Recovery of Ambulation Post Stroke Flashcards
Gait efficiency
- Distal foot in swing phase is lifted 1-2cm with <4mm step to step variation
- Precision of foot position in swing phase is determined by coordinated activation of LE muscles directly & trunk/arm muscles indirectly
- Combinations of muscle activations that lead to the same foot position is almost infinite (problem of motor redundancy)
- Muscle activities are not controlled individually but in synergies or modules
Stroke patients and their gait efficiency
- Stroke survivors with fewer modules on the paretic limb walk more slowly & demo more gait asymmetry
- Gait asymmetry leads to increased energy cost
Important information regarding prognosis for recovery of ambulation following stroke
- Static PASS score >3.5 better odds of walking at D/C
- Dynamic PASS score >8.5 better odds of walking at D/C
- 12/56 BBS predictive of regaining unassisted ambulation at D/C
- 29/56 BBS predictive regaining community ambulation speed at D/C
- Discharge = 4 wks of iPR
Factors influencing prognosis for recovery of ambulation
- Cognitive impairment & recovery
- Initial walking speed & distance
- Age
- Presence of depressive symptoms
- Self efficacy & motivation
- Stroke severity
- Social support
- Sitting balance
- Hemorrhagic stroke> ischemic stroke
- Most walking recovery will occur in the 1st 11wks after stroke
Determinants of walking function following stroke
- Balance is main determinant in pts with more severe gait deficits
- Cardiovascular fitness is main determinant in pts with more mild deficits
- Spasticity does NOT appear to be a major determinant of gait speed
Common gait patterns following stroke
- Slow flexed walker
- Slow extended walker (Circumduction)
- Fast walker
- Moderate walker
- Hemiplegic gait
Describe a slow flexed walker
- 10% normal gait speed
- Excessive hip/knee flexion in midstance
- Inadequate DF in swing
- Forward trunk lean
Describe a slow extended walker/Circumduction
- 11% normal gait speed
- Quads are too weak to support the knee during stance phase
- Glute Max retracts femur into knee hyperextension for stance limb support
- Ankle PF spasticity
- Hip hike & circumduction occur for foot clearance
- Usually require and assistive device (AD)
Describe a fast walker
- 44% normal gait speed
- Lack heel rise in terminal stance due to inadequate PF strength
- Knee hyperextension. in stance to compensate for lack of heel rise to allow the body to progress forward on the forefoot
- Compromised step length due to lack of transit of momentum from unaffected side
Describe a moderate walker
- 21% normal gait speed
- Increased weakness of PFs
- Weakness in hip extensors (glute Max) & knee extensors (quads)
- Greater knee flexion in midstance
Characteristics of hemiplegic gait
- Poor flexor muscle control during swing phase
- Spasticity of extensor muscles lengthening affected leg
- Equinovarus deformity: ankle flexed downward & inward
- Abnormal initial contact along lateral edge of foot & forefoot
- Stiff knee with hyperextension during stance & doesn’t flex during swing
- Contralateral step only meets the paralyzed limb instead of advancing
- Affected leg weight bears for less time
- Rhythmic reciprocal swing of arm with stance phase of opposite leg is absent
- Patient may drag toe of affected leg during swing or compensate another way: contralateral trunk lean or circumduction
What are we trying to improve in a post stroke patients gait
- Biomechanics
- Energetics
- Endurance
- Speed
- Independence
- Safety
- Level of physical activity
On year after a stroke, _______ of community dwelling individuals with stroke could not complete o 6min walk test (6MWT), and those who could were only able to walk _____ of their predicated normal distance
- One half, 40%
Describe how stroke patients have reduced cardiovascular capacity
- Stroke
- Increased energy demands of hemiplegic gait
- Reduced ambulatory activity
- Muscle weakness
- Reduced cardiovascular fitness
Average steps per age group (younger adults, older adults, people with disabilities/chronic illnesses, & stroke)
- Healthy younger adults: 7,000-13,000 steps/day
- Healthy older adults: 6,000-8,500 steps/day
- Chronic illness/disabilities: 3,500-5,500 steps/day
- Stroke: average 2,838 steps/day +/- standard deviation
