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Neuromuscular Exam and Rehab Exam 2 > Gait Interventions > Flashcards

Gait Interventions Flashcards

1
Q

Interventions for gait must be:

A
  • challenging
  • progressive and adapted
  • include active participation
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2
Q

Interventions include reducing _______________ of body structure and function

A

impairment

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3
Q

Interventions include _________ to effective and efficiently meet the progression and stability requirements

A

modifying

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4
Q

Interventions include developing the ability to ______ ____ to challenging task and environmental demands

A

adapt gait

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5
Q

What can the goal of treatement be aimed at?

A

the impairment level to maximize the performance of functional mobility skills

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6
Q

What can a hip stability impairment be?

A

shortened hip flexors and/or ankle PF limits the ability to advance the body over the stance foot

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7
Q

What can hip flexion strength treatment look like?

A

weakness of hip flexors will impact the ability to advance the swing limb using push off

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8
Q

What can ankle stability treatment look like?

A

weakness in ankle PFs limits a forceful push-off in terminal stance and shortened step

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9
Q

What are some impairment strategies?

A

stretching, sensory stimulation, voluntary and AA movement and strength training

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10
Q

What does strengthening do?

A
  • 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
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11
Q

Addressing impairments alone may not be enough to ensure recovery of …

A

functional ambulation skills, must be combined with functional performance

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12
Q

What do assistive devices do?

A
  • 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
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13
Q

What is part practice for?

A

to improve vertical alignment and stability, manual cues can be given as well as assistive devices and long poles to facilitate extension

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14
Q

What ability does part practice allow with loading the stance limb?

A

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

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15
Q

What does part practive introduce?

A

weight shifting toward the affected limb to advance the less affected

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16
Q

What is a major factor at determining stability?

A

foot placement at IC and throughout the stance
- reducing impairments that constrain a foot position is important

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17
Q

What can treatment include regarding foot placement?

A
  • stretching PF and HS, use of myofascial release and fascia can be helpful in preparing the foot to accept weight
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18
Q

What is a common cause of impaired heel strike?

A

inability to activate tibialis anterior

  • the ability to generate the force during voluntary contraction does not ensure the muscle will be automatically recuruited
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19
Q

What can patients do to improve progression of gait?

A
  • 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
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20
Q

What can we do to improve ankle stability?

A

aircast: corrects supination that is common in neurological gait

21
Q

What can we do to improve foot clearance?

A
  • ace wrap
  • tape on shoe, sliders, plastic bag, to reduce friction
  • TB knee flexion facilitation
22
Q

What kind of steps should we encourage?

A

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

23
Q

What is whole task practice also known as?

A

overground locomotor training

24
Q

What is a part of whole task practice?

A
  • 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
25
Q

What are progressions of overground training?

A
  • walking in all directions
  • walking on different surfaces
  • stair climbing, step over step
  • walking in the home environment or stimulated
  • ramps, curbs, uneven terrain, over and around obstacles
  • activities that involve coincident training
  • dual-task walking What are advanced
26
Q

What are advanced gait challenges overground?

A
  • step overs with affected LE, facilitates swing with hip, knee and ankle flexon
  • step overs with unaffected LE, encourages WB on affected limb, improve glut strength and stance
  • walking up a slope
  • walking down a slope
27
Q

What does walking up a slope do?

A
  • increased DF to clear ground
  • control knee hyperextension
28
Q

What does walking down a slope do?

A
  • eccentric control of knee flexion
  • requires eccentric glut activation
  • trunk extension to hold patient upright
29
Q

What are advanced gait challenges?

A
  • walking with paretic side next to wall, reduces circumduction and improves upright trunk
  • walking with unlevel surfaces promotes ankle and stance leg stability
30
Q

What are some benefits of body weight supported treadmill training?

A
  • Manual assistance can be provided by PT to normalize gait
  • may introduce safe fait earlier in the acute stage of poststroke for someone who otherwise may not be able to practice walking
  • encourages experience-dependent plasticity
  • harness minimizes the weight of the patient on the paretic limbs, provides safety, frees hands of the therapist for manual contracts, eliminates need for AD and compensation
31
Q

What does BWSTT improve?

A

no difference between TT and over ground training however BSWTT does improve velocity and distance

32
Q

When is BWSTT safe?

A

through all stages of recovery to promote early intervention

33
Q

What does TT encourage?

A

effective weight shifting onto paretic extremity
- allows advancement of the unaffected LE which allows the affected limb to be initiated from a hip ext position
- encourages equal WB, symmetical stepping and use of hip extension in terminal stance

34
Q

Can stepping and loading of LEs can be practiced before limbs are fully capable of suppporting body weight?

A

YES

35
Q

How can learned nonuse be prevented?

A

by focusing attention on involved side

36
Q

What fear does BWSTT help with?

A

fear of falling

37
Q

What can the rhythmic input of the TM assist with?

A

may reinforce a coordinated reciprocal gait pattern

38
Q

What is facilitated by the TM belt?

A

hip extension

39
Q

What velocity should we begin with with BWSTT?

A

.25m/s and 30% BW in non-ambulatory patients

40
Q

When should TM speed be increased?

A

incrementally asap along with BW

41
Q

What is high intensity gait training? (HIGT)

A
  • considers intensity, repetition, and specificity
  • 70-80% of HR max or HR reserve
42
Q

how often should we do HIGT?

A

3x per week 30-50 min sessions, 12 weeks 6 months of training

43
Q

What is variable task practice with HIGT?

A

overground, side stepping, backwards stepping, stairs, BWSTT

44
Q

What is NMES/FES?

A

improve force generate
- reduced rate of motor firing can be augmented with NMES
- studies show improved volunary recruitment of motor units

45
Q

Can NMES/FES reduce spasticity?

A

yes
- stimulation is applied to substitute for voluntary activation when the peripheral nerve remains intact

46
Q

What is FES?

A

functional electrical stimulation
- motor level ES to substitute for voluntary activation when the peripheral nerve remains intact

47
Q

What are other interventions for gait?

A
  • walking in tall kneeling
  • resisted gait
48
Q

What is beneficial about walking in tall kneeling?

A
  • requires weight shifting onto one knee
  • weight shifting to completely unweight contralateral leg is emphasized
  • great treatment for ataxia and people with extensor tone
49
Q

What is beneficial about resisted gait?

A
  • using manual resistance to add difficulty
  • can also use a TB to add resistance to gait

Neuromuscular Exam and Rehab Exam 2 (8 decks)

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