Fyzzio, thanks for your reply. Sorry for all the abbreviations. They might be a little different here in the States! LE= Lower extremity SC=straight cane RW= Rolling walker AD= Assistive device
BWSTT= body weight support treadmill training; FES=Functional Estim; TKE= terminal knee extension

Balance: Is very good from a sensory standpoint - in other words, when doing balance testing such as Berg Balance test, she is only limited in activities that require good strength. For Example, she can't do the Single Leg Stance item well because she can't maintain a consistent quad contraction, but she's fine with feet together stand. There is a bit unsteadiness with the item requiring 1/2 step up to a stair because she has to stand on her left leg to put the right up on the stair. The overall score is 54/56.

Likewise, on stairs she struggles most with taller steps that require strong concentric contraction ascending and especially a smooth eccentric contraction descending (has a "ratchety" appearence to it). So she is indep if using a rail but supervision without it.

Maybe I'm making this more complicated than it is and she just needs to continue strengthening, but I just expected a better outcome by now. When therapy started her quad strength with Manual muscle testing was 4/5, but best at midrange. Her endrange strength has improved but still can't withstand full body weight well for any length of time, it just tremors and wants to buckle.

In terms of overall coordination, she doesn't show signs of ataxia/pass pointing etc. It seems more a problem with grading/maintaining force and at times, coordinating agonist/antagonist alternation.

I hope that is clearer.

Jeremy