16 Clinical Reasoning / Gait Analysis Where ?Why ?
17 Clinically Reasoning Where is it going wrong Why is it going wrong How can I change this Improve Motor ControlDiscuss 2ndary complications e.g soft tissue shortening
18 Motor Control Theories Client Centred – Goal settingVan Den Broek (2005)Active problem solver – Procedural learningPractice, skilled learning results in structure change at a neural level, experience driving reorganisation Carry Over(Shunway-Cook & Woollacott 2001)(Van Den Broek 2005)(Buonomano & Merzenich 1998)E.g Learning outside the gym – MDT roleIt is suggestedMotor TheoristsIndividual learns through experience of movement (implicit learning)Being able to provide the patient the opportunity to experience movement outside the gym setting
19 Orthotics An Orthosis: An external device used to modify the structural or functional characteristics of the neuromuscular system (International Standards Organisation)E.g Callipers, braces, splints, supports, casts, insoles.FO, AFO, KAFO
20 AFO’s and Alignment Condie (2004) Consensus Conference Report ‘Alignment of the orthosis at terminal stance/pre- swing is critical and will influence step length, gait symmetry, speed and energy consumption’Meadows (1994)Owen (2004)Owen (2004) – Suggests when aligned in TS, lengthening of gastrocs, hamstrings and hip flexorsImportance of footwear/AFO combination Walking enables therapeutic lengthening
22 Clinical Reasoning Patient Example Increased Tone Fixed PF contracture Significant compensation strategiesNormalHow to manage this?
23 MidstanceRelate to somatosensoryTerminal Stance
24 AFO’s Related to Stroke Research Research poorly performedFocus on chronic strokePost rehabilitationWide variability in studiesLeung & Moseley (2003) (National Clinical Stroke Guidelines RCP )Improved temporal spatial, gait pattern and efficiency measuresNo strong conclusion can be drawnCondie (2004) Consensus Conference ReportOrthoses should be considered in the management of patients with strokeNHS Quality Improvement Scotland (2009)Best Practice Statement ~ Use of ankle-foot orthoses following strokeSWIFT Cast Trial – Early intervention cast walkingSmall scaleDifficult due to heterogeneous nature of rehab populationsPoor methodologyWide variety of studies
25 Summary Importance of biomechanical - neurophysiological principles Use of orthoses as an adjunctCondie (2004) Consensus Conference ReportNHS Quality Improvement Scotland (2009)Suggest earlier use