Abnormal Gait Flashcards
What you observe depends on
Type and extent of CNS pathology
Prior or resulting impairments
Compensatory strategies
What is the problem with grouping people based on distinct gait patterns
Saying that a certain diagnosis will result in a certain gait pattern and this is not true
Does not take comorbidities or variations into consideration
9 gait patterns
Ataxic Stiff/rigid Waddling, foot drop Veering Freezing, start/turn hesitation Wide based Narrow based Cautious
Ataxic gait description
irregular cadence and progression
Ataxic gait - can be seen with
Cerebellar ataxia
Sensory ataxia
Chorea
Stiff/Rigid gait description
Loss of flexibility, stiffness of legs and trunk
Stiff/Rigid gait can be seen with
Spasticity
Parkinsonism
Dystonia
Diffuse cortical and subcortical dx, multi-infarct
Weakness gait description
Waddling and foot drop
Weakness gait can be seen with
Muscle disorders
Peripheral neuropathies
Corticospinal tract lesion
Veering gait description
Deviation of gait to one side
Veering gait can be seen with
Vestibular disorders
Cerebellar disorders
Freezing gait description
Start and turn hesitation
Freezing gait can be seen with
Parkinsonism
Multi-infarct state
Normal pressure hydrocephalus
Frontal lesions
Wide based gait description
widened base with standing and walking
Wide based gait can be seen with
Midline, cerebellar disorders
Multi-infarct state
In conjuction with other ataxic syndromes
Narrow based gait description
narrow base with standing and walking
Narrow based gait can be seen with
Idiopathic parkinsonism
Spasticity
Cautious gait description
slowing, short steps and en bloc turns
Cautious gait can be seen with
Non specific, multifactorial
Subcortical white matter lesions
Bizarre gait description
Strange gait patterns that fit none of the other categories
Bizarre gait can be seen with
Psychogenic dx
Dystonia
Fear of falling gaits
Video - describe hemiplegic gait
Arm in clinical UE pattern
Circumduction of the foot is the most characteristic
If mild - will see circumduction and then arm might just not swing
Video - describe parkinsonism gait
Universal flexion at all joints
Festination - small steps
Maybe tremor too
Video - describe cerebellar gait
Broad stand and wide staggering gait
Tend to fall towards side of illness
Trunk sway in standing
Video - describe stomping gait
Slam foot down to get vibration into trunk to know that foot is on ground - see this more in dark because with light they can use vision
Video - diplegic/CP gait description
Ext spasm, walk on toes
Circumduction but also adduction spasm - if bad can see scissor gait
Video - myopathic or waddling gait description
Normally when we step, the hip we step with moves up
With this patient population, can’t hold pelvis so hip drops and trunk leans
Video - neuropathic or steppage gait description
Need high steppage because of foot drop
How do impairments contribute to abnormal gait - list the 3 main impairments that will contribute to abnormal gait
Motor
Sensory
Perception/Cognitive
Motor impairments - primary
Weakness/Paresis
Spasticity
Coordination difficulties
Motor impairments - secondary
Soft tissue contractures
Primary motor impairments - weakness - PF leads to changes in
progression - wont be able to propel body forward to the next step
wont see heel lift at terminal stance
Primary motor impairments - weakness - PF - leads to what with gait (step length and speed)
Shorter step length
Reduced gait speed
Primary motor impairments - weakness - PF - how does it affect knee motion
Reduces knee flexion velocity at toe off
Will see less knee flexion during swing
Primary motor impairments - weakness - PF - compensatory strategies
Hip flexors to pull off
Inc in hip and/or knee moments depending on force generating capacity available
Primary motor impairments - weakness - DF - What will you see at initial contact
Flat foot at heel strike
Initial contact with heel, but foot will drop quickly and you get foot slap due to poor eccentric control of the TA
Primary motor impairments - weakness - DF - what will you see during swing
Foot drag, reduced toe clearance
Primary motor impairments - weakness - DF - compensation
Steppage gait
Primary motor impairments - weakness - Quad - what will you see
Difficulty controlling knee during loading in early stance and vertical support in midstance
Normally we have eccentric control with loading response to accept the weight
Primary motor impairments - weakness - quads - compensation
Hyperextension of knee at midstance
Forward trunk lean - COG shifts forward, line of force falls anterior to knee and pushes knee into hyperextension
Primary motor impairments - weakness - Hamstring - what is the impact
Normally they contract eccentrically to decelerate at terminal swing - when weak they wont slow down the swinging forward motion so the knee may snap into extension
Primary motor impairments - weakness - hip flexors - Hip flexor moment is produced at
initiation of swing, normal gait requires 2+ strength
Primary motor impairments - weakness - hip flexors - inadequate activation leads to
Impacted limb advancement and loss of momentum to flex the knee
Primary motor impairments - weakness - hip flexors - leads to what with step length and toe clearance
shortened step length
decreased toe clearance during swing
Primary motor impairments - weakness - hip flexors - compensations
PPT and abdominals
Circumduction
Contalateral vaulting
Lean trunk towards opposite limb
Primary motor impairments - weakness - Hip abductors/glut med - normally do what and inadequate activation leads to what
stabilize pelvis with stance
inadequate activation leads to trendelenburg, pelvic drop on opposite side of weakness
Primary motor impairments - weakness - hip abductors/glut med - compensation
trunk leans over the ipsilateral side during stance phase
Primary motor impairments - weakness - hip abductors/glut med - hip abductors on swing limb contribute to what
adequate regulation of step width
Might see narrowed step width, loss of mediolateral stability
Primary motor impairments - Weakness/Force generation - impaired control through loss of
both eccentric and concentric contractions
Primary motor impairments - Weakness/Force generation - Affect on
progression (gait speed)
equilibrium/postural control
adaptation
Primary motor impairments - spasticity - impact gait in 2 ways
Inappropriate mm activation (particularly when mm is normally being lengthened)
Stiffness due to altered mechanical properties of the mm (intralimb/segmental coordination is disrupted)
Primary motor impairments - spasticity - PF - common with
MOST COMMON
Stroke, CP, TBI
Primary motor impairments - spasticity - PF - affects what phases of gait
stance and swing
Primary motor impairments - spasticity - PF - how is stance phase impacted
Foot position - there is an absent heel strike
Normally the tibia would rotate over the foot - TS is lengthened and spasticity pulls it back and does not let tibia rotate over the foot and you get hyperextension at the knee
Primary motor impairments - spasticity - PF - how is swing phase impacted
Tow drag
Reduced foot clearance
Primary motor impairments - spasticity - PF - gait speed and step length
Reduced gait speed
Shortened step length on the contralateral side
Primary motor impairments - spasticity - PF - TS and Post tib spasticity together - puts the foot in what position
equinovarus
foot contact often made with lateral border first, sometimes first met head is elevated and wont even make contact with the ground
Primary motor impairments - spasticity - quads - what happens to gait
excessive knee extension during stance
overall stiff leg gait
Primary motor impairments - spasticity - what happens to gait if quad spasticity is prolonged
reduces knee flexion at toe off
Overall stiff leg gait
Primary motor impairments - spasticity - hamstring - leads to what
excessive knee flexion
Primary motor impairments - spasticity - hamstring - common in
CP
Primary motor impairments - spasticity - hamstring - primary contributor to what type of gait
crouched gait
Primary motor impairments - spasticity - hamstring - what does it do to the knee with gait
prevents the knee from extending during terminal swing - knee flexion at initial contact
knee flexion can persist throughout stance
Primary motor impairments - spasticity - hamstring - big problem with this is
One of the most energy demanding
Heavy demands on the quads to prevent collapse of limb during stance
Primary motor impairments - spasticity - hamstring - step length
short steps
Primary motor impairments - spasticity - hip abductors - particularly problematic during
swing phase - as hip flexes the entire leg moves medially - scissor gait if medially enough and crosses midline
Limb might cross body and hit other elg
Primary motor impairments - spasticity - hip abductors - BOS
reduces the BOS - affects mediolateral stability
Primary motor impairments - coordination problems - can be (3)
abnormal synergies
impaired intersegmental coordination
co-activation
Primary motor impairments - Abnormal synergies - are what
Simultaneous recruitment at multiple joints, stereotypical movement patterns
Loss of fractionation and selective control
Primary motor impairments - abnormal synergies - often seen with
corticospinal lesions and stroke
Primary motor impairments - abnormal synergies - what type of synergy pattern is often seen
primitive mass synergy patterns
- everything flexes in swing and everything extends in stands
- But the timing and bursting is not appropriate
Primary motor impairments - abnormal synergies - gait speed
Slow!
Poor transitions from swing/stance
Primary motor impairments - abnormal synergies - often consistent with
poorer locomotor recovery
Primary motor impairments - impaired intersegmental coordination
impaired relative timing btw hip knee ankle
not a weakness or a spasticity problem, but a timing problem
Primary motor impairments - impaired intersegmental coordination - seen with who
cerebellar pathology, ataxic gait
Primary motor impairments - impaired intersegmental coordination - what type of gait patterns
Staggering
Veering
Variability in stepping
Primary motor impairments - coordination problems
Co-activation
Loss of selective recruitment
Primary motor impairments - coordination problems - seen with
Stroke, CP
Could be a primary problem due to CNS lesion/pathology or could be compensatory as a means to increase postural support/stance and therefore increasing overall stiffness
Primary motor impairments - coordination problems - energy
higher energy demands
Secondary musculoskeletal impairments include what
changes in passive properties of mm
Soft tissue contracions - Ankle extensor contracture, hip/knee flexion cotnracture
Secondary musculoskeletal impairments - PF does what to gait
Affect foot position at initial contact
Tibia can’t rotate over foot in stance
Hyperextension at knee
Reduced foot clearance and toe drag during swing
Secondary musculoskeletal impairments - Hip flexion does what
hip cannot extend
trunk flexes forward
shortens step length
Secondary musculoskeletal impairments - hip flexion does what to step length and speed
Shortens step length
Affects overall progression/speed
Secondary musculoskeletal impairments - hip flexion - seen with
Spastic CP
Older adutls
Secondary musculoskeletal impairments - knee flexion does what
Limits knee extension at terminal swing - foot not placed appropriately
Need more mm effort to control the knee
Sensory impairments - include
Somatosensory
Proprioceptive
Visual defects
Cognitive impairments - Alzheimer’s
Advanced Alzheimer’s you will see a gait disorder
Motor and cognitive centers are connected! So with disruption to cognition, you will see gait disturbance
Sensory impairments - visual disturbance does what
impairs planning, obstacle control, path finding and planning
Sensory impairments - somatosensory disturbance does what
Inability to feel foot on the floor would lead to a wider base gait, more time in double limb (reduced speed) to allow them to get more somatosensory info coming in
