SCI Gait Training Flashcards
Prognostic factors for recovery of ambulation for central cord injuries
40-97% walk with almost all younger pts walking
Prognostic factors for recovery of ambulation for brown-sequard injuries
75% recover some ambulation
Prognostic factors for recovery of ambulation for anterior cord injuries
Minimal chance of ambulation due to large damage to anterior/lateral SC, including CST
How does age play a factor in prognosis for those with SCI?
Worse prognosis with increased age
Traumatic SCI vs non-traumatic SCI have similar outcomes when…
controlled for age
Evidence supports…as an effective intervention after…
BWSTT
Incomplete SCI
Progression from treadmill to over ground walking
Walker
Crutches
Cane
No assistive device
BWSTT protocol
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
What are the prerequisites for getting up from the ground with lofstrand crutches?
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)
Equipment needed for complete SCI
Knee-ankle-foot orthoses
Forearm crutches (Lofstrand)
Gait belt
What type of patients benefit from Hip-knee-ankle-foot orthoses?
For pt without hip hcontrol (T12-L1 level injury)
HKAFOs are an example of
Reciprocating gait orthosis
Donning KAFOs instructions
Seated in w/c
Lean KAFO from floor to w/c seat
Place legs into braces and strap in individually with locked knees
How should PTs assist from wheelchair to stand transitions?
From the side and slightly behind
Where should the line of gravity be in a patient in the triangle resting position?
Behind the hip joint (hanging on the y ligament)
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?
A flexion force occurs in which the patient has no opposing force (trunk and hip extensors)
How should patients with SCI take their first steps?
Start in parallel bars
Swing-to, then swing-through pattern
Progress to walker
Progress to crutch walking over ground
How should PTs guard patients with lofstrand crutches on level ground?
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
What are some activities patients should master before gait? (pre-gait activities)
From triangle resting position
Master standing on one crutch while reaching with the other
Bilaterally
What is an essential technique for patients with lofstrand to aid in 4 and 2-point gait?
Head turns to the opposite direction to elicit leg advancement on the opposite side
Instructions for swing-through gait pattern
Start in resting triangle position
Swing-through gait
Finish in resting triangle position
How can a swing-through gait pattern be optimally performed?
When the ankles are joined to form a single pillar as the legs are very difficult to control individually
What method is easier and safer when going up the stairs with lofstrand crutches?
Facing away from the stairs and going up backwards
When going up the stairs backwards w/ crutches, what should the patient’s hands be doing?
grabbing 2 crutches in one hand
railing in the other
When going up the stairs backwards w/ crutches, where should the patient’s feet be?
Heels close, not under riser
Where should the PT guard when the patient is going up the stairs with the crutches?
Below the patient
When going up the stairs backwards w/ crutches, where should the patient’s hands be?
Placing crutch onto next step and the rail above
Where should the head and hips be when actively going up the stairs backwards with crutches?
Head forward and hips up to clear the stair riser, then rise to next step
Where should the head and hips be after rising up to the next step when going up the stairs backwards with crutches?
Head back and hips forward (line of gravity behind hip joint)
