Gait, Orthoses and Modalities Flashcards
what will u see with spatial asymmetries
- decreased step length
- decreased stride length
- variable step width
- decreased step height in swing
what will u see temporal asymmetries
- decreased single limb stance
- increased double limb stance
- increased swing time
- decreased cadence
what will u see additional asymmetries
- decreased weight bearing in stance
- decreased weight shift in stance
0.0-0.4 m/3; what ambulator would you be
household
0.4-0.8 m/s; what ambulator would you be
limited community ambulator
0.8-1.2 m/s; what ambulator would you be
community ambulator
1.2-1.4 m/s; what ambulator would you be
cross street; normal walking speed
what is the preferred gait speed with chronic stroke
0.10-0.76 m/s
what is the max gait speed with chronic stroke
0.76-1.09 m/s
orthosis
device worn to restrict or assist motion, or to transfer stress from one area of the body to another
splint
temp orthosis
orthotist
designs, fabricates, fits orthoses for limbs and trunks
pedorthist
designs, fabricates, fits shoes and foot orthoses
what are the goals for orthotic Rx
- 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
what are foot orthoses used for? (5 things)
most commonly used to redistribute forces on foot
- transfer WBing
- protect painful areas
- correct alignment
- accomodated fixed deformity
internal modifications
- inside shoe
- more versatile
- heel lifts, medial wedge
external modifications
- attached to sole or heel
- permanent to that shoe
- metatarsal bar, rocker bar, thomas heel
primary action of AFO
on foot and ankle
what do AFO affect
- motion and stability at proximal joints
- often custom-made, some pre-fabricated options
common indications for AFO
- weakness
- impaired proprioception
- spasticity
what gait abnormalities are common to warrant an orthotic eval
- foot drop
- poor foot clearance in swing
- ankle instability in stance
- knee buckling in stance
- hyperextension in stance
what transfer abnormalities are common to warrant an orthotic eval
- ankle instability in stance
- knee buckling in stance
exclusion criteria for orthoses
no ankle clonus
no LE swelling
no significant or poor healing skin breakdown
precautions for orthoses
adequate ROM in joints that will be braced
be careful with sensory impairments
considerations for cognitive, communication, and/or perceptual deficits
AFO ordered from most supportive to least
stirrup/double upright solid pre-hinged hinged/articulated ground reaction posterior leaf spring
considerations of orthoses
- each AFO will have a different impact on function
- decide what your goal for bracing is
- when is it appropriate to brace
- insurance
management of orthoses
- must always be worn with closed toes shoes
- should not be donned against bare skin
- wear schedules
- skin checks
indications for UE splints/orthotics
- management or prevention of contraction at fingers, wrist, or elbow
- hypotonia or spasticity management
- often used as resting splints
considerations for UE splints/orthotics
- when donned, eliminate functional use splinted joints
- skin checks
- patient ed
what is your biggest concern post stroke with walking on a treadmill
fall risk
what are the benefits of a harness system
effectively removes fall risk
unloading effect
what is the LEAPS trial of 2007
- 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
what is the STEPS trial 2007
- 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
what were the results of the CPG to improve locomotor function following chronic stroke, incomplete spinal cord injury and brain injury 2020
- 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
BWSTT: acute to subacute.. what does the research should an improvement of
gait speed
endurance
fear of falling
what are the indications for a pt going from acute to subacute using BWSTT
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
considerations for a pt going from acute to subacute using BWSTT
- allow for more steps/session
- be aware of CV status
- be cautious of behavioral or cognitive status
what should BWSTT look like for pt’s going from acute to subacute
- 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
protocol for BWSTT
3-5x week for 30-60min
how do u progress BWSTT
increased speed reduce BWS reduce assist and facilitation add incline increase duration less breaks
what is the L300 FES used for
foot drop
poor foot clearance
what is the L300+ FES used for
knee instability
poor foot clearance
EMG biofeedback is used when
pt has strength but struggling with activation or motor control of a muscle
