Cerebral Palsy - gait exam Flashcards
Gait Tests & Measures Participation and Activity ICF Level
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)
Patient Specific Functional Scale (PSFS)
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
Pediatric Evaluation of Disability Inventory (PEDI-CAT)
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
Gross Motor Function Measure (GMFM) - Dimension E: Walking, Running, and Jumping
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
Timed Up and Go (TUG)
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
Dynamic Gait Index (DGI)
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
Gait Tests & Measures Body Function and Structure
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
3D Gait Analysis
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
Edinburgh Visual Gait Scale
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
Endurance/Speed Tests
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.
Motor Control Tests
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
Range of Motion (ROM) and Strength
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
*** gold standard for gait analysis =
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
Edinburgh Visual Gait Score
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
EVGS stance:
initial contact
peak hip flexion (S)
peak knee extension (S)
foot contact (S)
EVGS stance:
midstance
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)
EVGS stance:
terminal stance
peak hip extension (S)
peak knee extension (S)
max ankle DF (S)
EVGS swing:
midswing
peak knee flexion (S)
max ankle DF (S)
foot clearance (S)
Children with CP have increased co-activation of muscles disrupting the synergetic neuromuscular control needed for gait
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
Ankle Lever Arm Dysfunction
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
lever arm =
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.
The longer the child walks on their toes =
the more at risk they are for developing a contracture
Altered Propulsion:
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
Joint and Bony Abnormalities
As the child grows and develops, muscle imbalances can lead to bony or positional deformities