Gait Training

Question 1

Primary Goal of Gait Training

Answer 1

for patient to attain a smooth, energy efficient gait to allow them to perform ADLs and participate in desired employment and recreational activities

Question 2

Patients function compaired to pre morbid

Answer 2

Patients who have functioned witha diseased limb for a considerable period of time frequently exceed their premorbid level of function

Question 3

Factors that Contribute to Smooth Gait

Answer 3

• accept weight of the body through both legs
• balance on one foot in single limb support
• advance each limb forward and prepare for step
• adapt to environment demands

Question 4

Before pt can develop smooth gait, pt must be able to balance on prosthesis long enough to bring other leg forward in controlled matter = Prosthetic control

Answer 4

• Goal Oriented activities
• side to sie weight shifting
• one legged standing
• reaching for objects in different directions
• one step - forward and back
• PT/PTA can provide feedback
• a mirror may help shift attention away from floor

Question 5

Initial Walking Principles

Answer 5

• generally using parallel bars
• pt ability to weight shift is key*
• decrease WB through UE
• *spend adequate time in balance and initial walking activities before moving ahead - or - pt may develop less desirable patterns and need more support
• *SHOULD transition from parallel bars to anticipated final external support
• safely perform sit to stands

Question 6

External Support

Answer 6

• energy expenditure is directly related to smootheness of the gait pattern
• most desirable = gait without device
• single point/quad cane often used by elderly for community ambulation
• crutches are also used with 4 point gait
• walkers are generally not indicated and should not be considered as a bridge**
• walkers do not allow smooth step over step gait, they reinforce flexion and eliminate normal use of arms

Question 7

Therapeutic Exercise - Purpose

Answer 7

increase:

• circulation
• strength
• ROM

prevent or decreased

• contractures
• sensitivity
• edema

Question 8

Positioning

Answer 8

• prevent shortening of soft tissue or contractures
• supine position with hip and knees STRAIGHT
• prone position with knees straight and legs held close together - decreased hip flex contacture
• sidelying position - residual limb hip/knee straight, small pillow between the legs to keep affected hip in neutral

Question 9

Desensitization

Answer 9

• after incision has healed completely
• massage
• rubbing
• tapping
• friction massage
• NWB - mild WB
• apply compression to RL with towel
• Coordination exercises - figure 8 etc

Question 10

Strengthening Exercises

Answer 10

• Need MD clearance first
• start slowly and increase gradually
• exercises should be done slowly
• any sharp or burning pain during exercise should result in that exercise being stopped or reduced
• isometrics for early rehab when other types of exercise may be too painful
• BRIME (brief, repetitive, isometric exercise)
  
  • up to 20 max contraction for 6 sec with 20 sec RB b/t
  • good for overloading muscle
• Important groups
  
  • hip extension
  • hip ABD/ADD
  • hip flexors
  • knee flex
  • knee ext

Question 11

PNF

Answer 11

• Rhythmic stabilization in quadruped - progress to kneling and standing
• pelvic anterior elevation/posterior depression - patterns for gait
• UE diagnosis for control and strength