INTERVENTIONS TO IMPROVE LOCOMOTOR SKILLS Flashcards
Objectives
- Collect responses to positional changes and observed balance strategies (Tues & Thur)
- Describe interventions to improve locomotor skills
fyi
important is Antigravity muscles
tactile cueing and approximation
Postural Tone-
Amount or excursion in one direction without losing balance
Limits of Stability
Path of bodies movement during normal standing
Sway envelope
Static postural control
Stability
Dynamic postural control
have to have stability first
Controlled mobility
knowing what adjustments of posture you wil have to make to keep balance
Anticipatory postural control
Vestibular, tactile, proprioceptive, visual with postural stability.
Sensory component
Normal Postural Synergies
Stay within LOS
these kick in first to adjust for balance loss
Ankle strategy
Normal Postural Synergies
Approach LOS
adjustment of balance to not take a step when ankles don’t kick in.
Hip Strategy
Normal Postural Synergies
Stepping
Grasp
ankle and hip strategy is not enought to keep balance
Change of support strategy
:you got pushed beyond BOS and you have to take a step or fall grabbing something.
Common Impairments in Standing?
Box 7.1
Alignment
Weight bearing
Muscle Weakness
Strategies to improve standing control for
- Flexibility and strengthening
- Postural stabilization
this is were neuro meets ortho Dr C said
Table 7.1 and Table 7.2
Flexibility and strengthening
- Core stability
- Extremity strength and flexibility
- Allow pt to use minimal touch down support
Postural stabilization
- Modify BOS, sensory input, etc
- Duel tasking- walking and carrying something
- Encourage awareness of correct position
- Focus augmented feedback on key errors
picking out one or two key things you think will make a difference for your pt.
Verbal Cueing
- WB on all four limbs
- Provides for early upright activities with wide BOS and high COM
What would initial position look like?
How can you progress this?
Modified Plantigrade
standing place both hands on hip height surface instead of paralell bars
Stabilizing reversals
Rhythmic stabilization
Weight shifts
Dynamic reversals
Where would we progress from here?
Modified Plantigrade
do them in standing
Standing…how do we get more control
What other activities?
What PNF activities
Do an entire body exercise involvement- ex use theraband in standing pt holds and PTA stands in front pulling.
Now you are stepping…
What activities are you going to do to improve this?
How do you improve balance?
How can you change sensory input to challenge the patient?
What activities are you going to do to improve this?
weight shifts, quick stretch
How do you improve balance?
change surface with purturbations
How can you change sensory input to challenge the patient?
use med bal for approximation for proprioception
Review Gait terminology
Table 8.1
Traditional
STANCE PHASE: Heel, Foot, Mid, Heel & Toe
SWING PHASE: Acceleration, Mid & Deceleration
Rancho Los Amigos
STANCE PHASE: Initial, Loading, Mid, Terminal & Preswing
SWING PHASE: Initial, Mid & Terminal
*Note mistake at top of 196- should read Swing Phase at top of table
Stance Phase- what percent
Swing Phase- what percent
Stance Phase- 60% of gait cycle
Swing Phase- 40% of gait cycle
go over
What is the difference between the following terms?
Stance time
Step length
Step width
Stride length
Stride width
go over table 8.2
how does a PT gather Data Collection from Gait Analysis?
- Identify gait deviations and possibly the cause
- Establish PT diagnosis and prognosis
- Developing a POC
- “Determining need for assistive device, protective equipment or prosthetic or orthotic devices”
- Analyzing the use of an assistive device or fit of a device
- Promote patient learning and improved function of the patient
Group Activity (30 min)- Review Box 8.1- Common Gait Deviations
Review and physically mimic gait deviations
Be prepared to discuss and demo
lateral trunk bend
trendelenburg gait
backward trunk lean
forward tunk lean
excessive hip flexion
limited hip extension
antalgic gait
Walking Interventions
what are the Prerequisites?
- “appropriate weightbearing status-may improve with assistive device.
- Postural alignment- if we can correct may not be as bad as thought
- ROM- work on to fix
- Muscle performance- meaning is it kicking in properly
- Motor function -is itfucntioning correctly
- _Balance- _
- Static and dynamic standing control”
Walking Interventions
Walking Forward and Backward
- Progression from stepping in place
- Therapist is looking for…
- Timing and sequencing
- Pelvic rotation
- Knee extension w/hip flexion and knee flexion w/hip extension
Clinical Decision Making/Critical Thinking:
What manual contacts can be used with a patient displaying decreased pelvic rotation during the swing phase? What about decreased hip extension with backward walking?
the quick stretch
Walking Interventions
Progressing walking forward and backward
- Level of assistance
- Step length
- Walking speed
- Modify BOS
- Acceleration/decelaration- can they do when they need to
- Dual-task walking- walk and carrying something/younger-walking and tossing a ball
- Environment- change to outside maybe hallways with people walking by
Walking Forward and Backward
Techniques and Verbal Cues
Resisted Progression
Fig 8.1
- Resistance should be light
- Approximation can be used over the pelvic of the stance leg
- Quick stretch can be used to elicit pelvic rotation-low level parkinsons
- What about verbal cues- keep simple
- T-Band…. Fig 8.2- assists with resistance for strength and endurance
- Wood poles (dowels)…. Fig 8.3- assists with reciprocal arm swing, pelvic rotation and trunk rotation
what we did in class
In groups, discuss the other activities located in the chapter
Procedure
Verbal or tactile cues?
Walking, Side-stepping
Walking, Side-stepping and Crossed-Stepping
Walking, Braiding
Stair Climbing
20-25 minutes
fyi
Strategies for Varying Locomotor Task Demands
take a look at
Box 8.2
Box 8.3- Varying Environmental Demands
fyi
Body Weight Support and Treadmill Training
- Body weight is supported through a trunk harness
- Can be used over the treadmill and over ground
Whole-task practice versus parts-to-whole
Whole-task practice - doing all together
parts-to-whole- breaking exerxise down
Sensory Stimulation Techniques are used how?
Manual contact from therapists
another thing we did
LAB ACTIVITY:
Box 8.6
Complete in pairs and/or small groups
Take notes for yourself
Nothing required to turn in
Continued practice of PNF and techniques if time allows
fyi
