Interventions for Walking Flashcards
Reactive Postural Control
Feedback
Recovery from an unexpected threat to balance.
Anticipatory Postural Control (APAs)
Feedforward
Postural adjustments in preparation for disturbances of balance during voluntary movements
What are APAs dependent on?
practice and learning through experience
Prerequisites of Normal Gait:
1- Stability in stance 2- Sufficient foot clearance during the swing phase of the gait cycle 3- Swing phase pre-positioning of foot 4- Adequate step length 5- Energy conservation
Gait Requirements
Progression
Postural Control
Adaptation
Components of progression:
forward fall of body weight as swing limb advances past body vector,
forward swing of lower limb – stance limb acting as inverted pendulum
Energy Conservation
Joint stability – GRF, ligaments. Minimize COM excursion in all planes. Eccentric muscle contractions. Utilize stretch energy. Transfer energy between limb segments through biarticular muscles.
Purpose of Swing Phase
40% of gait cycle. Advance the limb. Provide foot clearance. Vary cadence. Conserve energy – momentum.
Infant stepping
step length increases
*step width, foot rotations decrease
Dynamic base improves; straighter line of progression, less variability step-to-step
Most improvements in infant stepping?
fastest first 4 months of walking
Procedural Interventions for children with CP
GMFCS levels I, II, III
Volitional movement repertoires.
Sensorimotor experiences.
Strengthening.
Postural control in bench sitting and standing.
RPA’s and APA’s
Intra- and Inter-limb coordination.
Muscle extensibility through orthotic management, prolonged stretching, serial casting
Features of Crouch Gait:
Decreased plantar flexor strength –
-24 degrees at push-off
Incomplete knee extension in stance
Negative dorsiflexion in swing
Full knee flexion in swing (60 degrees) but 10% later in gait cycle.
Reduced knee excursion (5X > knee flex at initial contact, 40 degrees)
Consequences of Crouch Gait
Excessive stance hip/knee flexion, ankle dorsiflexion.
Increases patellofemoral force
Reliance on knee extensors to prevent collapse of lower limbs
Impedes toe clearance.
Increased energy requirements for walking.
Altered joint mechanics, knee pain
Secondary impairments with persistence of crouch:
Malalignment of joints Contractures Decreased strength in key muscles Gravity effects Stiffness
Stiff Knee Gait
Incomplete knee ext during swing Lumbar lordosis, anterior pelvic tilt Poor utilization of foot rockers decreased postural control, falling decreased step/stride lengths
