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Neuro Rehab Test 2 > Hemi LE > Flashcards

Hemi LE Flashcards

1
Q

what is the LE extensor (dominant) synergy

A

hip: EXADIR
knee: extension
ankle: PF and INVERSION
toes: flexion and adduction (if spasticity then great toe may extend)

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2
Q

what is the LE flexor synergy?

A

Hip: FABER

knee: flexion
ankle: DF and INVERSION
toes: extension (if spasticity then toes flex and great toe may extend)

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3
Q

describe the pelvic position with regards to hemi spasticity

A

posterior rotation (retraction) on hemi side with extension posturing throughout LE consistent with synergy pattern

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4
Q

why is it hard for a patient with LE synergy to do a heel slide in supine with the hemi LE?

A

pt will not be able to keep the heel on the table due to hip abd and ER

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5
Q

why is it hard for a patient with LE synergy to bridge?

A

extensor synergy will drive the heels outward along the floor/table

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6
Q

why is it hard for a patient with LE synergy to do knee flexion in prone with the hemi LE?

A

hip will come up off the table and ER

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7
Q

what will seated marching look like for a patient with LE hemi synergy

A

similar to heel slide but upright - think flexion synergy

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8
Q

what will LAQ look like in a LE hemi patient?

A

lean back, thigh drives into table - think extensor LE synergy

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9
Q

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?

A

ankle/foot

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10
Q

what is Brunnstrom’s perspective on weightbearing and walking?

A

the most important functions of the LEs so training must be geared towards restoring these tasks

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11
Q

what are 3 Rx ideas for FACILITATING motor activity in low LE tone/weak LE patients?

A
  1. WB in protected positions
  2. facilitating movement of the involved LE
  3. functional strengthening
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12
Q

What does it mean to WB in protected positions? (3 examples?)

A

to facilitate motor activity in low tone/weak LE patients

bridging, quadruped, kneeling, and progressing to upright

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13
Q

how do you facilitate movement of the involved hemi LE? (3)

A

to facilitate motor activity in low tone/weak LE patients

  1. powder board with skate - gravity eliminated positions
  2. Raimiste’s phenomenon to facilitate abd/add
  3. PNF at pelvis and LE
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14
Q

what is Raimiste’s phenomenon?

A

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

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15
Q

what is Julie’s #1 all time strengthening in a functional context exercise?

A

sit to stand for LE extensor strength

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16
Q

what are tx ideas for facilitating motor activity outside of synergy patterns in high tone/co-contracting patients?

A

the same strategies for those moving in synergy PLUS placing and targeted movements

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17
Q

how can we best encourage symmetry in weight bearing? (3)

A

play around with foot position, mirroring, and joint approximation

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18
Q

which leg should move posteriorly to train sit to stand progression?

A

weak leg more posterior is easier

19
Q

healthy adult gait speed

A

1.3 m/s (~3 mph)

20
Q

healthy older adult gait speed

A

1-1.3 m/s

21
Q

slower speed requires (inc/dec) balance and (inc/dec) need for postural adjustments

A

inc; inc

22
Q

3 primary tasks of gait

A
  1. weight acceptance
  2. single limb support
  3. limb advancement
23
Q

how might the challenges be different with each primary task of gait in a patient with hemiplegia?

A
  1. LR might be an issue due to bad STABILITY due to weak extensors
  2. BALANCE at slow speeds may be an issue due to decreased eccentric control of posterior compartment
  3. limb advancement may be limited due to extensor synergy
24
Q

how is stance time affected in hemiplegia

A

INCREASED stance time on normal side and DECREASED stance time on impacted side

25
Q

how is step length impacted by hemiplegia

A

decreased step length on normal side

26
Q

how is weight shifting affected by hemiplegia

A

decreased weight shift over involved LE

27
Q

how are propulsive forces impacted by hemiplegia

A

decreased forward propulsion off hemi LE

28
Q

Acutely, 70-80% of patients with CVA demonstrate ambulation problems… but what is the bottom line for ambulation of those who participate in IP acute rehab?

A

when participating in IP acute rehab, the pt has a 91% chance of walking independently in the long term

29
Q

what are five pre-gait strategies?

A
  1. static/dynamic standing
  2. weight shifting (various BoS as a progression)
  3. symmetry in stance
  4. multidirectional stepping
  5. decreasing UE support
30
Q

how do you integrate trunk into pre-gait activities

A

provide UE support and have the pt stand in slight plantigrade… then gradually wean UE support

31
Q

best intervention for gait recovery?

A

there is no “best” strategy - PBWST not superior to overground training, but may improve speed and endurance

32
Q

three biggest issues with weight acceptance

A
  1. shock absorption
  2. forward progression
  3. stability
33
Q

how does stability look in the hemiplegic weight acceptance up the kinematic chain

A

ankle inversion
knee flexion
hip flexion
contralateral pelvic drop

34
Q

two biggest issues with hemiplegic single limb support

A
  1. forward progression

2. stability (knee wobble and ankle DF control)

35
Q

two biggest issues with hemiplegic limb advancement

A
  1. foot clearance (need knee flxn and ankle DF)

2. limb advancement itself

36
Q

CPG to improve locomotor function in hemiplegics

A

strong evidence for gait training at mod-high intensity (70-85% HRmax) to improve speed and/or distance (even >6 months post stroke)

37
Q

steps taken per day is a key indicator of gait outcome (Henderson 2020)… what is the difference in steps per day from conventional tx and HIT

A

conventional: 250
HIT: 1270 median

38
Q

T/F: foot drop FES and AFO have similar outcomes when performed in isolation

A

true

39
Q

what three things can FES improve upon in combination with conventional PT

A

ankle DF, balance, and functional mobility

40
Q

Are PTs better or worse than Lokomat?

A

better!

41
Q

what are typical gait deviations in stance phase

A
  1. trunk: rigid and asymmetrical
  2. pelvis/hip: posterior rotation/retraction, lack of extension, trendelenburg
  3. knee: hyper ext or instability wobble
  4. ankle: lack of strike, decreased push off, instability
42
Q

typical gait deviations in swing phase

A
  1. trunk: posterior lean (advancement) and contralateral lean (clearance)
  2. hip/pelvis: lacks normal 30 deg flexion, hiking, circumduction
  3. knee: lack of normal 60 deg flexion (stiff)
  4. ankle: lack of normal DF (foot drop, toe drag) and inc inversion
43
Q

five gait outcome measures

A
  1. 10 meter walk test
  2. 6mwt
  3. TUG
  4. Tinetti (POMA)
  5. FGA - DGI

Neuro Rehab Test 2 (11 decks)

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