Retraining of disordered gait

Each lab group needs:

  1. Unless they use assistive devices, patients who have had hip replacement surgery often lean toward the affected limb when they put weight it during walking. They may continue to do this for several months.

    Why do they do this?

    Develop at least two exercises that a therapist might teach them to eliminate this problem. One exercise should be relatively easy and the other should be more difficult.

    Both exercises should account for exercise specificity, the fact that exercise produces changes that are specific to muscle group, joint angle or range of motion, type and speed of muscle action. Lab groups should also specify the frequency, intensity, and duration of the exercises that they develop.

  2. Therapists often must advise patients who are at risk for falling. Consider how you might instruct such a person to fall "safely," that is, how to minimize his or her risk of injury.

    One strategy to prevent falls is to make patients less anxious by making sure they know what to do in case they fall. How would you teach a person whose strength is poor to use their environment, including furniture, to arise from the floor, either to standing or or sitting on the piece of furniture?

    Discuss in your lab group, then share with the larger group, your thoughts about environmental and physical factors that predispose someone to fall.

    Therapists must be alert to the possibility that patients may lose their balance, and should guard them appropriately. Sometimes, even the most conscientious therapist cannot control a patient's mass and must lower the patient to the floor. Consider how you would do this, ensuring the patient's and your own safety, when the patient is using a walker and when the patient is using crutches.

  3. By practicing in the stairwell with your lab group, devise a way that a person with weak hip and knee extensors (2+/5) on the right side can ascend and descend a flight of stairs using just one of the handrails.

    Hints: Ignore any assistive device that the person might use, and instruct him or her to use a "sidestepping" strategy. Decide whether the person should use the handrail on the right or left side of the stairway.

  4. Consider a 56 year-old man whose left side is weak because of a recent CVA. He does not flex the left knee during swing, and so must elevate the pelvis' left side, and circumduct the left lower extremity during swing.

    What intervention strategies might improve his function?

  5. Consider a 73 year-old man has a right above-knee amputation due to the complications of diabetes mellitus and peripheral vascular disease. He received a temporary prosthesis one week ago, and is learning to walk using a standard adult walker. While using the walker, he bears little weight on the prosthesis. When he attempts to bear more weight on the prosthesis, he takes a short and brief step with the left lower extremity, but advances the prosthesis without difficulty.

    Suggest some therapeutic activities and tasks that require increased prosthetic weight-bearing.

    Hint: After you've given this problem some thought, you can view information on early gait training for people with transfemoral amputations. The information is also relevant for people with other problems that interfere with walking.
Last updated 5-9-02 © Dave Thompson PT