neuro eval lecture 3

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neuro eval lecture 3
2012-09-22 09:33:57
neuro eval lecture

neuro eval lecture 3
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  1. the force curve description, requires mediation from where?
    • it's a curve, a hump, that happens each time you move
    • force and speed are on the Y axis, time is on the X
    • the phases in order are: activation, acceleration, peak, deceleration, termination

    requires cortical, subcortical, and spinal mediation
  2. gait troubles - how it's looked at in impairment, functional limitation, and disability
    • impairment: loss of ROM, strenght, increased spasticity
    • functional: can't walk
    • disability: can't work, shop, cook
  3. gia phases in stance and swing
    • stance: heel strike, loading, heel off, toe off
    • swing: early, middle, late
  4. kinematics def
    description of movement - angular displacement, velocity, distance, (stride width + length, etc.)
  5. kinetics def
    forces producing mvmnt
  6. 3 critical gait components at the ankle/foot
    • ┬áheel initial contact w ground
    • smooth transition to foot flat
    • the push-off (heel off --> toe off)
  7. gait deviations in the ankle/foot, and the order in which they appear
    diminished clearance in swing --> foot slap--> foot drop --> foot drag (foot doesn't lift during swing)
  8. symptoms of gait deviations starting at ankle/foot
    toes not getting so high off the ground, may have an asymmetry in how high they lift on each side
  9. 3 causes of gait dev at ankle/foot
    • ankle plantarflexion contracture
    • platiflexion spasticity/tightness
    • dorsiflexor weakness
  10. treatment for gait dev at ankle/foot
    • sterthc plantarflexors
    • strenghten dorsiflexors
    • practice walking with foot landing on heel and rolling to toes
    • meds: baclofen, tizanidine
    • bracing/splinting
  11. problems w gait dev at ankle/foot
    • falls risk
    • worsens on uneven terrain - so it might not present indoors
    • may not present on shorter tests
  12. 8 foot drag compensations
    • circumduction
    • contralateral vaulting (going up on toes)
    • hip hiking
    • contralateral trunk lean
    • hip external rotation (then pt uses adductors to swing leg through)
    • trunk extension
    • contralat lean of trunk
    • high stepage gait
  13. 2 critical components of knee in gait
    • knee flexion at heel off
    • smooth transition of knee from flex to ext during stance
  14. extension thrust def
    knee pops into extension in stance phase
  15. causes for absensce or inadequate knee flexion at heel off
    quad spasticity w hamstring weakness
  16. treatment for inadequate knee flexion at heel off (quad spasticity w hamstring weakness)
    • strengthen hamstrings (do it in a standing pos. to mimic gait)
    • immed after exercise, practice walking
  17. the pathology behind extension thrust
    • plantarflexion spasticity or contracure
    • weak knee flexors
    • loss of eccentric knee control
    • ... it's a closed chain problem
  18. treatment ofr extension thrust
    • start by working from ankle
    • pt practices walking as PT holds knee gently
    • practice stepping back and forth w knee in slight flexion
    • very short 1 legged mini squats
    • ... build control!!
  19. genu recurvatum
    extension past neutral
  20. criticl components of hip in gait
    • flexion during swing
    • extension during stance
    • neutral ad/abduction during stance
    • ER during swing
    • IR during stance
  21. cause for the gait dev of inadequate hip flexion during swing
    • hip flexor weakness,
    • hamstring tightness
  22. common compensation for inadequate hip flexion during swing
    trunk extension in swing phase to get leg forward
  23. treatment ofr inadequate hip lfexion during swing
    stretch hammies, strenthen hip flexors ex: supine, one leg off side of table, raise knee. If this is difficult, PT raise leg, have pt eccentrically lower it. Work up to concentric
  24. inadequate hip lfexion during swing is often concomitant w what?
    foot drop
  25. Trendelenberg gait - how it looks and what muscles are weak
    • stance phase weakness of hip abductors resulting in closed chain hip adduction (hip drops on opp side)
    • glut med and DFL are weak, or, less common, spasticity of adductors
    • comp: ipsilat trunk lean
  26. treatment of for trendelenberg gait
    stand btwn parallel bars, lift opp leg, do small closed chain abd - raise and lower hip
  27. top 3 determinant of stability in gait
    • 1) hip extesnion force in stance (push off)
    • 2) med-lat stability (glut med and hip and trunk control)
    • 3) heel strike
  28. scissoring gait is a problem of what joint? what's the trouble?
    • hip in swing phase
    • the adductors are spastic, the flexors maybe too
    • weak abductors
  29. treatment for scissoring gait
    • stretch adductors (supine, now hold leg in abd)
    • exercise the abds (like in trendelenberg - the parallel bar exercise)
  30. gluteus maximus lurch - how does it look?
    • trunk is falling forward bc thip can't handle extension and falls into flexion
    • it's inadequate mid to late stance hip extension
  31. causes of glut max lurch
    • hip extensor weakness
    • hip flexor contracture

    comp: turnk extension
  32. treatments for glut max lurch
    stretch hip flexors - to do this do a passive stretch: lie prone (not supine bc it'll hurt yr back)
  33. unilateral pelvic retraction is due to what? looks like what? usually seen as part of what?
    • "weakness/atrophy of hip and trunk extensors"
    • 1 side of pelvis stays behind the other
    • usually part of a larger hemiplegic pattern - common in stroke, esp during cortical shock
  34. treatment for unilateral pelvic retraction
    • stretch hip into protraction
    • strengthen protractors
    • stand in front of pt w hands on her hips so she has to push against them as she walks forward
  35. excessive trunk flexion is due to...
    • trunk extension weakness and/or
    • flexion contracture/getting more and more kyphotic
  36. diminshed or absent trunk rotation is caused by what? what's a side effect of this?
    • caused by Parkinsonism
    • causes pt to lose counterbalance of trunk and lose med-lat stability
  37. gait dev of the scap?
    scapular protraction
  38. causes for scapular protraction if it's uni or bilateral
    • uni: hemiplegia
    • bi: postural fault, Parkinson's Disease
  39. treatment of scap protraction
    • retract scap
    • pinch shoulder baldes when walking
  40. causes for uni and bilateral absense or diminishment of arm swing in gait
    • uni: hemiplegia (flail arm/shoulder) -or- antalgic positioning
    • bi: Parkinsonism
  41. hemiballismus
    the gaid dev of unilateral excessive armswing
  42. gait dev of forward head is due to
    it increases what?
    • prolonged positioning
    • trunk flexion
    • scap protraction
    • Parkinson's disease

    increases falls risk, you ninny
  43. parkinsonian gait - 8 points
    • flexed trunk
    • cervical hyperextension - to get the head up
    • shuffling - toe-->heel contact instead of vice versa
    • festination - fast tiny steps, looks like pt's about to fall
    • absent or limited arm swing
    • absent trunk rotation
    • tremor
    • freezing aka akinesia (often when someone's about to cross a threshold
  44. Parkinson's TRAP mnemonic
    • T: tremor
    • R: rigidity (cog wheel)
    • A: akinesia (freezing)
    • P: posture
  45. cerebellar gait 3 traits
    • wide based arms and legs
    • ataxic
    • a lot of shaking
  46. ataxia def
    Loss of muscular coordination as a result of damage to the central nervous system.
  47. hemiplegic gait - 7 traits
    • unilateral
    • pelvic retraction
    • foot drag w/wo compensations
    • possible extension thrust
    • possible trendelenberg
    • unequal step lengths
    • diminished stance time in plegic leg rel. to other leg
  48. MS gait
    anything is possible, but it'll worsen with fatigue
  49. tabes dorsalis
    • a form of late syphilis that attacks the spinal cord causing
    • degeneration of the nerve fibres, pains in the legs, paralysis of the leg muscles, acute abdominal pain, etc.
    • Also called locomotor ataxia
  50. tabes dorsalis gait
    • stamping of feet to increase sensory feedback due to dorsal column damage
    • the stamping provides auditory cues and sends shock waves up the legs to compensate for the loss of sensation in the feet and help pt walk