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neuroscience and rehabilitation 5mpt2015 (y2) > Control of Lower Limb Movements and Common Gait Problems Associated with Neurological damage > Flashcards

Control of Lower Limb Movements and Common Gait Problems Associated with Neurological damage Flashcards

1
Q

Aims

A
  • Review features of applied anatomy that permit the role of the lower limb in human function
  • Explain the control of unilateral (discrete) and reciprocal (continuous/cyclical) lower limb movements.
  • Explain the common problems affecting gait and lower limb movement in central and peripheral nervous system disorders.
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2
Q

What is the role of lower limb?

A
  • Maintenance of erect posture- enables upper limb function
  • Absorption/ transmission of forces involved in weight bearing
  • Mobility- stance, stairs, walking
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3
Q

Define posture

A

Biomechanical alignment of the body and its orientation to thee environment.

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4
Q

In quiet stance where does the centre of gravity (COG) fall?

anterior to hip or posterior and so on for knee and ankle joint. so its a 3 point answer

A
  • In quiet stance the line of centre of gravity falls
  • posterior to hip joint
  • anterior to knee joint
  • anterior to ankle joint.
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5
Q

In quiet stance, the postural alignment of the lower limb is supported by which structures?

A
  • Hip: ilio-femoral ligament/iliopsoas
  • Knee: posterior joint capsule
  • Calf: gastrocnemius/ soleus
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6
Q

What are the roles of;
- Active restraints
- Passive restraints
In the maintenance of posture?

A
  • active restraints enable dynamic correction of postures

- passive structures minimise energy expenditure.

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7
Q

Bone structure; what are the 2 types of bone?

A
  • Compact: around the head of femur and on the exterior of the femur
  • Cancellous: usually internal, is porous.
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8
Q

Lower limb structures are subjected to different forces in a weight bearing position, what are these forces?

A
  • HAT = head, arms and trunk.

- As well as Ground reaction force.

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9
Q

What are the 2 types of bone/ bone structures.

A
  • Compact: around the head of femur and on the exterior of the femur
  • Cancellous: usually internal, is porous. much lighter helps absorb forces and direct it away from certain areas, SEE RECORDING
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10
Q

What is the role of the;

- Meniscus

A
  • Made of fibrocartilaginous material which helps the absorption and transmission of forces
  • Helps increase the congruence (contact) between the femur and tibia, which helps with stability.
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11
Q

During a gait cycle what is the COG like?

And what affects the COG?

A
  • During gait, the COG traverses a sinusoidal curve (goes up and down like a sound wave).
  • The displacement of COG is kept to a minimum to reduce energy expenditure as well as to minimise the amount of shock on the joints.
  • So reducing the amount the COG shifts it reduces the amount of shock to the lower limb and saves energy.
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12
Q

What are the key determinates of Gait for the Pelvis?

A
  • Pelvic rotation; Alternative left and right rotation –> decreases vertical COG displacement
  • Pelvic tilt; Tilts downwards on swing leg (by 5 degrees) –> decreases vertical COG displacement
  • Lateral pelvic rotation; Horizontal shift on pelvis with relative hip abduction to stance phase. Prevents excessive lateral weight shift.
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13
Q

What are the key determinates of Gait for the Knee?

Go through position of knee, flexion and extension degrees in the different phases of the gait cycle.

A

Knee flexion in mid-stance; 15-20 degrees during loading response –> decreases vertical COG displacement, also acts as shock absorption.

  • Foot, ankle and knee motions;
  • Ankle is dorsi flexed while knee almost fully extended in early stance phase.
  • Prevents further downward displacement of COG.
  • Ankle is plantarflexed while knee begins to flex in stance phase.
  • prevents further downward displacement of COG.
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14
Q

Define a Gait cycle.

A

The initial contact of one foot until that foot makes contact again with the ground.

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15
Q

In a gait cycle, what is the right step length

and left step length?

A

R step length = base of left foot to base of right foot.

L step length = base of right foot to base of left foot.

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16
Q

Do men or women have a larger toe out angle in their gait?

A

Men

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17
Q

Do men or women have a longer step length?

A

Men.

because men are generally taller than women, and its based off height

18
Q

What are the three main roles of the lower limb during human function?

A
  • maintenance of posture
  • transmitting forces
  • locomotion
19
Q

Why is it important to reduce the displacement of the COG during walking?

A
  • Energy efficient.

- Reduces forces to spinal cord, nerves and lower limb

20
Q

What situations change normal step length and walking speed?

A
  • Age (walking speed)
  • Height
  • Neuro conditions/ comorbidities
  • Any condition affecting balance
  • Patients mood
  • Footwear
21
Q

Discrete movements

A
  • recognizable beginning and end

- wend point is an inherent attribute of the task e.g. kicking, throwing sit-stand

22
Q

Continuous movement

A
  • no recognizable beginning or end
  • end point of task is not an inherent characteristic of the task but is decided arbitrarily by the performer e.g. swimming, walking, running, swimming etc.
23
Q

What are Central pattern generators.

Very long answer 4 points

A
  • Intrinsic spinal networks of neurons capable of generating cyclical, repetitive movement.
  • Responsible for the complex coordination of muscle contractions needed to generate rhythmic stepping movements of the legs.
  • rhythmic alterations of flexion & extension during swing and stance phases consist of differentially timed & spatially distributed synergy of muscle contraction.
  • Receive input from higher centres and peripheral/sensory feedback to modulate the stepping pattern.
24
Q

What lobes are responsible for different parts of control of walking?

  • Frontal lobe
  • Parietal lobe
  • Occipital lobe
  • Temporal lobe
  • Cerebellum
  • Basal ganglia
  • Brainstem
A
  • Frontal lobe;
    initiation, planning the motor execution that’re involved in walking.
  • Parietal lobe;
    Sensory lobe so integrates the sensory information from somatosensation. so detecting muscle length as well as tactile sensation associated with putting our feet on the ground and different surfaces.
  • Occipital lobe;
    Visual lobe so, helps us respond to visual stimuli, like threats within our field of vision.
  • Temporal lobe;
    Important for the topographical, 3D orientation of our body associated with walking.
  • Cerebellum;
    Co-ordination of movements, the fine tuning of the gait pattern.
  • Basal ganglia;
    Part of the motor planning aspect, also a key component where making choices between decisions when we walk e.g. walking through a door do we turn left or right after we pass through.
  • Brainstem;
    Within the brainstem we have a locomotor centre, this is where the first supraspinal control of walking above the spinal cord level.
25
Q

Which lobe is responsible for the planning and execution of movement

A
  • Frontal lobe
26
Q

Which lobe provides visual information to guide walking?

A
  • Occipital lobe
27
Q

True or false the cerebellum is involved in fine tuning and the coordination of movements?

A
  • True
28
Q

Peripheral neuro conditions?

A
  • Peripheral nerve injury
  • peripheral neuropathy
  • poliomyelitis
    myopathies e.g. muscular dystrophy
29
Q

CNS conditions

A
  • stroke
  • multiple sclerosis
  • spinal cord injury
  • traumatic brain injury
  • Parkinson’s disease
  • cerebral palsy
  • CNS tumour
30
Q

What are Primary impairments?

A
  • Change that occurs as a direct consequence of the diseases or lesion
31
Q

What are Secondary adaptions?

A
  • Changes that emerge as adaptive responses or compensations.
32
Q

E.G’s of primary impairments

A
  • weakness
  • sensory/proprioception loss
  • spasticity
  • pain
  • abnormal motor control/ movement pattern
33
Q

E.G’s of secondary impairments

A
  • weakness
  • disuse atrophy
  • soft tissue shortening/contracture
  • reduced cardiovascular endurance
  • learned non-use
  • reduced confidence
34
Q

How might Stroke affect a persons gait cycle / what is its typical presentation in post stoke patients.

A
  • Asymmetry between left and right side.
  • reduced hip control/alignment e.g. pelvic retraction, Trendelenburg sign.
  • reduced knee control hyper extended or flexed
  • plantar flexed/ inverted ankle
  • poor swing clearance- varying strategies
  • upper limb flexed position.
35
Q

How might Parkinson’s disease affect a persons gait cycle / what is its typical presentation in post stoke patients.

A
  • Bradykinesia most distinguishing feature in walking
  • Short step length, shuffling, narrow base
  • Posture- stooped, flexed, immobile trunk
  • limited arm swing
  • tremor maybe evident in arms, head.
36
Q

What is an Ataxic Gait / what is its clinical presentation?

and where are possible lesion sites?

A
  • Inability to coordinate the sensory and motor systems used in walking.
  • Wide base of support - awkward & unstable
  • tandem walk trial- forcing a narrow base of support may show tendency to fall.
  • Possible lesion sites;
  • cerebellum
  • vestibular system
  • dorsal columns in the spinal cord
37
Q

Stance phase possible deficits you would expect to see in some patients.

A
  • Problems with knee flexion and activating leg normally, so may use a variety of different strategies such as vaulting, hitching etc.
38
Q

Name 2 swing phase deficits.

A
  • circumduction
  • vaulting
  • or posterior lean
39
Q

What primary impairments cause knee flexion in stance phase?

A
  • poor quad control.
  • weakness in soleus or quads.
  • sensory loss at knee.
  • general extensor weakness.
40
Q

The Trendelenburg sign is caused weakness in which muscle(s)

A
  • Hip abductors.
41
Q

Absorption and transmission of forces through the lower limb is supported by what structures?

A
  • Bone structure.
  • Special structures e.g. menisci, plantar arches supported by soft tissue structures, calcaneal heel pad.
  • joint interactions during gait (under muscular control)
42
Q

What are 6 key factors that are responsible for minimising the displacement of COG?

A
  • Pelvic rotation
  • Pelvic tilt
  • Knee flexion in mid-stance
  • Foot, ankle and knee motion (2 different factors)
  • Lateral pelvic rotation.

neuroscience and rehabilitation 5mpt2015 (y2) (20 decks)

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