Assessment and physiotherapy management of Hyperkinetic gait.pptx

Hyperkinetic gait

1. Dr. madhu (PT) Assessment and physiotherapy management of Hyperkinetic gait

2. Introduction Hyperkinetic gait refers to abnormal, excessive, and involuntary movements that impact walking. It’s often associated with neurological conditions like Huntington’s disease, cerebral palsy, dystonia , and other disorders affecting the basal ganglia. The gait is characterized by excessive, erratic, and uncontrolled movements that disrupt normal walking patterns.

3. Kinematic Analysis Kinematics focuses on movement patterns, including joint angles, velocities, and timing of movement during walking: Involuntary Movements: Chorea (rapid, jerky movements): In conditions like Huntington's disease, chorea can affect the arms, legs, and trunk, leading to irregular gait patterns. - Dystonic movements: These involve sustained, twisting movements that can lead to abnormal posturing of the legs or trunk during walking.

4. Kinematic Analysis 2. Irregular Step Length: Patients with hyperkinetic gait typically have variable step lengths and inconsistent gait rhythm. This irregularity leads to poor gait efficiency and increased fall risk. 3. Abnormal Joint Movements: Due to the involuntary movements, there can be excessive joint motion* in the hips and knees, leading to uncoordinated limb movement during the swing and stance phases. - Altered foot placement: Erratic movement may cause the feet to land in abnormal positions during walking, leading to instability.

5. Kinematic Analysis 4. Reduced Coordination: - Poor timing and coordination between the upper and lower limbs result in impaired arm swing and trunk control. Patients may display asymmetric movement patterns. Unstable trunk control: A lack of core stability and erratic movements of the upper body further reduce balance during walking. 5. Gait Speed Variability: - Patients exhibit variability in gait speed, with intermittent episodes of fast, irregular movement followed by slower, halting walking.

6. Kinetics deals with the forces responsible for movement, such as muscle activation, joint moments, and ground reaction forces: Inconsistent Muscle Activation: There is irregular activation of muscles in the lower limbs, particularly during the stance phase. Involuntary contractions lead to inefficiency in movement and poor motor control. - Overactivation of antagonist muscles: Simultaneous contraction of muscles on opposite sides of the joint (agonist-antagonist co-contraction) can lead to increased joint stiffness and rigidity in some forms of hyperkinesia .

7. 2. Altered Ground Reaction Forces (GRF): Due to inconsistent foot placement and variable step length, ground reaction forces can vary significantly. The peak GRF may be abnormally high or low depending on the intensity of the involuntary movements. - There may be increased mediolateral forces due to erratic lateral movements of the body, leading to instability. 3. Energy Expenditure: - The erratic and uncoordinated nature of the movements increases energy expenditure during walking, leading to early fatigue and poor endurance in patients. Kinetic Analysis

8. 4. Impaired Postural Adjustments: - The body’s ability to maintain stability through postural reflexes is impaired due to the involuntary, excessive movements, leading to poor balance control and increased risk of falls. Kinetic Analysis

9. Involuntary and excessive limb movements disrupt gait efficiency. 2. Poor coordination between limbs leads to irregular step length and timing. 3. Inconsistent gait speed, alternating between fast, erratic movements and slow, halting steps. 4. Decreased postural stability, especially during dynamic tasks like turning or navigating obstacles. 5. Increased fall risk due to poor balance and unpredictable movements. 6. Abnormal joint postures during walking, such as excessive flexion or extension at the knee or hip. 7. Excessive energy expenditure, leading to early fatigue during walking. 8. Difficulty initiating and maintaining rhythmic gait patterns. 9. Compromised functional mobility, affecting daily activities such as walking in crowded spaces or climbing stairs. 10. Psychosocial impact, as the erratic gait can affect social interaction and confidence. List of Problems

10. Short-Term Goals Improve coordination and reduce excessive involuntary movements during walking. 2. Enhance gait symmetry by normalizing step length and timing. 3. Increase postural stability and reduce fall risk. 4. Increase muscle strength and flexibility to support more controlled movements. 5. Improve functional mobility, focusing on safe navigation in daily environments.

11. Long-Term Goals: Maintain functional independence in ambulation and daily activities. 2. Reduce fall frequency by improving balance and motor control. 3. Optimize gait efficiency to reduce energy expenditure and delay fatigue. 4. Enhance quality of life by improving walking ability and reducing reliance on assistive devices. 5. Increase participation in social and physical activities, mitigating the psychosocial impact of the condition.

12. Physiotherapy Management Management focuses on controlling the involuntary movements, improving balance, and optimizing gait patterns through targeted interventions: Movement Control and Coordination Training Motor control exercises: These help improve voluntary control over muscles. Techniques like PNF ( Proprioceptive Neuromuscular Facilitation) can improve coordination. Task-oriented training: Repeated practice of functional tasks, such as walking, turning, and climbing stairs, helps reinforce appropriate movement patterns. - Rhythmic auditory stimulation: Using rhythmic cues (e.g., metronome or music) can help synchronize limb movements and reduce erratic gait patterns.

13. Physiotherapy Management 2. Strengthening and Flexibility Exercises Strengthen proximal muscles (hips, core) to improve postural control and reduce excessive movement. - Focus on stretching tight muscles and increasing joint range of motion to counteract any abnormal postures caused by dystonic or choreiform movements.

14. Physiotherapy Management 3. Gait Training and Balance Exercises Treadmill training: This helps regulate speed and improve gait regularity. Body-weight-supported treadmill training is useful for those with severe balance impairments. - Balance exercises: Static and dynamic balance exercises like single-leg stance, tandem walking, and using a balance board can improve postural control and reduce fall risk. - Dual-task training: Incorporating cognitive tasks during gait training helps improve motor control under real-world conditions, which often require multitasking.

15. Physiotherapy Management 4. Postural Reeducation Use postural correction exercises to address any abnormal postures (e.g., forward flexed trunk, excessive hip or knee flexion) and improve overall alignment during walking. - Core stability training: Exercises like planks, bird-dog, and side bridges help improve trunk control and reduce involuntary trunk movements.

16. Physiotherapy Management 5. Use of Assistive Devices In severe cases, assistive devices like a walker or cane may be recommended to enhance stability and reduce the risk of falls. Orthotic devices may be used to control excessive joint motion and improve foot placement during walking. 6. Functional Mobility and ADL Training Practice walking in various environments, including stairs, uneven terrain, and crowded spaces, to improve functional mobility. - Work on transfers, bed mobility, and sit-to-stand to reinforce functional independence.

17. Physiotherapy Management 7. Freezing and Involuntary Movement Management Use of visual or auditory cues can help reduce freezing episodes* and improve movement initiation. Medications may be prescribed to reduce the severity of involuntary movements (e.g., levodopa for Huntington’s disease), and therapists work closely with physicians to optimize timing of therapy sessions around medication schedules. 8. Psychosocial Support and Patient Education Educate patients and caregivers on fall prevention strategies and how to modify the home environment to ensure safety. - Support groups and psychosocial interventions can help manage the emotional and social impact of the disease.

18. References Quinn, L., & Busse , M. (2012). Physiotherapy clinical guidelines for Huntington's disease. European Huntington's Disease Network. 2 . Morris, M., & Iansek , R. (1996). Motor control in Parkinson’s disease. Movement Disorders.