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MANAGING AND MAINTAINING MOBILITY

MANAGING AND MAINTAINING MOBILITY. TAM LEVY NOVEMBER 2011. GAIT AND MUSCLE ACTIVITY. 2 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 ACTIVITY.

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MANAGING AND MAINTAINING MOBILITY

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  1. MANAGING AND MAINTAINING MOBILITY TAM LEVY NOVEMBER 2011

  2. GAIT AND MUSCLE ACTIVITY • 2 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%)

  3. MUSCLE ACTIVITY • STANCE – 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

  4. GAIT PROBLEMS • In HSP there is a combination of spasticity and weakness • This causes muscle imbalance and leads to compensatory movement patterns (‘tug-of-war’ analogy)

  5. ISSUES RELATED TO WEAKNESS • EXTENSORS : 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

  6. ISSUES RELATED TO SPASTICITY • KNEE EXTENSORS : ‘stiff’ leg that is hard to bend • HIP 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

  7. MANAGEMENT • AIM 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

  8. STRETCHES • SHORT TERM : to loosen up prior to exercise or mobility Likely to need to address calf, hip adductors, hip flexors, hamstrings • website : physiotherapyexercises.com • LONG TERM : consider positioning (eg wedge for hip adductors), splinting (eg AFO), serial casting for calf shortening

  9. EXERCISES • ideal 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)

  10. Electrical Stimulation: Methods • Functional Electrical Stimulation (FES) • Programmed stimulation sequence • Gait • Reach and grasp

  11. OTHER CONSIDERATIONS • CONSIDER SAFETY at all times in positioning self for exercises • DON’T overdo it – rest is important as well • FITNESS is important- do what you can e.g. hydro, gym, exercise physiologist, tai chi • WALKING AIDS – ensure correct aid and at correct height • Seek the advice of a neurophysiotherapist. They have the skills to assess you, treat you and recommend a program.

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