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Year 2: Neuromuscular > Test 3: Gait Interventions > Flashcards

Test 3: Gait Interventions Flashcards

1
Q

statistics of walking deficits with stroke pts

A

2/3 of people w/ stroke cannot walk/require assist

3 months post stroke, 1/3 still require assistance

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2
Q

what stage of parkinsons are postural deficits common

A

stage 3

affects walking

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3
Q

statistics for those with MS who need walk assist

A

50% require assistance within 15 years of dx

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4
Q

locomotion definition

A

ability to move from one place to another

walking, wheelchair, etc

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5
Q

importance of locomotor training

A

decreased burden of care

better participation in social roles and work

higher QOL

better aerobic capacity

improved overall health

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6
Q

signs that gait is safe to begin training

A

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

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7
Q

what to consider before initiating gait training

A

has pt done it before?

if so, how much assistance?

use any orthotics/ADs?

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8
Q

how to analyze gait prior to starting training

A

observational gait analysis (continuous task- cant use hedman model)

RLA gait analysis form (foot clearance, weight acceptance, stance vs swing, etc)

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9
Q

gait assessment objective measure examples

A

TUG
10 MWT
FGA/DGI
6MWT
community balance and mobility scale
mini Best

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10
Q

examples of reasons a pt may have short step length

A

decreased strength in stance limb
weakness of hip flexors in swing
tight hip flexors
fatigue/endurance deficits
knee buckling/poor quad recruitment

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11
Q

interventions you may do prior to gait to address body structure and function impairments

A

hip stability
hip flexion strength
quad control
ankle stability
power training
ROM/spasticity reduction

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12
Q

PT considerations for functional strengthening of LEs for gait training

A

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

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13
Q

what may cause insufficient DF ROM

A

muscle tightness
loss of control
edema

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14
Q

what may cause inappropriate foot contact during gait

A

weakness at foot/ankle

muscle tightness

foot posturing

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15
Q

purpose of an aircast at the ankle

A

improve ankle stability to improve weight acceptance and decrease fear of re-injury

correct supination often seen in neurologic gait

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16
Q

ways to facilitate foot clearance

A

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

17
Q

general intervention goals

A

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

18
Q

what is pregait training

A

for lower lvl pts to emphasize stance stability

acute phase

b/c stance = 60% gait

19
Q

why is a good stance phase key to successful swing

A

quick stretch on hip flexors

swing is momentum

20
Q

what do you look for when observing gait and choosing interventions for pre gait training

A

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

21
Q

how to initiate overground training

A

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

22
Q

Examples of early gait activities in the acute stage

A

equal WBing in LEs

equal WBing in UEs

trunk cintrol

facilitated fwd progression

use it and improve it

23
Q

examples of functional task specific progressions in gait training

A

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

24
Q

advanced gait challenges/progressions

A

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

25
Q

goals of task oriented training

A

promote more normal gait pattern

encourages pt to solve motor problem

assists in meaningful every day tasks pt wants to perform

26
Q

PT considerations for Body Weight Supported TT (BWSTT)

A

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

27
Q

findings of the LEAPS study (locomotor experience applied post stroke

A

no difference between TT and overground

stroke pts continue to imporve 1 year post stroke

BWSTT improves walking VELOCITY AND DISTANCE

28
Q

research support for BWSTT

A

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

29
Q

concerns for BWSTT

A

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
30
Q

benefits of treadmill

A

encourage equal WBing

symmetrical stepping

use of hip ext at terminal stance

31
Q

parameters for BWSTT in post stroke pts

A

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

32
Q

PT considerations for robotic assisted gait training

A

cost
set up time
research limited
carry over of gait w/o device

33
Q

research concerns for robotic assisted gait training

A

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

34
Q

parameters for high intensity gait training

A

70-85% HR max or 60-80% HR reserve

3x/wk

30-50 min sessions

12wks - 6 months

35
Q

precautions for high intensity gait training

A

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

36
Q

how is NMES used to reduce spasticity

A

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

37
Q

what is Bioness/FES DF assist

A

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

38
Q

rationale for crawling in quadruped training

A

improve WSing and dynamic hip control

promote functional movements and proximal trunk stability

used to return to standing position from floor

39
Q

describe pt performance in walking in kneeling

A

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

Year 2: Neuromuscular (20 decks)

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