Abnormal Gait & Falls

Question 1

The 3 Components of Locomotion?

Answer 1

1. Rhythmic Control
2. Stability
3. Adaptation

Question 2

Rhythmic Control?

Answer 2

Achieved via Central Pattern Generators (CPG)
- located in the spinal cord

We can do all this at the same time due to the CPG

Sensory feedback effects CPG
- something in our shoe will effect our walking

Question 3

Stability?

Answer 3

Stability in walking is achieved through the Balance/Postural Control System

Dynamic walking requires a constant interaction between:

• Musculoskeletal System
• Nervous System
• Environment/task

A coordinated change of BOS is required to “contain” the ever moving COM/COG over a surface

Question 4

Adaptation?

Answer 4

We have to adjust to ever-changing environmental/task demands to prevent injury

Eg) We judge how fast cars are coming & we adjust our gait to speed up if we think can make it across the street

Question 5

Trendelenburg gait?

Answer 5

Weak gluteus medius (which stabilizes the hip)

= lack of support will show a drop of the pelvis in the opposite side
- We see it more in the gait swing

Question 6

Foot drop Gait?

Answer 6

Occurs in 2 movements –

1st = Toe off (need to hold dorsi flexion)
- Weak tibialis causes foot to drop

2nd = Heel is put on floor
- When foot is been transferred onto the floor, weak tibialis causes foot will slap
(peripheral nerve injuries will lead to this)

Question 7

Quadriceps Gait?

Answer 7

Quad helps extend the knee & also in stance phase to help stabilize.
If don’t have the support the knee will go into hyperextention
(this is called “Genu Recurvatum”)

Treatment:

• Increase strength of quad muscle (remedial)
• Splint (compensatory)

Question 8

Genu Recurvatum?

Answer 8

Knee goes into hyperextension

Question 9

Gluteus Maximus Lurch?

Answer 9

Inability to support during stance

- they will lurch forward due to no hip strength. This causes leg to lurch forward

Question 10

Ataxic Gait?

Answer 10

Inability to judge distance (dysmetria)
- start of movement will be shaky & uncontrolled when movement is being performed

High risk for falls due to narrow BOS
- also tremors & hypertonia

Question 11

Hemiplegic Gait?

Answer 11

We may see circumduction, & possibly foot drop, may also see Trendelenburg

Treatment:
- We work specifically on gait, but also ensure good balance strategies (hip & ankle strategies).

Question 12

Treatment for Abnormal gait ( Remedial Approach)?

Answer 12

NDT & Bobath
= To promote going through the milestones, to try to restore the stages, to restore abnormal movement & inhibit tone

Usually we use BOTH remedial AND compensatory at the same time & slowly wean them off compensatory

Question 13

Treatment for Abnormal gait (Compensatory Approach)?

Answer 13

GOAL = Restoring them to THEIR maximum normal

If function not restored after 6 months chances are it wont come back

We also work on strength & endurance

Question 14

How to measure Treatment of Gait?

Answer 14

Tinetti scale
TUG
10m walk

Indoor vs outdoor
(household vs community ambulation),

Question 15

Fall Facts?

Answer 15

Seniors who have fallen double their risk of future falls

90% of hip fractures are due to falls

40% of long-term care admissions are fall related

Question 16

‘Intrinsic’ Factors that contribute to falls?

Answer 16

Age
General health (active vs sedentary)
General physical functioning (neurologically & MSK fitness)
Balance & gait issues
Disability 
Medication use 
History of Falls
Aids & Devices

More Neurological

Question 17

‘Extrinsic’ Factors that contribute to falls?

Answer 17

Task Demands
Environment (busy, high traffic, cluttered)
Lighting
Floor/Support surface

More Environment & Task

Question 18

Fall Prevention Strategies?

Answer 18

Know the cause of the fall
Predict who is at risk 
Fall prevention & Treatment Program
BALANCE TRAINING 
Balance/Falls Risk Assessment
EXERCISE
Medication 
CLEAR CLUTTER
Vision check-up
PROPER USE OF GAIT AIDS
Lifeline/carry cell phone if live alone

Question 19

Working with High Risk Fall Clients?

Answer 19

Appropriate supervision/guarding

Proper set-up of treatment environment:

• external supports nearby (gait/transfer belt, extra help)
• client readiness: footwear & clothing
• expect a loss of balance & be ready

Know your client & history:

• history of balance disturbance
• history of falls
• deficits &diseases

Know what to do in case of fall

Question 20

If client falls!!!!?

Answer 20

GET THE CLIENT OFF THE FLOOR

Call for help, first aid, report the incident

Document the incident & discuss with assigning Therapist

Understand why the fall happened to prevent future occurrences