Exam 2: Pathological Gait Flashcards
What are the 5 functional categories of pathological gait
- Deformities
- Muscle weakness
- Sensory Loss
- Pain
- Impaired Control
When does a functional deformity exist?
When the tissues do not allow sufficient passive mobility for patients to attain the normal postures and ranges of motion used in walking
What is the most common type of deformity
Contractures
_____ represents structural changes in the fibrous connective tissue component of muscles, ligament, or joint capsule following prolonged inactivity or scarring from injury
Contracture
(Elastic/Rigid) contracture yields to forceful manual stretch
Elastic
(Elastic/Rigid) contracture resists all stretching efforts
Rigid
What is the term for insufficient muscle strength to meet the demands of walking
Muscle weakness
Disuse muscular atrophy and neurological impairments are both reasons why a patient could be experiencing _____ _____
muscle weakness
True or False:
Some patients will have the ability to substitute for weak muscle groups depending on cause of weakness
True
Impaired _______ obstructs walking because it deprives the patient of know the exact location of their hip, knee, ankle or foot and the type of contact with the floor
proprioception
Sensory Loss-
If the patient has good motor control, they may substitute by ______ ___ or hitting ground harder to know heel contact.
Locking knee
Sensory Loss-
People with poor motor control tend to walk (slow/fast) and (cautious/reckless)
slow and cautious
What is the primary cause of musculoskeletal pain
Excessive tissue tension
Physiological reactions to pain introduce what two obstacles to effective walking?
Deformity and muscular weakness
_____ results from natural resting positions of swollen joints
deformity
____ _____ occurs secondary to the pain of joint swelling causing reduced muscle activity
muscular weakness
What are the 5 functional deficits of central neurological lesion that results in spastic paralysis
- Muscle weakness
- Selective motor control is impaired
- Primitive locomotor patterns emerge
- Muscles change their phasing
- Spasticity
What are the most common causes of spastic gait
CP, strokes, brain injury, incomplete SCI and MS
Spasticity Gait-
Lack of selective muscle control prevents the patient from controlling the ____ and _____ of muscle action
timing and intensity
True or False:
In spastic gait, loss is more evident proximally
False, it is more evident distally
Spastic Gait-
Primitive patterns such as mass (flexion/extension) during swing and mass (flexion/extension) during stance
flexion, extension
Spastic gait obstructs the yielding quality of (concentric/eccentric/isometric) muscle action
eccentric
What are the general categories of foot gait deviations
Floor contact, ankle deviations, ST joint deviations, Toe Deviations
What are the different floor contact deviations
forefoot contact, delayed heel contact, foot-flat contact, low heel, foot slap
Which deviation of floor contact is when the forefoot is the initial point of contact with the ground during weight acceptance
Forefoot contact
Which phase of gait does forefoot contact occur in
initial contact
What is the functional significance of forefoot contact
Disrupts heel rocker, forward progression of tibia, and shock absorption at the knee
What are the underlying causes of forefoot contact
Inadequate pre-tibial strength, PF contracture, excessive knee flexion and PF combined, heel pain, or short leg
Which deviation of floor contact happens when the forefoot precedes heel in contacting ground
delayed heel contact
Which phases of gait does delayed heel contact occur in
Initial contact, loading response, or mid stance
What is the functional significance of delayed heel contact
disrupts heel rocker and forward progression
What are the underlying causes of delayed heel contact
Yielding PF contracture or spasticity
Which deviation of floor contact happens when the heel and forefoot simultaneously contact the floor
foot flat contact
Which phase of gait does foot flat contact happen in
initial contact
what is the functional significance of foot flat contact
limited heel rocker and forward progression
What are the underlying causes of foot flat contact
any impairment contributing to excess knee flexion, and compensation for weak quads
Which deviation of floor contact happens when the forefoot is very close to the floor as the heel makes IC
low heel
which phase of gait does low heel occur in
initial contact
What is the functional significance of low heel
reduces the heel rocker and forward progression
What are the underlying causes of low heel
any impairment contributing to excess PF
Which deviation of floor contact is uncontrollable PF at the ankle following initial heel contact, often accompanied by an audible slap
foot slap
Which phases of gait does foot slap happen in
IC and LR
What is the functional significance of foot slap
disrupts heel rocker, forward progression, and shock absorption
What is the underlying cause of foot slap
Pre-tibial weakness especially anterior tibialis
What are the deviations of ankle deviations
Excess PF, excess DF, prolonged heel only, premature heel off, no heel off/delayed heel off, drag, contralateral vaulting
Which deviation of the ankle is when PF exceeds normal for a particular phase
Excess plantar flexion
Which phases does excess plantar flexion happen in
all except pre swing
What is the functional significance of excess plantar flexion
disrupts rockers during stance, foot clearance and limb advancement during swing
What are the underlying causes of excess plantar flexion
PF contracture, pre tib weakness, quad weakness, proprioception deficits or ankle pain
Which ankle deviation has DF that exceeds normal for a particular phase
excess dorsiflexion
Which phases does excess dorsiflexion occur in
all phases of stance
Which deviation of the ankle happens when the heel only period extends beyond loading response
prolonged heel only
Which phases does prolonged heel only affect
LR, MS, TS, and preswing
What are the underlying causes of prolonged heel only
painful forefoot or toe clawing
Which deviation of ankle happens when the heel is not contact with the ground when it should be
premature heel off
Which phases does premature heel off happen in
LR and MS
Which deviation of ankle is the absence of a heel rise when the heel should be off the ground
No heel off/delayed heel off
Which phases of no heel off/delayed heel off occur in
TS, and pre swing
Which deviation of ankle is when the contact of toes, forefoot, or heel with the ground during swing
drag
Which phases of gait does drag occur in
initial swing, mid swing, terminal swing
What deviation of the ankle is prematurely rising onto the forefoot of the contralateral stance limb during SLA of the reference limb
contralateral vaulting
which phases of gait does contralateral vaulting happen in
initial swing, mid swing, terminal swing
