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Neuro 2 > Exam/Treatment of Gait > Flashcards

Exam/Treatment of Gait Flashcards

1
Q

What are key elements of gait?

A 
Stance phase
Swing phase
Symmetry
Step pattern
Speed
Trunk posture
Arm swing
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2
Q

What are aspects of motor control of gait?

A 
Steady state velocity
Initiate a step
Change speed or stop
Turns: spin turn or step turn
Recover from trip or slip
Walk-run transition
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3
Q

What is needed for normal gait?

A

Progression
Stability/Postural control
Adaptation: obstacles, surfaces, carrying items (dual task paradigm: cognitive demand while walking)

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4
Q

Where is center of pressure when taking a step?

A

When stepping with left foot: First put weight over right foot then shift weight to the left foot to take step

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5
Q

What is they hypothesis oriented model of observing abnormal gait?

A

Use exam findings to generate hypothesis about cause of problem.
Which impairment to address? ROM loss, hypertonicity, weakness, incoordination/synergy, sensory/perceptual/cognitive lsot

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6
Q

What are gait deviations causing impaired heel strike?

A

Low heel, flat foot, or forefoot contact
Excessive inversion: synergy
Excessive eversion: hypotonicity

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7
Q

What are possible causes for low heel, flat foot, or forefoot contact during heel strike?

A

Ankle PF: hypertonic pulling
Ankle DF: weak, can’t lift against gravity
Knee cause: lack extension in late swing/early stance

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8
Q

What may happen if there is excessive inversion or eversion during heel strike?

A

Inversion: toe clawing/supination during stance, will want AFO to go to toes
Eversion: pronation during stance, may have callous formation on navicular

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9
Q

What are possible abnormal gait patterns during midstance?

A

Knee hyperextension problems
Knee flexion problems
Hip flexion problems

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10
Q

What are possible causes of knee hyperextension during impaired midstance?

A

Ankle PF cause: hypertonic, loss of ROM into DF because or tight PF
Quadriceps cause: weakness, want to lock into recurvatum

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11
Q

What are possible causes of knee flexion or hip flexion in impaired midstance?

A

Knee flexion: hamstrings are hypertonic and pulling them into crouch, quads are weak and they want to lock into recurvatum

Hip flexion: may have hip or knee flexion contracture, hypertonicity of flexors

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12
Q

What are some abnormal gait patterns during terminal stance?

A

Insufficient hip extension

Insufficient toe off

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13
Q

What is cause of insufficient hip extension or insufficient toe off during terminal stance?

A

Hip flexor cause: contracture, hypertonicity
Hip extensor cause: weakness, poor stability

PF cause: weakness of PF
If no toe off: a lot of stopping, starting, less momentum and speed

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14
Q

What are some abnormal gait patterns during swing?

A 
Inadequate foot clearance
Excessive external rotation
Scissoring
Inadequate knee extension
Poor foot placement
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15
Q

What are causes for inadequate foot clearance during swing?

A

Weak hip flexors
Weak knee flexors
Weak DF
Proprioception: poor awareness, due to stroke, MS, LE surgery, neuropathy

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16
Q

What are causes for excessive external rotation during swing?

A

Hip flexors: weak, poor pull through

Hip adductors: use to compensate for flexors

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17
Q

What are causes of scissoring during swing? What about poor foot placement?

A

Hip adductor spasticity (bilateral or unilateral)

Poor coordination or proprioception

18
Q

What are causes for inadequate knee extension during swing?

A

Weak quads

Hypertonicity, contracture of hamstrings

19
Q

What does gait look like in different neuro disorders?

A

Stroke: step asymmetry
PD: shuffling, poor momentum control, decreased trunk rotation, freezing
Cerebellar: ataxic (inconsistent foot placement)
CP: crouched gait (hypertonicity in LE), may also see crouched gait in MS or incomplete SCI

20
Q

What are ways to examine gait at the participation level?

A

Self report measures of mobility: questionnares, life space
Activity monitors: pedometers, step activity monitors, accelerometers

Ths is most difficult for us to assess

21
Q

What is definition of community ambulation?

A

Important for discharge planning
1000 feet
Speed: traffic lights, busy sidewalks
Ambient conditions: rain, temperature, light
Physical loads: packages, manual doors
Terrain: stairs, curbs, slopes, obstacles
Attentional demands

22
Q

What can be used to examine gait at the functional level?

A

6 min walk
Dynamic gait index (walking with head turns)
TUG
10 meter walk

23
Q

What are the reference values for comfortable vs. maximum pace by decade and gender?

A

Young adults: 1.4 m/s vs. 2.5 m/s

Older adults: 1.3 m/s vs. 1.8 m/s

24
Q

What can the 10 m walk predict?

A

Predicts community mobility

Can use AD or different surfaces

25
Q

What is ambulation status for people based on their walking speed?

A

0.8 m/s = Full community

Average gait speed = 0.42 m/s

26
Q

T/F: gait velocity gains which result in transition to higher ambulation category are associated with better function and quality of life

A

True

27
Q

What are strategies to examine gait?

A 
Visual analysis:
Tinettis gait and balance scale: rate quality, subjectivity in ratings, 12 points for gait, 16 points for balance
Ranchos form
GARS
others
28
Q

How is gait examined in a research lab?

A

Spatio-temporal parameters
Kinematics: motion analysis
Kinetics (force measures): EMG, force plate

29
Q

What must we consider for patient application during examination of gait?

A

Classy functional/participation level (limited household/unlimited community)
Consider progression/stability/adaptation (obstacles, challenges)
Consider impairments

30
Q

What are possible goals for gait?

A

STGs: change impairments, improve gait patterns, interim step towards LTGs

LTGs: functional, patient oriented. Think of distance, level of assistance, AD, safety, energy expenditure

Progression/stability/adaptation

31
Q

Wha is task oriented approach for gait training?

A

Modify task/environment to allow practice
Modify individual: treat or minimize impairments
Principles of motor learning

32
Q

What are ways to improve movement strategies: progression?

A

Manually assist movement if they can’t clear foot.
Use ace wrap as temporary orthotic.
Focus on activating PF, hip flexors to generate momentum: facilitation, augmented feedback, exaggerate motion (marching), increase speed demands

33
Q

What are ways to improve stability in gait?

A

Postural alignment: visual target to keep eyes forward, augmented feedback, adjust height of AD
Postural control: mediolateral, single/double support phase, practice weight shifts

34
Q

T/F: practicing weight shifts alone will help improve gait

A

False

35
Q

What are ways to improve stability on stance limb?

A

Extensor support: augmented feedback, practice stepping with opposite leg, knee brace or orthotic
Foot placement and heel strike/foot flat transition: augmented feedback, hinged orthotic
AD

36
Q

What are ways to improve movement strategies: adaptation?

A

Vary speed, surfaces, visual environment

Obstacles: stationary, moving, surprises

Stop abruptly, change direction, turn head

Dual task: carry object, open door, cognitive task

37
Q

How can part practice be used in gait training?

A

Motor learning approach: break down task into pieces

Stance: unilateral WBing activities

Swing: step forward, back, side, use target or stool

Treadmill with body weight support

38
Q

What is BWSTT?

A

Decrease BWS and increase speed during training
Options for assistance: manual, electrical stim, robotic
Treadmill vs. overground

39
Q

How does BWSTT work?

A

Peripheral sensory input processed by CNS (CPG)
Residual connections in damaged spinal cord are plastic and recover
LE strength gains
Cardiovascular endurance gains
Massed practice
Decreased fear

40
Q

Can BWSTT be used with SCI?

A

ASIA A: no motor or sensory function below level of lesion: SC can “learn”, EMG timing and pattern of EMG activity improves, improvements are small not functional

Chronic incomplete SCI: increases walking speed and distance, improves limb coordination, improves strength and energy expenditure

Neuro 2 (23 decks)

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