on gait
hyperextension in stance
decreased knee flexion in swing
persistent flexion in stance
Crouch gait
dorsiflexor weakness affect on gait
toe drag
sensory impairments
- somatosensory impairments
- visual deficits
- vestibular deficits
- perceptual and cognitive impairments
Pre-Walking Skills
- Weight Bearing
- Facilitation and handling activities to promote dissociation, weight shift, proximal balance
- balanced flexion/extension through reciprocal creeping and kicking
Techniques to increase trunk stability for walking
- weight bearing
- bouncing
- approximation
- pushing
- pulling
- sit ups
- prone extension
Treadmill Training
- the earlier we start and the more steps they get in, the more impact we have for helping them walk at an earlier age
Does strength training along improve gait speed?
not necessarily
Common gait abnormalities in children with cerebral palsy
- In toeing/Internal femoral Torsion
- Trendelenburg-like gait pattern
- Crouched gait posture
- Genu recurvatum
- Toe Walking
- Pes Planus/Pes Valgus
- Ataxia, uncoordinated movement pattern
Impairments that result in internal femoral torsion in children with CP
- bone deformity
- spasticity
- contractures
- muscle imbalance (retained fetal alignment, abductor weakness)
Physical Therapy treatment for femoral torsion in children with CP
- Positioning
- Bracing –soft and rigid orthotics
- Relaxation/Inhibition Techniques
- Early Weight Bearing Experiences
- PROM/Stretching techniques (myofascial release) * Strengthening of weak muscles
- Gait training on level and unlevel surfaces
Trendelenburg- Like gait in children who have CP
Potential Impairments:
* Muscle Tightness
* Muscle weakness
* Increased muscle tone
* Contractures
Physical Therapy Treatment for a Trendelenburg Gait Pattern - Strengthening
Gross motor activities to promote single limb stance
Physical Therapy Treatment for a Trendelenburg Gait Pattern - Gait Training
- Stepping onto higher/lower surfaces
- Stepping ovre obstacles
Crouched gait in children who have CP
Potential impairments:
* Contractures
* Muscle Tightness
* Muscle weakness
* Increased muscle tone
Physical Therapy Treatment for Crouched Gait in Children with CP
- Positioning
- Serial Casting
- Bracing- Soft or rigid orthotics
- PROM/stretching/myofacial release
- Strengthening Exercises
- Gait training in corrected alignment
Genu Recurvatum in children who have CP
Potential impairments:
* Contractures
* Muscle Tightness
* Muscle weakness
* Increased muscle tone
Physical Therapy Treatment for Genu Recurvatum in children with CP
- Soft tissue techniques (tone vs tightness)
- Strengthening
- Bracing
- Support of joint: soft orthotic, taping, etc.
- Gait training in corrected alignment
Toe Walking in Children with CP
Potential Impairments:
* Hypertonicity
* Contracture
* Balance and sensory dysfunction
* Persistent knee flexion
Idiopathic Toe Walking
Potential Impairments
* Tightness (Possible: congenitally short tendon/myopathic disorder)
* Sensory processing deficits
* Balance deficits
Physical Therapy Treatment for Toe Walking
- Stretching (Positioning/Casting)
- Strengthening * Balance and movement
- Bracing
- Gait training in corrected alignment
- Sensory stimulation – surfaces, textures, movement
Pes Planus/Pes Valgus in children with CP
Potential Impairments:
* Bony deformity
* Contractures
* Tightness
* Weakness
* Hyper/hypotonicity
Physical therapy treatment for Pes Planus and Pes Valgus in children with CP
- Stretching
- Strengthening
- Neurological techniques for inhibition
- Bracing
- Gait training in corrected alignment
Ataxia/Uncoordinated Movement Patterns
Potential Impairments:
* Visual impairments
* Balance deficits
* Decreased coordination
* Atypical muscle tone
* Muscle imbalance
* Proximal muscle weakness
Physical Therapy Treatment for Ataxia
- Relaxation techniques
- Strengthening of trunk and proximal extremities * Coordination activities that work on timing -metronome
- Balance activities
- Gait training on level and unlevel surfaces
- Visual fixation
Assistive devices used with children who have CP
- Crutches –lofstrand crutches, Canadian crutches
- Walkers –posterior walkers, partial wt. supported walkers
- Gait Trainers
Common Gait abnormalities in Children with DS
- Crouched gait
- Wide based gait
- Genu Recurvatum
- Pes Planus
- Causes of gait abnormalities: hypotonia, joint laxity, hypermobility, weakness
Treatment for gait abnormalities in children who have Down syndrome
*Facilitation techniques
*Muscle strengthening
*Orthotic intervention
*Gait training on level and unlevel surfaces
Common gait abnormalities in children with Myelomenigocele
*Crouched gait
*Wide based gait
*Genu recurvatum
*Pes planus
*Trendelenburg gait
Physical therapy treatment for gait abnormalities in children with MM
- Positioning * Stretching
- Strengthening
- Orthotic Intervention
- Gait Training on level and unlevel surfaces
- Sensory activities –vary surfaces, textures
Assistive Devices used with Children who have MM
- Walkers –forward walkers, posterior walkers
- Lofstrand crutches
- Straight canes
- Parapodiums
- Wheelchairs
- Mobile parallel bars
- Mobile standers
