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Neuromus 2 > Walking Interventions CVA > Flashcards

Walking Interventions CVA Flashcards

1
Q

is walking whole or part practice

A

whole

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

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2
Q

what is the difference between gait and walking

A

gait is kinematics - heel toe, heel strike

walking is something you do with intention

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3
Q

what happens if we do not address walking impairments

A

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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4
Q

steps of gait

A

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

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5
Q

Stride Length

A

Distance from heel strike to heel strike of the same limb

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6
Q

Step Length

A

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

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7
Q

Step Width

A

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

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8
Q

Foot Angle

A

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

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9
Q

does the neural control of walking change with different circumstances

A

no
adapts to the different environments

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

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10
Q

do we want our pt to think about every step

A

no

the automaticity of walking is essential

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11
Q

gait CVA: weight acceptance

A

Diminished initial weight acceptance

Diminished single limb support

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12
Q

gait CVA: limb advancement

A

Diminished limb advancement

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13
Q

gait CVA: double support time

A

increased

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14
Q

gait CVA: univolved limb step length

A

Shortened step length by uninvolved limb

want to spend less time on the involved side

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15
Q

gait CVA: step length univolved side

A

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

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16
Q

gait CVA: base of support

A

widened

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17
Q

gait CVA: speed

A

Decreased overall speed

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18
Q

gait CVA: agonists/antagonists

A

Cocontraction agonists/antagonists

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19
Q

UE spastic presentation

A

flexion

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20
Q

extensor synergy LE

A

internal rotation, adduction, and extension of the hip

knee extension

ankle extension and inversion (foot pointed downward and inward)

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21
Q

arms, flexor synergy

A

shoulder abduction (raising the arm to the side)

elbow flexion

supination (palm facing upwards)
wrist and finger flexion

22
Q

is ankle clonus often seen in stroke pt’s

A

Ankle clonus may also be present

23
Q

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

A

Ankle spasticity

24
Q

The link between presence of spasticity and functional outcomes is

A

inconclusive

25
Q

how to perform gait analysis

A

starting at ankle -> trunk

26
Q

what is foot drop

A

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

Severe DF weakness

27
Q

what part of gait is foot drop effecting

A

initial contact, they are not getting in DF

28
Q

what is Foot Slap

A

Audible “slap” as the foot hits the ground after initial contact

Inability to eccentrically control plantarflexion moment

Moderate DF weakness

More aggressive

29
Q

what do we see with Steppage Gait

A

Excessive hip and knee flexion during swing to clear the foot

30
Q

what are the causes of Steppage Gait

A

DF weakness/paralysis
Limited DF ROM
PF contracture

31
Q

what do we see with Hip Circumduction

A

Swinging leg “out and around” to clear the foot

32
Q

what are the causes of Hip Circumduction

A

Reduced knee flexion
Lack of ankle dorsiflexion

33
Q

Trendelenburg Gait

A

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

34
Q

what side drops if we have weak left abductors

A

right side drop

35
Q

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

A

they rotate in opposite directions

36
Q

what does the pelvis and trunk relationship allow for

A

Allows for more efficient balance reactions

Minimizes lateral shifting

37
Q

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

A

opposite arm and leg swing

38
Q

lean with CVA gait

A

forward lean

39
Q

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

40
Q

Gait Assessments

A

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

41
Q

< 0.4 m/s

A

serve walking impairments
household amb

42
Q

0.4 - 0.8 m/s

A

moderate walking impairments

limited community amb

43
Q

> 0.8 m/s

A

minimal walking impairments

community amb

44
Q

> /= 1.2 m/s

A

normal gait speed

45
Q

why is gait speed a vitial sign

A

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

46
Q

Force production deficit can lead to what issues during walking

A

Insufficiently stabilize or advance limb

47
Q

how is Fractionated movement deficit assessed

A

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

48
Q

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

A

Swing gets all flexion

pre-swing gets all extension

49
Q

Sensory detection deficit and gait

A

Variation in foot placement,general clumsiness

50
Q

what part of gait does she work on first

A
  1. single limb support
  2. limb advancement
  3. Weight acceptance
51
Q

Leapfrogging” (or Reverse Transfer)

A

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

52
Q

what does the CPG say

A

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

Neuromus 2 (17 decks)

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