Chapter 10: Management of Impaired Lower Extremity Function

INTRODUCTION

With hope, each step leads forward.

Author Unknown

This final chapter is dedicated to all the aspiring therapists and assistants of the future. Never underestimate the blessings that come from giving to others.

This is the final chapter on management of the common clinical dilemmas faced by individuals with movement dysfunction due to neurological disorders. This chapter will focus on the lower extremity by discussing the functional tasks of the lower extremity, describing the main locomotor or mobility tasks so important for functional retraining, and describing clinical management of common lower extremity functional limitations encountered at different ages and accompanying common neurological disorders.

FUNCTIONAL TASKS OF THE LOWER EXTREMITY

Function, as defined in this text (see Chapter 4), is the act of carrying out or performing an activity, referring to a specific role or occupation. Functional movements are the movement patterns that are used for or adapted to a function or group of similar functions (Ryerson & Levit, 1997). As such, functional movement is made up of coordinated movements of the trunk, upper extremities, and lower extremities. Functional movement is able to develop and be maintained as long as several key elements are present: adequate mobility and range of motion, appropriate muscle tone and strength, evidence of variability and isolation of movements, postural stability and central control, antigravity control, proximal stability, mature weight-bearing and weight-shifting capabilities, and the ability to make postural adjustments.

Functional movements of the extremities rely on the specific task-related movements required, often divided into two broad categories: weight-bearing or closed-chain activities and non–weight-bearing or open-chain activities. Skillful use of both the upper and lower extremities requires the ability to be functional in both weight-bearing and non–weight-bearing positions.

Lower extremity control includes the ability to support body weight on both legs, to transfer weight from one to the other, to bear weight on one leg and then move the other, and to constantly adapt to movements of the trunk and upper extremities. Human beings use lower extremity control with trunk control for safety and balance within a wide variety of position options. Lower extremity capabilities allow for all of the functions of moving the body through space, including all ...