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General:

Occupational therapy practitioner CAN treat the lower body! In fact, in many ways, an occupational therapy practitioner is the BEST practitioner to take lead on lower body rehabilitation and restorative therapy. Despite what you may have learned…or maybe never learned in school…an occupational therapy practitioner should know just as much, if not more about the lower body as they do about the upper body! Occupational therapy practitioners treat the entire body! If your patient wants to do any of the activities found within the 8 domains of occupational therapy, they will need their occupational therapy practitioner to address mobility including restoring function, restoring structures, enhancing performance skills, and maximizing independence. This is a continuum! 

So what are some things an occupational therapy practitioner can do for the lower body? 

Assessments to use in Evaluation and Progress Notes:

• BERG Balance Assessment
• Timed Up and Go
• 5 Times Sit to Stand
• 10ft Tandem Line
• Modified Falls Efficacy Scale
• Lower Extremity Functional Scale (LEFS)
• Brief Pain Inventory 
• ABC Balance Scale
• Tinnetti Gait and Balance
• Gait analysis Checklist

Common Problems in the Lower Extremity

Foot Drop

• Difficulty or inability for dorsiflexion 
• Reduced knee function, hip flexion, and ankle dorsiflexion all may affect clearing during foot swing
• If untreated, client can develop a nonfunctional gait pattern, be at risk for falls. And further functional decline.
• Can cause hip circumduction 
• What muscle is affected? 
  • • • Common peroneal nerve, common fibular nerve
      • Branches off the sciatic nerve, lumbosacral plexus, and the L5 nerve root proximally 
      • Innervates anterior tibialis muscle 
    • What can cause this diagnosis? 
      • • • • Neurological damage in CNS / PNS
            • Diabetes mellitus
            • Tumors
            • Motor neuron disease
            • MS
            • Adverse reactions to drugs and alcohol
          • Treatment 
            • • Surgical Intervention
              • Modalities
              • Strengthening and movement therapy
              • Motor re-learning strategies
              • AFO management

Circumduction

• During hip swing the pelvis hikes while the hip abducts on the unsupported side
• The leg advances in a circular motion out to the side
• Decreases safety, increases energy expenditure, decreases movement options for the development of more functional gait patterns 

Hemiplegic Gait 

**New Research suggests that reciprocal arm swing has very little effect on gait efficiency**

• Foot drop
• Synergy pattern: hip adduction, hip extension, hip medial rotation, knee extension, ankle plantar flexion, and ankle inversion
• Slow speed, short stance phase, poorly coordinated movements, and decreased weight bearing on the affected extremity
• The trunk muscles may by hypertonic restricting normal pelvic forward rotation during gait

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