Ambulation and Functional Mobility Flashcards
What can be defined as a series of rhythmical , alternating movements of the trunk and limbs which result in the forward progression of the center of gravity?
Normal gait
Gait can also be defined as a series of controlled _____.
falls
What percent of the gait cycle is spent in stance and what percent in swing?
Stance = 60%
Swing = 40%
Describe the 4 phases of stance and during what part of the gait cycle they occur in
1) Loading Response: 0-10%
2) Mid-Stance: 10-30%
3) Terminal Stance: 30-50%
4) Preswing: 50-60%
Describe the 3 phases of swing and during what part of the gait cycle they occur in
1) Initial Swing: 60-73%
2) Med-Swing: 73-87%
3) Terminal Swing: 87-100%
What can be defined as the distance between corresponding successive points of heel contact of the opposite feet?
Step Length
What can be defined as the distance between successive points of heel contact of the same foot?
Stride Length
In normal gait what should stride length equal?
double the step length
What can be defined as the side-to-side distance between the line of the two feet?
Walking Base or Stride Width
What can be defined as the number of steps per unit time?
cadence
What is normal gait cadence?
100 – 115 steps/min
What can be defined as the distance covered by the body in unit time (m/s)?
velocity
How can you calculate average velocity?
= step length x cadence
What can be defined as the least energy consumption per unit distance?
Comfortable Walking Speed (CWS)
What is the average comfortable walking speed?
80 m/min (5 km/h or 3 mph)
With increasing walking speeds:
Stance phase ______
Swing phase ______
Double support ______
decreases
increases
decreases
What can be defined as walking without double support?
running
What happens to the stance/swing ration during running?
It reverses so that swing = 60% and stance = 40%
Where is the center of gravity located?
Midway between the hips and a few cm in front of S2
The least amount of energy is consumed if the center of gravity travels _____.
straight
At what point of the gait cycle is the COG the highest? Lowest?
midstance
double support
What is the average vertical displacement of the COG throughout the gait cycle?
5 cm
At what point of the gait cycle does the pelvis reach its lateral limit?
midstance
What is the average lateral displacement of the COG throughout the gait cycle?
5 cm
What are the 6 determinants of gait that are used to minimize excursion of the COG therefore significantly reducing energy consumption?
1) Pelvic rotation
2) Pelvic tilt
3) Knee flexion in stance phase
4) Ankle mechanism
5) Foot mechanism
6) Lateral displacement of body
Pelvic rotation is the forward rotation of the pelvis in the horizontal plane approximately _ degrees on the swing-phase side
8
Why does the pelvis rotate forward during the swing phase?
It reduces the angle of hip flexion and extension. Which in turn enables a slightly longer step-length w/o further lowering of the COG.
Pelvic tilt is described as the _ degree dip that occurs during the swing phase
5
If the dip occurs during the stance phase it is considered abnormal and called what?
Trendelenberg sign
During the stance phase there is approximately how much knee flexion?
20 degrees
Knee flexion in the middle of stance phase ____ the leg and _____ the height of the apex of the curve of the COG
shortens
reduces
The ankle mechanism that occurs during heel contact ______ the leg.
lengthens
The foot mechanism that occurs at toe-off _____ the leg as the ankle moves from DF into PF
lengthens
Both the ankle and foot mechanisms do 2 things to the COG, what are they?
- It smoothens the curve of the COG
- Reduces the lowering of the COG
What is the benefit of having a narrow walking base?
It minimizes the lateral displacement of the COG which in turn reduces muscular energy consumption
What are the 4 forces that have the most significant influence on gait?
(1) gravity
(2) muscular contraction
(3) inertia
(4) floor reaction
The force that the foot exerts on the floor due to gravity & inertia is opposed by what force?
ground reaction force
What are the 2 components of the ground reaction force?
horizontal and vertical
At initial contact what position is the ankle in?
DF
At initial contact what muscle is active at the knee?
quad
At initial contact what muscles are active at the hip?
gluteus max and hamstrings
Gait requires approximately __-__% of maximum muscle strength
20-25
A MMT of at least _ is required for gait
3+
List a few gait alterations that occur as one ages
- slowing in average speed
- increased step width
What is the Romberg quotient?
The ratio of body sway values with eyes open and closed
What does the Romberg quotient assess?
The effect of visual stabilization on posture
Typically what happens to the Romberg quotient as one ages?
It amount of sway increases which suggests vision becomes more important for balance
What percentage of the elderly have abnormal proprioception?
15-20%
What do sensory changes in older adults lead to in terms of gait?
more cautious, watching feet type gait
What are 5 things that can cause abnormal gait?
- pain
- impaired joint mobility
- muscle weakness
- spasticity
- sensory/balance deficit
- impaired central processing
What does a painful gait pattern look like?
Decreased single limb support on the impaired side which results in a shorter stride on the opposite side
LIMP
What are 6 things that can cause muscle weakness that can affect gait?
- Neuropathy
- Cardiac or pulmonary
- Anemia or other medical conditions
- Medications
- Orthostasis (orthostatic hypotension)
- Metabolic
What does spastic hemiparesis gait look like?
One arm is immobile and close to side with mass muscle group flexion; leg extended with plantar flexion of foot; With walking, foot drags or circles outward and forward
What muscles are most affected by rigidity?
trunk and proximal muscles
What does a rigid gait look like?
Decreased trunk rotation and arm swing. Flexed posturing. Shuffling and shorter steps.
What does Parkinsonian gait look like?
Stooped posture with head and neck forward. Hips and knees are slightly flexed. Gait is slow to initiate and results in short, shuffling steps with reduced arm swings.
Parkinsonian gait is also characterized by festination and propulsion, what does this mean?
Festination: speeding up
Propulsion: tendency to fall forward with walking)
What does sensory ataxia gait look like?
Wide, irregular, and uneven steps. They have a tendency to throw their feet forward and out and bring them down first on heels and then toes which causes a double tapping sound.
People with vestibular ataxia report what type of sensations during gait?
Decreased ocular fixation during motion leading to sense that world is “jiggling”
Balance loss due to cerebellar problems results in what type of gait abnormalities?
- Wide based
- Unsteadiness
- Irregularity of steps
- Lateral veering
- Exaggerated difficulty with turns
- Cannot stand steady with feet together (with eyes open or closed)
What can be defined as the inability to process nerve impulses to walk?
Gait Apraxia
What results in gait apraxia?
Dysfunction in Central Integration
What does apraxic gait look like?
- Difficulty initiating or changing direction
- Bradykinesia
- Festination or retropulsion
- Shuffling
- Wide based gait
Dysfunction in central integration that results in dementia will lead to what type of gait abnormalities?
gait hesitation or freezing
What test can be used to assess cognition?
Mini Cog test
How is the mini cog test performed?
alternating clock face and 3 item recall
What is Graphesthesia?
The identification of a letter/number written on palm
What is Stereognosis?
object identification such as place coin in hand
What are 3 tests you can perform to assess motor coordination?
- Finger to Nose
- Finger or Toe Tapping
- Heel-Knee-Shin
How do you test for retropulsion?
Examiner stands behind patient, vigorously pulls patient backward at the shoulders; normally patient will regain center of gravity with step backward and truncal flexion
What is pronator drift?
A sign of UMN disorder in that the patient is unable to hold extended arms straight outwards. Rather they drift towards pronation.
What pathologies lead to decreased muscle tone?
- motor neuron
- cerebellum
- acute stroke
- cord lesion
What are 3 types of increased muscle tone?
- spastic
- rigid
- paratonic
Describe paratonic muscle tone
The limb stiffens in response to any contact
What does paratonic muscle tone result from?
Damage to the frontal lobes or diffusely
A positive Babinski sign is indicative of what?
pyramidal tract damage or diffuse cerebral dysfunction
When performing the Romberg exam if the patient demonstrates worse balance with eyes closed what does it indicate?
sensory ataxia
When performing the Romberg exam if the patient demonstrates poor balance with eyes open and eyes closed what does it indicate?
motor ataxia (cerebral cortex), vestibular or cerebellar
How is the compass test performed and what does it indicate?
The patient closes their eyes and takes 8 steps forward and 8 steps back. They will turn toward side of lesion.
What 3 pathologies are patients unable to walk on their heels?
- motor ataxia
- spastic paraplegia
- foot drop
What 4 pathologies are patients unable to walk on their toes?
- Parkinson’s
- sensory ataxia
- cerebellar disease
- spastic hemiplegia
For the TUG if times are over __ seconds it is associated with risk for falls
10
For the chair rise test, the patient is asked to stand from a chair with their arms crossed 5 times. A normal score is anything under __ seconds.
13
How is the POMA performed?
The patient stands from their chair without using arms, step forward, put feet close together, receive mild nudge to sternum, close eyes, turn 360, walk about 25 feet at normal speed, turn around, walk back at faster speed, sit down.
A score less than __ on the POMA indicates a 5 times increased fall risk
20
What are 6 common gait abnormalities?
- Antalgic Gait
- Lateral Trunk bending
- Functional Leg-Length Discrepancy
- Increased Walking Base
- Inadequate Dorsiflexion Control
- Excessive Knee Extension
What does antalgic gait look like?
Shortened stance phase on affected side and a corresponding increase in stance on the unaffected side
What are some common causes of antalgic gait?
- OA
- fracture
- tendinitis
Lateral trunk bending is also known as what type of gait pattern?
Trendelenberg gait
What are some common causes of Trendelenberg gait?
- Painful hip
- Hip abductor weakness
- Leg-length discrepancy
- Abnormal hip joint
What are 4 compensations to make up for a leg length discrepancy?
- circumduction
- hip hiking
- vaulting
- steppage
What is the normal walking base?
5-10 cm
What are 2 deformities that can cause increased walking base?
- abducted hip
- valgus knee
What are 3 common causes of excessive knee extension?
- Quadriceps weakness (mid-stance)
- Quadriceps spasticity (mid-stance)
- Knee flexor weakness (end-stance)
