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Stephen Kanter, PT, DPT, ATC
Supervisor, Rehabilitation Services
International Multiple Sclerosis Management Practice
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Now
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2 Full time Physical
Therapists
Interviewing
Occupational Therapists
and other rehabilitation
professionals
Massage Clinic
Accessibility Design
Consulting
Expedited Equipment
Service
Upcoming
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WHEELCHAIR and
SEATING CLINIC
(Approved to start in
JANUARY 2009)
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Wii Fit® Trials
(November-January)
Vibration Platform
trials (2009)
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Part of a comprehensive treatment
approach
` Physical Therapy is beneficial for
all people with Multiple Sclerosis
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◦ Regardless of level of ability
◦ “EXERCISE” is ESSENTIAL for all people
(including those with MS!!!!!!!)
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PRIMARY GOAL:
◦ To create a plan
to maximize
independence
and safe function
through
MOVEMENT
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Proper physical therapy is more than just
exercise machines
PT Frequency different for people with MS
versus “orthopedic patients”.
Physical Therapy can help
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Increase independence
Decrease fatigue
Decrease number of falls
Improve balance
Improve walking
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Ambulation = “moving for one location to
another” (usually referring to walking)
Gait refers to the stages of physical
movements which occur during walking
Gait training helps people:
◦ walk “better”
x Optimize strength and balance abilities
◦ walk with less fatigue
◦ walk SAFER!
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Requirements for safe and quality walking
◦ Strength
◦ Flexibility
◦ Balance
x Proprioceptive component
x Vision component
x Vestibular component
◦ Coordination
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ALL CAN BE TREATED WITH QUALITY P.T.
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“a body of evidence accumulated over the
past decade or two shows that persons with
MS at various stages of disability can tolerate
and benefit from exercise training as
demonstrated by improvements at functional,
neurological, tissue, and molecular levels”
Giesser (2008)
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Source:http://me.queensu.ca/people/deluzio/images/GaitCycle.jpg
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Source: www.foot-pain-explained.com/gait-cycle.html
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Hip Abductors
Hip Flexors and Knee
Extensors
Ankle Dorsiflexors
Ankle Plantarflexors
Hip Extensors and
Knee Flexors
Source:
http://www.smpp.northwestern.edu/~jim/kinesiology/animations/animated_muscles_in_Gait.gif
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Example of a gait abnormalities
Source: www.wrongdiagnosis.com/bookimages/5/4373.1.jpg
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RULE NUMBER ONE:
◦KEEP YOUR
HANDS OFF
THE WALLS
(and furniture, and counter tops,
and…)
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Assessing balance status
Review RULE NUMBER ONE:
◦ KEEP YOUR HANDS OFF THE WALLS
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Assistive Device determination
◦ Standard Cane, Forearm crutch, Standard Walker,
Rolling Walker, Rollator
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The question of “Temporary or Permanent Need”
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Focused Gait Training
with needed support
◦ Forward walking
x Heel striking/clearing
feet
◦ Sideways and
backward walking
◦ Turning when
walking
x 90 degrees
x 180 degrees
◦ Stair Training with
rails
Advanced Gait Training
◦ Progression OFF
assistive device
◦ Negotiating stairs
without railing
(including curbs)
◦ Up and down hills
◦ Walking on uneven
surfaces (e.g. gravel,
grass, sand/beach)
◦ Carrying when walking
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Success comes from performing exercises
correctly and being compliant
Source: www.heelspurs.com/_intro2.html
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Static orthotics
◦ Solid AFO
◦ Hinged AFO
◦ Spring Leaf Orthosis
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Dynamic orthotics
◦ Walk- Aide ®
◦ Free Step ®
◦ Bio-Ness ®
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SOURCE: www.neuromuscularorthotics.com.au/AFO's.htm
Special orthosis
◦ Hip-Flexion Assist Orthosis
SOURCE: http://www.greop.com/gre_005.htm
SOURCE:www.ottobockus.com/.../lower_extre
mity_28U20.asp
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A 2007 pilot study by Giesser, Beres Jones,
Budovitch, Helihy, & Harkema
Four patients with MS and severe functional
limitations in walking received an average of
40 sessions of locomotor training using
manual facilitation.
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At the end of training, all subjects showed
improvement in muscle strength, and 3 out of
4 subjects improved in …
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balance
spasticity
endurance
quality of life
All subjects tolerated the training well
without incurring fatigue or interference with
their usual daily activities.
Treating Gait Impairments with
Physical Therapy
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Stephen Kanter, PT, DPT, ATC
Physical Therapist, International Multiple Sclerosis Management Practice
Professor, Seton Hall University – School of Health and Medical Sciences
Treating Gait Impairments with
Physical Therapy
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