cva pt- tone causing toes to flex (Full Version)

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jillberry -> cva pt- tone causing toes to flex (August 1, 2006 9:36:00 AM)

Can anyone help? I have a stroke pt whose toes curl under when he walks. This is worse without the AFO (which is wants to walk without) He is seeing a podiatrist to get an insole made. He currently does not take any antispasticity meds.



jillberry -> Re: cva pt- tone causing toes to flex (August 3, 2006 5:28:00 AM)

He walks with a cane. He has 2/5 DF, 0/5 Eversion
3/5 Inversioin, 2/5 PF. His toes curl w/ ankle DF, hip hip flexion, with anything that challenges or "stresses" him. It happens during the gait cycle with or without the AFO (but is worse without it) during swing phase, I think. He wants to stop wearing the AFO because he feels his ankle won't get stronger if he relies on it. Where I work, patients don't have the same therapist each time and one of the therapists mentioned this idea to him.



jillberry -> Re: cva pt- tone causing toes to flex (August 4, 2006 4:48:00 AM)

thanks for all of the ideas. His toes DO curl in the seated position w/ hip flexion, in non-gait activities. I'm not very familiar with "disassociating the synergy."



jillberry -> Re: cva pt- tone causing toes to flex (August 9, 2006 3:34:00 PM)

Wow! I really appreciate your ideas. I will certainly incorportate these in our next session and will contact the orthotist.



Dr Simon Bacaltos -> Re: cva pt- tone causing toes to flex (September 23, 2006 4:06:00 AM)

The curling of toes and other motor dysfunctions are manifestations of the brain effort towards gaining control over the affected limb. But to prevent secondary problems with too much curling (e.g. contractures) start with gentle ankle and toe stretches and once they're loosened, begin active extention of toes in positions that does not elicits those curling responses (i.e. supine?). But I would not worry too much about curling unless, when it interferes with his standing and walking balance.
When the brain goes thru healing after a stroke or brain injury, some "abnormal" patterns appears, what they are really are just manifestations of the brains current optimum state. Our roles as a PT is to facilitate optimal motor recovery. Progress practice of actively extending or relaxing toes in positions that elicits those signs.



niyas -> Re: cva pt- tone causing toes to flex (October 13, 2006 1:14:00 AM)

hi ihave also experienced such curling problems in my patients.
you can try keeping some absorbant-cotton or some soft cloth in between each toes so that intrincic muscles will get relaxed while walking



blast7 -> Re: cva pt- tone causing toes to flex (December 30, 2006 5:50:00 AM)

I had this problem with a patient of mine and severely affected our therapy where we were focusing on stance phase of the affected limb through the gait cycle. After speaking with some of my professors we decided to buy these pads that fit underneath the toes to prevent excessive flexion. I can't remember what they were called but I know this is documented in research and they were found in a Podiatrist product book. Look at Brunnstrom's Movement Therapy in Hemiplegia: A Neurophysiological Approach. I believe it is mentioned in here.



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