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S4- Neuro 1 > Week 3- Common Gait Abnormalities, Orthotics, Modalities and Assisted Technologies > Flashcards

Week 3- Common Gait Abnormalities, Orthotics, Modalities and Assisted Technologies Flashcards

1
Q

PART 1: COMMON GAIT ABNORMALITIES

A

PART 1: COMMON GAIT ABNORMALITIES

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2
Q

What are the 2 main types of asymmetries seen with hemiplegic gait?

A
  • Spatial asymmetries

- Temporal asymmetries

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3
Q

What is a spatial asymmetry seen with hemiplegic gait?

A
  • ↓ step length
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4
Q

What are some temporal asymmetries seen with hemiplegic gait?

A
  • ↓ single-limb stance time
  • ↑ swing time
  • intra-limb ratio of swing:stance time
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5
Q

What are some additional asymmetries seen with hemiplegic gait?

A
  • ↓ WB in stance
  • ↓ weight shift in stance
  • ↓ step height in swing
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6
Q

Temporal Features of Hemiplegic Gait:

  • __ stride time
  • __ double limb stance time
  • __ cadence

-But most importantly, we will see a decrease in ______ _______.

A
  • ↑ stride time
  • ↑ double limb stance
  • ↓ cadence

-gait speed

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7
Q
  • What is the preferred gait speed with a chronic stroke?

- What is the maximum gait speed with a chronic stroke?

A
  • 0.10m/s - 0.76m/s

- 0.76m/s - 1.09 m/s

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8
Q

What are common UE features of hemiplegic gait?

A

-Decreased or absent arm swing.

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9
Q

What are some common trunk features of hemiplegic gait?

A
  • Ipsilateral lateral trunk lean.

- Forward trunk lean.

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10
Q

What is one of the most common troublemakers with Hemiplegic Gait from IC to MSt?

A

↓ tibial progression

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11
Q

What will we commonly see to help with the ↓ tibial progression?

A

Increased knee flexion to push tibia forward.

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12
Q

Pelvis/Hip Common Patterns from IC to MSt? (4)

A
  • ↓ pelvic rotation
  • ↓ hip flexion
  • ↑ hip IR
  • ↑ hip adduction (Trendelenberg)
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13
Q

Knee Common Patterns from IC to MSt? (3)

A
  • ↑ KNEE FLEXION (particularly at IC)
  • ↓ knee flexion during the early-stance phase, followed by knee hyperextension in mid to late-stance
  • Excessive knee hyperextension throughout most of stance phase
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14
Q

Foot/Ankle Common Patterns from IC to MSt? (7)

A
  • ↓ tibial progression
  • ↓ ankle DF
  • lack of heel strike
  • foot flat IC
  • foot slap after IC
  • instability at foot/ankle complex → inversion, supination
  • pes planus
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15
Q

What is commonly seen with Hemiplegic Gait from MSt to TSt?

A

We don’t get hip extension, step to pattern common with hemiparetic gait.

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16
Q

Pelvis/Hip Common Patterns from MSt to TSt? (3)

A
  • Decreased pelvic rotation
  • Decreased hip extension/terminal stance
  • Hip flexion during forward progression
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17
Q

Knee Common Patterns from MSt to TSt? (3)

A
  • Decreased knee extension
  • Knee buckling
  • Delayed movement into knee flexion in preparation for the swing phase
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18
Q

Foot/Ankle Common Patterns from MSt to TSt? (2)

A
  • May still see ↓ tibial progression (step-to pattern)

- ↓ heel off at terminal stance

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19
Q

What is commonly seen with Hemiplegic Gait in swing phase?

A
  • People aren’t good at foot clearance.

- Reduction in hip flexion.

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20
Q

Pelvis/Hip Common Patterns from ISw to MSw AND MSw to TSw? (3)

A
  • ↓ hip flexion
  • Hip hiking
  • Circumduction
  • ↑ compensatory ER
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21
Q
  • Knee Common Patterns from ISw to MSw?

- Knee Common Patterns from MSw to TSw?

A
  • ↓ knee flexion

- ↓ knee extension

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22
Q

Tone Abnormalities:

  • How might spasticity present during gait?
  • How might hypotonia present during gait?
A
  • movements might appear stiff, en-block movements
  • clonus will cause jerky movements at joints
  • UE spasticity patterns commonly exacerbated during gait
  • Buckling LE
  • Floppy UE
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23
Q

Somatosensory Deficits:

-How might somatosensory deficits present during gait?

A
  • Variable foot placement at initial contact

- Risk for ankle rolling

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24
Q

What vision deficits may affect gait?

A
  • Visual Field Losses or Loss of Visual Acuity

- Dysconjugate Gaze

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25
Q 
Coordination Deficits:
Cerebellar or Sensory originates:
-Fractionated, dyskinetic \_\_\_\_\_\_ phase 
-Fractionated, dyskinetic arm swing 
-\_\_\_\_\_\_\_\_ movements 
-Variable \_\_\_\_\_\_ placement 
-Trunk \_\_\_\_\_\_\_\_ → LOB
-Cerebellar only: EOM incoordination → visual disruption → LOB
A
  • swing
  • slowed
  • foot
  • ataxia
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26
Q

Types of Perceptual Deficits that will affect gait? (4)

A
  • Visuospatial Neglect
  • Sensory Neglect
  • Motor Neglect
  • Pusher’s Syndrome
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27
Q

PART 2: ORTHOTICS (1)

A

PART 2: ORTHOTICS (1)

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28
Q

Basic Terminology:

  • What is an orthosis?
  • What is a splint?
  • What is a orthotist?
  • What is a pedorthist?
A
  • Orthosis: device worn to restrict or assist motion, or to transfer stress from one area of the body to another (=brace)
  • Splint: temporary orthosis
  • Orthotist: designs, fabricates, fits orthoses for limbs and trunks
  • Pedorthist: designs, fabricates, fits shoes and foot orthoses
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29
Q

Potential Goals for Orthotics:

  • Improving __________
  • Minimize influence of abnormal ______
  • Increasing _______ at a joint or segment
  • Preventing _________ or deformity
  • Facilitating weak muscles
  • Simulating an _______ or _______ muscle contraction
  • Limiting or facilitating motion
  • Providing ______________ feedback
  • Positioning a body part for optimum function
A
  • alignment
  • tone
  • stability
  • contracture
  • eccentric or concentric
  • proprioceptive
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30
Q

What are the main goals when using braces? (3)

A
  • assisting mobility
  • restricting mobility
  • redistributing forces
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31
Q

Foot orthoses are most commonly used for what reason?

A

Redistributing forces

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32
Q

What are the most common ways foot orthoses help to redistribute weight? (4)

A
  • transfer WBing stresses to pressure-tolerant sites
  • protect painful areas from contact with shoe
  • correcting alignment
  • accommodation for fixed deformity
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33
Q

Foot Orthoses modifications can be _________ or ___________.

A
  • internal

- external

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34
Q

The vast majority of patients post-stroke who need bracing will get a ________________.

A

Ankle-Foot Orthoses (AFO)

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35
Q

AFO primary action is on the ______ and _______.

A

foot and ankle

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36
Q

Even though AFOs primarily work at the ankle-foot, they have the ability to affect motion and stability at __________ joints.

A

-proximal

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37
Q

What are the (3) most common indicators for AFOs?

A
  • Ankle weakness = 4/5
  • Impaired or absent proprioception at the ankle and/or knee
  • Ankle PF spasticity
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38
Q
  • Patients have to be ___________ mobile to even be considered for orthoses.
  • Do they have to be walking to be considered appropriate for orthoses?
A
  • functionally

- no

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39
Q

What are the most common gait abnormalities preceding decision for orthotic evaluation? (5)

A
  • foot drop
  • poor foot clearance in swing
  • ankle instability in stance
  • knee buckling in stance
  • hyperextension in stance
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40
Q

What are the most common transfer abnormalities preceding decision for orthotic evaluation? (2)

A
  • ankle instability in stance

- knee buckling in stance

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41
Q

Precautions and Exclusion Criteria for Orthoses:

  • NO ______ _______
  • NO LE _________ or ________ breakdown
  • Adequate _______ in braced joints
  • Be careful with _________ impairments (specifically ______ touch and ________)
  • Considerations for _________, __________, and/or ____________ deficits.
A
  • ankle clonus
  • swelling or skin breakdown
  • ROM
  • sensory (light touch and pressure)
  • cognitive, communication, and/or perceptual
42
Q

At minimum for a LE brace, a patient must be able to reach ________ at the ankle.

A

neutral

43
Q

PART 3: ORTHOTICS (2)

A

PART 3: ORTHOTICS (2)

44
Q

List these AFOs from most supportive to least supportive.

  • Solid
  • Posterior Leaf String
  • Ground Reaction
  • Pre-hinged
  • Stirrup/Double Upright
  • Hinged/Articulated
A
  • Stirrup/Double Upright
  • Solid
  • Pre-hinged
  • Hinged/Articulated
  • Ground Reaction
  • Posterior Leaf Spring
45
Q

What is the Ranchos Orthotic Road Map?

A

Decision making tree to guide on what type of AFO is most appropriate.

46
Q

Stirrup/Double Upright AFO Indications:

  • ↑↑ concern for _____ integrity
  • Chronic ______ issues

Stirrup/Double Upright AFO Considerations:

  • Permanently attached to ______
  • ________, clunky
  • Can be unlocked to allow for ______
A
  • skin
  • edema
  • shoe
  • heavy
  • DF
47
Q

Solid AFO Indications:

  • Significant LE ________ or ________ requiring maximum stability
  • Primary brace recommended for ____ spasticity
  • Alignment issues

Solid AFO Considerations:

  • Rigid plastic, minimal pliability
  • Provides good support but limited mobility – recommended mostly for ____-___________ patients
  • Good for __/__ stability at ankle
  • Can include anterior shell for ______ control
A
  • weakness or hypotonia
  • PF
  • non-ambulatory
  • M/L
  • knee
48
Q

Pre-hinged AFO Indications:
-Significant __________ but anticipate continued motor return and potential to progress to articulated AFO

Pre-hinged AFO Considerations:

  • A great option to allow the ________ to progress with the patient
  • Can add a removable anterior plastic shell to help with ______ buckling
A

-weakness

  • brace
  • knee
49
Q

Hinged/Articulated AFO Indications:

  • Active ___ and ____ (ideally ≥3/5)
  • Adequate ______ control (quadriceps ≥3+/5)

Hinged/Articulated Considerations:

  • Provides adjustable ______ control
  • Can be fabricated with ____ assist or _____ stop if needed
  • Good __/__ stability
  • Allows for __________ gait pattern
A
  • DF and PF
  • knee
  • ankle
  • DF assist or PF stop
  • M/L
  • reciprocal
50
Q

Ground Reactive AFO Indications:

  • ______ foot
  • ___/___ ankle instability
  • *Knee buckling in ______ *

Ground Reactive AFO Considerations:

  • Creates knee __________ movement to prevent buckling
  • Aids in foot __________
  • Helpful with _________ gait pattern
A
  • drop
  • M/L
  • stance
  • extension
  • clearance
  • crouched
51
Q

Posterior Leaf Spring AFO Indications:

  • ____ foot with minimal to no M/L instability
  • Absent knee buckling, may see knee hyper________

Posterior Leaf Spring AFO Considerations:

  • Allows for some active _____ and _____ (Also provides counter moment to both)
  • Otherwise minimal support, will not aid with _____ buckling
  • “______ phase AFO”
A
  • drop
  • hyperextension
  • DF and PF
  • knee
  • “swing phase AFO”
52
Q

What is the one exception to the no edema allowed for AFOs?

A

Stirrup/Double Upright

53
Q

What is the only AFO that is attached to the shoe?

A

Stirrup/Double Upright

54
Q

Which AFO has no ankle mobility?

A

Solid

55
Q

Which AFO allows for relatively full DF but prevent most/all PF past neutral and starts to allow reciprocal gait?

A

Hinged/Articulated

56
Q

Which AFO requires hamstring ROM testing because of things that can cause crouched gait (flexion/flexion/flexion)?

A

Hinged/Articuated

57
Q

Which AFO is used when we see significant weakness but they have positive prognostic factors leading us to anticipate motor return and potential to progress to articulated AFO?

A

Pre-hinged

58
Q

Which AFO is a “stance phase AFO” that is used for drop foot with M/L ankle instability?

A

Ground Reactive

59
Q

Which AFO is a “swing phase AFO” that is used for drop foot without M/L ankle instability?

A

Posterior Lead Spring

60
Q

What orthoses add a thigh component to increase the stability provided at the knee?

A

KAFO (Knee-Ankle-Foot Orthoses)

61
Q

KAFO Indications:

  • Most commonly used for ___________
  • Can be used with hemiplegia (Severe knee hyper____________, ___/____ instability at knee)
A
  • paraplegia

- (extension, M/L)

62
Q

KAFO Considerations:

  • Most can be progressed to _____ AFO
  • Knee joint can be ________ to provide maximal sagittal plane support during standing/walking tasks (Unlocked for sitting)
  • VERY heavy and clunky (High reliance on ____ musculature to move forward)
A
  • solid AFO
  • locked
  • hip
63
Q

What is the biggest problem with KAFOs not being appropriate for significantly hemiplegic patients?

A

They are heavy, clunky, and uncomfortable. Won’t be able to advance limb with the KAFO on.

64
Q

Considerations of Orthoses:

  • Each AFO will have a different impact on _________.
  • Goas for choosing a brace should be the _____-_________ orthoses; is also most reflective of both patient ___________ and _________ for recovery.
  • ______ to brace.
  • 1 brace/__-__ years unless significant change in function. Medicare B: __% coverage.
A
  • function
  • least-restrictive, presentation AND prognosis
  • When
  • 3-5 years, 80%
65
Q

Management for Orthoses:

  • Must always be worn with __________ shoes.
  • Ideally should not be donned against _____ _____.
  • Wear schedules
  • Skin checks
A

closed-toed

-bare skin

66
Q

Upper Extremity Splints/Orthotics Indications:

  • Management or prevention of _________ at fingers, wrist, or elbow
  • Hypotonia, hypertonia
  • Often used as “resting splints”

Upper Extremity Splints/Orthotics Considerations:

  • When donned, eliminates __________ use splinted joints from
  • Skin checks important
  • RN, patient education
A
  • contractures

- functional

67
Q

PART 4: CVA MODALITIES (BWSTT)

A

PART 4: CVA MODALITIES (BWSTT)

68
Q

What is the primary line of defense for addressing post-stroke gait dysfunction?

A

over ground walking

69
Q

What is BWSTT?

A

Body Weight Supported Treadmill Training

70
Q

What are the benefits of walking on a treadmill?

A
  • increased stride length
  • increased step length
  • improved symmetry
  • improved activity tolerance
  • improved gait speed
71
Q

What is the biggest concern with treadmill training post-stroke?

A

FALL RISK

72
Q

What are the benefits of harness system/BWSTT?

A
  • effectively removes fall risk

- has an unloading effect

73
Q

BWSTT is recommended for _________ patients, but not _____________ patients.

A
  • acute/sub-acute

- chronic

74
Q

BWSTT Acute to Subacute:
What does research show today?
-Improvements seen in gait _____, ______, ______________.
No significance found in gait ___________.

A
  • speed, endurance, fear of falling

- mechanics

75
Q

BWSTT Acute to Subacute Indications:

  • Ambulatory patient with stable ___ status
  • Stable upright tolerance
  • Gait goals including gait ______ and/or reducing fall risk with gait
  • Eliminate ____ risk, many safety concerns
  • Decreased physical load on _________
A
  • CV
  • speed
  • fall
  • therapist
76
Q

BWSTT Acute to Subacute Considerations:

  • Allows for more ______/__________
  • Be aware of _____________ status
  • Be cautious with ________ or _________ deficits
A
  • steps/session
  • cardiovascular
  • behavioral or cognitive
77
Q

BWSTT Acute to Subacute:
What should it look like?
-Benefits are found at _______ treadmill speeds
-BWS should remain less than __%
-Should always be followed by ____ _______ ambulation to promote carryover.

A
  • higher
  • 40%
  • over ground
78
Q

What are some ways to progress BWSTT?

A
  • increase speed
  • reduce BWS
  • reduce assist and facilitation
  • add incline
  • increase duration, lessen rest breaks
79
Q

PART 5: ADDITIONAL MODALITIES

A

PART 5: ADDITIONAL MODALITIES

80
Q

What is NMES?

A

The use of electrical stimulation to activate muscles through stimulation of intact peripheral motor nerves.

81
Q

NMES Indications:

  • ______ injuries ONLY
  • UE: pain, subluxation, spasticity (short-term effects), strengthening
  • LE: spasticity, strengthening
A

UMN

82
Q

NMES-mediated task must be repetitive, novel, volitionally controlled, and __________ relevant.

A

functionally

83
Q

NMES Precautions:

-Impaired or absent _______ to area being stimulated.

A

sensory

84
Q

NMES Contraindications:

  • internal _________ or ______ implant
  • Open wounds, ________, cancerous lesions near site or stim.
A
  • electrical or metallic

- fractures

85
Q

What is the use of NMES to promote specific functional activity with devices called?

A

Functional Electrical Stimulation (FES)

86
Q
  • What are the most common FES we will work with as PTs?

- What are their indications?

A

Bioness L300

  • foot drop
  • poor foot clearance

Bioness L300+

  • knee instability
  • poor foot clearance
87
Q

How do the Bioness FES devices work:

  • Sensor placed in sole of shoe to detect when extremity is in ________ phase
  • Stims muscles in response to normal physiological activation of targeted muscles throughout gait cycle
A

stance

88
Q

Bioness Muscle Activation:

  • ________: stim during stance and 2nd half of swing
  • __________: stim during first half of swing
  • ___________: stim throughout swing
A
  • Quads
  • Hamstrings
  • Anterior Tibialis
89
Q

Bioness devices are good for ____ level functioning patients.

A

high-level

90
Q

EMG Biofeedback:

  • Most evidence surrounding use on __s (Shown to result in improvements in strength and motor control)
  • Requires some active movement of targeted muscle groups
  • Limitation: No standardized recommendations for treatment prescription (Typical rx: 3-5x/week over several weeks )
  • Insufficient evidence to suggest superiority over other forms of treatment in __
A
  • UE

- UE

91
Q

List some alternative therapies in addition to what has been described.

A
  • Partial Body-Weight Supported Overground Ambulation
  • Aquatic Therapy
  • Neurologic Music Therapy
  • Robotics
  • Virtual Reality
  • Mental Imagery
92
Q

PART 6: OUTCOME MEASURES

A

PART 6: OUTCOME MEASURES

93
Q

What is the Stroke Impact Scale?

A

Subjective questionnaire evaluating disability and health-related QOL after stroke.

94
Q

What are the 8 domains of the Stroke Impact Scale?

A
  • Strength
  • Hand function
  • ADL/IADL
  • Mobility
  • Communication
  • Emotion
  • Memory and thinking
  • Participation/role function
95
Q

Stroke Impact Scale tends to be more helpful with ______ patients.

A

chronic

96
Q

Stroke Impact Scale has excellent accuracy in predicting ______ post-stroke.

A

QOL

97
Q

What outcome measure provides a uniform system of measurement for disability based on how much assistance is required for the individuals to carry out activities of daily living?

A

Functional Independence Measure (FIM)

98
Q

The FIM is becoming obsolete, why?

A

Medicare has dropped it

99
Q

The FIM is performed by multiple healthcare providers typically at admission and discharge. It is scored on a scale of 1-7 with __ domains.

A

18

100
Q

What is the Orpington Prognostic Scale?

A

Provides an assessment of stroke severity via 4 domains?

101
Q

What are the 4 domains the Orpington Prognostic Scale looks at?

A
  • Motor Deficit
  • Proprioception
  • Balance
  • Cognition
102
Q

Orpington Prognostic Scale Scoring (1.6-6.8):

  • Minor = Scores _____ have high likelihood of returning home.
  • Moderate = Scores between ___-___ generally respond better to rehabilitation.
  • Major = Scores _____ are typically dependent with increased risk of institutionalism.
A
  • <3.2
  • 3.2-5.2
  • > 5.2

S4- Neuro 1 (12 decks)

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