Chód fizjologiczny, o co chodzi?


Chód czyli  przemieszczanie się jest bardzo łatwym zadaniem ruchowym ( podkreślmy, że dla osoby zdrowej), wynikającym z połączenia i kombinacji ruchów odrębnych części ciała.

Według Jamesa R. Gage’a normalnym (prawidłowym) chodem możemy określić ten, który jest skoordynowany i składa się z powtarzalnych ruchów kończyn, to doprowadza w istocie do przemieszczania całego ciała z miejsca na miejsce, ale z jak najmniejszym zużyciem energii.

Wyróżnia się 5 atrybutów normalnego chodu:
1. Stabilność w fazie podparcia
2. Przemieszczenie stopy nad podłożem
3. Ustawienia stopy w terminal swing, przygotowanie do initail contact
4. Długość kroku
5. Zachowanie energii.

Chód składa się z naprzemiennych faz podporu (stance) i przenoszenia(swing) oraz poszczególnych zadań:

Initial contact ( heel strike), pierwszy kontakt pięty z podłożem, w tym czasie obie kończyny dolne są w podporze ( stance ), tzw. podwójny podpór.

Loading response (foot flat), obciążenie, kontakt przodostopia z podłożem, przemieszczenie ciężaru ciała na kończynę podporową. Celem jest zamortyzowanie wstrząsu przez ugięcie stawu kolanowego.

Midstance, środkowa faza podporu ( stance ) na jednej kończynie, stabilne utrzymanie kończyn i tułowia.

Terminal stance (heel off), końcowa faza podporu ( stance ), od oderwania pięty do kontaktu drugiej kończyny z podłożem, następuje przeniesienie środka ciężkości poza unieruchomioną stopę.

Pre-swing (toe off),  przygotowanie do fazy przenoszenia (swing) , po raz drugi podwójny podpór, od kontaktu przeciwnej kończyny z podłożem do oderwania palucha, odciążanie kończyny.

Initial swing, uniesienie stopy do czasu zrównania się z drugą stopą, wybicie się, przeniesienie kończyny w przód.

Mid swing, od zrównania się obu stóp do ustawienia podudzia pionowo nad podłożem, przeniesienie kończyny w przód.

Terminal swing, końcowa faza przenoszenia ( swing ) , stopa przygotowana jest do przejęcia podporu ( stance ), od podudzia ustawionego pionowo nad podłożem do momentu dotknięcia piętą podłoża.

 

Tak w dużym skrócie omówiłam chód w kilku zdaniach, a to co na prawdę warto z tego zapamiętać i wdrożyć w swoim planie terapii:

  • kontakt pięty z podłożem nie jest najważniejszy w całym chodzie
  • podkreślmy istotę stabilności w fazie podparcia ( tak ćwiczmy więcej i częściej midstance niż initial contact )
  • tylko praca nad wszystkimi atrybutami i zadaniami ruchowymi pozwoli nam zbliżyć się swoim wzorcem do tej upragnionej normy.

Pamiętajcie także, aby zacząć samodzielnie chodzić trzeba też nauczyć się wielu umiejętności w niższych pozycjach.

W kolejnym wpisie skupię się na tym jak dotrzeć w swoim działaniu do pozycji stojącej by stabilnie stanąć a potem zrobić ten pierwszy krok.

 

 

  • Źródła:
  1. Gage J.R: Gait Analysis in Cerebral Palsy. Clinics in Developmental Medicine No 121. London: Mac Keith Press, 1991
  2. Kerkum Y.L:  Maximizing the efficacy of ankle foot orthoses in children with cerebral palsy. Praca doktorska  MOVE Research Institute Amsterdam, VU University medical center, Amsterdam, the Netherlands, 2015
  3. Owen E.: Paediatric gait Analysis and orthotic managment with afo footwear combinations. A segmental kinematic approach to rehabilitation, Course in Warsaw, 2015
  4. Perry J.: Gait Analysis, Normal and pathological function, NJ., 1992
  5. http://www.physio-pedia.com/Gait_in_prosthetic_rehabilitation

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