3- Impairments that Interfere with Walking

Question 1

Impaired body functions and structures include: (9)

Answer 1

1. Impaired flexibility
2. Impaired muscle tone
3. Impaired strength
4. Impaired activation of a muscle
5. Impaired sequencing of several muscles
6. Impaired timing of muscle
7. Impaired proprioception
8. Impaired vestibular function
9. Pain

Question 2

If the gait deviation is observed in all phases of motion, then ___ should be examined further through ___.

Answer 2

flexibility of joint or muscle should be examined through goniometry of muscle length or passive ROM.

Question 3

If the gait deviation is observed in most phases along with excessive stiffness, jerky motion, or a wobble; then ___ should be examined with ___.

Answer 3

hypertonicity should be examined with either the modified Ashworth Test or the Tardieu Test.

Question 4

If the individual aligns the ground reaction forces such that they can rely on passive structures during stance phases; then ___ should be examined further using ___.

Answer 4

hypotonicity should be examined further using qualitative description of muscle tone.

Question 5

If the individual aligns the ground reaction forces such that they can rely on passive structures during stance phases (such as knee hyper extension or backward trunk lean during stance) then ___ should be examined with ___.

Answer 5

strength of the muscles which are active during stance phases should be examined. Impaired strength is examined with MMT, dynamometry, or upright motor control test.

Question 6

If the individual has difficulty with antigravity motion during swing limb advancement, then the ___ should be examined with ___.

Answer 6

strength of muscles which are typically acrive during swing phases should be examined with MMT, dynamometry, or upright motor control test.

Question 7

If the individual has difficulty moving through the entire range of motion or moves excessively during the task, then ___ should be examined with ___.

Answer 7

impaired activation of a muscle, the insufficient amplitude or muscle activity or excessive amplitude of muscle activity, should be examined with electromyography or observation.

Question 8

If the individual has insufficient amplitude of motion during swing limb advancement or difficulty stabilizing a joint during stance phases, but strength appears to be sufficient giving the requirements for that phase of gait; then ___ should be further examined using ___.

Answer 8

timing of muscle activity should be further examined using electromyography or observation.

Question 9

If the individuals gait pattern appears to be stiff or arrhythmic, then ___ should be considered and examined through ___.

Answer 9

sequencing of the muscle activity should be considered and examined through electromyography or observation.

Question 10

If the individual aligns the ground reaction forces such that they can rely on passive structures during stance phases (such as ankle plantarflexion and knee hyperextension) to ensure stability during these phases, along with a wide base of support and excessive variability; then ___ should be examined using ___.

Answer 10

then proprioception should be examined using kinesthethetic joint testing.

Question 11

If the individual has limited head motion, a wide base of support, limited time in single limb stance, and poor reactive balance; then ___ should be further examined.

Answer 11

vestibular function

Question 12

Other environmental factors which are indicative of ___ are having greater difficulty in conditions of low light, surfaces with a grade (incling) and surfaces that are compliant.

Answer 12

Vestibular Function

Question 13

If an individual reduces time in single limb stance (particularly in terminal stance phase), limits motion during phases which have a high joint moment (such as knee flexion during loading response), or grimaces during walking; then __ should be recorded using ___.

Answer 13

pain should be recorded using a visual analog scale.

Question 14

What is an indicator flexibility of the joint or muscle should be examined and how is it examined?

Answer 14

If the gait deviation is observed in all phases of motion.

Examined further through goniometry of muscle length or passive ROM.

Question 15

What is an indicator hypertonicty should be examined and how is it examined?

Answer 15

If the gait deviation is observed in most phases along with excessive stiffness, jerky motion, or a wobble.

Examined with either the Ashworth Test or the Tardieu Test.

Question 16

What is an indicator hypotonicity should be examined and how is it examined?

Answer 16

If the individual aligns the ground reaction forces such that they can rely on passive structures during stance phases.

Should be examined further using qualitative description of muscle tone.

Question 17

What is an indicator strength should be examined and how is it examined? (2 situations)

Answer 17

1. If the individual aligns the ground reaction forces such that they can rely on passive structures during stance phases (such as knee hyper extension or backward trunk lean during stance).
2. If the individual has difficulty with anti-gravity motion during swing limb advancement.

Impaired strength is examined with manual muscle tests, dynamometry, or the upright motor control test.

Question 18

What is an indicator activation of a muscle should be examined and how is it examined?

Answer 18

Insufficient amplitude of muscle activity or excessive amplitude of muscle activity should be considered if an individual has difficulty moving through the entire ROM of moves excessively during the task.

Impaired activation is confirmed using electromyography or observation.

Question 19

What is an indicator timing of muscle activity should be examined and how is it examined?

Answer 19

If the individual has insufficient amplitude of motion during swing limb advancement or difficulty stabilizing a joint during stance phases, but strength appears to be sufficient giving the requirements for that phase of gait.

Timing of muscle activity should be further examined using electromyography or observation.

Question 20

What is an indicator sequencing of the muscle activity should be examined and how is it examined?

Answer 20

If the individual’s gait pattern appears to be stiff or arrhythmic.

Sequencing of the muscle activity should be considered and examined through electromyography of observation.

Question 21

What is an indicator prorioception should be examined and how is it examined?

Answer 21

If the individual aligns the ground reaction forces such that they can rely on passive structures during stance phases (such as ankle plantarflexion and knee hyperextension) to ensure stability during these phases, along with a wide BOS and excessive variability.

Proprioception should be examined using kinesthetic joint testing.

Question 22

What is an indicator vestibular function should be examined?

Answer 22

If the individual has limited head motion, a wide BOS, limited time in single limb stance, and poor reactive balance.
Other environmental factors are having greater difficulty in conditions of low light, surface with a grade (incling) and surfaces that are compliant.

Question 23

What is an indicator pain should be recorded and how is it recorded?

Answer 23

If the individual reduces time in single limb stance (particularly in terminal stance phase), limits motion during phases which have a high joint moment (such as knee flexion during loading response), or grimaces during walking; then pain should be recorded using a VAS.

Question 24

How do individuals with -15 degrees of ankle dorsiflexion display and in what phases? (5)

Answer 24

1) compensate with knee hyperextension during WA phases and MSt to keep the foot flat on the ground - The knee hyperextension allows the tibia to be posterior to vertical such that the individual can maintain plantarflexed position at the angle.
2) Foot flat contact is usually observed.
3) Excessive ankle plantarflexion at LR, MSt and TSt.
4) An early heel off may be observed during late MSt.
5) During SLA, excessive plantarflexion will be observed along with a compensatory strategy to clear the swing limb.

Question 25

How do individuals with -30 degrees of ankle dorsiflexion display and in what phases? (4)

Answer 25

1. compensate with a heel off through all stance phases.
   2) During SLA, excessive plantarflexion will be observed along with a compensatory strategy to clear the swing limb.
   3) Forefoot contact will be observed
   4) excessive plantarflexion during all phases of gait

Question 26

How do individuals with shortened hamstrings with popliteal angle of at least 45 degrees display and in what phases? (2)

Answer 26

1. lacking knee extension and will walk with excessive hip and knee flexion during all stance phases except for PSw.
2. TSw will be particularly problematic as the hamstrings will be on maximal stretch.

Question 27

How do individuals with a shortened iliopsoas with a Thomas test of at least 10 degrees display in what phases? (3)

Answer 27

1. lacking hip extension will walk with excessive hip flexion, along with knee flexion and dorsiflexion during all stance phases.
2. An anterior pelvic tilt is also likely
3. TSt will be particularly problematic as iliopsoas will be on maximal stretch.

Question 28

How do individuals with hypertonicity of gastroc-soleus display and in what phases? (3)

Answer 28

1. excessive plantarflexion throughout the gait pattern.
2. Compensatory mechanism to clear swing limb.
3. knee wobble may be observed at WA

Question 29

How do individuals with hypertonicty of hamstrings display and in what phases? (2)

Answer 29

1. excessive knee flexion during stance phases and TSw.

2. excessive hip flexion and ankle dorsiflexion will be observed during stance phases.

Question 30

How do individuals with hypertonicity of quadriceps display and in what phases? (3)

Answer 30

1. difficulty in SLA, particularly PSw and ISw.
2. limited knee flexion will be observed at LR, PSw and ISw along with limited hip flexion
3. Knee wobble may be observed at LR and PSw

Question 31

How do individuals with hypertonicity of iliopsoas display and in what phases? (2)

Answer 31

1. difficulty with TSt, excessive hip flexion along with anterior pelvic tilt.
2. As the limb is unloaded during SLA, a jerky motion may be observed at the thigh.

Question 32

How do individuals with weak tibialis anterior display and in what phases? (3)

Answer 32

1. difficulty with swing limb advancement, excessive plantarflexion
2. compensatory strategy to clear the swing limb.
3. likely a forefoot contact or a foot slap

Question 33

How do individuals with weak gastroc-soleus display and in what phases? (3)

Answer 33

1. difficulty stabilizing the limb in single limb stance.
2. excessive dorsiflexion along with knee flexion and hipflexion observed in midstance and terminal stance.
3. At preswing, difficulty pushing the knee forward using plantarflexion therefore excessive dorsiflexion and limited knee and hip flexion will be observed at PSw.

Question 34

How do individuals with weak quadriceps display and in what phases? (4)

Answer 34

1. greatest difficulty with LR, during WA may have forefoot contact which enables volitional extensor thrust at LR to keep the GRF in front of the knee and reduce load on quads.
2. forward trunk lean to keep GRF in front of knee
3. alternatively subtle knee hyperextension at LR without the above
4. potential excessive knee flexion at TSw as weight of tibia is not substantial

Question 35

How do individuals with weak hamstrings display and in what phases? (1)

Answer 35

1. greatest difficulty at TSw, not able to decelerate the tibia resulting in knee hyperextension or a past retract.

Question 36

How do individuals with weak iliopsoas and rectus femoris display and in what phases? (3)

Answer 36

1. difficulty with SLA, limited hip and knee flexion at PSw but most problematic at ISw.
2. to enable the adductor longus to function more as a hip flexor, external hip rotation may also be observed during SLA.
3. either foot drag or compensatory strategy to clear the swing limb

Question 37

How do individuals with weak iliopsoas, rectus femoris, and adductor longus display and in what phases? (4)

Answer 37

1. greatest difficulty in SLA, rely on abdominals to advance the swing limb with limited hip and knee flexion throughout
2. hip flexion accomplished through past retract.
3. at PSw, forward trunk lean with contracted abdominals, during ISw and MSw quickly moves trunk back with abominals active
4. above motion pulls pelvis to a posterior tilt position which also pulls the thigh to a flexed position

Question 38

How do individuals with weak gluteus maximus display and in what phases? (2)

Answer 38

1. greatest difficulty with WA, unilateral small impairment results forward trunk lean results in bobbing; compensate with backward trunk lean
2. compensation also used for larger impairment

Question 39

How do individuals with a weak gluteus medius display and in what phases? (2)

Answer 39

1. greatest difficultly with SLS, small impairment results contralateral pelvic drop
2. large impairement lateral trunk lean toward reference limb to reduce load requirement of glute med.

Question 40

How do individuals with ankle pain display and in what phases? (3)

Answer 40

1. difficulty moving the joint into dorsiflexion and bearing weight during SLS.
2. excessive plantarflexion likely observed during MSt and TSt
3. excessive hip flexion likely at TSt to limit dorsiflexion and time in SLS

Question 41

How do individuals with knee pain at flexion display and in what phases? (3)

Answer 41

1. difficulty rapid knee flexion, limited knee flexion at LR; PSw and ISw
2. limited hip flexion at LR PSw
3. compensatory clearance strategy at ISw and MSw

Question 42

How do individuals with knee pain at extension display and in what phases? (3)

Answer 42

1. difficulty rapid knee extension, excessive knee flexion at MSt and TSt
2. excessive knee flexion, hip flexion, and dorsiflexion at SLS
3. shortened time in SLS

Question 43

How do individuals with hip pain display and in what phases? (3)

Answer 43

1. difficulty with hip extension, particularly in TSt
2. excessive hip flexion at TSt with limited step length
3. shortened time in SLS

Question 44

How do individuals with proprioception deficits display and in what phases? (2)

Answer 44

1. walk with excessive variability
2. pre-position limb in an extended position during stance phases (excessive plantarfelexon and knee extension to ensure stable limb during stance

Question 45

How do individuals with vestibular deficits display and in what phases? (3)

Answer 45

1. walk with limited head motion avoiding cervical rotation or flexion/extension
2. excessively large or small BOS
3. difficulty walking in straight path

Question 46

The inability to simultaneously control multiple DOF is frequently related to ___.

Answer 46

coordination defects.

Question 47

Excessively large step width suggests ___ as well as ___ should be examined more closely.

Answer 47

time in single limb stance, as well as hip abduction during stance phases

Question 48

Excessively narrow step width suggests ___ and ___ should be examined more closely.

Answer 48

hip adduction and the amount of pelvic drop during swing limb advancement

Question 49

Excessively positive foot progression angle, insufficient positive foot progression angle, or negative foot progression angle suggests ___ should be examined more closely. The position of the ___ should be noted

Answer 49

foot, leg, and thigh rotation in transverse plane

position of the foot progression angle should be noted

Question 50

Limited step length suggests that ___ should be examined more closely. In addition consider the amount of ___.

Answer 50

single limb stance phases such as midstance and terminal stance
hip flexion and knee extension at terminal swing.

Question 51

Slow paced walking patterns are frequently related to ___; therefore ___ should be examined more closely.

Answer 51

limited time in single limb support phases; midstance and terminal stance