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Analysis of Movement > FINAL: Gait deviations > Flashcards

FINAL: Gait deviations Flashcards

1
Q

What may cause foot drop with a forefoot-heel contact?

A

common fibular nerve palsy and peripheral neuropathy

- this results in very weak DFs and/or pes equinus

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2
Q

T/F: There is no active dorsiflexion during swing for a foot drop with forefoot-heel contact.

A

true, just passive DF during stance, no active DF during swing

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3
Q

Why would one have a foot flat gait?

A

common fibular nerve palsy and peripheral neuropathy

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4
Q

What does the deep fibular n. innervate?

A

anterior compartment of leg (DFs)

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5
Q

What does superficial n. innervate?

A

lateral compartment of leg (everter/PFs)

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6
Q

What can cause a foot slap or drop?

A

weak DFs from common fibular nerve palsy or peripheral neuropathy

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7
Q

What major issues may follow at the ankle with a common fibular nerve palsy or peripheral neuropathy?

A
  • foot slap/drop
  • flat foot
  • foot drop with forefoot heel contact
    • all these are issues with the DFs
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8
Q

What are some ways we can compensate to help clear the floor?

A

hip hike, circumduct, vault, more KF/HF/DF

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9
Q

What likely impairments cause a forefoot-delayed heel contact gait?

A

spastic PFs or PF contracture; pes equinus

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10
Q

What happens at the tibia with a forefoot-delayed heel contact gait?

A

it needs to be thrust backwards to get the foot down, so you go into a good amount of extension at knee

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11
Q

What likely impairments occur with a foot flat gait?

A
  • markedly weak DFs, knee flexion contracture, overactive hamstrings
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12
Q

What pathological precursors can cause a forefoot-delayed heel contact gait?

A

UMN lesion, CP, CVA

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13
Q

Why would someone be a toe walker?

A
  • due to calcaneal pain

- upper motor neuron lesion, CP, CVA causing PF contracture or PF spasticity

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14
Q

What does a crouched gait look like?

A

may present in a toe walker: HF, KF, PF

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15
Q

What other excessive motions may accompany plantar flexor weakness during gait?

A

hip flexion and knee flexion

- no PF = no tibia control, causing more KF

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16
Q

Delayed heel rise is due to what deformity?

A

weak PFs, due to peripheral or CNS disorders

- or lengthening of Achilles tendon

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17
Q

What happens to gait when you have weak PFs?

A

no push off, shortened step length, prolonged heel contact

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18
Q

What can cause lateral foot weight bearing?

A

a supinated foot position (pes cavus) due to SCI, congenital structural deformity

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19
Q

With what gait deviation may you see reduced midfoot mobility?

A

lateral foot weightbearing

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20
Q

Dynamic excessive pronation can be due to a weak ___________ muscle.

A

tibialis posterior

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21
Q

In dynamic excessive pronation, the foot stays pronated too long in what stance?

A

midstance: should be moving from pronation to supination here and it doesn’t

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22
Q

What can cause static excessive pronation?

A

floppy foot can be caused by paralyzed inverters or pes planus deformity
- can be due to UMN lesion or congenital structural deformity

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23
Q

T/F: Subtalar joint is constantly everted with a floppy foot.

A

true

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24
Q

During what phase of gait does vaulting present?

A

midstance

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25
Q

An overall excessive internal rotation of the lower extremity in stance can be seen in what gait deviation?

A

floppy foot, or static excessive pronation

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26
Q

Why might someone present with a backward lurch during their gait?

A

to bring the LoG posterior to help the gluts not work as hard, they may be paralyzed or weak

  • decreases forward progression of body
  • this lurch can also help bring the swing limb forward
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27
Q

Excessive toe out can be caused by what bony alignment issue?

A

retroversion

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28
Q

Inadequate knee flexion affects what stages?

A

loading and most of swing phases

LR = no shock absorption
PSw = toe off is difficult
ISw = dragging toe here
MSw = continued toe drag
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29
Q

What can cause a knee extensor thrust?

A

upper motor neuron lesion causing spastic quads

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30
Q

What can cause weak quads?

A

UMN lesion, femoral nerve palsy, arthritis pain, L3-4 compression neuropathy

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31
Q

What does a person with weak quads present like?

A

knee stays extended during loading, may not be in recurvatum during stance

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32
Q

What other compensation can accompany weak quads?

A

anterior trunk lean

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33
Q

What can cause chronic KE weakness?

A

poliomyelitis

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34
Q

Constant recurvatum in stance and swing is labeled as what?

A

chronic quad weakness

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35
Q

Which gait deviation results in a vertical thigh? Why does this happen?

A

no HF results in vertical thigh

- can be caused by femoral nerve lesion

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36
Q

With hip flexor weakness, what must happen at the knee now?

A

increased flexion from BFSH

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37
Q

What can cause a varus thrust in gait?

A

laxity of lateral and posterior knee ligaments, also traumatic injury

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38
Q

T/F: A varus thrust is typically accompanied by genu recurvatum.

A

true

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39
Q

A flexor synergy can be found in what gait deviation?

A

flexed knee during stance and swing

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40
Q

What can cause excessive knee flexion throughout stance and swing?

A
  • KF contracture, KF spasticity due to UMN lesion

- knee pain/effusion due to arthritis or trauma

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41
Q

What can cause an excessively extended knee throughout stance and swing?

A

KE contracture/spasticity via UMN lesion or through surgical fusion

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42
Q

Impairments at the ankle or hip like a pes calcaneus deformity, PF weakness, or HF contracture can cause what to the knee?

A

excessive flexion during stance

- knee is forced into flexion via excessive DF or HF

43
Q

What can occur at the ankle to cause knee hyperextension during stance?

A

PF contracture, PF spasticity

44
Q

Why would someone have excessive KF in swing?

A

to compensate for lack of DF or HF

45
Q

What motion is occurring at the hip during midstance?

A

moving out of flexion into extension

46
Q

What are some causes of excessive hip flexion?

A
  • hip or ITB contracture/spasticity
  • HS weakness (doesn’t pull hip into extension)
  • hip pain (put it into position of comfort)
  • can coincide with other flexion as flexor synergy
47
Q

Excessive ankle PF can cause what at the hip to compensate?

A

HF

48
Q

Excessive HF can cause what two groups of muscles to fatigue?

A

HE and KE, so they’re unable to get a neutral thigh in stance

49
Q

What gait phases are affected in excessive HF?

A

IC, LR, MS, TS, and MSw

- these are where you want hip extension, basically from beginning to terminal stance

50
Q

How do we compensate for excessive HF in midstance? (4)

A
  • anterior trunk lean
  • anterior pelvic tilt (brings thigh back)
  • lumbar lordosis (see above)
  • flexed knee with increased DF (synergy)
51
Q

How much hip extension occurs at terminal stance?

A

10 degrees at hip

20 degrees at thigh (due to ant tilt and ER of pelvis)

52
Q

The loss of the trailing thigh occurs in what phase for what gait deviation of the hip?

A

loss of trailing thigh occurs in TS due to excessive hip flexion

53
Q

T/F: If patient is unable to extend R thigh, there will be a decreased step length on the ipsilateral side.

A

false, decreased step length on contralateral side

54
Q

A forward trunk lean results in what at the pelvis?

A

lumbar lordosis to keep head and trunk erect

55
Q

In what impairments are you likely to see a forward trunk lean? (3) * think about when you need to bring the body forward*

A

weak quads, HF contracture, PF contracture

56
Q

What phase is most affected by excessive hip flexion?

A

terminal stance

57
Q

What is normal HF ROM during swing? What happens with excessive HF during swing?

A

20-30 degrees

- with excessive HF, this may be more, which can cause an increased anterior tilt

58
Q

If a patient is unable to extend their hip in terminal stance, what can result?

A
  • lumbar lordosis with anterior pelvic tilt
  • loss of trailing thigh
  • increased KF
  • decreased step length on contra side
59
Q

What are the pathological precursors for forward trunk lean?

A

hip osteoarthritis, pain, UMN or LMN

60
Q

During what phases does a forward trunk lean occur?

A

midstance and terminal stance

61
Q

During what phases would you see a backward trunk lean? On what side?

A

during loading and through the rest of stance

- see the lurch when the weakened side heel strikes

62
Q

How does limited hip flexion interfere with stance and swing?

A 
stance = interferes with KF and PF
swing = interferes with thigh momentum, shortens step length, may cause toe drag
63
Q

A trunk posterior lurch can be compensating for what weaknesses?

A

HE weakness or HF weakness

  • HF = lurch toward the unaffected side to bring other one into HF
  • HE = lurch toward the affected side during heel strike
64
Q

What can cause limited HF?

A

HF weakness
hip pain
hams spasticity
compensating for weak HE

65
Q

How do we compensate for limited HF?

A

posterior lurch
posterior tilt of pelvis
hip circumduction (rely on frontal motion vs sagittal)

66
Q

T/F: An anterior tilt brings the thigh forward.

A

false, anterior tilt brings the thigh backwards

67
Q

How does lurching to the unaffected limb help the opposite side go into HF?

A

that affected side is now unweighted, so it can be brought forward with momentum
- also brings trunk to unaffected side, helping with balance

68
Q

Why will the patient exhibit toe drag during swing if they have limited hip flexion?

A

foot won’t clear floor; you lose momentum to drive knee into flexion and DF won’t be enough on it’s own

69
Q

If a patient has difficulty clearing the floor due to limited hip flexion, what motion at the pelvis can help?

A

posterior tilt

70
Q

When does past retract occur at the thigh?

A

during terminal stance the thigh starts to go forward but then starts going backward

71
Q

What can cause past retract?

A 
weak quads (past retract voluntarily to not use quads)
mass extensor pattern
hypertonic hams (drive thigh back)
72
Q

What are the causes of excessive adduction?

A

muscle weakness, spasticity, or voluntary substitution as a HF

73
Q

what is a scissor gait?

A

adduction with genu valgus

74
Q

What is the normal degree amount for pelvic drop?

A

4 degrees

75
Q

What compensation can occur to overcome a pelvic drop?

A

hip hike on the affected side

76
Q

With steppage gait, what position are the feet in?

A

equinas: hitting the floor like a horse

77
Q

How do we compensate for a long swing leg?

A

hip hike, circumduction, increase flexion at joints, vaulting

78
Q

With ankle instability, what position would you put the foot in? How would you clear the floor in this position?

A

ankle instability = put foot in plantarflexion

- clear floor now via hip hike

79
Q

Waddling gait indicates what weakness?

A

hip abductor weakness

80
Q

What can cause waddling or compensated trendelenburg gait? (compensated with lateral trunk lean)

A

guillain barre, poliomyelitis,

81
Q

How does a hemiplegic gait present in the lower extremity?

A

LE = mass extension (HE, KE, PF, IR, ADD, INV)

82
Q

How does a patient with trendelenburg compensate to make their weakness less noticeable?

A

trunk lean to affected side

83
Q

Excessive anteversion causes what excessive motion in the horizontal plane?

A

excessive anteversion = excessive IR

84
Q

What can cause excessive IR?

A

overactive IR, weak ER, CP (scissor gait) , pronation, anteversion

85
Q

What is happening at the hindfoot and forefoot to cause excessive pronation?

A 
hindfoot = everts (valgus)
forefoot = inverts (varus)
86
Q

To fix pronation, what motions would we address at the hip?

A

we want to fix excessive adduction and IR at hip to improve pronation at foot

87
Q

How does excessive PF lead to excessive hip ER?

A

PF causes a nonprogressive tibia, so ER at the hip helps this move forward

88
Q

If you’re stuck in PF tightness and need dorsiflexion, what can you do at the hip to make this happen?

A

ER at the hip helps force DF when you’re in tight PF

89
Q

Tight plantar flexion can be turned into dorsiflexion movement via what movement?

A

ER at the hip

90
Q

A short left limb will cause a pelvic drop on what side?

A

left side (ipsilateral)

91
Q

Right calf muscle weakness can cause a pelvic drop on what side?

A

right side (ipsilateral)

92
Q

An ipsilateral hip adduction contracture can cause a pelvic drop on what side?

A

contralateral

93
Q

A contralateral hip abductor contracture causes a pelvic drop on what side?

A

contralateral (whaaaat)

94
Q

Pelvic girdle weakness can cause pelvic drop on what side?

A

both ipsilateral and/or contralateral

95
Q

How does backward rotation of the pelvis help with PF weakness?

A

PF weakness = no pushoff, decreased step length

- ER of pelvis lengthens limb and maintains adequate step length, improves trailing limb extension

96
Q

Ipsilateral pelvic IR does what to the ipsilateral limb when in swing?

A

ipsilateral pelvic IR causes that same limb to drive more forward

97
Q

When does increased lumbar lordosis occur with excessive HF?

A

in terminal stance (to keep body erect)

98
Q

T/F: Trunk follows cane during gait when cane is on impaired side.

A

true

99
Q

What’s the difference in width between a wide base and a narrow base?

A 
wide = 4+ inches
narrow = 2- inches
100
Q

T/F: Genu varum causes a wider base.

A

false, feet are actually closer together so cause a narrower base

101
Q

What three things can cause a narrow base?

A

genu varus
genu valgus
spasticity

102
Q

What do patients with PD do to increase their stability during gait?

A

they crouch and lower CoM to the ground, as well as widen their stance, thus increasing their base of support

103
Q

What is festination?

A

short, shuffly steps that patients with PD often display

104
Q

What does an AFO do?

A

helps prevent foot drop
- increases step length
-

Analysis of Movement (14 decks)

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