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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
Q

ballpark of cadence

A

~100

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26
Q

ballpark of stride length

A

~70

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27
Q

0.4 gait speed implications

A

housebound
trouble walking in community

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28
Q

gait speed >0.7

A

independent

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29
Q

what is the gait kinematics of trunk and UE

A

reciprocal UE swing and trunk rotation in gait cycle

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30
Q

what is the purpose of UE and trunk kinematics during the gait cycle

A

dec energy demands

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31
Q

what is the function of opposite arm-leg swing

A

provides counter rotation and limits the excursion of the COG

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32
Q

what determines the magnitude of rotation and UE swing during gait

A

inc w an inc in walking speed (direct relationship)

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33
Q

what trunk extensors are activated in gait and what is its role

A

erector spinae

peaks in DLS periods to counter trunk flexion torque

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34
Q

what is trunk flexor activity in gait

A

variable

primarily obliques, minimal rectus abdominus activity

low level activity at slower speeds and inc w faster speeds

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35
Q

what is the purpose of trunk activation in gait

A

trunk ms activity minimizes horizontal and med-lat movements of head during gait

keeps head steady allowing for stable platform for eyes/gaze

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36
Q

how do UE ms activate during gait

A

posterior and middle delts extend UE (concentric) for posterior swing

and eccentrically control forward swing

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37
Q

how does the pelvis move in the transverse plane during gait

A

forward rotation of 6-8deg on side of swing
- relative posterior rotation to the same deg on the contralateral side

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38
Q

vertical displacement of pelvis during gait

A

peak of 3-5deg in midstance

pelvis drops about 5-8deg on contralateral side of pelvis w swing

39
Q

why is control of vertical displacement of the pelvis during gait important

A

don’t want too much movement bc not efficient

40
Q

why is gait movement important to gait

A

plays a key role in efficient gait

41
Q

when do hamstrings and glut max fire in gait

A

fire eccentrically to decelerate hip flex during terminal swing

fire concentrically during IC thru loading response

42
Q

what role do the hamstrings

A

eccentrically - to keep leg in good place for next step

concentrically - keep knee from buckling while loading

43
Q

when do glut med and TFL fire

A

terminal swing - concentrically to stabilize the pelvis and limit drop of pelvis

midstance - eccentrically to prevent contralateral pelvic drop

44
Q

what is trendelenburg gait pattern often a sign of

A

weak glut med
- can’t prevent contralateral drop

45
Q

what does a weak glut med cause

A

can’t prevent contralateral drop
- results in premature end of swing phase and dec step length

46
Q

when do ADD fire during gait

A

early and late stance during DLS along w peak firing of the quads, hamstrings, ABDs, and extensors when wt transfer occurs

47
Q

what muscles fire at early and late DLS when weight shifting

A

ADD
quads
hamstrings
ABDs
extensors

48
Q

what muscles are included in the hip flexor group during gait

A

iliopsoas
TFL
sartorius
rectus fem
ADD

49
Q

when do hip flexors fire during gait

A

brief concentric firing at initial swing, then silent

50
Q

how can hip flexors only fire briefly at initial swing

A

ABD and extensors turn on to stabilize the pelvis as is

51
Q

when do quads fire during gait

A

peak - eccentrically at IC and loading response

low level concentric in terminal stance to keep knee extended

52
Q

why do the quads fire eccentrically at IC and in loading response (3)

A
  1. decelerate knee flexion
  2. limit flexion moment
  3. absorb shock to prevent knee buckling
53
Q

when do the hamstrings (short head of biceps femoris) and gastroc fire during gait

A

pre swing - to flex knee

54
Q

describe the progression of knee flexion during the gait cycle

A

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
Q

when do the rectus fem, TFL, and sartorius fire to control knee movement

A

concentrically and briefly at start of initial swing to flex hip and extend knee

56
Q

how does eccentric firing of the hamstrings control knee movement

A

control knee extension in mid and terminal swing

57
Q

what does gait w knee snapping back into hyper extension (genu recurvatum) on every step indicate

A

weak quads
- can’t eccentrically control loading response so snaps back into bone on bone support

58
Q

describe the position of the ankle through the gait cycle

A

some DF on IC

go into neutral as come through

lot of PF as start to push off and get foot clearance

59
Q

when do pretibial muscles (ant tib, EHL, EDL) fire

A

concentric - swing
- prevent foot drop

eccentric control of foot lowering to ground from IC until foot is flat and loading response begins

60
Q

what would a compensation for weak pre-tibial ms look like

A

more hip flex and knee flex
- steppage gait

61
Q

why do you see a foot slap gait

A

still have some concentric pre tibs but lack of eccentric control that their foot slaps down once heel makes IC

62
Q

when does the gastroc fire concentrically in gait

A

strong firing in terminal stance

weakens at pre-swing for push-off

63
Q

when does the gastroc fire eccentrically in gait

A

control of DF in CC to slow and control advancement of tibia at end of loading response and thru mid-stance

64
Q

NM impairments that impact gait (9)

A

motor control/strength
ms tone
coordination
motor planning
sensory deficits
perceptual deficits
vestibular issues
visual changes
cognition

65
Q

what are MSK impairments that impact gait (7)

A

ROM
pain
postural alignment
ms length
joint integrity
ms power
ms endurance

66
Q

what are CV impairments that impact gait (3)

A
  1. endurance
  2. hemodynamic responses to change in position and activity
  3. HR rate and rhythm
67
Q

what are temporal gait deviations often seen (5)

A
  1. asymmetry
  2. dec gait speed
  3. inc DLS time
  4. dec swing duration
  5. inc or dec cadence
68
Q

what does temporal asymmetry mean/look like

A

time difference b/w steps or stride

69
Q

what are spatial deviations often seen (3)

A
  1. asymmetry
  2. inc or dec step width and/or length
  3. dec stride length
70
Q

what are 2 stance deviations at the ankle seen in the neuro population

A

foot flat during IC or IC w forefoot

dec toe off in terminal stance

71
Q

what are 2 stance deviations at the knee seen in the neuro population

A

excessive knee flex at IC or toe off

knee hyperextension at midstance

72
Q

what is a stance deviation at the hip seen in the neuro population

A

dec peak hip extension in late stance

73
Q

what are 2 stance deviations at the pelvis/trunk seen in the neuro population

A

inc lateral, backward, or forward lean

poorly aligned trunk

74
Q

how can a deviation at one joint impact the other joints

A

issue at one can cause undue stress at another

75
Q

what is one swing deviation at the ankle seen in the neuro population

A

insufficient DF

76
Q

what are 2 swing deviations at the knee seen in the neuro population

A

inc or dec knee flex throughout

dec knee ext during late swing

77
Q

what are 3 swing deviations at the hip seen in the neuro population

A

excessive hip flex

dec hip flex

circumduction

78
Q

why would someone present w a circumduction gait

A

circle out to the side
- compensation for not being able to knee flex

79
Q

what are 3 swing deviations at the trunk/pelvis seen in the neuro population

A

poorly aligned trunk

insufficient forward pelvic rotation

lack of reciprocal arm swing

80
Q

what are other reasons for a lack of reciprocal arm swing other than NM path

A

lack of confidence

pain at the trunk - which makes it difficult to move arms

81
Q

what is a consideration of AD use for gait analysis

A

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
Q

what knowledge is required for a gait analysis

A

biomechanical factors - normal gait kinematics

forces - kinetics

83
Q

what should you ask of the patient/ have them do for a thorough gait analysis

A

shoes on, off
w orthotics
w and w/o AD
dual task
different environments

84
Q

what are observational general spatial and temporal gait characteristics (8)

A

UE swing
trunk rotation
velocity
cadence
step length
stride length
DLS:SLS ratio
BOS

85
Q

what are 3 standardized timed tests

A

10m walk test
TUG/ DT TUG
6min walk test

86
Q

what are 2 standardized balance tests

A

dynamic gait index
functional gait assessment

87
Q

what is the purpose of doing a TUG

A

determining if someone is a fall ris

88
Q

what is the purpose of doing a 6min walk test

A

endurance and aerobic capacity

89
Q

functional gait vs dynamic gait testing

A

functional is more difficult
- eyes closed
- tandem gait

90
Q

purpose of a 10m walk test

A

assess walking speed
- preferred speed and/or fast speed

91
Q

what is a normal gait speed

A

> 0.8m/s

92
Q

what is the purpose of a dynamic gait index

A

looking at balance and at risk for falls

93
Q

what does functional gait assessment assess

A

postural stability during various walking tests

Neuro Rehab 1 (27 decks)

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