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MANAGING AND MAINTAINING MOBILITY

This overview addresses the complexities of gait and muscle activity during the stance and swing phases of mobility. It elucidates the significance of muscle stability and push-off mechanisms, and challenges faced in conditions such as hereditary spastic paraplegia (HSP), highlighting the interplay of weakness and spasticity. Key management strategies are discussed, including customized exercise programs, stretches, and the use of electrical stimulation. Emphasis is placed on the importance of safety and ongoing assessment by neurophysiotherapists to enhance mobility effectively.

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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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