Ankle Dorsiflexion: A Case Study

In 2015, researchers conducted a study on 79 adults (mean age 68.7) to determine the validity of the BESTest, Mini-BESTest and Brief BESTest. Activities-Specific Balance Confidence Scale, The Physical Activity Scale for the Elderly, The Timed Up and GO Test, and The Single Leg Stance test were used to assess the

Patients will report to physical therapists with a multitude of impairments throughout the progression of the disease. The most prominent impairments will present during cerebellar testing. Patients will show signs of dysmetria, dysphasia, dysdiadochokinesia, and ataxia primarily as a result of the atrophy and damage to the cerebellum. Instability and lack of postural control will be demonstrated during the Romberg's test. Additionally, cranial nerve testing will have positive results for many cranial nerve palsies such as CN III, V, VII, IX, and XII. Patients show weakness in their trunk and extremities during the manual muscle testing. Vestibular testing will result in abnormal VOR, saccades, smooth pursuits and nystagmus. As a result of these impairments, patients experience functional limitations. Primarily, these patients are considered to be “high fall risks,” which ultimately decreases their independence due to weakness, instability and decreased postural control. These patients will feel uncomfortable in many situations and be unable to function independently in the community. This creates an increased risk for further injury. Due to the dysmetria and weakness, patients will also experience difficulty with their daily living skills, such as maintaining proper hygiene; They will have trouble bathing themselves and brushing their teeth without assistive equipment. PT interventions can help minimize and control these limitations. The implementation of balance training and assistive devices will be imperative interventions for an individual to modify and adapt to their gait

The Lower Extremity Functional Scale (LEFS) is a tool that is administered, and scored due to its’ simple applicability to a vast variety of disability levels and conditions and all lower-extremity sites. This particular scale is easy to read when it comes to understanding error-associated measurements and for verifying the least clinically important score changes and is adequate enough to measure of reliability, validity, and sensitivity to change, at a position that is proportionate with application at an individual patient level (1). The LEFS scale abstract framework is based on the World Health Organization’s model of the handicap and disabled. It was developed to be competent to manage, score, and record in the medical record with

The sample group involved 280 old people who were 79-90 years old and have a history of falling especially in the last 6 months. The intervention recommended was assigned one of the four controlled groups which applied different balance and strength exercise.

The ankle-brachial index is a test used to find peripheral vascular disease (PVD). PVD is also known as peripheral arterial disease (PAD). PVD is blocking or hardening of the arteries anywhere within the circulatory system beyond the heart. PVD is caused by cholesterol deposits in your blood vessels (atherosclerosis). These deposits cause arteries to narrow. The delivery of oxygen to your tissues is impaired as a result. This can cause muscle pain and fatigue. This is called claudication.

Among a wide array of risk factors for falls among older client with type 2 diabetes are the use of multiple medications, excess muscle weakness, especially at the ankle, and a host of environmental factors. Specific factors that significantly heighten risk among many with type2 diabetes are the presence of motor and/or sensory neuropathy, which increases the displacement of the center of pressure recordings during static balance tests in a dose dependent manner, the use of insulin, vision impairments, and the level of glycated hemoglobin. Others include lower levels of physical activity, and poor postural control or balance. As well, people with type 2 diabetes tend to be older rather than younger, and in addition to poor levels of neuromuscular control, may have diabetic foot ulcers, and high rates of body pain as well as foot pain that lead to the use of psychotropic medications and polypharmacology.

With the process of aging, movement, gait, flexibility and reflexes are altered. Reduced stability and gait is an increasing risk factor in older adults that are at risk for falls. Research studies compare the mobility of older adults that have fallen and compared to non-fallers and have determined that once an older adult falls, there is an increase in hesitance when it comes to mobility. Since the older adult then reduces their mobility as a result of fear of falls, they will ultimately decreased their functional capacity and result in gait unsteadiness. This will consequently increase the risk of falls in the older adult since they are more apprehensive to walking independently and performing activities of daily living on their own (Sapir,

impaired sensation in her feet due to Diabetic Neuropathy, decreased aerobic capacity, decrease lower extremities muscle strength, and impaired cognitive functional further increase her fall risk.

The control group was researched for balance, limits of stability, and gait of patients with AD, FTD’s. The balance was measured using dynamic posturography, in single and dual tasks and gait with Biodex Gait Trainer. In

The Center for Disease Report (CDC) for Mortality and Morbidity Weekly has reported falls as being the leading cause of injury among the elderly adult. According to stats released by the CDC, there are an estimated one to three falls that occur among the elderly resulting in a direct medical cost of $30 billion yearly. According to Barbour et al. (2012) falls often result in significant consequences for the elderly adult patients including, hip fracture, brain injuries, limited functional abilities, and reductions in physical activities. Barbour et al. further reported that falls are more commonly seen in an older adults with some form of arthritis condition that results in poor neuromuscular functioning. Falls, as reported by Barbour et al. states that the incidence of falls within the fifty United States was highest among adult with arthritis condition as compared to a person without arthritis.

If you've ever sprained your ankle you know how it feels to walk and feel like you’re going to fall over due to weakness. Images living with that feeling all the time. I found an article in the "Journal of Orthopedic and Sports a Physical Therapy" that researches ways to improve ankle instability. The article, "Feedback and Feedfoward Control During Walking in Individuals with Chronic Ankle Instability" written by Sheng-Che Yen PT PhD, Marie B. Corkery DPT, Amy Donohoe DPT, Maddison Grogan DPT, and Yi-Ning Wu PhD, studies whether chronic ankle instability (CAI) is associated with changes in patient’s feedback and feedforward control to help develop interventions for chronic ankle instability prevention or treatment.

Be aware of neurological conditions that may present as orthopaedic conditions e.g. ataxia, reduced proprioception, dragging feet.

Stay active. mobility is limited due to aging require certain amount of assistance in ADL

In the case of Anne Morrell there are several normal physiologically changes that impact her quality of life. Anne is experiencing normal aging related changes to her musculoskeletal system. Changes in musculoskeletal tissue occur through the loss of muscle mass and strength which replace lean body mass which fat and fibrous tissue. These changes in tissue cause a decrease in contractile muscle force with increased weakness and fatigue (Boltz, Capezuti, Fulmer, & Zwicker, 2012). As discussed in her case study she reports back pain when standing or walking for longer than 15 minutes, needs assistance with steps, ambulates with a cane since she fell last year which affects her mobility and ability to perform her activities of daily living. This loss in Anne’s muscle function greatly increases her chance of falls and she also has an increased risk for disability.

There is evidence of using the software for populations with Stroke and Parkinson’s disease, and children with Cerebral Palsy. The psychometric properties of the walkway system have been established in all these populations and normalization data is available for children as well. No data is available for children diagnosed as idiopathic toe walkers. Persistent toe walking beyond age two years’ merits further investigation because it can be a first sign of an underlying neuromuscular or developmental abnormality like Cerebral Palsy (CP), Duchenne Muscular Dystrophy and autism3-5. Walking on toes has numerous consequences and primary gait deviations are seen in subjects at ankle joint6. Evidence also shows that idiopathic toe walkers have significant increase in ankle plantarflexion during stance and swing phases6. Hence, a bigger project to evaluate the use of GAITRite in children diagnosed as idiopathic toe walkers is being planned.