Mobility Rehabilitation Flashcards
What type of approach should we take to examination and intervention for mobility disorders?
Task-oriented approach
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
C
Some of the tests and measurements that can be used to document functional abilities related to mobility include what 2 things?
- Level of Mobility Disability
- Functional Mobility Skills
Define level of mobility disability
A restriction in participation of mobility related activities in the person’s home and community environment
What is level of mobility disability referred to in the ICF framework?
performance
Functional mobility skills are performed in what type of setting?
Within a standard setting, such as a clinical environment
What are functional mobility skills referred to in the ICF framework?
capacity
In a task-oriented approach, examination of mobility function analyzes performance on what three levels?
- Functional
- Strategy
- Impairment
When is a test is classified as a measure of participation (performance)?
when it gathers information about the person’s mobility behavior in his or her environment
What are the 2 ways in which participation is measured?
- self-reported
- technology such as pedometers and activity monitors
What are 3 standard measures of functional activity?
- gait velocity
- 6 or 12 minute walk test
- technological devices (force plate, EMG) for the clinic
List 5 assessment tools for examining mobility on the functional level
- Dynamic Gait Index
- Functional Gait Assessment
- Rivermead Mobility Index
- Emory Functional Ambulation Profile
- Physical Performance and Mobility Examination
What are 2 limitations of functional gait measures?
- 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)
Why is important to examine mobility on the strategy level?
In order to describe the quality of performance (e.g., the ways in which gait patterns deviate from normal)
What is the most commonly used clinical tool to assist the therapists in analyzing a patient’s gait strategies in a systematic way?
Observational Gait Analysis (OGA)
List 3 other assessment tools for examining mobility on the strategy level
- Rancho Los Amigos Gait Analysis Form
- Gait Assessment Rating Scale
- Rivermead Visual Gait Assessment
What are the limitations to visual gait analysis?
There is poor reliability and it is time consuming
According to Perry what are the 2 period of gait?
- Stance
- Swing
According to Perry what are the 2 tasks of stance?
- weight acceptance
- single limb support
According to Perry what are the 2 phases of weight acceptance?
- initial contact
- loading response
According to Perry what are the 2 phases of single limb support?
- mid stance
- terminal stance
According to Perry what is the single tasks of swing?
limb advancement
According to Perry what are the 4 phases of limb advancement?
- preswing (also part of stance phase)
- initial swing
- mid swing
- terminal swing
Who does “Perry” refer to?
Jacqueline Perry
People often associate the name Perry with what?
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
What are 4 possible causes of short step length according to Winter’s framework for determining causes of atypical gait?
- 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
What are the associated biomechanical and neuromuscular diagnostic evidences behind short step length?
- 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
Do impairments (strength, ROM, spasticity) predict gait speed?
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
What factors play a role between impairments and gait parameters?
- the type and extent of impairment,
- the functional level of the patient, and
- the capacity for compensation by other systems
What kind of relationship is there between strength training and gait performance?
The relationship is nonlinear.
As LE strength increases so do walking speed, up until a point, then it levels off
True of False
Oftentimes resolution of impairments alone may not be enough to ensure recovery of functional ambulation skills.
True
Training at what level is essential?
the strategy level
What are the 3 facets of intervention on the strategy level?
- progression
- stability/postural control
- adaptation
What are the 3 important components of treatment plans regarding progression?
- energy generation
- advancement of the swing leg
- foot clearance
Treatments aimed at postural control include
- 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
What are 3 ways in which intervention on the strategy level can test adaptation?
- Obstacle courses
- Forward/Backward/Sideways
- Anticipation of potential balance threats
What must we as PTs do in order to meet the task requirements of progression, stability, and adaptability?
Set goals
*Understanding there is no one right strategy to meet these requirements
What is necessary in order to achieve maximal locomotor function?
combining part with whole-task practice
What is an example of whole-task training?
Body-weight support on a treadmill (BWST)
In conclusion the most important thing in which we want to train in regards to regaining mobility is what?
gait speed
