What do you observe in inadequate shock absorption?
- Instability in early stance
- Knee Extension or buckling
- Forward trunk lean
What are the impairments related to shock absorption?
- Excessive activation of Gastroc/soleus for controlled ankle (spasticity)
- Impaired activation of quads for controlled knee flexion
- Excessive Activation of quads
- impaired simting of glutes medius, glute max, and hamstrings for hip stability
What are some interventions to promote shock absorption with the Gastroc/soleus?
- EMG (gastroc)
- Visual feedback
- reduce or increase graph size
- FES (TA)
- Excitating sensory and motor neurons of DF muscle
- TA activation can help with eccentric contol
What interventions would help with the Quads for impaired shock absorption?
- FES to quad and hamstring
- Quad - eccentric contrl knee flexion in LR
- BWSTT with manual guidance
- faster speed allows to target eccentric control
- community ambulation speed
- Practice stepping to target
- Whole practice walking (floor ladder)
- EMG to quads for activty
- visual feedback
Interventions for glute med, max, and hamstring?
- BWSTT (timing and sequencing)
- Approximation or compression (weighted vest/ compression garmet = timing and sequencing)
- Backwards walking on treadmill
- Walking with wider steps for ABductors
What are the critical events for LR?
- Hip stability, controlled kne flexion, controlled ankle PF
What are the critical events for MSt?
Tibial Advacnement
What is observed during inadequate single leg support?
- Instability in early and mid stance
- Short step on uninvolved leg
- Late heel lift
- Lack of push off in Pre Swing
What are the impairments related to inadequate single limb support?
- Impared Activation of gastroc soleus
- Imparired proprioception of ankle
- Impaired activation of glute med
- Impaired flexibility of iliopsoas
- Impaired upper body and lower body coordination
Intervention for SLS for gastroc soleus?
- FES to gastroc
- Part Practice in staggered stance with mirror feedback
- fade to intrinsic feedback
Gastroc soleus is needed to maintain upright posture
What are interventions to promote SLS from impaired sensation of the ankle/foot?
- Visual target to increase step length
- Sensory E stim
- sub motor threshold, no visual contraction
- Mental imagery
What are some interveions to promote SLS due to impaired glute med activation?
- Mental imagery for hip ABduction?
- FES to glute med
- Unilateral treadmill stepping
- affected limb is stationary
- wider steps with abduction band
- part practice with INCREASED step length
What are interventions to promote SLS from impaired iliopsoas flexibility
- HEP
- Part practice with visual target
- taking full step will stretch opposite side
Describe the imapired upper body in coordination for SLS
- Upper vody stays righted with gravity and lower body responds to the surface
- Arm swing and trunk rotation have a tight conenction with coordinated gait
- stroke affects input from involved leg does not trigger arms
- Arm can improve gait
- Balance improvements using the arm for reach to grasp in stading
- Intervention
- Facilitaing trunk rotation via UE swing
What do you observe in inadequate forward propulsion?
- Reduced trailing limb posture in pre-swing
- lack of push off
What impairments are related to inadequate forward propusion?
- impaired gastroc soleus power
- impaired activation of iliopsoas, rectus femorus, and adductor longus
- Impaired proprioception at the hip
- Excessive activation of quadriceps
What interventions for Forward propulsion that affect gastroc soleus?
- FED for gastroc timing an dpower
- Jump training
- BWSTT - FAST speed, Variable speed, backwards walking
- VR (biofeedback)
- Sensory component
POWER more important that strength
What are interventions for forward propulsion for impaired activation of iliospoas, rectus femoris, adductor longus?
- Part practice with rapid hip and knee flexion to a taret
- Treatmill training
- fast walking with or without BWSTT
- Fast unilateral stepping on a treadmill
- Marching fast (quickly)
- walking to stretch spindles and activate flexors (trailing limb posture)
What are interventions for forward propulsion from impaired proprioception in the hip?
- Whole body vibration
- Manual cues to facilitage stretch of iliopsoas on treatmil
- Visual targets for increase step length - (trailing limb posture)
What are interventiosn to promote forward propulsion for weak quadriceps?
- backwards walking - trailing limb
- EMB to quads
What do you observe with inadequate foot clearence?
- Toe drag/catch
- Hyperextension in stance
- Impaired knee flexion in preswing
- Circumduction in Swing leg
- Decreased angle of hip flexion
What causes inadequate foot clearance?
- Lack of PF power in stance/preswing
- Slowed hip flexion power results in DECREASED knee flexion in early swing and less toe clearance
- impaired Proximal distal sequencing of TA and hip Flexors
- Hip Flexion power is critical
What are the impairments related to inadequate foot clearance?
- Reduced power of hip felxors
- impaired activation of iliopsoas and adductor longus
- Excessive Activation of Quads
- Reduced power of PF
- Excessive activation of Gastroc soleus
- Impaired timing of TA
- Impaired ankle proprioception
Foot clearance intervention fos reduced hip flexion power
- BWSTT
- VR
Emphasize trailing limb posture for more power (inc spindles)
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1 Stroke19
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1 Stroke Risk/Management10
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1 Neuroscience16
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1 Stroke Recovery Prognostic Factors10
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2 GAIT14
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2 Gait Abnormalities29
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2 Communication/Aphasia7
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3 Standing29
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3 Sit to Stand35
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4 Rolling11
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4 Coming to Sit14
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4 Sitting APA RPA10
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4 Reach To Grasp11
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5 Perception20
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5 Facial Paralysis13
