Gait Interventions Flashcards
Interventions for gait must be:
- challenging
- progressive and adapted
- include active participation
Interventions include reducing _______________ of body structure and function
impairment
Interventions include _________ to effective and efficiently meet the progression and stability requirements
modifying
Interventions include developing the ability to ______ ____ to challenging task and environmental demands
adapt gait
What can the goal of treatement be aimed at?
the impairment level to maximize the performance of functional mobility skills
What can a hip stability impairment be?
shortened hip flexors and/or ankle PF limits the ability to advance the body over the stance foot
What can hip flexion strength treatment look like?
weakness of hip flexors will impact the ability to advance the swing limb using push off
What can ankle stability treatment look like?
weakness in ankle PFs limits a forceful push-off in terminal stance and shortened step
What are some impairment strategies?
stretching, sensory stimulation, voluntary and AA movement and strength training
What does strengthening do?
- increases muscle force production
- increased recruitment of motor units
- salience, specific, repetition, intensity
- performed for time rather than reps
- focus on concentric and eccentric: wall squats, step-ups and downs
Addressing impairments alone may not be enough to ensure recovery of …
functional ambulation skills, must be combined with functional performance
What do assistive devices do?
- expand BOS
- reduce WB through LEs
- maximize stability
- more stability
- safety to prevent falls
- allow more repetition
- can create asymmetrical lean
- can create asymmetrical gait pattern
- can cause UE posturing
What is part practice for?
to improve vertical alignment and stability, manual cues can be given as well as assistive devices and long poles to facilitate extension
What ability does part practice allow with loading the stance limb?
the ability to load the stance limb without collapsing - therapist can use manual cues and assistance to prevent collapse while working on WB as well as stepping up onto a higher surface
What does part practive introduce?
weight shifting toward the affected limb to advance the less affected
What is a major factor at determining stability?
foot placement at IC and throughout the stance
- reducing impairments that constrain a foot position is important
What can treatment include regarding foot placement?
- stretching PF and HS, use of myofascial release and fascia can be helpful in preparing the foot to accept weight
What is a common cause of impaired heel strike?
inability to activate tibialis anterior
- the ability to generate the force during voluntary contraction does not ensure the muscle will be automatically recuruited
What can patients do to improve progression of gait?
- practice a forceful push off of the paretic limb while maintaining an extended leg
- can also practice exaggerated hip flexion during the initiation of swing, marching in place and high step gait
What can we do to improve ankle stability?
aircast: corrects supination that is common in neurological gait
What can we do to improve foot clearance?
- ace wrap
- tape on shoe, sliders, plastic bag, to reduce friction
- TB knee flexion facilitation
What kind of steps should we encourage?
larger steps!
- a step large enough to place the less affected foot in front of the affected foot
- facilitates loading the paretic limb in an hip extended position to prep for swing
- hip flexors in a stretched position activates hip flexors which will assist in a reciprocal pattern
What is whole task practice also known as?
overground locomotor training
What is a part of whole task practice?
- reciprocal stepping with emphasis on the whole task
- focuses on practicing walking to increase speed and endurance
- initiated after appropriate pre-gait postural stability has been met
- may need to brace or use ACE wrap AFO for stability
- facilitate gait as a CONTINUOUS TASK
