L12 Gait after Stroke

Question 1

Rancho Phases of Gait

Answer 1

divides gait into stance and swing phase
helps to determine microchanges to gait

also looks at spatiotemporal characteristics, kinematics, and muscle activation

Question 2

Biomechanical Subcomponents of Gait

Answer 2

propulsion, postural stability, stance control, limb advancement

helps with macrochanges to gait kinematics

Question 3

Stance Phase EMG

Answer 3

Hip stabilization with extension

Question 4

Swing Phase EMG

Answer 4

hip flexors for propulsion

Question 5

Loading Response EMG

Answer 5

hip extensors and DF

Question 6

Mid/Terminal Stance EMG

Answer 6

PF

Question 7

Initial Swing EMG

Answer 7

DF

Question 8

Terminal Swing EMG

Answer 8

hamstrings and quads

Question 9

Limb Swing

Answer 9

positive step length
5-10% energy cost

Question 10

Propulsion

Answer 10

forward progression
50-75% energy cost

Question 11

Stance Control

Answer 11

preventing trunk, hip, and knee collapse
sagittal plane control
25% energy cost

Question 12

Postural stability

Answer 12

frontal plane stability
5-10% energy cost

Question 13

Ultimate goal of PT and gait

Answer 13

to improve efficiency, not to normalize

Question 14

Using Phases of Gait for PT, trends

Answer 14

1. normalize gait kinematics before changing speed or environment
2. low repetition, intensity, error
3. Blocked practice
4. Part task to then whole task
5. Work on transfers, balance, strength, gait in one session

Question 15

Using Biomechanical Subcomponents for PT gait, trends

Answer 15

1. Address subcomponents early
2. High repetition
3. Moderate to high intensity
4. Allow for errors
5. Variable practice
6. Whole task
7. One task per session

Question 16

Why does gait need to be facilitated?

Answer 16

helps pts to overcome weaknesses so they can have other movement options rather than only using synergies

Question 17

Spontaneous recovery after stroke

Answer 17

occurs in first 3-6 months

extent of recovery is variable, depends on age, stroke size/location, pre-stroke capacity

one function may develop different than other functions in the same patient

Question 18

Why implement gait training?

Answer 18

walking speed is the 6th vital sign!!

it predicts d/c setting, correlates with fall risk, fear of falling, community mobility, strength, balance

also predicts survival rates post stroke

Question 19

Error Augmentation

Answer 19

allowing errors to promote learning

efficacy of this type of training for patients with stroke is mixed

Question 20

HIGT

Answer 20

involves 100% of session devoted to gait
minimal focus on kinematics/normalizing gait
more difficult b/c of higher intensity and minimal rests

Question 21

Documenting Gait

Answer 21

Frequency = days/week
Intensity = RPE/HR, # of steps
Type = gait
Time = % of session working on gait, % of time in HR zone

Question 22

Using HIGT is more effective in

Answer 22

sub acute stroke
but yields superior outcomes vs all other interventions

Question 23

What did the step activity monitoring behavioral intervention include?

Answer 23

1. use watch to monitor step acitivty daily
2. Set a daily step goal, increasing 5-8% every 4 to 6 sessions
3. Identifying barriers to goals

Question 24

Outcomes of SAM and HIGT Research

Answer 24

HIGT helped improve the capacity of pt (could walk longer in 6MWT)

SAM helped improve performance (increased amount of daily steps)