Subacute rehabilitation- trunk and LL

Question 1

How to treat impairments- sensory, ataxia, muscle weakness, muscle tightness

Answer 1

sensory deficit- sensory stimulation/vestibular exs/visual interventions,
ataxia- coordination and core stability (core exercise=bridging and 4 point kneeling),
muscle weakness/low tone- progressive strengthening work/electrical stim/splinting
muscle tightness/high tone- medication/soft tissue mobs/ stretching/ splinting/ positioning

Question 2

How to treat impairments- stiffness, pain, quality of movement, efficiency of movement, confidence/anxiety

Answer 2

stiffness- joint mobs,
pain- hot/cold/tens/jt mobs/soft tissue mobs/ medication
quality= repetition of specific movement/facilitation of movement
efficiency= analysis of movement/biomechanical analysis
confidence- reps and reassurance

Question 3

how to prep a patient for sit to stand

Answer 3

soft tissue mobs use as prep, patient sitting on edge of bed- foot rested on quads (therapist kneeling down)- grab gastroc and mobilize left to right (whole muscle belly), joint mob- apply force through ankle then through foot, can stretch DF

Question 4

standing balance treatment ideas- step to stand, feet together

Answer 4

step to stand- standing/standing and throwing ball/heel lifts/onto toes/ kick a ball/ trap a ball- standing on stable/unstable surface
feet together- standing with one foot on step (forward/backwards/sideways)- use of parallel

Question 5

standing balance treatment ideas- feet apart, tandem stand

Answer 5

feet apart- sit to stand/stand to sit/squats/picking object off the floor- high plinth/ low plinth or perched sitting
tandem stand- stepping with unaffected leg (forwards, backwards, sideways)- use gym ball (sit to stand)

Question 6

standing balance treatment ideas- eyes open/closed, talking, use of arms

Answer 6

eyes- stepping with affected leg (forwards/backwards/sideways)- use of step, rollersakte cloth
talking- sliding foot with cloth/rollerskate- use of table (front/side)
use of arms- standing and reaching (forwards/sideways/back)- use of ball, balloon, cones, functional objects

Question 7

qualitative gait assessment

Answer 7

head position, trunk, arm swing, BOS, weight transference, toe out/in,

Question 8

what can go wrong with low tone hemiplegia

Answer 8

slow and effortful, asymmetrical, uneven rhythm, increased wt bearing on unaffected side, decreased weight transference, decreased step length- affected elg, decreased step time- unaffected leg

Question 9

part practice- before gait

Answer 9

put bed height up to support non-affected side, wheelchair behind, therapist in front and something to support other side, lock the knee, start with non affected leg- take step side to side then back and forward- do same with non affected leg- support upper and lower limb

Question 10

part practice- gait cycle

Answer 10

start with non affected leg- step forward- activate and push up hip and knee ext on affected leg, step on affected leg- place knee in front of non-affected knee- one hand on lat leg- one on inside of knee, flex the knee and hip, use another therapist to dorsi flex ankle and stabilize lower leg

Question 11

treadmill training

Answer 11

with or without PBWS provides an opportunity to practice repetitively the components of gait. A harness can be used for individuals with significant functional limitations- provides security and earlier mobility

Question 12

rationale for treadmill training

Answer 12

workload input/ output is measurable, improves strength/fitness, opportunities for speed and endurance training, improves walking, gait training may commence early, task specific practice, minimises mannual handling risk, enables practice of complete gait cycle

Question 13

what are orthoses

Answer 13

they are external devices that support or enhance an impaired limb, in neurological rehab orthoses are used to improve function and to prevent or correct deformity.

Question 14

uses of AFO’s

Answer 14

ankle feet or orthoses- have been shown to increase speed and efficiency of gait. May make some activities more difficult- e.g. sit to stand and stairs

Question 15

types of AFO

Answer 15

rigid, dynamic and semi-dynamic, foot up splint, prevent too much inversion and eversion

Question 16

FES and gait

Answer 16

Aims to produce muscle contractions that mimic normal voluntary gait movement by applying electrical impulses to the common peroneal nerve through skin surface or implanted electrodes

Question 17

FES- pressure sensitive

Answer 17

a pressure sensitive foot switch triggers the electrical stimulation when weight is taken off the foot and when DF is required for swing phase and initial stance, the stimulation is switched off when weight is taken of the foot

Question 18

use of FES for gait

Answer 18

for strokes, for the treatment of drop foot in CNS lesions- MS, SCI

Question 19

benefits of FES

Answer 19

improved walking speed, walking required less effort/less tiring, more normal gait patterns, reduced compensations, reduced spasticity, ability to walk longer distance, improved safety with reduced incidence of falls, improved confidence, increased independence with ADL’s