Cerebral Palsy - gait exam Flashcards

1
Q

Gait Tests & Measures

Participation and Activity ICF Level

A

Patient Specific Functional Scale

Pediatric Evaluation of Disability Inventory or PEDI-CAT

Gross Motor Function Measure Dim E: Walking, Running, and Jumping Domain

Timed Up and Go

Dynamic Gait Index (typically used in adult population)

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2
Q

Patient Specific Functional Scale (PSFS)

A

self-reported tool where patients identify and rate their difficulty with specific activities that are important to them

focuses on the individual’s perceived limitations in performing activities that are meaningful to them

Helps to measure activity limitations and set personalized functional goals

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3
Q

Pediatric Evaluation of Disability Inventory (PEDI-CAT)

A

assesses functional abilities and participation in various domains, including self-care, mobility, and social function

evaluates a child’s ability to perform daily activities and participate in family and community life

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4
Q

Gross Motor Function Measure (GMFM) - Dimension E: Walking, Running, and Jumping

A

standardized measure assessing gross motor function in children with CP. Dimension E specifically evaluates walking, running, and jumping

Assesses the child’s ability to perform gross motor tasks related to mobility and dynamic movement

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5
Q

Timed Up and Go (TUG)

A

measures the time it takes for an individual to stand up from a seated position, walk a short distance (usually 3 meters), turn around, walk back, and sit down

Evaluates basic mobility, balance, and gait speed

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6
Q

Dynamic Gait Index (DGI)

A

assesses gait, balance, and the ability to perform various walking tasks, including walking over obstacles and changing speeds

Evaluates how well an individual can maintain balance and adjust gait in different scenarios

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7
Q

Gait Tests & Measures

Body Function and Structure

A

3D Gait Analysis

Edinburgh Visual Gait Scale

Endurance/Speed (eg, 6 min or 2 min walk test, 10-meter walk or shuttle test) – there are wheelchair user versions!

Motor Control (eg, Selective Control Assessment of Lower Extremity SCALE)

ROM and Strength

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8
Q

3D Gait Analysis

A

uses motion capture technology and force plates to provide a detailed, three-dimensional assessment of gait patterns

Measures joint angles, segmental movements, and forces during walking, running, or other dynamic activities

Provides comprehensive data on kinematic (movement) and kinetic (forces) aspects of gait, which can be used to plan surgical, therapeutic, or orthotic interventions

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9
Q

Edinburgh Visual Gait Scale

A

clinical tool used to visually assess and rate gait abnormalities

systematic approach to observing and documenting gait deviations, including foot progression, stride, and overall gait pattern

quick assessment of gait quality and deviations during clinical evaluations

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10
Q

Endurance/Speed Tests

A

6-Minute Walk Test (6MWT): Measures the distance an individual can walk in 6 minutes, assessing endurance and functional capacity.

10-Meter Walk Test (10MWT): Measures walking speed over a 10-meter distance, providing insights into gait speed and functional mobility.

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11
Q

Motor Control Tests

A

Selective Control Assessment of Lower Extremity (SCALE)

assesses the ability to control movements of the lower extremities in a selective manner

Evaluates motor control by examining how well an individual can isolate and control specific lower limb movements

Highly correlated with an individuals gait speed and TUG score

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12
Q

Range of Motion (ROM) and Strength

A

Measures the range of motion in joints and the strength of muscle groups

assesses the flexibility and movement capacity of joints, while strength tests evaluate the force that muscles can generate

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13
Q

*** gold standard for gait analysis =

A

3D gait analysis
requires high tech equipment in order to capture:
Kinematics
Muscle activity
Ground reaction forces

Gait analysis is required if a family is considering
any surgical intervention

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14
Q

Edinburgh Visual Gait Score

A

Reliability: moderate to excellent
(60-92% agreement)

Validity: good correlation
with GMFM and 3D gait analysis

MCID: 2.4

17 observations of each leg through the gait scale
*higher scores = greater deviations

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15
Q

EVGS stance:
initial contact

A

peak hip flexion (S)
peak knee extension (S)
foot contact (S)

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16
Q

EVGS stance:
midstance

A

max trunk postion (S)
max trunk shift (C)
max pelvis obliquity (C)
pelvis rotation (T)
knee progression angle (T)
heel lift (S)
hindfoot varus/valgus (C)
foot progression angle (T)

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17
Q

EVGS stance:
terminal stance

A

peak hip extension (S)
peak knee extension (S)
max ankle DF (S)

18
Q

EVGS swing:
midswing

A

peak knee flexion (S)
max ankle DF (S)
foot clearance (S)

19
Q

Children with CP have increased co-activation of muscles disrupting the synergetic neuromuscular control needed for gait

A

One cause = increased muscle co-activation and asynchronies 
during ambulation

Activation of the TA muscle is much more noisier during the 
full gait cycle for children with CP than those who are typically 
developing

Not having NM control of their legs makes it hard for them 
to walk with a typical gait pattern

Increased co-activation leads to a lack of smoothness and coordination in movement, as opposing muscles work against each other rather than in a controlled, synergistic manner

20
Q

Ankle Lever Arm Dysfunction

A

Toe walking decreases ankle power generation by ~50% (requires ½ the strength than heel-toe walking)

This may be a beneficial compensation for children with CP

a bit counter-intuitive

This gait deviation = compensation strategy for weak 
plantar flexors

Children without CP can also display this behavior 
when learning to walk

21
Q

lever arm =

A

distance between the axis of rotation (the joint) and the point where force is applied (where muscles exert their force)

For the ankle, this involves the tibia and the foot.

22
Q

The longer the child walks
on their toes =

A

the more
at risk they are for 
developing a 
contracture

23
Q

Altered Propulsion:

A

Dysfunction in the ankle lever arm can reduce the efficiency of the push-off phase during walking, impacting forward propulsion and gait dynamics

Inefficiencies in the lever arm function lead to increased energy expenditure and potentially more fatigue during walking

Spasticity can restrict ankle dorsiflexion, affecting the lever arm function and leading to an altered gait pattern

24
Q

Joint and Bony Abnormalities

A

As the child grows and develops, muscle imbalances can lead to bony or positional deformities

25
A set of conditions in which lever arms become distorted because of bony or positional deformities
Results in different force capabilities Difficult to determine where rotation is occurring without full gait and physical examination Examples include femoral anteversion, external rotation of the tibia, equinovalgus, genu recurvatum
26
altered Force Capabilities
Changes in joint alignment and bone structure can alter the mechanical leverage available to muscles, affecting propulsion, stability, and overall gait performance Lever arms found up the LE chain and into the pelvis (NOT only at ankle)
27
Complexity of Rotation:
Identifying the exact location and nature of rotational abnormalities can be complex, as they may occur at multiple sites (e.g., hip, knee, ankle) and can interact in ways that are difficult to isolate without comprehensive evaluation
28
Femoral Anteversion
condition where the femoral head is rotated forward relative to the femoral shaft, leading to an internal rotation of the thigh Results in an internally rotated gait pattern, often seen as "in-toeing" during walking Requires examination of hip range of motion and gait patterns to determine the degree of anteversion and its impact on function
29
External Rotation of the Tibia
Occurs when the tibia is rotated outward relative to the femur Causes an outward rotation of the foot during gait, which can contribute to a "toe-out" walking pattern Involves evaluating tibial alignment and its effect on the foot and knee during walking
30
Equinovalgus
characterized by the foot being in a plantar-flexed (equinus) and everted (valgus) position Results in a loss of normal foot alignment, which can affect weight distribution and gait efficiency Often leads to difficulties with heel strike and push-off phases Requires examination of foot positioning, range of motion, and gait dynamics to understand the impact on overall function
31
Genu Recurvatum
condition where the knee hyperextends, causing the tibia to move posteriorly relative to the femur Leads to an abnormal knee alignment, which can affect stability and gait dynamic can impact shock absorption and contribute to balance issues Involves evaluating knee alignment, range of motion, and its impact on gait and functional mobility Gene recurvatum = Compensating for lack of DF to get foot flat on floor OR tightness/contracture of quads
32
Gait Patterns in Cerebral Palsy
jump knee gait TRUE VS APPARENT EQUINUS GAIT crouch gait stiff-knee gait
33
jump knee gait
Ankle in equinus, particularly in late stance. Knee and hip in hyperflexion in early stance, followed by extension to a variable degree in late stance, pelvis within normal ROM or anterior tilt
34
TRUE VS APPARENT EQUINUS GAIT
True: Ankle in equinus during stance, full knee extension, full hip extension, pelvis within normal ROM or anterior tilt Apparent: Ankle normal ROM, knee and hip in hyperflexion throughout stance, pelvis within normal ROM or anterior tilt
35
CROUCH GAIT
Ankle in excessive dorsiflexion throughout stance, knee and hip in hyperflexion, pelvis in normal ROM, anterior or posterior tilt
36
STIFF-KNEE GAIT
Reduction in knee flexion during swing is coupled by excessive hip circumduction
37
Jump Knee Gait CHARACTERISTICS
Increased hip and knee flexion at initial contact and in early stance Rapid hip extension, knee extension and plantarflexion in midstance Plantarflexion/knee extension couple Looks like jumping from one foot to another Often in younger children GMFCS Level II and III More often in younger children who weigh less and haven’t spent much time in standing or walking
38
Equinus Gait CHARACTERISTICS
True Equinus = Toe walking with plantarflexion in stance *Heel never comes down Apparent Equinus = Toe walking with neutral DF in stance * Heel comes
down
during stance * More with speed that you see
toe walking * Can progress 
to crouch 
gait Confirm by assessing ROM
39
Crouch Gait CHARACTERISTICS
Increased hip and knee flexion; usually increased dorsiflexion in sagittal plane Associated with high energy cost Associated with decreased force production relative to body weight Can make functional ambulation difficult or impossible Often develops and/or worsens in adolescence - When body size/weight increases too
40
Stiff Knee Gait CHARACTERISTICS
Reduced knee flexion in swing may be due to tight and/or spastic rectus femoris Limits ability to flex the knee Results in hip circumduction in order to progress leg forward Reduced step length, single leg stance time, 
cadence, and velocity Prob with foot clearance during swing phase Risk of hip subluxation over time
41
Consider the ---- before deciding which test/measure to use (eg, gait speed, gait endurance)
goal
42
_____ is common in children with CP, resulting in decreased _____ when walking
Co-contraction of muscles neuromuscular control