Improving Walking Ability - Physiotherapy Presentation PDF

IMPROVING WALKING ABILITY PRAMUDYA UTAMA, M.Fis, FTr  Theoretical Framework Task MOVEMENT ▪ Mobility ▪ Stability ▪ Manipulation Task...

IMPROVING WALKING ABILITY PRAMUDYA UTAMA, M.Fis, FTr  Theoretical Framework Task MOVEMENT ▪ Mobility ▪ Stability ▪ Manipulation Task Individual Individual ▪ Cognition ▪ Perception ▪ Action Environment ▪ Regulatory Environment ▪ Non Regulatory LOCOMOTION  Sensory Information Gait cycle Local dynamic stability Human Locomotion Spinal motor output Challenging human locomotion: stability and modular organization in unsteady conditions SENSORY INFORMATION The importance of afferent information in the control of movement SENSORY INFORMATION Neurovisual Deficit 20-40% of people with a brain injury experience related vision disorders (Kerkhoff, 2000) Untuk dapat meraih objek : ▪ Motivasi ▪ Locate the object in space SENSORY INFORMATION Propioception Muscle Spindle and Golgi Tendon Organ SENSORY INFORMATION SENSORY INFORMATION Heel Strike Loading Response Terminal Stance Initial swing 0% 20 % 75 % 100 % SENSORY INFORMATION GAIT CYCLE ASSESSMENT  A walking velocity of 1.1-1.5 m/s Berjalan Perubahan Lingkungan Konteks Sosial Time Up and Go Test  Cut-off time for high risk of falls An older adult who takes ≥12 seconds to complete the TUG is at risk for falling. Cut of scores indicating risk of falls by Population (in seconds) Community dwelling adults - 13.5 Older stroke patients - 14 Frail elderly - 32.6 Local Dynamic Stability ▪ The multifidus pass along 2 or 3 spinal level. Work as segmental stabilizers. ▪ Position sensor of spinal segment ▪ Rich composition of muscle spindle ▪ Multifidus have been found to atrophy in people with low back pain. Core Stability Muscle Anticipatory Mechanisms Spinal Motor Output  PHYSIOTHERAPY FOR IMPROVING WALKING ABILITY The major requirements for walking are: Support of body mass by lower limbs Propulsion of the body in the intended direction A basic locomotor rhythm Dynamic balance control Flexibility Support of body mass by lower limbs  ORIENTASI CONTAC Propulsion of the body in the intended direction Progression ▪ Classic “Butterfly” Ground Force Reaction ▪ Progression initial contact – pre swing → takes place from left to right WEIGHT BEARING Dynamic Balance Control A basic locomotor rhythm Forwards weight displacement reactive walking pattern Automatical / CPG activity Cadence: >70 Steps/min Normal speed 112-120 Steps/min Energy Expenditure HUMAN LOCOMOTION contains two aspects: Voluntary initiation and adaptation Cognition is involved with visual scanning, perception, navigation etc. Automatic control of movement Motivation to walk:- Cortex & Limbic System. Initiation of walking:- Midbrain and subthalamic locomotor regions. Central Pattern Generators:- Basic Locomotor patterns. Flexibility CONCLUSION Human The major requirements for walking are: Locomotion Support of body mass by lower Sensory Information limbs Gait cycle Propulsion of the body in the intended direction Local dynamic stability Spinal motor output A basic locomotor rhythm Dynamic balance control Flexibility Activity Limitations