Transcript Quadriceps Spasticity

2) Knee
3) Hip
4) Head, Trunk and Pelvis
5) Arm
6) Total Limb Function
① Initial contact 0-2% GC
Critical event : Floor contact by the heel.
To initiate an optimum heel rocker, the ankle is at neutral,
knee extended and hip flexed.
② Loading Response 0-10% GC
Critical event : Restrained knee flexion.
Restrained ankle plantar flexion. Hip stabilization.
③ Mid stance 10-30% GC
Critical event : Restrained ankle dorsiflexion. Knee extension.
Hip stabilization.
④ Terminal Stance 30-50% GC
Critical event : Heel rise. Free forward fall of the body.
⑤ Pre-Swing 50-60% GC
Critical event : Knee flexion.
6) Total Limb Function
⑥ Initial Swing 60-73% GC
Critical event : Knee flexion. Hip flexion.
⑦ Mid Swing 70-85% GC
Critical event : Ankle dorsiflexion. Hip flexion.
⑧ Terminal Swing 85-100% GC
Critical event : Hip deceleration. Knee deceleration.
Knee extension. Ankle dorsiflexion.
Total Limb Function Summary
 Walking is a pattern of motion under muscular control.
The relative significance of the events occurring during
each stride is best summarized by the sequence of
muscular action.
 Phasing within the stride displays the gross control
requirement. The timing of peak muscle activity
accentuates their unique responsibility for the limb’s
function.
 Such information groups the muscles according to
three basic functions ; stance, swing and foot control.
Stance Muscle
Control Pattern
Swing Muscle
control Pattern
Intrinsic Foot
Muscle Control
5. Pathological Gait
1) Pathological Mechanism
① Deformity(Contracture)
1) Pathological Mechanism
② Muscle Weakness
Insufficient muscle strength
Disuse muscular atrophy
Neurological impairment
③ Sensory Loss
Proprioceptive impairment
④ Pain
Trauma or Arthritis
Deformity
Muscular weakness
1) Pathological Mechanism
⑤ Impaired Motor Control(Spasticity)
Overreaction to stretch(i.e., spasticity)
Selective control is impaired
Primitive locomotor patterns emerge
Muscle change their phasing
Proprioception may be altered
2) Ankle and Foot Gait Deviation
① Causes of Excessive Plantar Flexion
Pretibial Muscle Weakness
Plantar Flexion Contracture
30◦ plantar flexion contracture
Rigid 15◦ contracture
Elastic 15◦ contracture
Soleus and Gastrocnemius Spasticity
Voluntary Excessive Ankle Plantar Flexion
② Causes of Excessive Dorsiflexion
Soleus Weakness
Ankle Locked at Neutral
Stance Knee Flexion
2) Ankle and Foot Gait Deviation
Stance Knee Flexion
Persistent knee flexion during
the foot flat support period(mid
stance) requires ankle
dorsiflexion beyond neutral in
order to align the body vector
over the foot for standing
balance.
The amount of dorsiflexion
required is proportional to the
flexed knee posture.
As the body progresses over
the supporting foot, the normal
sequence of floor contact by
the heel, foot flat and forefoot
may be altered.
3) Knee Abnormal Gait
① Causes of Inadequate Knee
Flexion and Excessive
Extension
Quadriceps Weakness
Quadriceps Spasticity
Pain
Excessive Ankle Plantar Flexion
Hip Flexor Weakness
Extension Contracture
Excessive Knee Flexion
Inadequate Extension
② Causes of Excessive
Flexion and Inadequate
Extension
Inappropriate Hamstrings Activity
Knee Flexion Contracture
Soleus Weakness
Excessive Ankle Plantar Flexion
1) Pathological Mechanism
② Muscle Weakness
Insufficient muscle strength
Disuse muscular atrophy
Neurological impairment
③ Sensory Loss
Proprioceptive impairment
④ Pain
Trauma or Arthritis
Deformity
Muscular weakness
1) Pathological Mechanism
⑤ Impaired Motor Control(Spasticity)
Overreaction to stretch(i.e., spasticity)
Selective control is impaired
Primitive locomotor patterns emerge
Muscle change their phasing
Proprioception may be altered
2) Ankle and Foot Gait Deviation
① Causes of Excessive Plantar Flexion
Pretibial Muscle Weakness
Plantar Flexion Contracture
30◦ plantar flexion contracture
Rigid 15◦ contracture
Elastic 15◦ contracture
Soleus and Gastrocnemius Spasticity
Voluntary Excessive Ankle Plantar Flexion
② Causes of Excessive Dorsiflexion
Soleus Weakness
Ankle Locked at Neutral
Stance Knee Flexion
2) Ankle and Foot Gait Deviation
Stance Knee Flexion
Persistent knee flexion during
the foot flat support period(mid
stance) requires ankle
dorsiflexion beyond neutral in
order to align the body vector
over the foot for standing
balance.
The amount of dorsiflexion
required is proportional to the
flexed knee posture.
As the body progresses over
the supporting foot, the normal
sequence of floor contact by
the heel, foot flat and forefoot
may be altered.
3) Knee Abnormal Gait
① Causes of Inadequate Knee
Flexion and Excessive
Extension
Quadriceps Weakness
Quadriceps Spasticity
Pain
Excessive Ankle Plantar Flexion
Hip Flexor Weakness
Extension Contracture
Excessive Knee Flexion
Inadequate Extension
② Causes of Excessive
Flexion and Inadequate
Extension
Inappropriate Hamstrings Activity
Knee Flexion Contracture
Soleus Weakness
Excessive Ankle Plantar Flexion
3) Knee Abnormal Gait
Quadriceps Weakness
Two actions prevent loading response
knee flexion.
Hyperextension is used when an
adequate passive range is available.
This provides greater stability for an,
otherwise, uncontrollable knee during
weight bearing.
The anterior body weight vector serves
as a knee extensor force.
Quadriceps Spasticity
Knee flexion through the heel rocker
action induces a rapid stretch of the
quadriceps. An excessive response by
the vasti inhibits the full flexion range.
Premature knee extension results.
Hamstrings spasticity
Mid stance and terminal stance - Knee
flexion action during these phases may
represent continued participation of the
hamstrings in the primitive extensor
pattern or a response to forward trunk
lean.
The patient’s forward posture to
accommodate inadequate ankle
dorsiflexion increases the need for hip
extensor support.
While out of the normal timing, this
would be appropriate hamstring
response to a functional demand.
Excessive abduction(valgus)
refers to excessive lateral
deviation of the distal tibia from
the center of the knee.
Excessive adduction(varus) of the
knee is displayed by a medial tilt
of the tibia and medial
displacement of the foot relative
to the knee.
4) Hip
① Causes of Inadequate
Extension and Excessive
Hip Flexion
Hip flexion contracture
Iliotibial band contracture
Hip Flexor spasticity
Pain
③ Causes of Inadequate
Flexion
Hip Flexor Insufficiency
Hip Joint Arthrodesis
Substitutive Actions
② Causes of Excessive Adduction
Ipsilateral Pathology
Abductor Weakness
Adduction Contracture or Spasticity
Adductors as Hip Flexors
Contralateral Pathology
Contralateral Hip Abduction Contracture
Excessive Abduction
④ Causes of Excessive Abduction
⑤ Causes of Excessive Rotation
Ipsilateral Pathology
External Rotation
Abduction Contracture
Gluteus Maximus Overactivity
Short Leg
Excessive Ankle Plantar Flexion
Voluntary Abduction
Contralateral Pathology
Contralateral Hip Adduction Contracture
Internal Rotation
Medial Hamstring Overactivity
Adductor Overactivity
Scoliosis with Pelvic Obliquity
Anterior Abductor Overactivity
Excessive Abduction
Quadriceps Weakness
5) Pelvis and Trunk Pathological Gait
① Causes of Anterior Pelvic Tilt
Weak Hip Extensors
Hip Flexion Contracture or Spasticity
Posterior Tilt(Symphysis Up)
② Causes of Contralateral Pelvic Drop
Weak hip Abductor Muscles
Hip Adductor Contracture or Spasticity
Contralateral hip Abductor Contracture
Ipsilateral Drop
③ Causes of Ipsilateral Pelvic Drop
Contralateral hip Abductor Weakness
Short Ipsilateral Limb
Calf Muscle Weakness
④ Causes of Backward Trunk Lean
Weak Hip Extensors
Inadequate Hip Flexion
⑤ Causes of Lateral Trunk Lean
Ipsilateral Trunk lean
⑥ Causes of Ipsilateral Trunk Lean
Weak hip Abductors
Contracture
Short Limb
Scoliosis
Impaired Body Image
Contralateral Trunk lean
6. Influence Factor
1) Sensory input(Visual input)
Understanding the roles of vision in the control of
human locomotion, Aftab E. Patla
2) Navigation
3) Mobility & stability
4) Balance & coordination
5) CPG
6) Obstacle, situation of floor
7) etc.