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Peds Neuro > Evaluation of Pathologic Gait in Children > Flashcards

Evaluation of Pathologic Gait in Children Flashcards

1
Q

5 prerequisites of typical walking

A
  1. stability in stance
  2. clearance in swing
  3. adequate pre-positioning of foot for initial contact
  4. Adequate step length
  5. energy conservation
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2
Q

2 major factors that challenge stability in stance

A
  • The body is top-heavy – The Center of Mass is above the Base of Support
  • Walking continually alters segmental alignment – The COM is constantly moving forward and laterally relative to each support (foot)
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3
Q

For stability in stance, not only is a stable food requires, but the lower extremity segments must function to:

A
  • Allow advancement of the limb in swing
  • Maintain balance
  • Provide propulsion
  • Ensure appropriate position of the structures above
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4
Q

Sufficient foot clearance requires

A
  • Appropriate position and power at the hip, knee and ankle on the stance side
  • Adequate ankle dorsiflexion, knee flexion and hip flexion during swing
  • Stability of the stance foot
  • Adequate body balance
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5
Q

Appropriate pre-positioning of food for initial contact requires

A
  • Appropriate body balance
  • Stability, power and proper position of the stance limb
  • Adequate ankle dorsiflexion, balance between foot invertors/evertors, and knee position
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6
Q

Adequate step length requires

A
  • Appropriate body balance
  • Stability and proper position of the stance limb
  • Adequate hip flexion and knee extension
  • Neutral ankle and foot position
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7
Q

Energy conservation includes:

A

a. Joint stability
b. Minimization of the COM excursion
c. Muscle forces optimized

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8
Q

Age of normal walking

A

9-15 months

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9
Q

mature, synchronous gait pattern

A

3.5 years

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10
Q

heel strike

A

between 2-3 years

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11
Q

reciprocal arm swing

A

2 years

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12
Q

mature arm swing

A

4 years

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13
Q

mature food angles (arches)

A

3 years

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14
Q

adult gait pattern

A

7 years

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15
Q

walking speed of average adult (above 13 yrs)

A

4.95 feet/sec

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16
Q

7 year old average walking speed

A

2.6 feet/sec (1.8 mph)

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17
Q

2 year old average walking speed

A

1.5 ft/sec (1 mph)

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18
Q

What is there a linear relationship between?

A

step length and leg length

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19
Q

duration of single limb stance increases as…

A

walking pattern matures

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20
Q

when does rapid change in single limb stance occur

A

between 1.5-3.5 years

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21
Q

standing energy expenditure rate decreases with…

A

age

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22
Q

at a high speed of walking, energy expenditure is…

A

70% greater for a 3-4 year old and 40% greater
in a 5-6 year old than adult energy expenditure at same speed.

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23
Q

Gait pathology - primary impairments

A

abnormalities that are a direct result of CNS injury

24
Q

Gait Pathology- Secondary Impairments

A

compensations/mechanisms that are used by the child to
circumvent the primary abnormality

25
Q

Why do abnormal gait patterns typically develop?

A

bony deformities, loss of ROM, muscle weakness, spasticity, and/or abnormal motor control.

26
Q

Gait evaluation methods

A

-Observation (Edinburgh Visual Gait Scale)
- Efficiency and Practicality of Walking
- Footprint Analysis Method
- Gait Assessment tools
- Gait Analysis Laboratory

27
Q

Video analysis falls into what category?

A

observation

28
Q

what is the most common type of gait analysis?

A

observation

29
Q

components of gait analysis

A
  1. Type of environment/Surface(s):
  2. Requirement of orthotics and ambulatory aids
  3. Length of observation (minutes) to assess typical household and community distances
  4. arm swing
  5. trunk position and sway
  6. compensated or uncompensated trendelenburg
  7. excessive hip flexion and rotation
  8. excessive knee flexion or hyperextension
  9. toe clearance
  10. foot position
  11. push off effectiveness
  12. foot progression angle
  13. coordination and fluidity of movement
30
Q

Considerations for type of environment/surface

A

a. walking on level surfaces versus unlevel outdoor surfaces, carpet versus tile, hard wood floors
b. quiet versus busy, clinic versus school, home

31
Q

How long should you assess gait?

A

AT LEAST TEN MINUTES

32
Q

How to evaluate efficiency and practicality of walking

A

a. Calorimetry – Using oxygen consumption as an indirect measure of energy metabolism
b. heart rate – linear relationship of HR with O2 consumption,
c. EEI (energy expenditure index)
d. Velocity = distance/time
*need to normalize velocity for stature to compare over time. Divide velocity by leg length (best) or height (less precise).
e. 30 second walk test – measure of casual or comfortable walking speed; number of feet child can walk within 30 seconds

33
Q

Standardized observational gait analysis tool

A

Edinburgh Visual Gait Score

34
Q

Footprint analysis Methods

A
  • Chalk, paint, water and paper
  • Commercial paper/tools
35
Q

Parameters of footprint analysis

A
  • Velocity
  • Cadence
  • Foot progression angle
  • Base of support
  • Toe clearance
  • Stride length
  • Step length
36
Q

There is a linear relationship between what and what

A

heart rate and oxygen uptake during walking for normal children and children with CP

37
Q

Energy Expenditure index equation

A

EEI = (HR walking - HR resting) / average velocity

38
Q

Supported walking ambulation performance scale (SWAPS)

A

method used to qualify video-taped observations of gait

39
Q

Gait assessment tools

A

a. SWOC – Standardized Walking Obstacle Course
b. DGI – Dynamic Gait Index (modified version for children)
c. FMA - Functional Mobility Assessment tool
d. FMS – The Functional Mobility Scale
e. GOAL – Gait Outcomes Assessment List
f. Gaitrite
g. Write Step

40
Q

Gait analysis laboratory

A

facility that uses specialized measurement technology to
provide objective data about a patient’s gait

41
Q

Data collected by gait analysis laboratory

A

a. Kinematics – Motion of the patient’s individual body segments and joint rotations
b. Kinetics – Joint reactions including forces, torques (moments), and power
c. Electromyography (EMG) – Skeletal muscle on-off activity (i.e. timing), not strength

42
Q

Standardized Walking Obstacle Course

A

 Measures stability and speed of gait under difference circumstances
 Measures: time, number of steps, and observation of stability
 Designated path
 Includes negotiating 3 directional turns and negotiation of barriers

43
Q

Gait Outcomes Assessment List (GOAL)

A

 Patient-reported outcome (PRO) for ambulatory children
with CP (GMFCS I-III)
 Spans all domains of the ICF
 Very helpful with goal setting
 Ages: Child version for 13 y/o+ (or younger if they can complete on their own or give verbal responses) OR Parent version for younger

44
Q

Subscales of Gait Outcome Assessment List

A

 ADL
 Gait function & mobility
 Pain
 Discomfort & fatigue
 Physical activities
 Sports & recreation
 Gait pattern & appearance
 Use of braces and mobility aids
 Body image & self-esteem

45
Q

Guidelines for 3 dimensional Gait analysis

A

 Child’s age (typically around 3 years old)
 Lack of progress in PT
 Goals of Intervention
 Changes in Intervention
 Post Intervention Gait Analysis
 Typical Diagnosis

46
Q

Giat abnormalities in children with cerebral palsy

A

 Bony Abnormalities
 Inadequate ROM and Spasticity
 Muscle Weakness
 Abnormal Motor Control
 Energy Expenditure

47
Q

Gait abnormalities in children with myelomeningocele

A

 typically results in hypotonicity/areflexia and sensory impairment
 Bony Problems (hip instability and torsional malalignment)
 Additional Areas of Weakness Resulting in Gait Abnormalities (glut med lurch or crouch)
 Energy Expenditure

48
Q

L1

A

weak hip movements (iliopsoas L1-L4)

49
Q

L2

A

present hip flexors, adductors and hip rotators are grade 3 or better. Hip flexion and
adduction contractures. Dislocated hips common. Short distance household amb. Possible using
KAFO’s and UE support

50
Q

L3

A

strong hip flexion and adduction. Weak hip rotators and anti-gravity knee extension. With
at least grade 3 quads, can ambulate with KAFO’s and forearm crutches, HH and short distance
community amb.

51
Q

L4

A

anti-gravity knee flexion and grade 4 ankle df with inversion. Calcaneal foot deformities are
common. AFO’s and forearm crutches

52
Q

L5

A

lateral hamstring muscle with at least grade 3 strength, grade 2 glut min, grade 3 post tib.
Gluteal lurch (trendelenburg) without assistive device, hindfoot valgus/calcaneal deformities

53
Q

S1

A

gastroc/soleus grade 2, glut med grade 2 or glut max grade 2, no orthosis or assistive device
needed, mild/mod glut lurch, may require orthotics for medial/lateral stability

54
Q

S2/S3

A

gastroc/soleus, glut med and glut max grade 4, decreased push off, decreased strike length, orthotics may be required to maintain subtalar neutral

55
Q

Additional bony problems of myelomeningocele

A

a. talipes equinovarus – clubfoot
b. infant heel - atypical development of the calcaneus due to lack of weight bearing

56
Q

Additional area of weakness resulting in abnormalities in posture/gait due to myelomeningocele

A

a. Excessive lumbar lordosis and anterior pelvic tilt
b. Exaggerated movement of pelvis and pelvic obliquity
c. Excessive hip, knee flexion and ankle dorsiflexion (crouched gait)
d. Genu Valgum alignment in stance phase due to the combination of internal hip and pelvic
rotation and knee flexion
e. Calcaneovalgus

57
Q

Energy Expenditure with walking children with MM

A

a. HR higher than non-disabled peers during walking
b. May require shorter distance or rest periods to keep HR at a steady state.

Peds Neuro (19 decks)

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