Abnormal Posture & Gait Flashcards
What are common NM conditions affecting posture and gait?
- Stroke
- Parkinson’s
- Cerebral palsy
- Cerebellar palsy
- NM changes with ageing
- Spinal & lower leg pain
- Muscle weakness
- Lower leg biomechanics
What is stroke (cerebrovascular accident)?
Neurological deficit due to acute focal injury of CNS by a vascular cause
What are the signs & symptoms of stroke?
- Sudden weakness/numbness to face, arm, leg (usually on one side)
- Dizziness
- Confusion
- Severe headache
- Fainting/unconsciousness
- Difficulty speaking/understanding speech
- Difficulty seeing with one/both eyes
What are some of the vascular causes of stroke?
- Cerebral infarction
- Intracerebral haemorrhage (ICH)
- Subarachnoid haemorrhage (SAE)
What does the FACE acronym stand for?
- Face: Mouth drooping
- Arms: Can they raise both arms?
- Speech: Slurred, strange, not understanding
- Time: Call 000 immediately
What are the common posture signs associated with a hemiplegic (one-sided) stroke patient?
- Arm bent, hand spastic/floppy, often of little use
- Walking on tiptoe/outside of foot on affected side
- Unaffected side almost/completely normal
What is Parkinson’s?
- Progressive neurological condition due to decline in production of dopamine in basal ganglia
- Average age of diagnosis 65 years
What are the signs & symptoms of Parkinson’s?
- Tremor - shaking at rest, rigid muscles, stooped posture
- Slowed movement (bradykinesia)
- Loss of automated movement (e.g. blinking, smiling, swinging arms)
- Speech - softly, quickly, slurred, hesitate, monotone (vocal cords affected)
- Writing - small, hard to read
What are the common posture signs associated with a Parkinson’s patient?
- Repetitive “pill rolling” movement with hands
- Persistent tremors
- Shuffling gait, taking small steps
What is cerebral palsy?
- Persistent but not unchanging disorder of movement & posture due to defect or lesion of developing brain
What is the clinical presentation of cerebral palsy?
- Delayed motor milestones (e.g. sitting, standing, walking)
- Asymmetric movement patterns
- Abnormal muscle tone (hypertonia or spasticity)
- Visual problems
- Hearing problems
- Speech/language problems
- Epilepsy
- Cognitive impairments
What are the 4 types of cerebral palsy?
- Monoplegia (one limb, usually an arm)
- Hemiplega (one side of the body)
- Diplegia (symmetrical parts of the body, legs or arms)
- Quadriplegia (affects all 4 limbs)
What are the common posture signs associated with a cerebral palsy patient?
- Spastic gait (legs apart, feet turned in)
- Scissor gait (legs falling together)
What is cerebellar ataxia?
Inflammation or damage to cerebellum due to viruses, head trauma, degeneration or toxins
E.g. MS
What are the sign & symptoms of cerebellar dysfunction?
- Decomposition of movement (uncoordinated)
- Intentional tremor
- Dysdiadochokinesia (difficulty performing rapidly alternating movements)
- Deficits in motor learning
What are the signs of ataxia?
- Unsteady gait, staggering, tripping, falling, unsteadiness
- Difficulty with fine motor coordination e.g. writing, buttoning
- Speech & swallowing difficulties
- Visual abnormalities
- Fatigue
- Cognitive & mood disorders
What is the role of the cerebellum?
- Maintenance of balance & posture
- Control of voluntary movements (coordination)
- Motor learning - adapting & fine control of motor patterns, cognition & mood
What is the impact of ageing & posture on gait?
- Reduction in muscle strength/mass
- Decreased ROM & flexibility (stooped standing posture, OA, increased kyphosis)
- Change in psychomotor speed (slowed reaction & movement times)
- Reduction in sensation
- Reduction in vestibular function (dizziness, poor balance)
What is the potential impact of ageing on posture?
- Increased postural sway & greater muscle activity at rest
- Delayed onset muscle activity & smaller responses to pertubation
- Delayed activation of postural anticipatory/reactive responses
What is the potential impact of ageing on gait?
- Reduced velocity due to shorter step length & variability in step timing
- Flexed posture & excessive lateral trunk movement
- Difficulty performing dual tasks
What is the definition of low back pain?
Pain between buttock folds & 12th ribs in posterior trunk, +/- leg pain
What are the impairments associated with low back pain?
- Painful loss of movement due to muscle spasm, tightness, joint stiffness
- Pain with loading in different postures with different activities
- Weakness & delayed onset of deep stabilising lumbopelvic muscles, overactivity of superficial muscles
What is OA?
Degenerative joint disease ass. with radiographic chanes (joint space narrowing, osteophytes, bony slcerosis)
What are the risk factors for OA?
- > 45 years in knee & hip
- Modifiable: Excess body mass, join injury, knee pain, occupation, structural malalignment, muscle weakness
- Non-modifiable: Gender, age, race, genetics
What are the signs and symptoms of OA?
- Pain
- Swelling
- Stiffness of joint
- Decreased ROM
- Loss of flexibility & muscle strength
What is Trendelenberg Gait?
- Excessive adduction of WB hip in mid stance
- Due to inefficient strength of glud med
- Common in several hip & knee pathologies (glut med tendinopathy, PFS)
When is excessive pronation common?
- Plantar fascitis
- Tib post strain/tendinopathy
- Med tibial tress syndrome
- PFS
- Achilles tendinopathy
