Hemi LE Flashcards
what is the LE extensor (dominant) synergy
hip: EXADIR
knee: extension
ankle: PF and INVERSION
toes: flexion and adduction (if spasticity then great toe may extend)
what is the LE flexor synergy?
Hip: FABER
knee: flexion
ankle: DF and INVERSION
toes: extension (if spasticity then toes flex and great toe may extend)
describe the pelvic position with regards to hemi spasticity
posterior rotation (retraction) on hemi side with extension posturing throughout LE consistent with synergy pattern
why is it hard for a patient with LE synergy to do a heel slide in supine with the hemi LE?
pt will not be able to keep the heel on the table due to hip abd and ER
why is it hard for a patient with LE synergy to bridge?
extensor synergy will drive the heels outward along the floor/table
why is it hard for a patient with LE synergy to do knee flexion in prone with the hemi LE?
hip will come up off the table and ER
what will seated marching look like for a patient with LE hemi synergy
similar to heel slide but upright - think flexion synergy
what will LAQ look like in a LE hemi patient?
lean back, thigh drives into table - think extensor LE synergy
know this for the test: what is the most unstable joint/highest area risk area to be considerate of prior to WB in the hemiplegic patient?
ankle/foot
what is Brunnstrom’s perspective on weightbearing and walking?
the most important functions of the LEs so training must be geared towards restoring these tasks
what are 3 Rx ideas for FACILITATING motor activity in low LE tone/weak LE patients?
- WB in protected positions
- facilitating movement of the involved LE
- functional strengthening
What does it mean to WB in protected positions? (3 examples?)
to facilitate motor activity in low tone/weak LE patients
bridging, quadruped, kneeling, and progressing to upright
how do you facilitate movement of the involved hemi LE? (3)
to facilitate motor activity in low tone/weak LE patients
- powder board with skate - gravity eliminated positions
- Raimiste’s phenomenon to facilitate abd/add
- PNF at pelvis and LE
what is Raimiste’s phenomenon?
when you resist a movement (eg abduction) with one leg, your other leg will resist (eg abduct) as well - can be used to facilitate LE motor in hemi patients
what is Julie’s #1 all time strengthening in a functional context exercise?
sit to stand for LE extensor strength
what are tx ideas for facilitating motor activity outside of synergy patterns in high tone/co-contracting patients?
the same strategies for those moving in synergy PLUS placing and targeted movements
how can we best encourage symmetry in weight bearing? (3)
play around with foot position, mirroring, and joint approximation
which leg should move posteriorly to train sit to stand progression?
weak leg more posterior is easier
healthy adult gait speed
1.3 m/s (~3 mph)
healthy older adult gait speed
1-1.3 m/s
slower speed requires (inc/dec) balance and (inc/dec) need for postural adjustments
inc; inc
3 primary tasks of gait
- weight acceptance
- single limb support
- limb advancement
how might the challenges be different with each primary task of gait in a patient with hemiplegia?
- LR might be an issue due to bad STABILITY due to weak extensors
- BALANCE at slow speeds may be an issue due to decreased eccentric control of posterior compartment
- limb advancement may be limited due to extensor synergy
how is stance time affected in hemiplegia
INCREASED stance time on normal side and DECREASED stance time on impacted side
