DPT 652 Midterm Study Guide: Balance, Gait, Orthotics, CVA, SCI, Cerebellar Ataxia, and MS

Vocabulary practice flashcards covering postural balance strategies, sensory organization, gait deviations, lower-limb orthotics, stroke syndromes and recovery, spinal cord injury levels and syndromes, cerebellar ataxia, and multiple sclerosis clinical characteristics.

Ankle Strategy

A postural motor strategy used for small, slow perturbations on a firm surface; moves the body as a single unit around the ankles with muscle activation firing distal to proximal.

Hip Strategy

A postural motor strategy used for larger or faster perturbations, compliant surfaces, or when the base of support (BOS) is smaller than the feet; produces rapid movement at the hips with antiphase ankle movements and serves as the primary strategy for recovering stability in the mediolateral direction.

Stepping Strategy

A postural motor strategy used when ankle and hip strategies are insufficient, involving taking a step to bring the base of support (BOS) back underneath the center of mass (COM).

Feedforward Mechanism (Anticipatory)

Postural adjustments occurring before movement or disturbance to prepare and stabilize the body (e.g., activating trunk muscles before raising an arm).

Feedback Mechanism (Reactive)

Postural responses occurring after an external disturbance to correct an error and regain stability (e.g., taking a step after being pushed).

CTSIB Condition 2

Clinical Test of Sensory Integration and Balance condition consisting of standing on a firm surface with eyes closed; tests somatosensory/proprioceptive reliance as vision is eliminated.

CTSIB Condition 5

Clinical Test of Sensory Integration and Balance condition consisting of standing on a foam surface with eyes closed; isolates and tests the vestibular system because somatosensory information is inaccurate and vision is unavailable.

Foot Slap

A gait deviation at initial contact/loading response caused by dorsiflexor weakness or an impaired eccentric control of the plantarflexors.

Knee Buckling (Loading Response)

Excessive knee flexion during loading response resulting from quadriceps weakness or poor eccentric quadriceps control.

Anterior Trunk Lean (Loading Response)

A gait deviation during loading response used as a compensation for quadriceps weakness.

Posterior Trunk Lean (Loading Response)

A gait deviation during loading response resulting from hip extensor or gluteal weakness.

Early Heel Rise

A gait deviation during stance phase caused by limited dorsiflexion ROM, heel pain, gastrocnemius/soleus spasticity, or plantarflexor tightness/contracture.

Knee Thrust into Extension

Knee hyperextension during stance caused by quadriceps weakness, glute/hip weakness, spasticity, or plantarflexor contracture.

Trendelenburg Gait

Contralateral pelvic drop during single-limb stance caused by hip abductor weakness, specifically weakness of the gluteus medius.

Hip Hiking (Swing Phase)

Elevation of the pelvis during swing to compensate for decreased foot clearance, often caused by inadequate knee flexion or ankle dorsiflexion.

Posterior Leaf Spring AFO

An ankle-foot orthosis providing dorsiflexion assistance during the swing phase of gait while permitting normal plantarflexion during loading response.

Carbon Posterior Leaf AFO

An orthosis designed to provide energy storage and return, assisting with dynamic swing-phase clearance and smoother transitions.

Custom Solid AFO (Tuned)

An orthosis providing maximum ankle immobilization to control severe spasticity or instability.

Anterior Shell AFO

An orthosis designed to limit dorsiflexion in stance, preventing the knee from buckling or collapsing forward during the stance phase of walking.

Swedish Knee Cage

An orthotic device used to prevent knee hyperextension.

Anterior Trimlines

Brace trimlines where material extends more anteriorly, providing increased control and allowing less motion.

Posterior Trimlines

Brace trimlines where material provides less contact, providing decreased control and allowing more motion.

Brunnstrom Stage 1

The post-CVA motor recovery stage characterized by flaccidity and no active limb movement.

Brunnstrom Stage 3

The post-CVA motor recovery stage characterized by voluntary control of movement strictly within synergy patterns and maximized spasticity (peak tone).

Brunnstrom Stage 4

The post-CVA motor recovery stage characterized by movement beginning outside of synergy patterns and a decrease in spastic tone.

Middle Cerebral Artery (MCA) Syndrome

A vascular stroke presentation with contralateral face and upper extremity weakness greater than lower extremity weakness ($\text{face} + \text{arm} > \text{leg}$), contralateral sensory loss, aphasia (if dominant hemisphere), or neglect (if non-dominant hemisphere).

Anterior Cerebral Artery (ACA) Syndrome

A vascular stroke presentation with contralateral lower extremity weakness greater than upper extremity weakness ($\text{leg} > \text{arm}$), lower extremity sensory loss, possible behavioral/personality changes, and urinary incontinence.

Posterior Cerebral Artery (PCA) Syndrome

A vascular stroke presentation primarily characterized by contralateral visual field deficits, possible sensory deficits, and memory/language impairments if the dominant hemisphere is involved.

Head/Hip Relationship

A functional transfer and mobility principle in spinal cord injury rehabilitation stating that the head must move in the opposite direction of the intended movement of the hips.

Tenodesis Grasp

A functional passive grip observed at the C6 SCI level where active wrist extension naturally produces passive finger flexion.

C7 Spinal Cord Injury Level

A major functional transition level in SCI marked by triceps innervation, allowing independent transfers without a sliding board, independent wheelchair push-ups for pressure relief, and manual wheelchair mobility.

Anterior Cord Syndrome

An incomplete cord injury syndrome typically caused by flexion trauma damaging the anterior spinal artery, corticospinal tract, and spinothalamic tract; results in loss of motor, pain, and temperature function below the lesion with preserved dorsal column function (vibration, conscious proprioception, and discriminative touch).

Central Cord Syndrome

An incomplete cord injury typically caused by hyperextension trauma; characterized by motor and sensory loss affecting the upper extremities greater than lower extremities ($\text{UE} > \text{LE}$) with sacral sparing.

Brown-Séquard Syndrome

An incomplete spinal cord hemisection injury caused by penetrating trauma; produces ipsilateral loss of motor function, light touch, vibration, and proprioception below the lesion, along with contralateral loss of pain and temperature starting $1\text{--}2$ segments below the lesion.

Autonomic Dysreflexia

A life-threatening medical emergency occurring in spinal cord injuries at or above $T6$ triggered by noxious stimuli (e.g., full bladder, blocked catheter, UTI, constipation, pressure sore) causing sudden hypertension; managed by immediate removal of the noxious trigger.

Heterotopic Ossification (SCI)

Abnormal bone formation in soft tissue typically arising within approximately $4\text{ months}$ post-injury around the hips and knees; manifests with redness, heat, decreased ROM, and a bony end-feel.

Dysmetria

An impaired ability to accurately judge distance or force during movement, commonly observed with cerebellar pathology.

Dysdiadochokinesia

Difficulty in performing rapid, alternating movements, indicative of cerebellar dysfunction.

Intention Tremor

A tremor that increases in amplitude and worsens as the limb approaches a targeted destination, characteristic of cerebellar ataxia.

Sensory Ataxia vs. Cerebellar Ataxia

Sensory ataxia stems from lost proprioceptive/sensory input, displays a positive Romberg test, and improves significantly with visual guidance; cerebellar ataxia is an intrinsic motor coordination deficit that does not resolve with visual input.

Relapsing-Remitting MS (RRMS)

The most common form of multiple sclerosis ($70\%$ of cases), characterized by temporary flare-ups (relapses) followed by periods of recovery without disease progression (remissions).

Secondary-Progressive MS (SPMS)

A clinical course of multiple sclerosis that begins as relapsing-remitting MS and gradually shifts into continuous, worsening disease progression (developing in approximately $80\%$ of RRMS patients).

Primary-Progressive MS (PPMS)

A form of multiple sclerosis accounting for $10\text{--}15\%$ of cases, characterized by continuous symptom worsening from disease onset without distinct relapses or remissions.

Lhermitte's Sign

A neurological symptom seen in multiple sclerosis characterized by an electric-shock sensation radiating down the spine and into the limbs upon neck flexion.

4 P's of Energy Conservation

Pacing, planning, prioritizing, and positioning; principles utilized in multiple sclerosis rehabilitation to manage fatigue.