Mobility Rehabilitation

Question 1

What type of approach should we take to examination and intervention for mobility disorders?

Answer 1

Task-oriented approach

Question 2

Task-oriented approach to examination and intervention is based on:

a. ICF framework only
b. Systems framework only
c. Both ICF and systems framework
d. None

Answer 2

C

Question 3

Some of the tests and measurements that can be used to document functional abilities related to mobility include what 2 things?

Answer 3

• Level of Mobility Disability

- Functional Mobility Skills

Question 4

Define level of mobility disability

Answer 4

A restriction in participation of mobility related activities in the person’s home and community environment

Question 5

What is level of mobility disability referred to in the ICF framework?

Answer 5

performance

Question 6

Functional mobility skills are performed in what type of setting?

Answer 6

Within a standard setting, such as a clinical environment

Question 7

What are functional mobility skills referred to in the ICF framework?

Answer 7

capacity

Question 8

In a task-oriented approach, examination of mobility function analyzes performance on what three levels?

Answer 8

• Functional
• Strategy
• Impairment

Question 9

When is a test is classified as a measure of participation (performance)?

Answer 9

when it gathers information about the person’s mobility behavior in his or her environment

Question 10

What are the 2 ways in which participation is measured?

Answer 10

• self-reported

- technology such as pedometers and activity monitors

Question 11

What are 3 standard measures of functional activity?

Answer 11

• gait velocity
• 6 or 12 minute walk test
• technological devices (force plate, EMG) for the clinic

Question 12

List 5 assessment tools for examining mobility on the functional level

Answer 12

• Dynamic Gait Index
• Functional Gait Assessment
• Rivermead Mobility Index
• Emory Functional Ambulation Profile
• Physical Performance and Mobility Examination

Question 13

What are 2 limitations of functional gait measures?

Answer 13

• do not provide insight into underlying impairments because no information is given as to how the performance is achieved
• they are only indications of the end project (determine level of disability related to mobility)

Question 14

Why is important to examine mobility on the strategy level?

Answer 14

In order to describe the quality of performance (e.g., the ways in which gait patterns deviate from normal)

Question 15

What is the most commonly used clinical tool to assist the therapists in analyzing a patient’s gait strategies in a systematic way?

Answer 15

Observational Gait Analysis (OGA)

Question 16

List 3 other assessment tools for examining mobility on the strategy level

Answer 16

• Rancho Los Amigos Gait Analysis Form
• Gait Assessment Rating Scale
• Rivermead Visual Gait Assessment

Question 17

What are the limitations to visual gait analysis?

Answer 17

There is poor reliability and it is time consuming

Question 18

According to Perry what are the 2 period of gait?

Answer 18

• Stance

- Swing

Question 19

According to Perry what are the 2 tasks of stance?

Answer 19

• weight acceptance

- single limb support

Question 20

According to Perry what are the 2 phases of weight acceptance?

Answer 20

• initial contact

- loading response

Question 21

According to Perry what are the 2 phases of single limb support?

Answer 21

• mid stance

- terminal stance

Question 22

According to Perry what is the single tasks of swing?

Answer 22

limb advancement

Question 23

According to Perry what are the 4 phases of limb advancement?

Answer 23

• preswing (also part of stance phase)
• initial swing
• mid swing
• terminal swing

Question 24

Who does “Perry” refer to?

Answer 24

Jacqueline Perry

Question 25

People often associate the name Perry with what?

Answer 25

analysis of normal and abnormal movement of the trunk, upper extremity, and lower extremity and the restoration of movement through surgery, bracing, electrical stimulation, and exercise

Question 26

What are 4 possible causes of short step length according to Winter's framework for determining causes of atypical gait?

Answer 26

- Weak push-off prior to swing - Weak hip flexors at toe-off and early swing - Above-normal knee extensor activity during push-off - Excessive deceleration of leg in late swing

Question 27

What are the associated biomechanical and neuromuscular diagnostic evidences behind short step length?

Answer 27

- Below-normal plantar-flexor moment or power generation or EMG during push-off - Below-normal hip flexor moment or power or EMG during late push-off and early swing - Above-normal quadriceps EMG or knee extensor moment or power absorption in late stance - Above-normal hamstring EMG or knee flexor moment or power absorption late in swing

Question 28

Do impairments (strength, ROM, spasticity) predict gait speed?

Answer 28

Static examination of factors such as strength, ROM, and spasticity are important; however, they do not always predict gait performance in patients with neurologic lesions

Question 29

What factors play a role between impairments and gait parameters?

Answer 29

- the type and extent of impairment, - the functional level of the patient, and - the capacity for compensation by other systems

Question 30

What kind of relationship is there between strength training and gait performance?

Answer 30

The relationship is nonlinear. As LE strength increases so do walking speed, up until a point, then it levels off

Question 31

True of False Oftentimes resolution of impairments alone may not be enough to ensure recovery of functional ambulation skills.

Answer 31

True

Question 32

Training at what level is essential?

Answer 32

the strategy level

Question 33

What are the 3 facets of intervention on the strategy level?

Answer 33

- progression - stability/postural control - adaptation

Question 34

What are the 3 important components of treatment plans regarding progression?

Answer 34

- energy generation - advancement of the swing leg - foot clearance

Question 35

Treatments aimed at postural control include

Answer 35

- improving postural alignment of the head, arms, and trunk (HAT) segments - effective generation of an extensor support moment - control of mediolateral stability (including placement of the foot at initial con-tact of stance) - improving balance in the single- and double-support phases of gait - use of assistive devices that broaden the base of support

Question 36

What are 3 ways in which intervention on the strategy level can test adaptation?

Answer 36

- Obstacle courses - Forward/Backward/Sideways - Anticipation of potential balance threats

Question 37

What must we as PTs do in order to meet the task requirements of progression, stability, and adaptability?

Answer 37

Set goals *Understanding there is no one right strategy to meet these requirements

Question 38

What is necessary in order to achieve maximal locomotor function?

Answer 38

combining part with whole-task practice

Question 39

What is an example of whole-task training?

Answer 39

Body-weight support on a treadmill (BWST)

Question 40

In conclusion the most important thing in which we want to train in regards to regaining mobility is what?

Answer 40

gait speed