Neuro

• - weight acceptance/ limb loading
• - single limb support
• - limb advancement

• - most demanding/ hardest task
• - involves transfer of weight, shock absorption and maintenance of forward progression

- one limb supports entire body weight andprovide truncal stability

- requires foot clearance and limb swing

• - stance phase
• - when the limb is weight bearing movement of distal jt influences the position of the proximal joints

- when the limb is non-weight bearing movement of a proixmal jt influences the position of jts distal

- weak tib ant or spastic PF

• - positive energy involves mm to produce the movement and acceleration
• - negative- decelerating

• - mm act over brief periods- should be submaximal torc
• - involved more in deceleration than progression
• - changing the spee of gait alters mm activation patterns- timing and forces of contractions will change. The slower they walk the more energy is required

• - soft tissue stretch contributes significantly to power bursts
• - reduces the active energy required
• - passive contributions increase with gait speed- due to a great deal of stretch, increaselength of stride
• particularly:
• - hip flexor stretch at terminal stance- 50% passive
• - Ankle PF- 15% thru passive recoil

• Major problem in mm that cross two joints

• - in walk not that important for gait initiation
• - controlled falling- COP is shifted behind COG by decreasing PF activity you increase DF
• - gait initiation takes about 3 steps until steady state is reached. SOmething to think about

• - max WB thru legs
• - optimize sensory cues
• - max recovery not compensation
• - evidence- training at faster speed = better
• - use the least restrictive assistive devices or no devices
• - start early, maximise intensity and volume

• -requires many therapists
• - we can be injured
• - often limited by therapist endurance
• - takes time

• - use of aids and assistive devices is controversial in physio
• - does the use help or delay?
• Need to think of:
• - clinical significance
• - differential effects
• - long term effectiveness
• - pt satisfaction with long term use
• - effectiveness compared with other interventions eg treadmill training

• - pt needs to be able to weight bear
• - pt in sling over treadmill
• - improves independence with mobility, gait speed, strength and symmetry
• - increase cardio fitness and decrease energy expendture
• Advantages:
• - safe
• -more symmetrical legs stance and weight shift
• - faster walking practice- can increase speed and volume
• - is adjustable
• - therapist can facilitate missing componenets

NEED to make sure pt hasw right gait patterns and treat trunk control, balance and strenght

• - some evidence that with physio could help
• - cost heaps
• - how often should they be use?

• - robotic gait training system using a BWS treadmill
• - by itself it is not the answer
• Limited by:
• - no pelvic rot
• - too passive
• - therapist cannot control sensory cues or facilitate specific mms

- gait- look at impairement level

• - function- what pts care about
• - dual tasks
• - community access
• - participation
• Scales include- timed upand go
• - 6 mint walk test
• - ilanoi agility test
• they increase in difficulty

• Independent walking
• - secondary tasks
• - greater cognitive demands
• - upper limb activities
• - envt demands
• - greater physical demands
• then return to work, sport and leisure activities

• - 75% of neurological cases report community mobility essential or very important
• - only 50% of people with stroke regain independent community mobility
• - inability associated with poor satisfaction, QoL and mood disorders
• - gait speed 48m/min and distance of 90m may be predictive- may be able to do community training

• - multidimensional
• - no single measure is sufficient
• - no singleintervention will be sufficient

• Associated factors:
• - age and sex- men better
• - strength of affected limbs
• - usual gait speed
• - environmental self efficacy- big thing
• - psychological factors

• - functional needs to involve a turn
• - for indoor activities such as shopping 35-50% of all steps involve a turn
• - 40% of all walking bouts are less than 12 steps- stop/ start
• - 50 steps in a row accounts for 0.7% of total walk bouts
• - 60% of walking lasts <30 sec

• - stroke pts use 2x energy to walk than non stroke
• - increased energy requirement for walking in neurological conditions
• - fatigue common symptoms
• - functional implications
• - how long would it take a person to walk 150m from a parking space to the bnak- 2 min normal, stroke 6 min
• stroke pts ned to be fit due to the high energy demands

• - speech prodces more gait interference than memory and visuospinal tasks
• - even when pts are mobility impaired they priortize the cognitive tasks
• - optimal time to introduce dual task training

• - importance of speed
• - effort of mobilising- up 2x for stroke
• - practice task in its entirety
• - flexible envts
• - cognitive ability
• - ability to self monitor
• - CV fitness
• - use of aids

at least grade 4

dynamic tests needed

best indicator, need stable ankle and knee

• - running extends locomotor ability 
• - the bability to take a quick step if required
• - faster transport between places
• - crossing the road before the lights change
• - avoiding dangerous situations
• - to play and care for small children
• - method for promoting fitness and social participation
• - for all these activities you need to increase your speed

walking

• - Verticle GRF 3x BW (walking 1x)
• - AP GRF 30% BW (walking 15%)

• - walking mid stance- high point
• - running mid stance- low point

• - work isometrically
• - transfer energy from one jt to the next therefore reducing metabolic demands
• - are unique in that they often work in opposing actions at adjacent jts

• - push off 
• - hip extension early in stance
• - hip flexion in late stance

• - push off
• - hip flexion in late stance

• - greater proportion of swing phase
• - ball of foot contact
• - calf is primary shock absorber

• - significantly greater jt moments at knee and ankle 
• - significantly greater quads activity

• - predominantly concentric
• - maintain gait speed by shorter stride length and greater stride rate

- predominantly eccentrically

• - WB through ball of foot
• - Greater ROM, jt movements and powers
• - almost completely concentric
• - stance phase called pull up
• - no heel strike

• - WB through lateral border of ball of foot
• - greater ankle ROM, similar to knee ROM, less hip ROM
• - almost completely eccentric
• - you need more DF to go down- ankle at back

• - slower velocity
• - greater cadence, shorter stride
• - requires significantly greater mm activity, esp quads and gluts
• - shows a greater training effect for mm strength than forward running