Test 3: Gait Interventions Flashcards
statistics of walking deficits with stroke pts
2/3 of people w/ stroke cannot walk/require assist
3 months post stroke, 1/3 still require assistance
what stage of parkinsons are postural deficits common
stage 3
affects walking
statistics for those with MS who need walk assist
50% require assistance within 15 years of dx
locomotion definition
ability to move from one place to another
walking, wheelchair, etc
importance of locomotor training
decreased burden of care
better participation in social roles and work
higher QOL
better aerobic capacity
improved overall health
signs that gait is safe to begin training
trunk control (HAT- head, arm, trunk)
weight shift/acceptance on affected limb
attention to task
ROM at LE joints
stability at ankle
static/dynamic standing control
what to consider before initiating gait training
has pt done it before?
if so, how much assistance?
use any orthotics/ADs?
how to analyze gait prior to starting training
observational gait analysis (continuous task- cant use hedman model)
RLA gait analysis form (foot clearance, weight acceptance, stance vs swing, etc)
gait assessment objective measure examples
TUG
10 MWT
FGA/DGI
6MWT
community balance and mobility scale
mini Best
examples of reasons a pt may have short step length
decreased strength in stance limb
weakness of hip flexors in swing
tight hip flexors
fatigue/endurance deficits
knee buckling/poor quad recruitment
interventions you may do prior to gait to address body structure and function impairments
hip stability
hip flexion strength
quad control
ankle stability
power training
ROM/spasticity reduction
PT considerations for functional strengthening of LEs for gait training
resistance training should be at intensities lower than 60% 1RM
perform for time rather than reps
improve oxidative capacity of muscles for power/endurance
perform both concentric and eccentric
what may cause insufficient DF ROM
muscle tightness
loss of control
edema
what may cause inappropriate foot contact during gait
weakness at foot/ankle
muscle tightness
foot posturing
purpose of an aircast at the ankle
improve ankle stability to improve weight acceptance and decrease fear of re-injury
correct supination often seen in neurologic gait
ways to facilitate foot clearance
ace wrap around ankle and foot to facilitate DF
tape on toe/plastic sliders to reduce toe friction
theraband to facilitate knee flex; need 60 deg of flexion in swing for foot clearance
general intervention goals
improve functional skills/motor learning
make interventions intense enough to promotr behavioral change and neural organization
final goal = adaptability of learned skill for independent function
what is pregait training
for lower lvl pts to emphasize stance stability
acute phase
b/c stance = 60% gait
why is a good stance phase key to successful swing
quick stretch on hip flexors
swing is momentum
what do you look for when observing gait and choosing interventions for pre gait training
dynamic standing posture control while executing
ability to weight shift at initiation
ability to accept weight
stability/ROM of ankle
overshooting step length in termination
how to initiate overground training
pregait therapy - i.e. weight shift
lead up exercises - affected limb in ext; work to lead up to reciprocal stepping
encourage larger steps; hip flexors stretched activates gait pattern generator
Examples of early gait activities in the acute stage
equal WBing in LEs
equal WBing in UEs
trunk cintrol
facilitated fwd progression
use it and improve it
examples of functional task specific progressions in gait training
walking in all directions
different surfaces
stair climbing
step over
walking in simulated home environment
walking in community
activities with coincident timing
dual task activities
advanced gait challenges/progressions
step over with affected or unaffected LE - facilitate swing or WBing
walking on slope- increase DF/control knee hyperext
walking down slope- eccentric activation
walk wiht paretic side by wall- reduce circumdiction
walking on unlevel surface - promote stability
goals of task oriented training
promote more normal gait pattern
encourages pt to solve motor problem
assists in meaningful every day tasks pt wants to perform
PT considerations for Body Weight Supported TT (BWSTT)
PT can provide manual assist to normalize pattern
closed loop training
less deg of freedom
can introduce safe gait earlier
use it improve it/repetition matters
harness for safety, free PT hands, reduce weight of pt, and eliminate need for AD
can transition away from harness and slowly reduce support
findings of the LEAPS study (locomotor experience applied post stroke
no difference between TT and overground
stroke pts continue to imporve 1 year post stroke
BWSTT improves walking VELOCITY AND DISTANCE
research support for BWSTT
safe in all stages of recovery
preferred to aquatic therapy for kinematics that more closely resemble normal gait
intensive, task specific training may facilitate cortical reorganization following cerebral damage
concerns for BWSTT
major difference between normal gait and treadmill walking
- swing initiated by lifting up instead of pushing off
- stand limb is pulled backward instead of trunk advancing forward onto it
benefits of treadmill
encourage equal WBing
symmetrical stepping
use of hip ext at terminal stance
parameters for BWSTT in post stroke pts
initial velocity of 0.25 m/s and 30% BW in non-ambulatory pts
increase speed incrementally as soon as possible
BWS should be decreased ASAP
PT considerations for robotic assisted gait training
cost
set up time
research limited
carry over of gait w/o device
research concerns for robotic assisted gait training
no difference in outcomes for conventional BWSTT vs robotic assistance
ANPT does not recommend
most beneficial for person who is very dependent in early stages of recovery
parameters for high intensity gait training
70-85% HR max or 60-80% HR reserve
3x/wk
30-50 min sessions
12wks - 6 months
precautions for high intensity gait training
HR blocking meds or dxs
monitor vitals throughout
manually check HR for rhythm and potential arrhythmias prior to initiating
have AED in hand
prepare for possible falls
how is NMES used to reduce spasticity
motor stimulation delivered to antagonist of spastic muscle and through reciprocal inhibition the agonist relaxes its tone
longer lasting effects of tone reduction are the result of improved motor control which is allowed when muscles are not in spasm
what is Bioness/FES DF assist
assists in muscle that control ankle DF to improve foot clearance
FES for use during gait - used on anterior tibialis
indicated for pts with significant DF weakness
rationale for crawling in quadruped training
improve WSing and dynamic hip control
promote functional movements and proximal trunk stability
used to return to standing position from floor
describe pt performance in walking in kneeling
kneel stepping requires weight shifting onto one knee
contralateral hip hike and fwd pelvic RT to advance other knee
weight shift to completely unweight other leg is stressed
good for treatment of ataxia or pts with LE spasticity
