Gaittraining And Walking Recovery After Spinal Cord Injury Flashcards
What is the LE requirements to attain “PARA- stance”
Hip
Hamstring length
Knee
Ankle
- Hip: 0-10º of extension and full flexion
- Hamstring length: 0-110º for knee ankle foot orthoses KAFOs) or reciprocating gait orthosis (RGO) users
- Knee: full extension
- Ankle: 0-10º of dorsiflexion (more than neutral
What is the UEs requirement for a patient to attain para stance
WNL, especially shoulders
When doing the para stance position how does the pt lean for stability
Sufficient ankle DF , hip extension , and lumbar extension PROM .. pt leans into anterior hips Y ligaments for stability
For a functional gait what does the patient need to show throughout UE
5/5 strength
Scap must be stable and strong mm
50 dip rule - do 50 dips but dont get fatigue
Should u rely on ASIA alone to help w graving specifications for gait
No u need to do true MMT to test all their muscles
What are the pros for spasticity for gait
Can help to maintain muscle
bulk
Can assist in circulatory
function
Can assist with postural control
Can help prevent weight gain
May be indicative of recovery
potential
Can assist with
mobility/standing/ambulation
What are the CONS for have spasticity during gait
Can interfere with mobility,
standing, ambulating
PROM changes
Can interfere with orthosis
use
According to the clinical exam example for the criteria for long leg bracing program
❑ Patient has desire to ambulate with ___ and ___ goals
❑ Patient within ___ of ideal body weight
❑ Patient must be able to stand in parallel bars for ___ min with stable BP/joints
❑ ___ body-weight dip
❑ ____ with all transfers/WC mobility
❑ WC propulsion: ___ ___ in less than ____ min
Specific and realistic
10%
60 mins
50
Indepednce
1 mile than 20 mins
How is the functional independence measure for locomotion measured
Levle surfaces and stairs
What is the area of assessment for walking index for spine cord injury (WISCI-11)
Functional mobility and gait
Amount of physcial assistance needed as well as devices required
What does the spinal cord injury functional ambulation inventory (SCI-FAI)
Assesses functional walking ability in ambulatory individuals with SCI
Which ASIA score has the best prognosis for walking
ASIA D
During the POC u want to decide which intervention route u will use what are 2 u could use
Compensatory movement patterns
Recovery of normal movement patterns
What are some risks we need to consider in the POC
Fx to proximal femur and tibia
Overuse of UE/LE
Cost/benefit ratio of energy expenditure
C1-C8 AIS A has what kind of voluntary motor function
Inadequate motor function for functional ambulation
How much assist with C1-C8 AIS A need to stand
Total assist
What kind of varying control does T1-T12 AIS A have
Trunk and pelvic control
What is the lowest functional mm group for T1-T12 AIS A
Abs
What kind of AFO would be good for children and some adults for exercise/househil ambulation with assistive device from T1-T12 ASIA A
HKAFO/RGO
What level can have modified indepdennt in parallel bars
T1-T8
What does L1 AIS A have control of and deficits of
Pelvic control - quad lum
Sensory deficits
What does L2 AIS A have control of and deficits of
Hip control- iliopsoas
Sensory deficits
What does L3 AIS A have control of and deficits of
Knee control - quads
Sensory deficits
What does L4-5 AIS A have control of and deficits of
Knee and some foot control - anterior tibialis
Sensory deficits
What are the pros and cons of training braces for KAFO
Pros:
• Allows assessment of patient’s ability &
training prior to ordering
Cons:
• Not customized
• Difficult to control amount of DF
• Heavy/ugly
What is the “para stance” position
• Ankles dorsiflexed – fixed
• Knees extended
• Hips extended, leaning into Y ligament
• Lumbar extension
What kind of pre gait is the most inefficient for weakest pateints and/or early training for Para stance
Drag 2
Where should ur hand be when. Guarding a complete SCI during KAFO training
On back and on shoulder
T/F: Subjects with “clinically complete” SCI can generat stepping patterns on treadmill, but cannot sustain it (3- 10 steps).
True
What does teh use of partial body weight support decrease and allow
Decreases biomechanical & equilibrium constraints.
Allows for repetitive practice of complex gait cycles.
What are the 3 beneifits of body weight support treadmill for locomotor training
– Provide earlier intervention to ↓ secondary
complications
– Provide task specific training, sensory input, and
repetition
– Minimize compensation
How does the Body weight support treadmill for locomotor training minimize compensation
• ↑ LE weight-bearing, ↓ UE weight-bearing
• Promote good trunk, pelvic, and limb kinematics
• Promote upright posture and balance
What are the disadvantages for manual body weight support treadmill training
Requires up to 3-4 trainers.
• Patients with severe spasticity can
be very difficult
• Trainer fatigue and experience
level (injuries) can alter results
• Inconsistent seating systems for the
trainers
• Weight limit: 250 lbs
What are the advantages for manual body weight support treadmill training
• Fall-free environment
• Patient is more active, esp. at hips
and trunk
• Allows for manual facilitation by
trainer
• Allows for active arm swing
• Can use FES and/or orthotics
• Manual facilitation
What are the clinical considerations prior to locomotor training with body weight supported treadmill
- spinal stability
- weightbearing status
- joint PROM
- balance
- comorbidities
- pain
-CV status - pulmonary status
Clinicians should perform what CPG for improving walking function in ambulatory chronic CVA, iSCI, TBI
- walking training at moderate to high aerobic intensities
- walking training with virtual reality
Clinicians MAY perform what CPG for improving walking function in ambulatory chronic CVA, iSCI, TBI
- strength training at > 70% 1 rep max
- circuit training , cycling or recumbent stepping at 75-85%
- balance training with VR
Clinicians SHOULD NOT perform what CPG for improving walking function in ambulatory chronic CVA, iSCI, TBI
- static or dynamic standing balance activities including pre gait
- BWSTT with emphasis on kinematics
- robot assisted gait training
Clinicians SHOULD NOT perform what CPG for improving walking function in ambulatory chronic CVA, iSCI, TBI
