assessing gait in older adults Flashcards
gait cycle:
phases of weight acceptance
initial contact
loading response
gait cycle:
SL support phases
midstance
terminal stance
gait cycle:
limb advancement phases
- preswing
- initial swing
- midswing
- terminal swing
Common gait changes with age:
temporal
- decreased step and stride length
- increased stance and DL support time
Common gait changes with age:
spatial
- decreased step and stride length
- increased step width
Common gait changes with age:
kinematic/postural
- decreased excursion of movement at LE joints
- decreased reliance on ankle kinetics and power
- less upright posture
T/F: abnormal gait associated w/progressive risk of institutionalization and death
True
Slow gait speeds:
- defining feature of frailty
- fall pts slower than age match peers
- worse performance across all cog domains
effect of complex dual task on gait in MCI and AD groups compared to healthy
- significant decrease in gait velocity
- increased stride time
- increased stride variability
stride length in AD group compared to healthy controls
decreased mean value and greater CoV
gait variability:
step length and # of steps
reduced mean value for all CDRs compared to CHI at UP, FP, SP, and dual-task conditions
Gait and cognition
- decreased gait and cognition=high risk for dementia
- cognitive domains have critical impact on gait
- MCRS
- strong need to integrate cog demands w/gait and mobility training
Motoric Cognitive Risk Syndrome (MCRS)
slowed gait and subjective cog impairment
- 2-3x more likely to develop dementia than those w/o MCRS
Predictive value of gait speed:
> 1.2 m/s
extremely fit
can cross street safely
Predictive value of gait speed:
> 1 m/s
Healthy older population w/ lower risk of hospitalization or adverse health events
independent in ADLs
Predictive value of gait speed:
< 1 m/s
- increased risk for cog decline within 5 years
- increased risk for death/hospitalization within 1 year
Predictive value of gait speed:
< 0.8 m/s
- limited community ambulator
- increased risk of mortality, mob/ADL disability in 2 years
Predictive value of gait speed:
< 0.7 m/s
increased risk of death, hospitalization, institutionalization, and falls
Predictive value of gait speed:
< 0.4 m/s
- functional dependence
- severe walking disability
Predictive value of gait speed:
< 0.2 m/s
extremely frail
highly dependent
FIM determinant of highest level locomotion
150 ft
Conservative estimate of distances walked at superstores
2000 ft
Gait speeds required to safely cross the street
.49 - 1.32 m/s
Things to consider for functional ambulation
- time constraints
- ambient conditions
- terrain
- external physical load
- attentional demands
- postural transitions
- traffic level
T/F: Clinical gait training focuses on getting from point A to point B
False
MUST include more
Assistive Device considerations
- find best device on stability-mobility continuum
- proper adjustment, use, and footwear
- energy cost
- resistance of use
- environmental barriers
Assessing Hait
- Dx and relevent comorbidities
- social Hx including PLOF
- Body system screening
- Observational gait analysis
- Instrumental gait analysis
- level ground vs stairs
- gait speed
- outcome measures
Specific assessment for gait
- ROM
- Strength
- Motor Control
- Joint P!
- Coordination
- Somatosensation
- Vestibular
- Proprioception
Assessing Gait:
Stair Negotiation
- requires greater ROM and muscle strength
- ascending vs descending
- usual pace walking speed and SLS time best
- safety, handrails, step-to, AD, physical assist
Geriatric Gait Interventions
- flexibility
- strength
- power
- agility
- CV training
- multimodal training
Interventions:
Strength
LE strength associated with improved gait speed and function
Interventions:
Power
rapid bursts needed for motor control
Interventions:
CV training
aerobic exercise enhances functional endurance
Intervention:
Specificity of training
what is the goal?
Intervention:
training speed
increase of as little as 0.1 m/s can reduce disability and mortality
Intervention:
progressing task and environment
- reactive, predictive, and anticipatory control
- obstacle courses
- dual task
Intervention:
obstacle courses and stair training
- altered terrain
- obstacle avoidance
- steps
- ramps
Intervention:
Directional training
- backward and lateral stepping
- turning 90/180/360 degrees
- backward walking slower than 4 m/s may increase fall risk
Intervention:
Dual Task
- reduction in gait speed w/simple vs complex dual task
- increased gait variability leads to decreased postural stability
examples: counting backwards, animal naming
