Assessment and physiotherapy management of Spastic gait.pptx

spastic gait

1. Assessment and physiotherapy management of Spastic gait Dr. Madhu(PT)

2. Overview Spastic gait is a characteristic walking pattern often seen in individuals with cerebral palsy, multiple sclerosis, or other neurological conditions affecting motor control. It is typically caused by hypertonia (increased muscle tone) and spasticity, leading to stiffness in the legs and decreased range of motion in the joints. This gait is marked by poor coordination, uneven step lengths, and exaggerated movements, which can result in challenges with balance and stability.

3. Kinematic Analysis Kinematic analysis involves assessing the movement patterns during walking: Pelvic Motion: - The pelvis may demonstrate limited lateral movement, leading to a reduced hip abduction and increased pelvic tilt. - There may be a tendency for anterior pelvic tilt, which affects overall posture and gait dynamics.

4. Kinematic Analysis 2. Hip Movement: The hip typically exhibits increased flexion and adduction during the swing phase, which may lead to the legs crossing (scissoring). - Reduced hip extension during the stance phase can contribute to shorter step lengths and inefficient gait.

5. Kinematic Analysis 3. Knee Motion: There is often excessive knee flexion during the stance phase due to spasticity in the hamstrings, which may lead to stumbling and tripping. - The inability to achieve full extension can compromise stability and weight-bearing efficiency.

6. Kinematic Analysis 4. Ankle Movement: The ankle may exhibit limited dorsiflexion , leading to a toe walking pattern and affecting foot clearance during the swing phase. - Increased muscle tone in the gastrocnemius can lead to equinus gait, characterized by the inability to bring the heel down during the stance phase.

7. Kinematic Analysis 5. Trunk and Upper Body Motion: The trunk may lean forward or sideways to maintain balance, resulting in an abnormal posture. - Arm movements may be altered, with reduced arm swing on the affected side, contributing to instability.

8. Kinetic Analysis Kinetic analysis examines the forces and moments involved during walking: Ground Reaction Forces (GRF): - GRF patterns may show asymmetry between the two legs, leading to *increased loading on the stronger side during stance. - Vertical GRF may be exaggerated during initial contact, leading to increased impact forces on the lower extremities.

9. Kinetic Analysis 2. Muscle Activation: Increased activation of spastic muscles (e.g., adductors, hamstrings) can lead to uncontrolled movements and difficulty in achieving smooth gait patterns. - Compensatory activation of other muscle groups (e.g., hip flexors) may occur to facilitate movement despite spasticity.

10. Kinetic Analysis 3. Joint Moments: The knee and hip joints often exhibit altered moments, with increased moments required to stabilize the knee and control forward motion. - Abnormal joint loading can contribute to joint pain and secondary complications over time.

11. Kinetic Analysis 4. Energy Expenditure: Individuals with spastic gait generally exhibit higher energy expenditure due to inefficient movement mechanics and compensatory strategies. - This can lead to fatigue and decreased endurance during prolonged activities.

12. List of Problems Increased muscle tone and spasticity, leading to reduced mobility and flexibility. 2. Limited range of motion in the hips, knees, and ankles. 3. Poor coordination and balance, increasing the risk of falls. 4. Abnormal gait mechanics, such as toe walking or scissoring. 5. Joint pain and discomfort due to altered loading patterns. 6. Fatigue during ambulation, impacting participation in daily activities. 7. Decreased confidence in mobility, which may affect social interactions and quality of life. 8. Potential for secondary complications, such as contractures or musculoskeletal deformities.

13. Short-Term Goals Reduce spasticity through targeted stretching and relaxation techniques. 2. Improve flexibility and range of motion in the lower extremities, focusing on hip, knee, and ankle joints. 3. Enhance strength in hip abductors and extensors to promote better stability and gait mechanics. 4. Increase balance and coordination to reduce the risk of falls during ambulation. 5. Educate the patient and caregivers about proper positioning and gait techniques.

14. Long-Term Goals Achieve functional independence in ambulation and daily living activities. 2. Normalize gait mechanics to enhance walking efficiency and decrease energy expenditure 3. Enhance overall strength and endurance in the lower extremities. 4. Prevent secondary complications such as joint deformities, chronic pain, or contractures. 5. Promote social participation and improve quality of life through increased mobility and confidence.

15. Physiotherapy Management The management of spastic gait focuses on reducing spasticity, improving strength and flexibility, and enhancing overall gait mechanics through targeted interventions: Stretching and Flexibility Exercises Static and Dynamic Stretching: Regularly incorporate stretching of the hip adductors, hamstrings, and gastrocnemius to improve flexibility and reduce spasticity. - Passive Range of Motion (ROM) Exercises: Help maintain joint mobility, particularly in the hips and ankles.

16. Physiotherapy Management 2. Strengthening Exercises Hip Abductor and Extensor Strengthening: Exercises like side-lying leg raises and bridges can enhance muscle strength and stability. Quadriceps and Hamstring Strengthening: Incorporate resistance training with exercises such as squats and leg curls to improve muscle function. 3. Gait Training Treadmill Training: Controlled environment to practice proper gait mechanics and improve rhythmic walking patterns. - Visual and Auditory Cues: Use markers or sounds to promote proper foot placement and cadence during walking.

17. Physiotherapy Management 4. Balance and Coordination Training Static and Dynamic Balance Exercises: Activities such as single-leg stands, balance boards, and dynamic weight shifts to enhance stability. - Coordination Drills: Incorporate movements that require coordination of the upper and lower body, such as reaching while walking

18. Physiotherapy Management 5 . Functional Mobility Training Engage patients in functional tasks, such as walking over obstacles, climbing stairs, and changing direction. - Practice strategies for safe transfers and mobility in daily activities.

19. Physiotherapy Management 6. Orthotic and Assistive Devices - Evaluate the need for orthotic devices (such as AFOs) to maintain proper foot alignment and enhance gait mechanics. Consider recommending assistive devices like a walker or cane for individuals with significant balance issues.

20. Physiotherapy Management 7. Education and Home Program Educate patients and families about home exercise programs focusing on stretching, strengthening, and balance training. - Provide strategies for fall prevention, including environmental modifications to enhance safety at home.

21. Physiotherapy Management 8. Psychosocial Support Address any psychosocial barriers to mobility, encouraging participation in social activities and fostering a supportive environment. - Encourage participation in group therapy or social groups to improve confidence and social interaction.

22. References Sutherland, D. H., & Olshen , R. (2007). Gait Analysis in Cerebral Palsy: A Review. Journal of Pediatric Orthopaedics . 2. Gage, J. R., & Sutherland, D. H. (2004). Orthopaedic Management of the Child with Cerebral Palsy. Butterworth-Heinemann. 3. Tzeng , Y. H., et al. (2012). Kinematic and kinetic gait analysis of children with cerebral palsy. Journal of Biomechanics.