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assessing gait in older adults Flashcards

1
Q

gait cycle:

phases of weight acceptance

A

initial contact

loading response

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2
Q

gait cycle:

SL support phases

A

midstance

terminal stance

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3
Q

gait cycle:

limb advancement phases

A
  • preswing
  • initial swing
  • midswing
  • terminal swing
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4
Q

Common gait changes with age:

temporal

A
  • decreased step and stride length

- increased stance and DL support time

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5
Q

Common gait changes with age:

spatial

A
  • decreased step and stride length

- increased step width

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6
Q

Common gait changes with age:

kinematic/postural

A
  • decreased excursion of movement at LE joints
  • decreased reliance on ankle kinetics and power
  • less upright posture
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7
Q

T/F: abnormal gait associated w/progressive risk of institutionalization and death

A

True

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8
Q

Slow gait speeds:

A
  • defining feature of frailty
  • fall pts slower than age match peers
  • worse performance across all cog domains
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9
Q

effect of complex dual task on gait in MCI and AD groups compared to healthy

A
  1. significant decrease in gait velocity
  2. increased stride time
  3. increased stride variability
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10
Q

stride length in AD group compared to healthy controls

A

decreased mean value and greater CoV

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11
Q

gait variability:

step length and # of steps

A

reduced mean value for all CDRs compared to CHI at UP, FP, SP, and dual-task conditions

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12
Q

Gait and cognition

A
  • 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
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13
Q

Motoric Cognitive Risk Syndrome (MCRS)

A

slowed gait and subjective cog impairment

  • 2-3x more likely to develop dementia than those w/o MCRS
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14
Q

Predictive value of gait speed:

> 1.2 m/s

A

extremely fit

can cross street safely

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15
Q

Predictive value of gait speed:

> 1 m/s

A

Healthy older population w/ lower risk of hospitalization or adverse health events

independent in ADLs

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16
Q

Predictive value of gait speed:

< 1 m/s

A
  • increased risk for cog decline within 5 years

- increased risk for death/hospitalization within 1 year

17
Q

Predictive value of gait speed:

< 0.8 m/s

A
  • limited community ambulator

- increased risk of mortality, mob/ADL disability in 2 years

18
Q

Predictive value of gait speed:

< 0.7 m/s

A

increased risk of death, hospitalization, institutionalization, and falls

19
Q

Predictive value of gait speed:

< 0.4 m/s

A
  • functional dependence

- severe walking disability

20
Q

Predictive value of gait speed:

< 0.2 m/s

A

extremely frail

highly dependent

21
Q

FIM determinant of highest level locomotion

A

150 ft

22
Q

Conservative estimate of distances walked at superstores

A

2000 ft

23
Q

Gait speeds required to safely cross the street

A

.49 - 1.32 m/s

24
Q

Things to consider for functional ambulation

A
  • time constraints
  • ambient conditions
  • terrain
  • external physical load
  • attentional demands
  • postural transitions
  • traffic level
25
Q

T/F: Clinical gait training focuses on getting from point A to point B

A

False

MUST include more

26
Q

Assistive Device considerations

A
  1. find best device on stability-mobility continuum
  2. proper adjustment, use, and footwear
  3. energy cost
  4. resistance of use
  5. environmental barriers
27
Q

Assessing Hait

A
  1. Dx and relevent comorbidities
  2. social Hx including PLOF
  3. Body system screening
  4. Observational gait analysis
  5. Instrumental gait analysis
  6. level ground vs stairs
  7. gait speed
  8. outcome measures
28
Q

Specific assessment for gait

A
  • ROM
  • Strength
  • Motor Control
  • Joint P!
  • Coordination
  • Somatosensation
  • Vestibular
  • Proprioception
29
Q

Assessing Gait:

Stair Negotiation

A
  • requires greater ROM and muscle strength
  • ascending vs descending
  • usual pace walking speed and SLS time best
  • safety, handrails, step-to, AD, physical assist
30
Q

Geriatric Gait Interventions

A
  1. flexibility
  2. strength
  3. power
  4. agility
  5. CV training
  6. multimodal training
31
Q

Interventions:

Strength

A

LE strength associated with improved gait speed and function

32
Q

Interventions:

Power

A

rapid bursts needed for motor control

33
Q

Interventions:

CV training

A

aerobic exercise enhances functional endurance

34
Q

Intervention:

Specificity of training

A

what is the goal?

35
Q

Intervention:

training speed

A

increase of as little as 0.1 m/s can reduce disability and mortality

36
Q

Intervention:

progressing task and environment

A
  1. reactive, predictive, and anticipatory control
  2. obstacle courses
  3. dual task
37
Q

Intervention:

obstacle courses and stair training

A
  • altered terrain
  • obstacle avoidance
  • steps
  • ramps
38
Q

Intervention:

Directional training

A
  • backward and lateral stepping
  • turning 90/180/360 degrees
  • backward walking slower than 4 m/s may increase fall risk
39
Q

Intervention:

Dual Task

A
  • reduction in gait speed w/simple vs complex dual task
  • increased gait variability leads to decreased postural stability
    examples: counting backwards, animal naming

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