gastrocnemus exs in stoke patients

[anagha]

suggesions are appreciated to improve gastrocnemus power in stoke patients

[Gawaine]

i have rarely had a patient with a CVA who i felt needed strengthening of the gastrocs... most of mine have had weakness with the dorsiflexors-- therefore ANY strengthening of the gastrocs would simply shift the balance of power even FURTHER from normal.....

why would you EVER think that you needed to strengthen the gastrocs...? i know that with neuro patients there is no such thing as a rule that can't be broken, but seriously, i'd only ever strengthen the gastrocs if the patient was VERY high-level and had acheived full dorsiflexion with 5/5 MMT and full EVERSION with 5/5 MMT.....

and at that point why would you need to ask? for a patient like that you should try........ oh, i don't know---- heel raises???


good luck...

[Flarenixie]

Hi
I worked alongside a very skilled clinical specialist, With a stroke patient who had a strange gait pattern, but no foot drop, and appeared to almost sink at his knees when walking but when checking strength had no apparent weakness. I felt he was constantly in pelvic tilt and wanted to work on that aspect but the clinical specialist said simply it was his gastrocs.........We began with jumping on a trampette (I think in an attempt to switch on the gastrocs/soleus), and then jumping in standing and progressed to jumping off a small step, quite a dynamic approach, it worked and although once the patient fatigued he returned to his abnormal gait we did see results in a couple of weeks.

[Gawaine]

i'm assuming you mean the patient had increased knee flexion in midstance (more or less) phase.....
considering that the gastrocs are a flexor of the knee, i'm not quite clear how increasing the strength of them would decrease the knee flexion...
what i have found to be rather appropriate in cases of increased knee flexion in midstance on the hemi-side is to use aggressive PNF extension patterns on the lower extremity...
now what may have occurred in your case is that bouncing on the trampoline and jumping on flat ground probably inadvertently strengthened the quads, which clearly act to decrease knee flexion in midstance...
though if you can explain HOW increased strength of the gastrocs led to decreased knee flexion, i'd like to hear it...

and you were probably very correct to address the pelvis rotation issue, but i usually find that hyperextension of the knee in midstance is associated with posterior pelvic tilt as well as hyperactivity of the plantarflexors...

congrats on making me turn around on my snarky comments and post something of actual substance...

[Flarenixie]

Haha, I do not pretend to know his (his being the clinical specialists reasoning, he was a man of few words) but I believe that in an attempt to increase gastroc strength he also worked on maintaining active quads. In gait as soon as the gastrocs switched on the quads appeared to switch off the patient was unusual, and also presented with slight ataxic characteristics aswell, so it seemed the balance/co ordination between which muscles working at which time was compromised

[Canuck Physio]

Are you attempting to shift weight on the weaker limb? Is there an effort to activate the RAS , with concomitant facilitation forcing the patient to appreciate the weight on the weaker limb?

[Gawaine]

awww man!! my last snarky comment was lost!!! damn!!!