Approaching the Post-CVA Patient

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Why are patients who are post-cerebrovascular accident (CVA) a particularly important population to consider in podiatry?

Dr. Phillips points out that most patients, after experiencing a CVA, will have some degree of disability in being able to walk normally, which in turn affects their quality of life.

“Podiatry should have as a major goal to help the post-CVA patient to gain as much mobility as possible to minimize the disability,” he says. “We should be the profession that studies more about gait than any other profession and should have more knowledge about how the foot affects the rest of the body and how other body systems affect the foot.”

Noting that podiatrists have full scope of practice to diagnose, prescribe and treat these concerns, he advocates for DPMs to take the lead in exercising that scope to maximize the benefits for these patients who have had such a life-changing experience.

What are some of the biomechanical factors at play for patients after a CVA?

He shares that muscle testing is a vital component of the biomechanical exam in these cases.

“Any weaknesses or spasms of the lower or upper extremity will have a consequential effect on the gait,” he says. The more we understand the relationship of the interactions between all segments of the body during all the phases of gait, the better we'll be able to prescribe the best therapy for the patient, whether it be surgical, mechanical and/or medical.” 

Are there any unique biomechanical examination or intervention concepts that podiatrists should be particularly aware of in these cases?

Reinforcing the importance of muscle testing in the biomechanical exam, he reminds providers to include upper extremity testing, as well. When it comes to gait analysis, Dr. Phillips reflected on modern availability of the phone camera as a tool to accomplish this and stresses the importance of readily using this option. Conversely, he remembers a time when extensive camera setups were necessary to approximate a similar result. Lastly, he advises one to check for range of motion aberrations that can contribute to overall disability.

What do you most hope DPMs will add to or change in their practices today when encountering this patient population?

“I hope that physicians will take the time with their patients who have experienced a CVA to do a full and extensive examination,” he adds. “I also hope they will do more frequent and extensive follow-up exams on the therapy they recommend to determine whether patient goals are being met and whether treatments need to changed and modified.”

Dr. Phillips is a Diplomate of both the American Board of Foot and Ankle Surgeons and the American Board of Podiatric Medicine. He has previously been in private, VA, and academic practice settings. He is currently the Associate Editor for Biomechanics of the Journal of the American Podiatric Medical Association.