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Peds Neuro > Gait Interventions > Flashcards

Gait Interventions Flashcards

1
Q

Factors affecting gait intervention

A
  • 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.
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2
Q

“Why can’t my child walk?”

A
  • Neuromuscular impairments
  • Musculoskeletal impairments
  • Sensory impairments
  • Compensatory Strategies
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3
Q

Limitations in Ambulatory Capacity

A
  • 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

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4
Q

Neuromuscular Impairments

A
  • atypical tone
  • paralysis/weakness
  • decreased coordination
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5
Q

Musculoskeletal impairments

A
  • weakness
  • loss of ROM
  • contractures
  • changes in alignment: torsional malalignment - “lever arm dysfunction”
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6
Q

Hip flexors MMT < 2+ compensatory patterns

A
  • posterior pelvic tilt
  • circumduction
  • contralateral vaulting
  • abduction of hip
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7
Q

hip abductor weakness affect on gait

A

trendelenburg

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8
Q

hip extensor weakness affect on gait

A

forward trunk lean

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9
Q

knee extensors 3+ to 4 affect on gait

A

difficulty controlling knee flexion during loading results in hyperextension of knee
- can result in toe drag

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10
Q

knee flexor weakness affect on gait

A

lack of control of knee in swing
decreased stability of knee in stance

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11
Q

plantar flexor weakness affect on gait

A

hyperextension in stance
decreased knee flexion in swing
persistent flexion in stance
Crouch gait

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12
Q

dorsiflexor weakness affect on gait

A

toe drag

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13
Q

sensory impairments

A
  • somatosensory impairments
  • visual deficits
  • vestibular deficits
  • perceptual and cognitive impairments
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14
Q

Pre-Walking Skills

A
  • Weight Bearing
  • Facilitation and handling activities to promote dissociation, weight shift, proximal balance
  • balanced flexion/extension through reciprocal creeping and kicking
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15
Q

Techniques to increase trunk stability for walking

A
  • weight bearing
  • bouncing
  • approximation
  • pushing
  • pulling
  • sit ups
  • prone extension
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16
Q

Treadmill Training

A
  • the earlier we start and the more steps they get in, the more impact we have for helping them walk at an earlier age
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17
Q

Does strength training along improve gait speed?

A

not necessarily

18
Q

Common gait abnormalities in children with cerebral palsy

A
  • In toeing/Internal femoral Torsion
  • Trendelenburg-like gait pattern
  • Crouched gait posture
  • Genu recurvatum
  • Toe Walking
  • Pes Planus/Pes Valgus
  • Ataxia, uncoordinated movement pattern
19
Q

Impairments that result in internal femoral torsion in children with CP

A
  • bone deformity
  • spasticity
  • contractures
  • muscle imbalance (retained fetal alignment, abductor weakness)
20
Q

Physical Therapy treatment for femoral torsion in children with CP

A
  • 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
21
Q

Trendelenburg- Like gait in children who have CP

A

Potential Impairments:
* Muscle Tightness
* Muscle weakness
* Increased muscle tone
* Contractures

22
Q

Physical Therapy Treatment for a Trendelenburg Gait Pattern - Strengthening

A

Gross motor activities to promote single limb stance

23
Q

Physical Therapy Treatment for a Trendelenburg Gait Pattern - Gait Training

A
  • Stepping onto higher/lower surfaces
  • Stepping ovre obstacles
24
Q

Crouched gait in children who have CP

A

Potential impairments:
* Contractures
* Muscle Tightness
* Muscle weakness
* Increased muscle tone

25
Q

Physical Therapy Treatment for Crouched Gait in Children with CP

A
  • Positioning
  • Serial Casting
  • Bracing- Soft or rigid orthotics
  • PROM/stretching/myofacial release
  • Strengthening Exercises
  • Gait training in corrected alignment
26
Q

Genu Recurvatum in children who have CP

A

Potential impairments:
* Contractures
* Muscle Tightness
* Muscle weakness
* Increased muscle tone

27
Q

Physical Therapy Treatment for Genu Recurvatum in children with CP

A
  • Soft tissue techniques (tone vs tightness)
  • Strengthening
  • Bracing
  • Support of joint: soft orthotic, taping, etc.
  • Gait training in corrected alignment
28
Q

Toe Walking in Children with CP

A

Potential Impairments:
* Hypertonicity
* Contracture
* Balance and sensory dysfunction
* Persistent knee flexion

29
Q

Idiopathic Toe Walking

A

Potential Impairments
* Tightness (Possible: congenitally short tendon/myopathic disorder)
* Sensory processing deficits
* Balance deficits

30
Q

Physical Therapy Treatment for Toe Walking

A
  • Stretching (Positioning/Casting)
  • Strengthening * Balance and movement
  • Bracing
  • Gait training in corrected alignment
  • Sensory stimulation – surfaces, textures, movement
31
Q

Pes Planus/Pes Valgus in children with CP

A

Potential Impairments:
* Bony deformity
* Contractures
* Tightness
* Weakness
* Hyper/hypotonicity

32
Q

Physical therapy treatment for Pes Planus and Pes Valgus in children with CP

A
  • Stretching
  • Strengthening
  • Neurological techniques for inhibition
  • Bracing
  • Gait training in corrected alignment
33
Q

Ataxia/Uncoordinated Movement Patterns

A

Potential Impairments:
* Visual impairments
* Balance deficits
* Decreased coordination
* Atypical muscle tone
* Muscle imbalance
* Proximal muscle weakness

34
Q

Physical Therapy Treatment for Ataxia

A
  • 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
35
Q

Assistive devices used with children who have CP

A
  • Crutches –lofstrand crutches, Canadian crutches
  • Walkers –posterior walkers, partial wt. supported walkers
  • Gait Trainers
36
Q

Common Gait abnormalities in Children with DS

A
  • Crouched gait
  • Wide based gait
  • Genu Recurvatum
  • Pes Planus
  • Causes of gait abnormalities: hypotonia, joint laxity, hypermobility, weakness
37
Q

Treatment for gait abnormalities in children who have Down syndrome

A

*Facilitation techniques
*Muscle strengthening
*Orthotic intervention
*Gait training on level and unlevel surfaces

38
Q

Common gait abnormalities in children with Myelomenigocele

A

*Crouched gait
*Wide based gait
*Genu recurvatum
*Pes planus
*Trendelenburg gait

39
Q

Physical therapy treatment for gait abnormalities in children with MM

A
  • Positioning * Stretching
  • Strengthening
  • Orthotic Intervention
  • Gait Training on level and unlevel surfaces
  • Sensory activities –vary surfaces, textures
40
Q

Assistive Devices used with Children who have MM

A
  • Walkers –forward walkers, posterior walkers
  • Lofstrand crutches
  • Straight canes
  • Parapodiums
  • Wheelchairs
  • Mobile parallel bars
  • Mobile standers

Peds Neuro (19 decks)

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