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Neuro Rehab 1 > Activity Level Neuro Physical Therapy Exam: Gait > Flashcards

Activity Level Neuro Physical Therapy Exam: Gait Flashcards

1
Q

gait

A

series of rhythmic and cyclical movements of the trunk and limbs resulting in forward progression of the COM

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2
Q

gait cycle

A

begins w initial contact (IC) of the reference limb and ends when that same limb comes into contact w surface again

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3
Q

what is included in one gait cycle

A

full stance phase and swing phase of the reference limb and contralateral limb

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4
Q

what % of the gait cycle is stance

A

60

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5
Q

what happens during the stance phase

A

reference limb: IC, loading response, midstance, terminal stance, and pre-swing

contralateral limb: in swing phase

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6
Q

function of stance phase (3)

A
  1. shock absorption
  2. stability
  3. forward progression of body
    - make sure other leg gets off the ground
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7
Q

what % of the gait cycle is swing

A

40

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8
Q

what happens in the swing phase

A

reference limb not in contact w the ground
- initial swing
- mid swing
- terminal swing

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9
Q

what is the functions of swing phase (3)

A
  1. foot clearance
  2. limb advancement
  3. forward progression of COM
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10
Q

single limb support % of the gait cycle

A

76-80
- majority of the gait cycle

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11
Q

what is single limb support phase

A

period when only one limb is in contact w the ground

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12
Q

what is required to maintain single limb support

A

high degree of stability and postural control required as entire COM contained over one limb w small BOS

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13
Q

% of the gait cycle is double limb support

A

20-24

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14
Q

when do you see DLS in the gait cycle

A

2 different time periods
1 - early stance
2 - late stance

as soon as IC on either leg

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15
Q

how does duration of DLS vary

A

varies inversely w walking speed

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16
Q

why is DLS a critical itme

A

wt transference occurs w high level of LE ms activity

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17
Q

what are two categories that gait can be characterized into

A

spatial parameters
- distance
temporal parameters
- time

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18
Q

what are spatial parameters of gait (3)

A

step length
stride length
BOS/step width

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19
Q

what are temporal parameters of gait (4)

A

speed/velocity
cadence
stride time, step time
DLS:SLS ratio

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20
Q

step length

A

length of one leg taking a step

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21
Q

stride length

A

both limbs

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22
Q

what do you look at w someone’s BOS

A

how wide
too wide?
scissoring?
too narrow?

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23
Q

cadence

A

how many steps are they taking to get to the same place

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24
Q

what is a community ambulator gait speed

A

1.3m/s

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25
ballpark of cadence
~100
26
ballpark of stride length
~70
27
0.4 gait speed implications
housebound trouble walking in community
28
gait speed >0.7
independent
29
what is the gait kinematics of trunk and UE
reciprocal UE swing and trunk rotation in gait cycle
30
what is the purpose of UE and trunk kinematics during the gait cycle
dec energy demands
31
what is the function of opposite arm-leg swing
provides counter rotation and limits the excursion of the COG
32
what determines the magnitude of rotation and UE swing during gait
inc w an inc in walking speed (direct relationship)
33
what trunk extensors are activated in gait and what is its role
erector spinae peaks in DLS periods to counter trunk flexion torque
34
what is trunk flexor activity in gait
variable primarily obliques, minimal rectus abdominus activity low level activity at slower speeds and inc w faster speeds
35
what is the purpose of trunk activation in gait
trunk ms activity minimizes horizontal and med-lat movements of head during gait keeps head steady allowing for stable platform for eyes/gaze
36
how do UE ms activate during gait
posterior and middle delts extend UE (concentric) for posterior swing and eccentrically control forward swing
37
how does the pelvis move in the transverse plane during gait
forward rotation of 6-8deg on side of swing - relative posterior rotation to the same deg on the contralateral side
38
vertical displacement of pelvis during gait
peak of 3-5deg in midstance pelvis drops about 5-8deg on contralateral side of pelvis w swing
39
why is control of vertical displacement of the pelvis during gait important
don't want too much movement bc not efficient
40
why is gait movement important to gait
plays a key role in efficient gait
41
when do hamstrings and glut max fire in gait
fire eccentrically to decelerate hip flex during terminal swing fire concentrically during IC thru loading response
42
what role do the hamstrings
eccentrically - to keep leg in good place for next step concentrically - keep knee from buckling while loading
43
when do glut med and TFL fire
terminal swing - concentrically to stabilize the pelvis and limit drop of pelvis midstance - eccentrically to prevent contralateral pelvic drop
44
what is trendelenburg gait pattern often a sign of
weak glut med - can't prevent contralateral drop
45
what does a weak glut med cause
can't prevent contralateral drop - results in premature end of swing phase and dec step length
46
when do ADD fire during gait
early and late stance during DLS along w peak firing of the quads, hamstrings, ABDs, and extensors when wt transfer occurs
47
what muscles fire at early and late DLS when weight shifting
ADD quads hamstrings ABDs extensors
48
what muscles are included in the hip flexor group during gait
iliopsoas TFL sartorius rectus fem ADD
49
when do hip flexors fire during gait
brief concentric firing at initial swing, then silent
50
how can hip flexors only fire briefly at initial swing
ABD and extensors turn on to stabilize the pelvis as is
51
when do quads fire during gait
peak - eccentrically at IC and loading response low level concentric in terminal stance to keep knee extended
52
why do the quads fire eccentrically at IC and in loading response (3)
1. decelerate knee flexion 2. limit flexion moment 3. absorb shock to prevent knee buckling
53
when do the hamstrings (short head of biceps femoris) and gastroc fire during gait
pre swing - to flex knee
54
describe the progression of knee flexion during the gait cycle
start w knee flexion, don't want to be locked out to accept weight peak flexion when go into swing to clear the toe
55
when do the rectus fem, TFL, and sartorius fire to control knee movement
concentrically and briefly at start of initial swing to flex hip and extend knee
56
how does eccentric firing of the hamstrings control knee movement
control knee extension in mid and terminal swing
57
what does gait w knee snapping back into hyper extension (genu recurvatum) on every step indicate
weak quads - can't eccentrically control loading response so snaps back into bone on bone support
58
describe the position of the ankle through the gait cycle
some DF on IC go into neutral as come through lot of PF as start to push off and get foot clearance
59
when do pretibial muscles (ant tib, EHL, EDL) fire
concentric - swing - prevent foot drop eccentric control of foot lowering to ground from IC until foot is flat and loading response begins
60
what would a compensation for weak pre-tibial ms look like
more hip flex and knee flex - steppage gait
61
why do you see a foot slap gait
still have some concentric pre tibs but lack of eccentric control that their foot slaps down once heel makes IC
62
when does the gastroc fire concentrically in gait
strong firing in terminal stance weakens at pre-swing for push-off
63
when does the gastroc fire eccentrically in gait
control of DF in CC to slow and control advancement of tibia at end of loading response and thru mid-stance
64
NM impairments that impact gait (9)
motor control/strength ms tone coordination motor planning sensory deficits perceptual deficits vestibular issues visual changes cognition
65
what are MSK impairments that impact gait (7)
ROM pain postural alignment ms length joint integrity ms power ms endurance
66
what are CV impairments that impact gait (3)
1. endurance 2. hemodynamic responses to change in position and activity 3. HR rate and rhythm
67
what are temporal gait deviations often seen (5)
1. asymmetry 2. dec gait speed 3. inc DLS time 4. dec swing duration 5. inc or dec cadence
68
what does temporal asymmetry mean/look like
time difference b/w steps or stride
69
what are spatial deviations often seen (3)
1. asymmetry 2. inc or dec step width and/or length 3. dec stride length
70
what are 2 stance deviations at the ankle seen in the neuro population
foot flat during IC or IC w forefoot dec toe off in terminal stance
71
what are 2 stance deviations at the knee seen in the neuro population
excessive knee flex at IC or toe off knee hyperextension at midstance
72
what is a stance deviation at the hip seen in the neuro population
dec peak hip extension in late stance
73
what are 2 stance deviations at the pelvis/trunk seen in the neuro population
inc lateral, backward, or forward lean poorly aligned trunk
74
how can a deviation at one joint impact the other joints
issue at one can cause undue stress at another
75
what is one swing deviation at the ankle seen in the neuro population
insufficient DF
76
what are 2 swing deviations at the knee seen in the neuro population
inc or dec knee flex throughout dec knee ext during late swing
77
what are 3 swing deviations at the hip seen in the neuro population
excessive hip flex dec hip flex circumduction
78
why would someone present w a circumduction gait
circle out to the side - compensation for not being able to knee flex
79
what are 3 swing deviations at the trunk/pelvis seen in the neuro population
poorly aligned trunk insufficient forward pelvic rotation lack of reciprocal arm swing
80
what are other reasons for a lack of reciprocal arm swing other than NM path
lack of confidence pain at the trunk - which makes it difficult to move arms
81
what is a consideration of AD use for gait analysis
if pt doesn't use AD normally, try gait analysis without at first - want to see how far from baseline walker takes out a lot of joint movements (no arm, trunk)
82
what knowledge is required for a gait analysis
biomechanical factors - normal gait kinematics forces - kinetics
83
what should you ask of the patient/ have them do for a thorough gait analysis
shoes on, off w orthotics w and w/o AD dual task different environments
84
what are observational general spatial and temporal gait characteristics (8)
UE swing trunk rotation velocity cadence step length stride length DLS:SLS ratio BOS
85
what are 3 standardized timed tests
10m walk test TUG/ DT TUG 6min walk test
86
what are 2 standardized balance tests
dynamic gait index functional gait assessment
87
what is the purpose of doing a TUG
determining if someone is a fall ris
88
what is the purpose of doing a 6min walk test
endurance and aerobic capacity
89
functional gait vs dynamic gait testing
functional is more difficult - eyes closed - tandem gait
90
purpose of a 10m walk test
assess walking speed - preferred speed and/or fast speed
91
what is a normal gait speed
>0.8m/s
92
what is the purpose of a dynamic gait index
looking at balance and at risk for falls
93
what does functional gait assessment assess
postural stability during various walking tests

Neuro Rehab 1 (27 decks)

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