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er C'f body rnts .....:;=;.:f flttdom~ rI:rat ::Jusl he )11ed. se tec:-ruqt:!'s thaI....", be use. P~tllents frequently repon dlfticulty hlting their legs (hIp no,or w«lkness). Weak dor·
siflex.or ... are also common. resulting in fo~,)t Jrop. Problems \\'Ith foot clearance may n.:-~uh in a clreumJutteu gait pat. h:~m.
Later prohlem, evolve OWing tt) clonus. sp3Sticny. sellloss. and!or ataXIa. Weakness generally extends 10
Box 19.6 Frenkel"s Exercises ('C'nc:ral instructions: i ~cr;. 1st::. can he pcrfonnt'd ",llh the part liOupponr..:t1nf un....upponcd. UOII;,h:rJlIy ('f I'tll.ul..'ralh,. lky should pr.4:~-j., 1>m.)otk tir.1!'"'VC'~s 10 MOrpU1~ ~d H.. lrlln~ on comrn..mJ, 1Ik.'re:mnf thl.'" (.Ill"" ;md ~rf"rmln2 tht onccntration In.! 1"(:pc/iIIPn JIc the ~.::.\~ Itl succ('\.\, -\ '\11111101f pm"
, H···· Il
Chapter 19 Multiple Sclerosio;; .1 Ie the qumirin'ps and Illp abductors. Quadriceps
kn('~S n pit'alh n:sult ... III hyperexlensJOn of the knee 1'C'J"r 'r\\ •-".j nt'\i~n of tht' trunk wIth increased lumbar lor;itl (
"'11 ':ltxiuC'wr wt'.IJ...ncss result:-; in a Trendclcnburg . ·,tICnl with a strong latC'J'al lean to the weak side, ) I £:11 I' . . • A well-designed exercise program of tone reductIOn, d('''IS.
,1ft.' ,l ·1),·,,(1 /::,,'and
stnmglhcl1ing exercises can improve gait. Jill!! ami walking ;;Klj\"ltic~ should strc. Mi safely. and · St;\n • .m;l1· ·n[·,lnmc a slclbk base 0f "upport: maximum wClght.. bCJnng through the LEs; and adequate weight tr'Ulsfer and fo(V.ard progression \\ nh trunk. 11mb, and peJvic kinematIn con,lstent with nOnllaJ walklOg. Verbal and manual
l"Ucmg «111 assist dlC pafu~nl in the con'eel mechanics of 12;111. The pool is an important medium that can also be ~.. ed to a~~bl training while reducing tone and fatigue and (lnLrolhng for ataxia. L~Kl)mOlOr training lIsing an overhead harness to supP'-lrt ~) _weIght and a m~ltori7ed trea~mill has been the f(x-'u~ L1j mcrea~mg atLenflon 111 the literature and used e\tcnsl,·ely TO Improve gail In patients with spinal cord JIlIUf) and .... trokel.~O"l...~ (see discussion in Chapter 13). '\rpIlC"dflOn to other chronic neurological conditions is liml!,;-d hut emerging. ~."4 Thi . . ta . . k-oriented intervention was u'-t.'d a." part of;1 comprehensive 12-week program by Fulk 10 unpRWt' gail speed, endurance. and balance in a patient with \15 (EDSS ,core of 1.5).'" The amount of body 'weIght ~upporl was reduced (.:!O percent to 0 percent) while ~"t'reed mcrea,ed by 21 percent (10 meter walk test) and 24.0 percent (6 minute walk teSl). Score, on the Berg Balance Scale (BBSI. and AClivi[ies-Specitlc Balance Confidence (ABC) ,cale, and the Modified Fatigue Impact S,-;ile-- 5·nem tN 1~1AS·:;) aho Improved. Perhaps moS! unporunl of all. the patient reported feeling safer and beller abk to engage in dally ~<X:laJ activities. Thu~ this foml of locomotor lraining appears to be a feasible and safe Intervt'ntion prodUl:mg .'Ignifk,mt positive effects and ,kservm.g 01 additional researt'h. Paticn~ With 'is lypH~all)' relJuire onholic devices a . . .unbulaLon fLu', decline Allkle· fOOl bt"b,lny can be achieved b) the nddiuon of oln all1.Ie· f(~lt ortho>i, (ArO), Improvement> ::.:."1 ene'l!Y rfflclt"'nc), and safety are :t1so Imponall1 OUh:0mes. Ai 'Os ~re prt.~Ill( .:la[O