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52 Cards in this Set
- Front
- Back
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Concentric vs Eccentric contractions? |
C: Generate motion and force E: Control motion |
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Basic challenges to gait |
Accomplish progression Achieve postural stability during steady state gait Ability to adapt gait to changing task and environmental demands |
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Functional objects at weight acceptance |
IC, LR Achieve stability and shock absorption |
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Functional Objective at SLS |
Mst, Tst Stability and progression |
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Functional objective for Swing limb adv |
PSw, ISw, MSw, TSw Progression Foot Clearance |
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Objectives and Challenges of Weight Acceptance |
Shock Absorption Initial Limb Stability Preservation of progression Challenge: Accept abrupt transfer of body weight onto a limb that is in unstable alignment after it just finished swinging |
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Objective and challenges to SLS |
Progression over stationary foot Limb and trunk stability Challenge: One limb has responsibility for support and progression of entire body in both sagittal and coronal planes |
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Objective and Challenge in Swing limb advancement |
Position the limb for swing Accelerate progression Foot clearance Adv of limg from trailing position Complete limb advancement Challenge: to assist with forward progress by providing a forward push prior to lifting and responding to the rapid demands of swing |
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0-100% benchmarks of the gait cycle |
10% - LR 20% - Midstance 30-40% - Terminal Stance 50% - Pre-swing 60-70% - Initial Swing 80% - Mid Swing 100% - Terminal Swing |
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ROM Req for normal gait |
Hip Fx - 0-30 Hip Ext - 0-10 Knee Fx - 0-60 Knee Ext 0 Ankle DF - 0-10 Ankle PF - 0-20 |
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Determinants of progression
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Initial Step Foot Rocker Fwd fall of body weight Propulsive force |
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Define Deformity |
Tissues will not allow sufficient passive mobility to attain normal postures and ROM |
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Define Elastic ontractures |
Inactivity; yield to forceful stretch Ex. PF Contracture - limits DF during swing but allows normal ankle motion during dtance |
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Define Rigid Contracture |
Resists considerable force Ex. PF contracture - blocks tibial progression in stance and foot clearance in swing |
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Define muscle weakness |
Insufficient strength to meet demands Normal sensation and motor control are intact Affects both progression and postural control |
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What can cause muscle weakness |
Paresis - primary nm impairment affecting #, type, and firing fq of motor neurons) --Dec DTRs Disuse Atrophy |
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Muscle weakness strategies |
Each major muscle group has a substitution -Modified timing -Reduce speed to reduce demand -Protective alignment during stance |
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Define sensory loss |
Impaired sensation/perception, proprioception, kinesthesia |
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Ways pts compensate to sensory loss |
Slamming foot onto ground Walking slow Watching the ground as the walk |
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When do you grade sensory testing response as "normal" |
Only give grade of normal if responses are rapid and consistently correct |
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What is the primary cause of MSK pain |
Excessive tissue tension |
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Swollen joints assume what position? |
Resting position Ankle 15deg PF Knee 15-60deg Hip 30-65 deg |
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A pts ability to substitute for impaired motor control is proportional to what? |
The amount of selective control and the acuity of their proprioception Hemiplegia - best opp for efficient gait Paraplegia - incomplete spinal cord injury Spastic diplegia - most disabiling |
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What is impaired selective control |
Interpreted as weakness but DTRs intact -interupts timing and intensity of muscle action -Whole limb may be involved, but loss of control will be most severe distally |
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Emergence of primitive locomotor pattern |
Loss of smooth transition from swing to stance, modulation of intensity of action Swing - mass flexion Stance = mass extension |
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What pairs together in normal gait? (Knee/ankle) |
Knee ext and dorsiflexion Knee flexion and plantarflexion |
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Define Spasticity |
Inappropriate activation of a muscle when it is being rapidly lengthened. Inversely related to gait speed |
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Limits of spasticity |
-Affects freedom of segments to move rapidly in respect to each other -Limits transfer of momentum during gait |
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Define locomotor spasticity |
Phase dependent |
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Describe plantarflexor paresis |
Disturbed CPG with preserved voluntary and isolated activation Often accompanied by dorsiflexor weakness/paresis |
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Plantar flexion weakness and phases |
Stance - strong hyper extension Pre swing - reduced kinetic energy to acheive propulsion (inc hip/knee movements) Swing - lack of kneeflexion |
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Effects of Quad paresis on phases |
LR and MSt - difficulty controlling knee flexion -Knee extension Swing - compensatory hyper extension prevents knee from moving freely -Inhibits progression -Results in toe drag |
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Effects of Hip Flexor Paresis on Phases |
Swing - knee flexion and toe clearance are lost affecting progression and postural control Shotrened step Abnormal positioning of foot at initial contact |
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Compensations for Hip Flexor Paresis |
Posterior tilt of pelvis and activation of abdominals to advance swing limb Circumduction Contralateral vaulting Leaning the trunk toward opposite limb |
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Describe Hip Extensor Paresis |
Can result in forward trunk lean Backward lean to bring CoM behind hips Strongly correlated to reduced gait velocity |
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Describe Hip Abductor paresis |
Drop of pelvis on contralateral side Contributes to deformity Decreased mediolateral stability of CoM --Frontal plane instability is correlated with inc risk for falls |
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Compensations for hip abductor paresis |
Lateral shift of CoM over stance limb with lateral lean of trunk |
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Reduced amplitude of what muscles at push off cause slower gait speed? |
PF and hip flexors |
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PF spasticity and Weight Acceptance |
Affects foot position at IC (stability) Limits DF preventing heel strike Loss of ankle rocker obstructing progression |
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What is Equinovarus |
Lateral border contact of the foot (TS and posterior tib) |
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What is Equinovalgus |
Medial border contact of the foot (TS and fibularis brevis) |
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Effects of spasticity in SLS - PF |
-Early activation pulls leg backward producing knee extension -Reduces ability to build tension in PF for push off -Leads to persistent obstruction of progression and loss of ankle rocker |
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Effects of spasticity in SLS - Quads |
-Produces excessive knee extension during stance -Knee extension spasticity during pre-swing inhibits limb advancement and leads to stiff legged patter |
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Effects of spasticity in SLS - Hamstrings |
-May cause excessive knee flexion -Compensated shorter stride |
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Effects of spasticity in SLS - Hip adductors |
-Produces contralateral hip drop as femus is drawn medially -Can produce sever medial displcement of entire limb so swing limb catches on stance limb |
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Effects of spasticity in SLS -Hip Flexors |
-Restricts ability to achieve trailing limb in terminal stance |
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Effects of spasticity in swing limb - Quads |
Activation during lengthening in early swing may limit knee flexion No association between quad spasticityand gait speed |
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Effects of spasticity in swing limb - Hamstrings |
Limits effectiveness of terminal swing, restricts thigh advancement resulting in knee flexion at IC |
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Effects of spasticity in swing limb - PFs |
-Can affect forward foot clearance during swing (toe drag) -Resists extension at the knee and dorsiflexion of the foot for heel strike at IC |
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Describe loss of selective control |
Emergence of abnormal synergies Abnormal coupling of muscles resulting in stereotypical movement patterns --Total flexion - cannot extend knee while flexing the hip --Total extension |
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Describe Non-stretch related muscle overactivity |
-In activation of muscles that is unrelated to spasticity-mediated stretch -Impairs ability to recruit muscles for progression and postural control |
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Coactivation of agonist and antagonist muscles |
Loss of selective recruitment of physiologically antagonistic muscles -Pathologically disorganized central programs -Additional postural support activity -Immature gait programs -Compensatory programming |
