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NI1 > Walking > Flashcards

Walking Flashcards

1
Q

What are the 3 components of the gait cycle?

A
  • Stance phase: 58-61%
  • Swing phase: 42-39%
  • Double support: 8-11%
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2
Q

What is the purpose of the stance phase?

A
  1. Support upper body & prevent collapse
  2. Maintain balance by keeping COM over BOS
  3. Propulsion of the body
  4. Absorption of energy for shock absorption & control of the body’s forward velocity
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3
Q

What is the purpose of the swing phase?

A
  1. Clear foot from the ground

2. Prepare foot for heel strike

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4
Q

What are the important components of the stance phase? **Exam question

A
  • Hip extension throughout
  • Knee yield (15 deg flexion) on heel strike then extension in mid-stance & flexion prior to toe-off
  • DF until end of stance then fast PF
  • Lateral horizontal shift of pelvis & trunk
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5
Q

What are the important components of the swing phase?

A
  • Knee flexion with hip initially in extension
  • Hip flexion throughout
  • Ankle DF throughout
  • Slight lateral pelvic tilt downward
  • Rotation of pelvis forwards
  • Knee extension prior to heel strike
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6
Q

What are the common missing important components in the stance phase after stroke?

A
  • Reduced hip extension
  • Excessive lateral pelvic shift to affected side
  • Loss of knee yield
  • Knee hyperextension or flexion
  • Absent knee flexion at end stance
  • Reduced PF at toe off
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7
Q

What are the common missing important components in the swing phase after stroke?

A

Decreased

  • Hip flexion
  • Knee flexion mid swing
  • Knee extension at heel strike
  • DF
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8
Q

What are the common adaptive strategies in walking after stroke?

A
  • Decreased amplitude of movement
  • Decreased walking velocity
  • Decreased stride & step length
  • Uneven step & stride lengths
  • Increased stride width
  • Increased time in double support
  • Increased cadence
  • Use of arms
  • Trunk inclined forward during stance
  • Elevation of pelvis & abduction of leg
  • Toes not clearing ground during swing
  • Trunk inlined backwards at end of swing
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9
Q

How is normal step length calculated?

A

0.4 x height (or height divided by 3)

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10
Q

What is the normal cadence for a healthy adult?

A

120bpm

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11
Q

What is normal stride width for healthy adults?

A

3-6cm between heels or 0cm between medial malleoli

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12
Q

What are some of the changes in gait variables in frail elderly?

A 
Decreased
- Step length
- Balance
- Ankle PF ROM & strength
- Hip extension
Increased double support phase
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13
Q

What evidence is there for the importance of the PFs in gait?

A

Unilateral tibial nerve block paralysing PFs lead to

  • Decreased weight transference to front of foot
  • Decreased single leg stance
  • Decreased step length on intact side
  • Decreased walking speed
  • Increased ankle DF & knee flexion in stance (as PFs couldn’t control DF)
  • Increased quads activity
  • Exaggerated fall of centre of gravity, resulting in excessive work output to lift with it the intact leg
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14
Q

What are the clinical implications of the findings regarding PFs in gait?

A
  • Train PFs

- PFs are important for step length on both sides & walking speed

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15
Q

What does the assessment of walking include?

A
  • Observation from in front & side
  • Note deviations from important components
  • Note adaptive strategies
  • Determine impairments
  • Consider safety (harness, physio assistant)
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16
Q

What measurement tools are used for walking?

A
  • MAS
  • 10m walk test (for walking speed, cadence, step length/width)
  • 6 minute walk test
  • Rivermead gait assessment
17
Q

What does training in preparation for walking include?

A
  • Strength training
  • Dexterity training (part practice)
  • Management of other impairments
18
Q

What are the strategies for training walking as a whole activity?

A
  • Treadmill with/without body weight support
  • Overground training with/without body weight support
  • Use of cues for symmetry & speed
  • Stairs
19
Q

How do you train flexibility of walking?

A
  • Obstacles
  • Uneven surfaces
  • Crowded environments
  • Add cognitive demands
20
Q

What evidence is there for the likelihood of patients who are non-ambulatory in the first month after stroke regaining independent walking?

A
  • Systematic review
  • Measures taken at 3, 6 & 12 months
  • Rehab unit: 91% at 12 months
  • Acute unit: 74% at 12 months
  • Clinical implications: Advocate for rehab
21
Q

What evidence is there for body weight support & treadmill walking?

A
  • Compared muscle activity in lower limbs at different levels of BW support
  • Increased single stance in stroke patients
  • But > 30% BW reduced muscle activation in lower limbs
  • Clinical implications: Use BW support with treadmills, but no more than 30%
22
Q

What evidence is there for treadmill training in acute stroke patients?

A
  • Systematic review of treadmill training in acute stroke patients
  • Significantly more patients walked independently at 4 weeks/6 months in treadmill groups
  • Patients in treadmill groups walked significantly faster & further at 6 months
23
Q

What evidence is there for treadmill training in chronic stroke patients?

A
  • Randomly assigned to treadmill training or control
  • Training: 30 mins 3/week for 4 weeks
  • Control: Low intensity home exercises
  • Treadmill group had significant improvement in speed, increased step length & endurance, maintained at follow up
24
Q

What evidence is there for the use of ankle/foot orthosis (AFO) in walking training?

A
  • Examined effects of AFO in normal walking
  • Use of AFO resulted in decreased stance, increase vertical force at push-off & lateral shift of centre of pressure
  • AFO restricts PF
  • Doesn’t encourage patient to clear their foot
  • Wouldn’t use in stroke patients in first few months of recovery
25
Q

What evidence is there for feedback & walking training?

A
  • Systematic review of effectiveness of biofeedback in improving lower limb activities after stroke
  • Significant improvement in walking performance when biofeedback used with normal walking training
26
Q

What evidence is there for exercise dose & walking?

A
  • Acute stroke patients
  • Measured lower limb dose & walking speed at discharge
  • For every 100 reps of LL exercise completed in a day, there was an increase in walking speed of 0.08m/s
27
Q

What evidence is there for walking goals after discharge for community ambulation?

A
  • People with mild-mod stroke followed up at 1, 3, 6 months after stroke
  • Community ambulation measured with accelerometer & GPS
  • Amount of walking did not change until 6 month follow up
  • Still reduced when compared to healthy adults
28
Q

What are the minimum goals for independent community ambulation?

A
  • Gait speed: > 0.8m/s, but optimal 1.2-1.3m/s
  • Gait endurance: > 300m
  • Able to climb stairs
29
Q

What are the principles of walking training?

A
  • Treadmill training with/without BWS provides a form of modified task practice & forced use
  • Walking aids & orthoses should be carefully considered for retraining walking after stroke
  • Must be accompanied by feedback
  • Primary & secondary impairments must be addressed
  • Modify the environment to promote flexibility & automaticity

NI1 (10 decks)

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