TAM LEVYNOVEMBER 2011

GAIT AND MUSCLE ACTIVITY2 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%)

MUSCLE ACTIVITYSTANCE – 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

GAIT PROBLEMSIn HSP there is a combination of spasticity

and weakness

This causes muscle imbalance and leads to compensatory movement patterns (‘tug-of-war’ analogy)

ISSUES RELATED TO WEAKNESSEXTENSORS : 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 : can’t 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 can’t clear the ground, so we find another way e.g. hitch or drag toes

ISSUES RELATED TO SPASTICITYKNEE EXTENSORS : ‘stiff’ leg that is hard to

bendHIP ADDUCTORS : ‘scissoring’ gait which

may lead to falls (as trip self)CALF : can’t get heel down, which impedes

gait and stability, also makes it harder to clear foot

MANAGEMENTAIM 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

STRETCHESSHORT TERM : to loosen up prior to exercise

or mobilityLikely to need to address calf, hip adductors, hip flexors, hamstrings

website : physiotherapyexercises.comLONG TERM : consider positioning (eg

wedge for hip adductors), splinting (eg AFO), serial casting for calf shortening

EXERCISESideal 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)

Functional Electrical Stimulation (FES)Programmed stimulation sequence

Gait Reach and grasp

Electrical Stimulation: Methods

OTHER CONSIDERATIONSCONSIDER SAFETY at all times in

positioning self for exercisesDON’T overdo it – rest is important as wellFITNESS is important- do what you can e.g.

hydro, gym, exercise physiologist, tai chiWALKING AIDS – ensure correct aid and at

correct heightSeek the advice of a neurophysiotherapist.

They have the skills to assess you, treat you and recommend a program.