Week 9 (a). Gait training after stroke Flashcards
What are the temporal characteristics of gait?
Stance phase - 0-60%
Swing phase - 40%
Characteristics gait - how are they different in older people?
Similar kinematics Increased stance phase - 66% Increased double support - 15% Decreased stride length Decreased push-off power
What is critical during swing phase at the ankle?
Quick change from powerful PF to DF
Concentric activity during stance phase
Occurs primarily in double support
Hip ext - beginning of stance
Hip flex - at the end of stance
Ankle PF - end of stance
Eccentric activity during stance phase
hip flex
hip abd to control the lateral displacement centre of mass on stance leg
knee ext
ankle PF
Concentric activity swing phase
Hip flex. initially
Ankle DF throughout
Is swing phase concentric or eccentric
Primarily pendular motion with eccentric muscle activity used to control limb segments
Eccentric activity swing phase
Hip ext. mid swing
Knee extensors initially and knee flexors for rest of swing
What are the walking outcomes after stroke?
after 12 months, 80 % are walking in some manner
What is the mean walking speed following stroke compared with age matched controls
- 53 (+/- 0.22)
1. 34 (+/- 0.17)
What is the speed considered necessary for community ambulation
> 0.8
What is the walking speed of 0.8 m/s
Minimum speed considered necessary for community ambulation
Studies into functional walking capacity in people with stroke
Less than half could walk further than home/letterbox
What aspects of gait can be commonly affected by stroke
Stance on affected leg
Swing on affected leg
Asymmetrical step length, increased step width
What are common problems in stance after stroke?
Shortened
Increased propulsion of intact leg to shorten swing phase
What are common problems in swing after stroke??
Decreased propulsion prior to swing phase
Decreased knee flexion and ankle DF in swing
Compensatory circumduction or elevation of pelvis
What problem at the hip can cause decreased hip extension in stance
Flexor contracture
Weak concentric hip extension
Decreased eccentric hip abd
? Eccentric hip flexor
What problem at the knee can cause decreased hip extension in stance
Quad weakness
What problem at the ankle can cause decreased hip extension in stance
decreased DF
decreased eccentric PF
Correct way of wording treatment goal for somebody who needs to improve DF
need to increase range, strength and speed of concentric dorsiflexion
What problem at the hip can cause knee hyperxtension in stance
decreased hip extension
What problem at the knee can cause knee hyperxtension in stance
decreased eccentric hamstrings
Lack of control in inner range
What problem at the ankle can cause knee hyperxtension in stance
Any cause of decreased DF
What problem at the hip can cause increased knee flexion in stance
Decreased ext
What problem at the knee can cause increased knee flexion in stance
Contracture of knee flexors
Decreased concentric quads inner range
What problem at the ankle can cause increased knee flexion in stance
decreased eccentric PF
Reasons for increased lateral pelvic shift
Cannot control the shift and go too far (lack eccentric hip Abd.)
Reasons for decreased lateral pelvic shift
Don’t shift weight enough. - concentric hip Abd
Reasons for decreased ankle PF at end of stance (hip)
Any cause of not staying on the leg long enough. - Decreased Hip extension, decreased control Hip Abd (don’t want to stay on one leg)
Reasons for decreased ankle PF at end of stance (Knee)
Any cause not wanting to stay on leg long enough. decreased knee extension
Reasons for decreased ankle PF at end of stance (ankle)
Loss of dexterity required to switch from eccentric PF to concenctric PF rapidly with large force
Reasons for decreased hip flexion in swing
Not in the right position for the start of swing.
- any cause of lack of hip extension.
- decreased concentric hip flexion
Causes decreased knee flexion in swing
Knee flexion normally happens after a burst of PF and Hip Ext and is a pendular movement. Address these other joints as causes instead of just giving exercises for hamstrings.
Reasons for decreased ankle dorsiflexion in swing
Decreased concentric DF strength Joint Spasticity Muscle length Lack of dexterity in switch between DF and PF
