managing and maintaining mobility
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TAM LEVYNOVEMBER 2011
GAIT AND MUSCLE ACTIVITY2 main components – STANCE and SWING
STANCE – the phase from when the foot strikes the ground (60%)
SWING – when the foot starts to leave the ground (40%)
MUSCLE ACTIVITYSTANCE – need ‘stability’ by activating
extensor muscles at hip, knee and ankle
SWING – need a ‘push off’ from calf muscle, then hip flexor to ‘pull’ leg through
GAIT PROBLEMSIn HSP there is a combination of spasticity
and weakness
This causes muscle imbalance and leads to compensatory movement patterns (‘tug-of-war’ analogy)
ISSUES RELATED TO WEAKNESSEXTENSORS : a lack of strength at the knee
may cause buckling or hyperextending (‘flicking’). Buckling could lead to falling, hyperext may cause knee pain
HIP FLEXORS : can’t bring leg through straight so have to compensate and find another way e.g. hitching the leg or vaulting on the other leg
DORSIFLEXORS (raise the foot) : toes can’t clear the ground, so we find another way e.g. hitch or drag toes
ISSUES RELATED TO SPASTICITYKNEE EXTENSORS : ‘stiff’ leg that is hard to
bendHIP ADDUCTORS : ‘scissoring’ gait which
may lead to falls (as trip self)CALF : can’t get heel down, which impedes
gait and stability, also makes it harder to clear foot
MANAGEMENTAIM IS TO CONTROL SYMPTOMS AND
MAINTAIN MOBILITY
find what works for you – consult a neurophysiotherapist to get a personal, safe, specific program and treatment as needed.
options would include stretches, exercises for specific muscle groups, ES (elec stimulation), medication, fitness
STRETCHESSHORT TERM : to loosen up prior to exercise
or mobilityLikely to need to address calf, hip adductors, hip flexors, hamstrings
website : physiotherapyexercises.comLONG TERM : consider positioning (eg
wedge for hip adductors), splinting (eg AFO), serial casting for calf shortening
EXERCISESideal is ‘task-specific’, goal-directed and repetitive
muscles likely to need addressing are hip abductors, extensors and flexors; knee extensors and flexors; ankle dorsiflexion (DF) - raise the toes/feet and plantarflexion (PF) - point the toes/feet
can supplement with the use of electrical stimulation (ES), especially for DF (addressing toe-dragging)
Functional Electrical Stimulation (FES)Programmed stimulation sequence
Gait Reach and grasp
Electrical Stimulation: Methods
OTHER CONSIDERATIONSCONSIDER SAFETY at all times in positioning
self for exercisesDON’T overdo it – rest is important as wellFITNESS is important- do what you can e.g.
hydro, gym, exercise physiologist, tai chiWALKING AIDS – ensure correct aid and at
correct heightSeek the advice of a neurophysiotherapist.
They have the skills to assess you, treat you and recommend a program.
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