neuro eval lecture 3

• 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

• impairment: loss of ROM, strenght, increased spasticity
• functional: can't walk
• disability: can't work, shop, cook

• stance: heel strike, loading, heel off, toe off
• swing: early, middle, late

description of movement - angular displacement, velocity, distance, (stride width + length, etc.)

forces producing mvmnt

•  heel initial contact w ground
• smooth transition to foot flat
• the push-off (heel off --> toe off)

diminished clearance in swing --> foot slap--> foot drop --> foot drag (foot doesn't lift during swing)

toes not getting so high off the ground, may have an asymmetry in how high they lift on each side

• ankle plantarflexion contracture
• platiflexion spasticity/tightness
• dorsiflexor weakness

• sterthc plantarflexors
• strenghten dorsiflexors
• practice walking with foot landing on heel and rolling to toes
• meds: baclofen, tizanidine
• bracing/splinting

• falls risk
• worsens on uneven terrain - so it might not present indoors
• may not present on shorter tests

• 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

• knee flexion at heel off
• smooth transition of knee from flex to ext during stance

knee pops into extension in stance phase

quad spasticity w hamstring weakness

• strengthen hamstrings (do it in a standing pos. to mimic gait)
• immed after exercise, practice walking

• plantarflexion spasticity or contracure
• weak knee flexors
• loss of eccentric knee control
• ... it's a closed chain problem

• 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!!

extension past neutral

• flexion during swing
• extension during stance
• neutral ad/abduction during stance
• ER during swing
• IR during stance

• hip flexor weakness,
• hamstring tightness

trunk extension in swing phase to get leg forward

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

foot drop

• 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

stand btwn parallel bars, lift opp leg, do small closed chain abd - raise and lower hip

• 1) hip extesnion force in stance (push off)
• 2) med-lat stability (glut med and hip and trunk control)
• 3) heel strike

• hip in swing phase
• the adductors are spastic, the flexors maybe too
• weak abductors

• stretch adductors (supine, now hold leg in abd)
• exercise the abds (like in trendelenberg - the parallel bar exercise)

• trunk is falling forward bc thip can't handle extension and falls into flexion
• it's inadequate mid to late stance hip extension

• hip extensor weakness
• hip flexor contracture

comp: turnk extension

stretch hip flexors - to do this do a passive stretch: lie prone (not supine bc it'll hurt yr back)

• "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

• 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

• trunk extension weakness and/or
• flexion contracture/getting more and more kyphotic

• caused by Parkinsonism
• causes pt to lose counterbalance of trunk and lose med-lat stability

scapular protraction

• uni: hemiplegia
• bi: postural fault, Parkinson's Disease

• retract scap
• pinch shoulder baldes when walking

• uni: hemiplegia (flail arm/shoulder) -or- antalgic positioning
• bi: Parkinsonism

the gaid dev of unilateral excessive armswing

• prolonged positioning
• trunk flexion
• scap protraction
• Parkinson's disease

increases falls risk, you ninny

• 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

• T: tremor
• R: rigidity (cog wheel)
• A: akinesia (freezing)
• P: posture

• wide based arms and legs
• ataxic
• a lot of shaking

Loss of muscular coordination as a result of damage to the central nervous system.

• 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

anything is possible, but it'll worsen with fatigue

• 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

• 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