Chapter 14 Flashcards
What do limitations in gait result in?
restricted participation in the mobility domain
What does mobility disability cause?
reduced performance on functional activities
overall ADLs
Effect of motor system impairments:
paresis
spasticity
cocontraction
non-neural component
What can paresis/weakness result in?
inability to generate adequate FORCES to move the body forward
What does weakness affect the ability to walk independently depend on?
which muscles are affected.
how weak are the affected muscles.
What’s the capacity of other muscles to compensate
Plantor flexion gait abnormalities:
Strong hyperextension in stance; lack of knee flexion in swing;
Low plantar flexor power/work
Plantor flexion gait abnormalities compensation:
Partially compensated by hip flexors during pull-off
Quad gait abnormalities:
trouble in stabilizing the knee during MSt
Quad gait abnormalities compensation:
Hyperextension in MSt
Hip flexor gait abnormalities:
Inadequate hip flexion during swing phase;
Additionally, inadequate hip flexion causes a lack of knee flexion in swing phase; as a result, the toe clearance is reduced or lost
Hip flexor gait abnormalities compensation:
abdominals in conjunction with posterior tip of pelvis
circumduction
contralateral vaulting
leaning trunk laterally toward opposite limb
Hip extensor gait abnormalities:
Inadequate control of HAT segment;
Forward trunk lean that threatens stability
Hip extensor gait abnormalities compensations:
Backward lean in stance used to compensate by controlling CoM
Hip abductor gait abnormalities:
Drop of the pelvis on the less impaired side, i.e., Trendelenburg gait
Hip abductor gait abnormalities compensation:
A lateral shift of CoM over the stance leg along with lateral lean of the trunk toward the stance leg
How does spasticity contribute to gait disorder?
inappropriate activation when muscle is lengthened during the gait cycle
alterations in mechanical properties of the muscle causing changes in intrinsic stiffness
What is an abnormal strategy?
loss of fractionation of movement (corticospinal lesions)
Examples of disordered pattern of muscle activation and recruitment?
Reduced recruitment
Overactivity (unrelated to spasticity)
Examples of dyscoordination:
abnormal synergies
disordered pattern of muscle activation
cocontraction
Musculosketal impairments Non-neural contributing factors to dyscoordination):
Decreased ROM
Weakness
Contracture
Changes in alignment
How many degrees of DF are required for normal progression during gait?
5 degrees
How many degrees of PF contracture results in low heel contact and early flat foot during loading?
15 degrees
How about in children with spastic CP to produce a forefoot contact at foot strike
30 degrees
What do sensory inputs serve as?
a trigger for initiation of swing
are necessary for adapting locomotion to changing environmental conditions.
Effect of sensory impairments include:
Somatosensory deficits
Visual deficits
Vestibular deficits
What does somatosensory deficits result in?
gait ataxia
What can loss of proprioception cause?
reduced modulation of muscle activity throughout the gait cycl
Visual deficits:
Critical to anticipatory control of balance during gait
Critical for obstacle avoidance
Loss of visual inputs affect both stability and adaptability requirements of gait.
What do vestibular deficits depend on?
the age at the time of the loss of vestibular function
Impairment in perceptual system:
Body Image and Scheme Disorder
Spatial
Pain
Cognitive
Body Image and Scheme Disorder:
Decreased stability
Inappropriate foot placement
Difficulty controlling the center of mass relative to a changing base of support
Spatial relation disorder:
Reduced ability to navigate safely through the environment
“Topographic disorientation”
What is antalgic gait pattern characterized by?
decreased velocity, shortened stance, stiffer limbs, decreased push-off
Compensatory strategies used in presence of pain:
Reduced weight bearing on painful side
Avoidance of impact loading
Reduced joint excursion
Decreased joint compressive forces
