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Neuro 1 > Gait, Orthoses and Modalities > Flashcards

Gait, Orthoses and Modalities Flashcards

1
Q

what will u see with spatial asymmetries

A
  • decreased step length
  • decreased stride length
  • variable step width
  • decreased step height in swing
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2
Q

what will u see temporal asymmetries

A
  • decreased single limb stance
  • increased double limb stance
  • increased swing time
  • decreased cadence
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3
Q

what will u see additional asymmetries

A
  • decreased weight bearing in stance

- decreased weight shift in stance

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4
Q

0.0-0.4 m/3; what ambulator would you be

A

household

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5
Q

0.4-0.8 m/s; what ambulator would you be

A

limited community ambulator

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6
Q

0.8-1.2 m/s; what ambulator would you be

A

community ambulator

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7
Q

1.2-1.4 m/s; what ambulator would you be

A

cross street; normal walking speed

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8
Q

what is the preferred gait speed with chronic stroke

A

0.10-0.76 m/s

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9
Q

what is the max gait speed with chronic stroke

A

0.76-1.09 m/s

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10
Q

orthosis

A

device worn to restrict or assist motion, or to transfer stress from one area of the body to another

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11
Q

splint

A

temp orthosis

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12
Q

orthotist

A

designs, fabricates, fits orthoses for limbs and trunks

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13
Q

pedorthist

A

designs, fabricates, fits shoes and foot orthoses

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14
Q

what are the goals for orthotic Rx

A
  • improve alignment
  • minimize influence of abnormal tone
  • increase stability at joint or segment
  • preventing contracture or deformity
  • facilitating weak muscles
  • simulating an eccentric or concentric muscle contraction
  • limiting or facilitating motion
  • providing proprioceptive feedback
  • positioning a body part for optimum fxn
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15
Q

what are foot orthoses used for? (5 things)

A

most commonly used to redistribute forces on foot

  • transfer WBing
  • protect painful areas
  • correct alignment
  • accomodated fixed deformity
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16
Q

internal modifications

A
  • inside shoe
  • more versatile
  • heel lifts, medial wedge
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17
Q

external modifications

A
  • attached to sole or heel
  • permanent to that shoe
  • metatarsal bar, rocker bar, thomas heel
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18
Q

primary action of AFO

A

on foot and ankle

19
Q

what do AFO affect

A
  • motion and stability at proximal joints

- often custom-made, some pre-fabricated options

20
Q

common indications for AFO

A
  1. weakness
  2. impaired proprioception
  3. spasticity
21
Q

what gait abnormalities are common to warrant an orthotic eval

A
  • foot drop
  • poor foot clearance in swing
  • ankle instability in stance
  • knee buckling in stance
  • hyperextension in stance
22
Q

what transfer abnormalities are common to warrant an orthotic eval

A
  • ankle instability in stance

- knee buckling in stance

23
Q

exclusion criteria for orthoses

A

no ankle clonus
no LE swelling
no significant or poor healing skin breakdown

24
Q

precautions for orthoses

A

adequate ROM in joints that will be braced
be careful with sensory impairments
considerations for cognitive, communication, and/or perceptual deficits

25
Q

AFO ordered from most supportive to least

A 
stirrup/double upright
solid
pre-hinged
hinged/articulated
ground reaction
posterior leaf spring
26
Q

considerations of orthoses

A
  • each AFO will have a different impact on function
  • decide what your goal for bracing is
  • when is it appropriate to brace
  • insurance
27
Q

management of orthoses

A
  • must always be worn with closed toes shoes
  • should not be donned against bare skin
  • wear schedules
  • skin checks
28
Q

indications for UE splints/orthotics

A
  • management or prevention of contraction at fingers, wrist, or elbow
  • hypotonia or spasticity management
  • often used as resting splints
29
Q

considerations for UE splints/orthotics

A
  • when donned, eliminate functional use splinted joints
  • skin checks
  • patient ed
30
Q

what is your biggest concern post stroke with walking on a treadmill

A

fall risk

31
Q

what are the benefits of a harness system

A

effectively removes fall risk

unloading effect

32
Q

what is the LEAPS trial of 2007

A
  • supported use of BWSTT with functional overground walking training with patients 2-6 months post stroke compared to standard strengthening and balance HEP
  • significant differences found in gait speed, balance confidence
33
Q

what is the STEPS trial 2007

A
  • compared BWSTT / UE-EX with cycle ergometry / UE-EX training programs with pts 4 months to 5 years post stroke
  • significant differences found in gait speed and endurance
  • addition of LE strengthening program made no difference in outcomes
34
Q

what were the results of the CPG to improve locomotor function following chronic stroke, incomplete spinal cord injury and brain injury 2020

A
  • little benefit of BWSTT on walking speed and distance as compared with overground walking training or other interventions in ambulatory individuals with chronic stroke, iSCl and TBI
35
Q

BWSTT: acute to subacute.. what does the research should an improvement of

A

gait speed
endurance
fear of falling

36
Q

what are the indications for a pt going from acute to subacute using BWSTT

A

ambulatory pt with stable CV status
gait goals of gait speed and reducing fall risk
eliminate fall risk, many safety concerns
decreased physical load on therapist

37
Q

considerations for a pt going from acute to subacute using BWSTT

A
  • allow for more steps/session
  • be aware of CV status
  • be cautious of behavioral or cognitive status
38
Q

what should BWSTT look like for pt’s going from acute to subacute

A
  • high treadmill speed
  • BWS should remain <40$ to remain functional
  • facilitations can be at LE, trunk and UE
  • should be followed by over ground ambulation
39
Q

protocol for BWSTT

A

3-5x week for 30-60min

40
Q

how do u progress BWSTT

A 
increased speed
reduce BWS 
reduce assist and facilitation
add incline
increase duration 
less breaks
41
Q

what is the L300 FES used for

A

foot drop

poor foot clearance

42
Q

what is the L300+ FES used for

A

knee instability

poor foot clearance

43
Q

EMG biofeedback is used when

A

pt has strength but struggling with activation or motor control of a muscle

Neuro 1 (21 decks)

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