Week 9 (Impairments of Walking)

Question 1

Reasons for increased knee flexion at early stance

Answer 1

• Weakness in eccentric knee extensors
• Loss of co-ordination of knee extensors to eccentrically control or slow down speed of knee extension
• Loss of co-ordination to control amount of knee flexion

Question 2

Reasons for hyperextension of knee at mid stance

Answer 2

• Weakness in eccentric plantar flexors to control forward shank progression
• Loss of co-ordination to control position of knee

Question 3

Reasons for reduced ankle plantar flexion at late stance

Answer 3

• Weakness in concentric plantar flexors

- Loss of co-ordination of plantar flexors to generate power at appropriate time

Question 4

Reasons for reduced dorsiflexion throughout

Answer 4

• Weakness in ankle dorsiflexors which work concentrically in first half of swing and isometrically in second half of swing
• Loss of co-ordination to switch dorsiflexors on fast enough or at the time right

Question 5

What exercise to give someone if they have increased knee flexion or hyperextension during mid stance

Answer 5

Train knee extension/flexion 0-10 degrees in standing in prep for mid stance of walking. Moving their knee back and forth on a block with the other foot on a block.

Question 6

What exercise to give someone if they have decreased hip and knee extension in stance phase of walking

Answer 6

Train hip and knee extension in preparation for mid-stance of walking so patient takes weight across to affected leg by moving at the shoulders and hips and move back to the good side or can place foot up onto a block and back down.

Question 7

What exercise to give someone if they lack hip and knee extension in stance or hyperextend knee in stance, increased double support time

Answer 7

Train hip and knee extension in preparation for whole stance phase of walking. Patient steps with their intact leg onto the block and back down and therapist is positioned on intact side.

Question 8

What exercise to give someone if they have increased or decreased horizontal pelvic shift in stance phase of walking and wide or variable BOS during walking

Answer 8

• Train hip abduction in lying in preparation for mid to end stance phase of walking
• Train hip abduction in standing in preparation for mid to end stance phase of walking

Question 9

What exercise to give someone if they take short steps, slow walking speed and lack plantar flexion at end stance phase of walking

Answer 9

Train ankle plantar flexion in preparation for mid to end stance by plantar flexing up and down on a stool

Question 10

What exercise to give someone if they have reduced hip extension during end stance

Answer 10

Train hip extension in supine in preparation for mid to end stance phase of walking. Patient lies in bed and pushes with their heel down to train buttocks.

Question 11

What exercise to give someone if they have reduced knee flexion and reduced hip flexion during swing

Answer 11

Tran hip and knee flexion in preparation for swing phase of walking by letting the patient step on a block and down. Train knee flexion by patient standing in front of a table and flexes their knee while maintaining hip extension.

Question 12

Whole-task practise of walking by providing physical assistance

Answer 12

Train whole task by providing physical assistance
- 1st physio stands in front holding a walking belt
- 2nd physio manually guides at hip, knee and ankle
Train whole task of walking using a treadmill with partial body weight support
- 30% BW

Question 13

Whole-task practise of walking by providing physical assistance

Answer 13

Walking on a treadmill without weight support
Train whole task of walking overground with no assistance so use non-stick footprints, metronome, measuring tape and stopwatch