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Semester 5 FSNM Exam 5 > Abnormal Gait > Flashcards

Abnormal Gait Flashcards

1
Q

What you observe depends on

A

Type and extent of CNS pathology
Prior or resulting impairments
Compensatory strategies

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2
Q

What is the problem with grouping people based on distinct gait patterns

A

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

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3
Q

9 gait patterns

A 
Ataxic
Stiff/rigid
Waddling, foot drop
Veering
Freezing, start/turn hesitation
Wide based
Narrow based
Cautious
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4
Q

Ataxic gait description

A

irregular cadence and progression

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5
Q

Ataxic gait - can be seen with

A

Cerebellar ataxia
Sensory ataxia
Chorea

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6
Q

Stiff/Rigid gait description

A

Loss of flexibility, stiffness of legs and trunk

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7
Q

Stiff/Rigid gait can be seen with

A

Spasticity
Parkinsonism
Dystonia
Diffuse cortical and subcortical dx, multi-infarct

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8
Q

Weakness gait description

A

Waddling and foot drop

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9
Q

Weakness gait can be seen with

A

Muscle disorders
Peripheral neuropathies
Corticospinal tract lesion

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10
Q

Veering gait description

A

Deviation of gait to one side

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11
Q

Veering gait can be seen with

A

Vestibular disorders

Cerebellar disorders

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12
Q

Freezing gait description

A

Start and turn hesitation

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13
Q

Freezing gait can be seen with

A

Parkinsonism
Multi-infarct state
Normal pressure hydrocephalus
Frontal lesions

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14
Q

Wide based gait description

A

widened base with standing and walking

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15
Q

Wide based gait can be seen with

A

Midline, cerebellar disorders
Multi-infarct state
In conjuction with other ataxic syndromes

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16
Q

Narrow based gait description

A

narrow base with standing and walking

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17
Q

Narrow based gait can be seen with

A

Idiopathic parkinsonism

Spasticity

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18
Q

Cautious gait description

A

slowing, short steps and en bloc turns

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19
Q

Cautious gait can be seen with

A

Non specific, multifactorial

Subcortical white matter lesions

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20
Q

Bizarre gait description

A

Strange gait patterns that fit none of the other categories

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21
Q

Bizarre gait can be seen with

A

Psychogenic dx
Dystonia
Fear of falling gaits

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22
Q

Video - describe hemiplegic gait

A

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

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23
Q

Video - describe parkinsonism gait

A

Universal flexion at all joints
Festination - small steps
Maybe tremor too

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24
Q

Video - describe cerebellar gait

A

Broad stand and wide staggering gait
Tend to fall towards side of illness
Trunk sway in standing

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25
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
26
Video - diplegic/CP gait description
Ext spasm, walk on toes | Circumduction but also adduction spasm - if bad can see scissor gait
27
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
28
Video - neuropathic or steppage gait description
Need high steppage because of foot drop
29
How do impairments contribute to abnormal gait - list the 3 main impairments that will contribute to abnormal gait
Motor Sensory Perception/Cognitive
30
Motor impairments - primary
Weakness/Paresis Spasticity Coordination difficulties
31
Motor impairments - secondary
Soft tissue contractures
32
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
33
Primary motor impairments - weakness - PF - leads to what with gait (step length and speed)
Shorter step length | Reduced gait speed
34
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
35
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
36
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
37
Primary motor impairments - weakness - DF - what will you see during swing
Foot drag, reduced toe clearance
38
Primary motor impairments - weakness - DF - compensation
Steppage gait
39
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
40
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
41
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
42
Primary motor impairments - weakness - hip flexors - Hip flexor moment is produced at
initiation of swing, normal gait requires 2+ strength
43
Primary motor impairments - weakness - hip flexors - inadequate activation leads to
Impacted limb advancement and loss of momentum to flex the knee
44
Primary motor impairments - weakness - hip flexors - leads to what with step length and toe clearance
shortened step length | decreased toe clearance during swing
45
Primary motor impairments - weakness - hip flexors - compensations
PPT and abdominals Circumduction Contalateral vaulting Lean trunk towards opposite limb
46
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
47
Primary motor impairments - weakness - hip abductors/glut med - compensation
trunk leans over the ipsilateral side during stance phase
48
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
49
Primary motor impairments - Weakness/Force generation - impaired control through loss of
both eccentric and concentric contractions
50
Primary motor impairments - Weakness/Force generation - Affect on
progression (gait speed) equilibrium/postural control adaptation
51
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)
52
Primary motor impairments - spasticity - PF - common with
MOST COMMON | Stroke, CP, TBI
53
Primary motor impairments - spasticity - PF - affects what phases of gait
stance and swing
54
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
55
Primary motor impairments - spasticity - PF - how is swing phase impacted
Tow drag | Reduced foot clearance
56
Primary motor impairments - spasticity - PF - gait speed and step length
Reduced gait speed | Shortened step length on the contralateral side
57
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
58
Primary motor impairments - spasticity - quads - what happens to gait
excessive knee extension during stance | overall stiff leg gait
59
Primary motor impairments - spasticity - what happens to gait if quad spasticity is prolonged
reduces knee flexion at toe off | Overall stiff leg gait
60
Primary motor impairments - spasticity - hamstring - leads to what
excessive knee flexion
61
Primary motor impairments - spasticity - hamstring - common in
CP
62
Primary motor impairments - spasticity - hamstring - primary contributor to what type of gait
crouched gait
63
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
64
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
65
Primary motor impairments - spasticity - hamstring - step length
short steps
66
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
67
Primary motor impairments - spasticity - hip abductors - BOS
reduces the BOS - affects mediolateral stability
68
Primary motor impairments - coordination problems - can be (3)
abnormal synergies impaired intersegmental coordination co-activation
69
Primary motor impairments - Abnormal synergies - are what
Simultaneous recruitment at multiple joints, stereotypical movement patterns Loss of fractionation and selective control
70
Primary motor impairments - abnormal synergies - often seen with
corticospinal lesions and stroke
71
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
72
Primary motor impairments - abnormal synergies - gait speed
Slow! | Poor transitions from swing/stance
73
Primary motor impairments - abnormal synergies - often consistent with
poorer locomotor recovery
74
Primary motor impairments - impaired intersegmental coordination
impaired relative timing btw hip knee ankle | not a weakness or a spasticity problem, but a timing problem
75
Primary motor impairments - impaired intersegmental coordination - seen with who
cerebellar pathology, ataxic gait
76
Primary motor impairments - impaired intersegmental coordination - what type of gait patterns
Staggering Veering Variability in stepping
77
Primary motor impairments - coordination problems
Co-activation | Loss of selective recruitment
78
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
79
Primary motor impairments - coordination problems - energy
higher energy demands
80
Secondary musculoskeletal impairments include what
changes in passive properties of mm | Soft tissue contracions - Ankle extensor contracture, hip/knee flexion cotnracture
81
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
82
Secondary musculoskeletal impairments - Hip flexion does what
hip cannot extend trunk flexes forward shortens step length
83
Secondary musculoskeletal impairments - hip flexion does what to step length and speed
Shortens step length | Affects overall progression/speed
84
Secondary musculoskeletal impairments - hip flexion - seen with
Spastic CP | Older adutls
85
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
86
Sensory impairments - include
Somatosensory Proprioceptive Visual defects
87
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
88
Sensory impairments - visual disturbance does what
impairs planning, obstacle control, path finding and planning
89
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

Semester 5 FSNM Exam 5 (5 decks)

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