Gait scenario 1

• Unilateral foot drop with forefoot initially contact:

  • Main Analysis Findings:
  • impaired heel strike / initial contact - forefoot touches ground before
  • potential due to weak dorsiflexors / lack of ROM
  • potential sensation/proprioception problems so doesnt know which part of foot touches floor first
• Unilateral foot drop with forefoot initially contact:

  • Further tests/investigations you would like to do:
  • strength and rom test of dorsiflexors (dorsiflexors needed for heel strike)
  • check the individual - fear etc
  • proprioception/sensation test
• Unilateral foot drop with forefoot initially contact:

  • Suitable outcome measure
  • count the amount of heel strikes within a timed situation e.g. 6 minute walk test
  • strength of dorsiflexors against a resistance band (what colour can they get up to)
  • proprioception/sensation scale?
• Unilateral foot drop with forefoot initially contact:

  • Justification for selection of treatment
  • place stickers on floor to indicate area of heel strike (maybe place random objects between each sticker) - aim is to place heel onto each sticker
• Unilateral foot drop with forefoot initially contact:

  • Potential progression:
  • start with bars on either side for stability, progress to without bars
  • start with walking in straight lines, progress to add turns
  • progress by removing stickers
  • close eyes if visually dependent
• Unilateral foot drop with forefoot initially contact:

  • Justification of approaches to facilitated learning - DEPENDS ON PTS AGE AND STAGE ETC:
  • motor imagery
  • reduce complexity and risk of injury by starting in part practice focusing on only heel strike, progress to whole practice - gait cycle
  • start with constant and blocked practice by walking in straight line to reduce errors and increase confidence, progress to variable and random practice to help simulate real life scenarios and enhancing positive transfer of learning
• Unilateral foot drop with forefoot initially contact:

  • Justification of approaches to facilitated learning - DEPENDS ON PTS AGE AND STAGE ETC:
  • distributed practice is better than massed practice:
  • memory consolidation hypothesis - distributed practice provides better opportunities as neurochemical processes required for storing memories occur over time without additional practice (Brashers-Krug et al, 1996, 1997)
  • Cognitive effort Hypothesis - massing practice within a few days may become monotonous leading to reduced cognitive effort (Shea et al, 2000, Dail and Christina, 2004)
• Unilateral foot drop with forefoot initially contact:

  • Justification of approaches to facilitated learning - DEPENDS ON PTS AGE AND STAGE ETC:
  • cues - imaging walking up a really steep hill - increases dorsiflexion
  • demonstration
  • start with extrinsic feedback, progress to intrinsic once patients has mastered the technique
  • knowledge of results - knowing if heel touched the floor first
  • fade feedback using bandwidths - start to only give feedback once performance decreases
• Unilateral foot drop with forefoot initially contact:

  • Justification of approaches to facilitated learning - DEPENDS ON PTS AGE AND STAGE ETC:
  • Motor Learning theory - Skill Learning: acquiring new patterns of muscle activation to achieve improvements in performance, by reducing errors without compromising movement speed
  • gentiles learning stages model - start as a closed skill when focusing on heel strike
  • stage of learning - depend on experience - cognitive, associative, autonomous