Walking Interventions CVA Flashcards
is walking whole or part practice
whole
you can practice parts of walking (step ups, weight shifting) the the actual task is whole
what is the difference between gait and walking
gait is kinematics - heel toe, heel strike
walking is something you do with intention
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
steps of gait
Initial Contact
Loading Response
Midstance
Terminal Stance
Pre-swing
Initial Swing
Mid-swing
Terminal Swing
Stride Length
Distance from heel strike to heel strike of the same limb
Step Length
Distance from heel strike of one limb to heel strike of the opposite limb
Step Width
Lateral distance from midpoint of one heel to midpoint of the opposite heel
Foot Angle
Angle between the line of progression of the body and the long axis of the foot
Amount of “toeing out”
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
do we want our pt to think about every step
no
the automaticity of walking is essential
gait CVA: weight acceptance
Diminished initial weight acceptance
Diminished single limb support
gait CVA: limb advancement
Diminished limb advancement
gait CVA: double support time
increased
gait CVA: univolved limb step length
Shortened step length by uninvolved limb
want to spend less time on the involved side
gait CVA: step length univolved side
eased step length (prolonged swing phase) in involved limb
Making up for the other side
gait CVA: base of support
widened
gait CVA: speed
Decreased overall speed
gait CVA: agonists/antagonists
Cocontraction agonists/antagonists
UE spastic presentation
flexion
extensor synergy LE
internal rotation, adduction, and extension of the hip
knee extension
ankle extension and inversion (foot pointed downward and inward)
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
- single limb support
- limb advancement
- Weight acceptance
Leapfrogging” (or Reverse Transfer)
Achievement in high-complexity activities will also improve performance in less complex activities IFthey 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
