Neuro, Hemi Le And Gait Interventions 2:7

Front 1

a pt with high tone will have problems with what during gait

Back 1

being able to flex

Front 2

a pt with low tone will have problems with what during gait

Back 2

weight acceptance, single leg stance

Front 3

what does pts with stroke do not have benefit of vs pts without stroke

Back 3

-intact automatic postural adjustments
-intact equilibrium and righting reactions
-functional protective responses of UE & LE
-normal muscle tone
-isolated muscle control of trunk and EEs
-intact motor unit recruitment
-normal muscle pliability
-good biomechanical alignment
-intact sensory and perceptual systems
-intact motor planning capabilities
-intact balance and coordination
-normal speed of movemente

Front 4

what are the characteristic gait for a pt with hemiplegia

Back 4

-decreased speed
-increased stance time on unaffected side & decreased stance time on affected side
-decreased step length on uninvolved side
-limited weight shift over involved LE
-generally reduced joint excursions (at all joints)
-poor trunk control on the moving LE base, usually resulting in rigid trunk without rotation
-rigid head & neck posture
-gait is affected on BOTH sides

Front 5

T/F: gait is only affected one the "affected side" after stroke

Back 5

False

Front 6

what is the LL extensor synergy for the: hip

Back 6

extension, adduction, IR

Front 7

what is the LL extensor synergy for the: knee

Back 7

extension

Front 8

what is the LL extensor synergy for the: ankle

Back 8

plantar flexion with inversion

Front 9

what is the LL extensor synergy for the: toes

Back 9

plantarfexionand adduction

Front 10

what is the LL flexor synergy for the: hip

Back 10

flexion, abduction, ER

Front 11

what is the LL flexor synergy for the: knee

Back 11

flexion

Front 12

what is the LL flexor synergy for the: ankle

Back 12

dorsiflexion with Inversion

Front 13

what is the LL flexor synergy for the: toes

Back 13

extension (toes flex, G.toe extend)

Front 14

B/c of the inverstion in the flexor and extensor synergies, what is common

Back 14

lateral ankle sprains

Front 15

with LE spasticity, what is the pelvic position

Back 15

rotated posteriorly on hemi side, with extesion postureing throughout LE

Front 16

with flexor patter on spasticity, what reflex may you see

Back 16

flexor withdrawal reflex is prominent

Front 17

what will help with distal tone

Back 17

realigning proximally

Front 18

if the pt is in extensor tone while in supine what can you do in order to break up tone

Back 18

heel slide- hip and knee flexion

Front 19

During the LE motor status what do you need to observe

Back 19

-position assumed at rest
-volitional movements in different positions
-abnormal patterns/postures
-describe joint by joint capabilities

Front 20

During the LE motor status what do you need to "put your hands on"

Back 20

-ROM limitations
-how pts movement changes with your hand placement
-are they responding to your facilitation

Front 21

During the LE motor status what do you need for functional mobility

Back 21

-rolling
-supine <-> sit
-sit <-> stand
-transfer
gait

Front 22

what are tx ideas for low tone

Back 22

Weight bearing
approximation
bridging
facilitation cues
guide through normal motion
overflow
alignment
function

Front 23

what are tx ideas for high tone

Back 23

positioning changes
bridging
PNF
developmental sequencing

Front 24

what is Brunnstrom's perspective

Back 24

WB and walking are the most important functions of LE so training should be geared towards restoring safety during these tasks

Front 25

during sit to stand what can we do to encourage symmetry in motion and WB

Back 25

-wedge on nonaffected foot so can weight bear on weaker side
-tactile cueing
-approximation

Front 26

during sit to stand what can make it more difficult for pts to get their weight forward

Back 26

-rigid
-falling
-nerves
-lack of trunk control
-normal sensory loss
-PF contracture
-extensor synergy

Front 27

what is the role of trunk during gait

Back 27

to maintain upright posture and balance

Front 28

what are pre-gait activities

Back 28

-standing
-weight shifting with varied foot positions
-stepping in all directions
-decreasing UE support

Front 29

what are some components to gait training you need to consider

Back 29

environment (// bars, high mat etc)
AD training
manual facilitation

Front 30

what are the types of "high technology" that can be used to aid with ambulation/gait training

Back 30

-partial weight bearing supported training (over treadmill or over ground, LEAPS)
-FES
-Robotics (lokomat)

Front 31

what are the "typical"gait deviations seen in stance phase for the:
Trunk

Back 31

extraneous motion or rigid trunk

Front 32

what are the "typical"gait deviations seen in stance phase for the:
Hip

Back 32

hip flexion/lack of hip extension, Trendelenburg

Front 33

what are the "typical"gait deviations seen in stance phase for the:
Knee

Back 33

hyper-extension or "wobbie"

Front 34

what are the "typical"gait deviations seen in stance phase for the:
Ankle

Back 34

lack of heel strike risk of lateral instability, impaired tibial advancement, decreased push-off

Front 35

what are the "typical" gait deviations seen in swing phase for the:
Trunk

Back 35

posterior lean to assist with advancement,lateral lean to assist with clearance

Front 36

what are the "typical" gait deviations seen in swing phase for the:
Hip

Back 36

lack of normal 30" flexion, abnormal adduction due to synergy or abduction to increase BOS< tendency to internally rotate due to synergy or ER to use adductors to advance limb,hiking, or circumduction

Front 37

what are the "typical" gait deviations seen in swing phase for the:
Knee

Back 37

lack of normal 60 flexion

Front 38

what are the "typical" gait deviations seen in swing phase for the:
Ankle

Back 38

lack of normal DF (foot drop, toe drag) excessive supination

Front 39

what are ways to progress gait training

Back 39

-adapting speed of gait
-sudden starts and stops
-side stepping
-stepping over/around obstacles
-turning & abrupt direction changes
-backward walking
-picking up and carrying objects
-jumping/running

Front 40

what are gait outcome measures

Back 40

-timed walks (10m)
-6 minute walk
-TUG
-Tinetti
-Dynamic gait index
-functional gait assessment
-rivermead mobility index/visual gait assessment
-modify Emory functional ambulation profile scale
-functional ambulation classification scale
-gait assessment rating scale