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MS FootDrop Clinical Pathway by Mind Map: MS FootDrop Clinical
Pathway
0.0 stars - reviews range from 0 to 5

MS FootDrop Clinical Pathway

Does Patient have Footdrop

Foot Drop

Does Pt. have DF PROM >/=0, Yes, Are the DF 0/5 strength?, Yes, Accomodate, Pt. has >3+/5 Knee Extension, Hinged AFO: PF Stop at max allowable PF without toe drag with DF assist, Pt. has <3+/5 Knee Ext., Hinged AFO with DF Assist AND DF Stop to prevent buckling, Pt. has <2/5 Knee Extension, Fixed AFO, Fixed in PF to maintain knee ext in stance, KAFO, No, Does Pt. have PF Spasticity (>2 Modified Ashworth Scale), Yes, Spasticity Management, Stretching Program, Positional Brace to prevent contracture/muscle tightening, Discuss Medications with MD, If Spasticity is profoundly affecting ability to walk discuss with MD, Accomodation, Fixed AFO with Talar Strap, No, Does Pt. have >1+/5 DF, Yes, Correct, Perform Motor Output Assessment, Strengthening, Conventional Ther-ex, NMES, Motor Control, Evaluate, Coordination, Motor Timing, PNF, Brunnstrom, Utilize Flexion Synergy to engage DF, Rood's Principle, Associated Reactions, NDT, Facilitation of Anterior Tibialis, Mild Spasticity Management, Stretching/ROM, Positional Brace, Compensate, Synergists, Extensor Hallicus, Fibularis Longus, Accomodate, Does Pt. have medial/Lateral ankle control, Yes, If Pt. has >3+5 Knee Extension, Does Pt. have >2+/5 DF, Yes, Light weight alternatives, Dorsi-X, X-strap, No, PLS, Spiral Orthosis, Functional NMES ONLY IF HIP FLEXION >2+/5, Walk-aide, Bioness, If Pt. has <3+/5 Knee Extension, Hinged AFO with DF assist AND DF Stop to prevent knee buckling, No, Pt. has >3+/5 Knee Extension, Hinged AFO with DF assist, IF PT. HAS PF STRENGTH ALLOW MAX PF ROM WITH TOE CLEARANCE, Pt. has <3+/5 Knee Ext., Hinged AFO with DF Assist AND DF Stop to prevent buckling, IF PT. HAS PF STRENGTH ALLOW MAX PF ROM WITH TOE CLEARANCE, No, Accomodate, Does Pt. have medial/Lateral ankle control, Yes, If Pt. has >3+5 Knee Extension, PLS, Spiral Orthosis, Functional NMES ONLY IF HIP FLEXION >2+/5, Walk-aide, Bioness, If Pt. has <3+/5 Knee Extension, Hinged AFO with DF assist AND DF Stop to prevent knee buckling, No, Pt. has >3+/5 Knee Extension, Hinged AFO with DF assist, Pt. has <3+/5 Knee Ext., Hinged AFO with DF Assist AND DF Stop to prevent buckling, Compensate, Encourage Ipsilateral Limb Flexor Synergy, Hip Flexion, Anterior Elevation, Knee flexion, Encourage contralateral limb extensor synergy, No, Identify Limiting Body Structure, Push Talus Posteriorly: Does this improve ROM?, Yes, Dx. Positional Fault, Treatment, Standard Mobilizations, Mulligan Mobilizations, No, Assess EndFeel (ask pt. where they feel stretch), Springy End feel stretch - Posterior Calf, Cause: Muscle, Short Muscle vs. Hypertonic, Treatment, Stretch, Prolonged Positional Stretch, Bracing, Night Splints, Serial Casting, Habits, Soft Tissue, Massage Cross friction over tendon, Modalities, Heat Pack, Ultrasound, 2.0 W/cm2, 100%, Time: 5-10min Heat up to 4 C from baseline, Spasticity, Stretch, Discuss Medications/ Treatment options with MD, Prolonged Positional Stretch, Mulit-podus boot, Capsular Patient feels no stretch, Treatment, Mobilizations, Hard Patient feels no stretch, True Contracture, Positional Bracing to Prevent Worsening

Rule Out Occult Foot Drop

Patient reports footdrop

Assess fatigue, 6-minute walk test, Treatment, Intermittent Training, Volume and Repetition, Medications

Shoe wearing pattern