DPTD 862 - HIGT & postural control

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18 Terms

1
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mod-high intensity walking should be performed at ___ maxHR

70-80%

2
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locomotor CPG recommendations that should NOT be performed

  • sitting/standing balance without augmented visual input

  • robotic-assisted walking training

  • body weight support treadmill trading w/ physical therapy assist

3
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benefits of HITG

  • increased gait efficiency & decreased O2 cost

  • increased average daily steps

  • improving walking outcomes including gait speed & distance

  • rapidly assist patient to reach significant outcomes on 6MWT & 10MWT

  • decrease resource utilization

  • compared to low-intensity, has greater improvements in: aerobic fitness & motor function and protection from cardiovascular events

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who is NOT appropriate for HIGT

  • severe LE contractures

  • orthopedic injuries aggravated by gait

  • significant osteoporosis

  • cardiovascular or metabolic instability

  • cognitive impairment (following commands)

  • untreated major depression

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If unsure about cardiovascular history/ability in terms about gait training, you should…

contact physician for clearance

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parameters for moderate-high intensity =

60-80% HRR (max HR-resting HR) OR 70-85% max HR

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outcome measures for HIGT

6MWT & 10MWT

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target RPE for HIGT

15-17

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signs to terminate HIGT

  • drop in SBP >10 mmHg w/ increased workload

  • SBP >250 mmHg or DBP >115 mmHg

  • angina

  • dizziness/near syncope

  • cyanosis or pallor

  • patient wants to stop

  • fatigue, SOB, wheezing, leg cramos, claudication

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intrinsic risk factors for falling

  • advancing age

  • female

  • gait & balance impairments!

  • acute & chronic illnesses

  • cognitive & functional impairment

  • depression

  • visual deficits

  • muscle weakness!!

  • polypharmacy

  • h/o previous falls

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extrinsic risk factors for falling

  • inadequate lighting

  • slippery floor/ice

  • loose rugs

  • uneven surfaces

  • cluttered walkways

  • use of ADs

  • ill-fitting shoes

12
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if a pt does poorly on condition 4 of mCTSIB, this indicates…

vestibular dysfunction - NOT diagnostic

13
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components required to maintain balance

  1. quiet standing- maintain COM within BOS

  2. self-induced perturbations- reposition COM within BOS

  3. external perturbations- able to achieve adequate stepping responses

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sensory strategies for balance

  • vision

  • somatosensory system

  • vestibular system

15
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motor strategies for balance

  • ankle or hip strategy

  • stepping strategy

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medial/lateral weight shifting is primarily controlled by…

hip musculature

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anterior/posterior weight shifting is primarily controlled by…

ankle musculature

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most difficult directions to weight shift

anterior/posterior