Exam/Treatment of Gait Flashcards by Megan Rehm

What are key elements of gait?

Stance phase
Swing phase
Symmetry
Step pattern
Speed
Trunk posture
Arm swing

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What are aspects of motor control of gait?

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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What is needed for normal gait?

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

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Where is center of pressure when taking a step?

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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What is they hypothesis oriented model of observing abnormal gait?

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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What are gait deviations causing impaired heel strike?

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

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

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

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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What are possible abnormal gait patterns during midstance?

Knee hyperextension problems
Knee flexion problems
Hip flexion problems

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What are possible causes of knee hyperextension during impaired midstance?

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

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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What are some abnormal gait patterns during terminal stance?

Insufficient hip extension

Insufficient toe off

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

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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What are some abnormal gait patterns during swing?

Inadequate foot clearance
Excessive external rotation
Scissoring
Inadequate knee extension
Poor foot placement

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What are causes for inadequate foot clearance during swing?

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

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What are causes for excessive external rotation during swing?

Hip flexors: weak, poor pull through

Hip adductors: use to compensate for flexors

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

Hip adductor spasticity (bilateral or unilateral)

Poor coordination or proprioception

What are causes for inadequate knee extension during swing?

Weak quads

Hypertonicity, contracture of hamstrings

What does gait look like in different neuro disorders?

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

What are ways to examine gait at the participation level?

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

Ths is most difficult for us to assess

What is definition of community ambulation?

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

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

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

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

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

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

What can the 10 m walk predict?

Predicts community mobility

Can use AD or different surfaces

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

0.8 m/s = Full community Average gait speed = 0.42 m/s

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

True

What are strategies to examine gait?

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

How is gait examined in a research lab?

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

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

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

What are possible goals for gait?

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

Wha is task oriented approach for gait training?

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

What are ways to improve movement strategies: progression?

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

What are ways to improve stability in gait?

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

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

False

What are ways to improve stability on stance limb?

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

What are ways to improve movement strategies: adaptation?

Vary speed, surfaces, visual environment Obstacles: stationary, moving, surprises Stop abruptly, change direction, turn head Dual task: carry object, open door, cognitive task

How can part practice be used in gait training?

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

What is BWSTT?

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

How does BWSTT work?

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

Can BWSTT be used with SCI?

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