Walking Interventions CVA Flashcards by VB VB

is walking whole or part practice

whole

you can practice parts of walking (step ups, weight shifting) the the actual task is whole

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what is the difference between gait and walking

gait is kinematics - heel toe, heel strike

walking is something you do with intention

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what happens if we do not address walking impairments

loss of independence

pain from compensation

permanent stiffness or MSK changes

increase risk of falls

activity inefficiency

general deconditioning

lower QOL

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steps of gait

Initial Contact
Loading Response
Midstance
Terminal Stance
Pre-swing
Initial Swing
Mid-swing
Terminal Swing

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Stride Length

Distance from heel strike to heel strike of the same limb

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Step Length

Distance from heel strike of one limb to heel strike of the opposite limb

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Step Width

Lateral distance from midpoint of one heel to midpoint of the opposite heel

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Foot Angle

Angle between the line of progression of the body and the long axis of the foot
Amount of “toeing out”

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does the neural control of walking change with different circumstances

no
adapts to the different environments

Letsmultiple centers of control (heterarchical control!) take over for adjustments

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do we want our pt to think about every step

the automaticity of walking is essential

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gait CVA: weight acceptance

Diminished initial weight acceptance

Diminished single limb support

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gait CVA: limb advancement

Diminished limb advancement

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gait CVA: double support time

increased

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gait CVA: univolved limb step length

Shortened step length by uninvolved limb

want to spend less time on the involved side

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gait CVA: step length univolved side

eased step length (prolonged swing phase) in involved limb
Making up for the other side

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gait CVA: base of support

widened

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gait CVA: speed

Decreased overall speed

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gait CVA: agonists/antagonists

Cocontraction agonists/antagonists

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UE spastic presentation

flexion

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extensor synergy LE

internal rotation, adduction, and extension of the hip

knee extension

ankle extension and inversion (foot pointed downward and inward)

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arms, flexor synergy

shoulder abduction (raising the arm to the side)

elbow flexion

supination (palm facing upwards)
wrist and finger flexion

is ankle clonus often seen in stroke pt’s

Ankle clonus may also be present

what was the most important independent determinant of temporal and spatial gait asymmetry

Ankle spasticity

The link between presence of spasticity and functional outcomes is

inconclusive

how to perform gait analysis

starting at ankle -> trunk

what is foot drop

Inability to lift the foot to at least neutral DF/PF Severe DF weakness

what part of gait is foot drop effecting

initial contact, they are not getting in DF

what is Foot Slap

Audible “slap” as the foot hits the ground after initial contact Inability to eccentrically control plantarflexion moment Moderate DF weakness More aggressive

what do we see with Steppage Gait

Excessive hip and knee flexion during swing to clear the foot

what are the causes of Steppage Gait

DF weakness/paralysis Limited DF ROM PF contracture

what do we see with Hip Circumduction

Swinging leg “out and around” to clear the foot

what are the causes of Hip Circumduction

Reduced knee flexion Lack of ankle dorsiflexion

Trendelenburg Gait

Contralateral pelvic drop during stance due to stance leg hip abductor weakness

what side drops if we have weak left abductors

right side drop

in normal gait what is the relationship between the pelvis and the trunk

they rotate in opposite directions

what does the pelvis and trunk relationship allow for

Allows for more efficient balance reactions Minimizes lateral shifting

As a result of opposite trunk and pelvis rotation, we get WHAT

opposite arm and leg swing

lean with CVA gait

forward lean

hip flex, rotation, arm swing, and lateral shifting and CVA

minimized

Gait Assessments

10 MWT 6 MWD Figure of 8 – curve walking DGI (being replaced slowly by FGA) FGA Tinetti (quality of movement) - not as popular as it was

< 0.4 m/s

serve walking impairments household amb

0.4 - 0.8 m/s

moderate walking impairments limited community amb

> 0.8 m/s

minimal walking impairments community amb

>/= 1.2 m/s

normal gait speed

why is gait speed a vitial sign

waring bell telling you that something is the body is changing neg.

Force production deficit can lead to what issues during walking

Insufficiently stabilize or advance limb

how is Fractionated movement deficit assessed

asking the patient to move one segment in isolation and keep other, adjacent segments still

is fractional movement is messed up what will we see with gait

Swing gets all flexion pre-swing gets all extension

Sensory detection deficit and gait

Variation in foot placement, general clumsiness

what part of gait does she work on first

1. single limb support 2. limb advancement 3. Weight acceptance

Leapfrogging" (or Reverse Transfer)

Achievement in high-complexity activities will also improve performance in less complex activities IF they are sufficiently related (Horn 2005) BM is not related to Gait; therefore you can get better at gait without showing improvement in unrelated tasks

what does the CPG say

Higher reps (step counts) matter Get it however you get it