TAM LEVY NOVEMBER 2011 Slide 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%) Slide 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 Slide 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) Slide 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 : cant 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 cant clear the ground, so we find another way e.g. hitch or drag toes Slide 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 : cant get heel down, which impedes gait and stability, also makes it harder to clear foot Slide 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 Slide 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 Slide 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) Slide 10 Slide 11 Functional Electrical Stimulation (FES) Programmed stimulation sequence Gait Reach and grasp Electrical Stimulation: Methods Slide 12 OTHER CONSIDERATIONS CONSIDER SAFETY at all times in positioning self for exercises DONT 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.