SCI Gait Training

Question 1

Prognostic factors for recovery of ambulation for central cord injuries

Answer 1

40-97% walk with almost all younger pts walking

Question 2

Prognostic factors for recovery of ambulation for brown-sequard injuries

Answer 2

75% recover some ambulation

Question 3

Prognostic factors for recovery of ambulation for anterior cord injuries

Answer 3

Minimal chance of ambulation due to large damage to anterior/lateral SC, including CST

Question 4

How does age play a factor in prognosis for those with SCI?

Answer 4

Worse prognosis with increased age

Question 5

Traumatic SCI vs non-traumatic SCI have similar outcomes when…

Answer 5

controlled for age

Question 6

Evidence supports…as an effective intervention after…

Answer 6

BWSTT

Incomplete SCI

Question 7

Progression from treadmill to over ground walking

Answer 7

Walker
Crutches
Cane
No assistive device

Question 8

BWSTT protocol

Answer 8

Start at 40% body weight support and decrease BWS as tolerated
Progress to 20 mins of walking in total in bouts
Treadmill speed at 2 mph
Promote hands free and active arm movement

Question 9

What are the prerequisites for getting up from the ground with lofstrand crutches?

Answer 9

Exceptional ability to lift body weight from below shoulder level
Increased AROM of shoulder extension and internal rotation
Excellent dynamic standing balance/coordination
Capable of complex motor skill learning
Good CV and muscular endurance (lifting bodyweight repeatedly ~ 6 METS)

Question 10

Equipment needed for complete SCI

Answer 10

Knee-ankle-foot orthoses
Forearm crutches (Lofstrand)
Gait belt

Question 11

What type of patients benefit from Hip-knee-ankle-foot orthoses?

Answer 11

For pt without hip hcontrol (T12-L1 level injury)

Question 12

HKAFOs are an example of

Answer 12

Reciprocating gait orthosis

Question 13

Donning KAFOs instructions

Answer 13

Seated in w/c
Lean KAFO from floor to w/c seat
Place legs into braces and strap in individually with locked knees

Question 14

How should PTs assist from wheelchair to stand transitions?

Answer 14

From the side and slightly behind

Question 15

Where should the line of gravity be in a patient in the triangle resting position?

Answer 15

Behind the hip joint (hanging on the y ligament)

Question 16

What happens if the line of gravity is not where it needs to be (opposite of where it should) when the patient is in the triangle resting position?

Answer 16

A flexion force occurs in which the patient has no opposing force (trunk and hip extensors)

Question 17

How should patients with SCI take their first steps?

Answer 17

Start in parallel bars
Swing-to, then swing-through pattern
Progress to walker
Progress to crutch walking over ground

Question 18

How should PTs guard patients with lofstrand crutches on level ground?

Answer 18

PT positioned beside and slightly behind patient
One hand on gait belt to guard against backward falls
One hand on shoulder to guard against forward falls
PT moves forward with patient, avoid crutches

Question 19

What are some activities patients should master before gait? (pre-gait activities)

Answer 19

From triangle resting position
Master standing on one crutch while reaching with the other
Bilaterally

Question 20

What is an essential technique for patients with lofstrand to aid in 4 and 2-point gait?

Answer 20

Head turns to the opposite direction to elicit leg advancement on the opposite side

Question 21

Instructions for swing-through gait pattern

Answer 21

Start in resting triangle position
Swing-through gait
Finish in resting triangle position

Question 22

How can a swing-through gait pattern be optimally performed?

Answer 22

When the ankles are joined to form a single pillar as the legs are very difficult to control individually

Question 23

What method is easier and safer when going up the stairs with lofstrand crutches?

Answer 23

Facing away from the stairs and going up backwards

Question 24

When going up the stairs backwards w/ crutches, what should the patient’s hands be doing?

Answer 24

grabbing 2 crutches in one hand

railing in the other

Question 25

When going up the stairs backwards w/ crutches, where should the patient’s feet be?

Answer 25

Heels close, not under riser

Question 26

Where should the PT guard when the patient is going up the stairs with the crutches?

Answer 26

Below the patient

Question 27

When going up the stairs backwards w/ crutches, where should the patient’s hands be?

Answer 27

Placing crutch onto next step and the rail above

Question 28

Where should the head and hips be when actively going up the stairs backwards with crutches?

Answer 28

Head forward and hips up to clear the stair riser, then rise to next step

Question 29

Where should the head and hips be after rising up to the next step when going up the stairs backwards with crutches?

Answer 29

Head back and hips forward (line of gravity behind hip joint)