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Morgan E&M > First Abnormal Gait Lecture > Flashcards

First Abnormal Gait Lecture Flashcards

1
Q

Why do we perform gait analysis?

A
  • To compare to normal
  • Hypotheses for underlying mechanisms for observed dysfunction (i.e.- WHY is the hip dropping? WHY is he circumducting?)
  • Classification of disability severity
  • Prediction of future status
  • Det: need for AD (adaptive/orthotic/prosthetic vs assistive/protective/supportive), effectiveness/fit of the AD)
  • Assess effectiveness of intervention
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2
Q

Advantages of observational gait analysis

A
  • Easy to perform in any clinical environment
  • Time efficient
  • Low cost
  • Initial impression can be gleaned
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3
Q

Disadvantages of observational gait analysis

A
  • Tendency to focus eye on gross deviations, not subtle ones
  • Depends on experience and individual bias
  • Unknown reliability and validity, integrated assessments are qualitative
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4
Q

Which leg do you observe first?

A

Right

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5
Q

When referring to pelvis/trunk, refer to _____ leg

A

Stance

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6
Q

Reliability of OGA?

A

-Low to moderate

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7
Q

How to improve reliability of OGA

A
  • Video tape clients (you can pause or slow down the tape, don’t have to fatigue them by making them repetitively walk)
  • Training
  • Experience
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8
Q

Scales we use to quantify OGA

A

Physicians Rating Scale
Edinburgh Visual Gait Analysis
Gait Assessment Rating Score (GARS)
Dynamic Gait Index (DGI)

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9
Q

Physicians Rating Scale:

  • Normal Gait Rating
  • Categories Observed
A

Normal Gait: 0

  • Crouch
  • Knee recurvatum
  • Foot contact
  • Hindfoot position (at contact/during stance)
  • Speed of gait (slow/variable)
  • Change (3–don’t know what that means)
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10
Q

Edinburgh Visual Gait Analysis:

  • Number of levels/what is normal
  • Number of variables, and what categories
A

-3-5 levels (0 normal, 1 is mild, 2 is mod deviation, etc)
-17 variables– 6 foot, 4 knee, 3 hip, 2 trunk, 2 pelvis)
I.e.- knee in stance:
2 is 30 degrees flexion, 1 is 15-30 degrees, 0 is 0-15 degrees. 1 is 10 degrees recurvatum, 2 is more than 10 degrees recurvatum

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11
Q

Gait Assessment Rating Score

A

Greater than 18 on long form and greater than 8 on short form (for client’s risk of falls)

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12
Q

DGI

A

Adds walking with head turns, walking and turning 180 degrees, stepping over/around obstacles, stairs
-4 levels: Normal to impairment (0-3, 3 is normal)

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13
Q

Dual tasking challenge examples

A

standardized walking and talking tasks (med predictive value and decent specificity if person keeps walking)

  • Standardized tests = serial subtraction, recite alphabet, recite items in a category
  • walking and remembering test (forward digit span)
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14
Q

Functional Mobility Scale

A 
5 m, 50 m, 500 m
1- WC
2- Indep walker
3- Two crutches
4- One crutch
5- Indep. On level surfaces
6- Indep. On all surfaces/stairs
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15
Q

Functional Ambulation Categories (FAC)

A

Physically Dependent:
0 = nonfunctional (req help of 2 people)
1= dependent, level 2 (needs help with carrying weight and balance)
2= dependent, level 1 (needs help with one person for balance/coordination)

Physically Independent:
3= dependent on supervision (verbal or standby)
4 = indep on level ground
5 = independent on any surface

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16
Q

What is the average onset of independent walking?

A

11-15 months old

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17
Q

When does consistent heelstrike arise with absent push off?

A

24 months old

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18
Q

When does reciprocal arm swing develop?

A

30-36 months

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19
Q

What decreases after 4-5 months of independent walking? Be specific.

A

BoS decreases. First abduction, then ER (last component to decrease)

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20
Q

When does temporal phasing begin? What is it?

A

(Swing to stance phase)

Occurs 3-6 months after the onset of walking

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21
Q

When do we have a mature walking pattern?

A

5 to 6 years of age

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22
Q

Which gait changes are noted in the elderly?

A

Mild stiffness (greater proximally i.e. Less rotation at pelvis and trunk)
Decreased arm swing
Decreased speed
Increased Cadence
Decreased step length (decreased swing excursion and increased stance/double support)
Increased stride width (hip and, greater toeing out)
Increased toe-floor clearance
Decreased heel strike

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23
Q

Comfortable Gait Speed in 40s for men and women

A

Men: 146 cm/sec
Women: 139 cm/sec

24
Q

Comfortable gait speed for 70 year olds

A

Men: 133 cm/sec
Women: 137 cm/sec

25
Q

Max gait speed for those in their 40s

A

Men: 246 cm/sec
Women: 212 cm/sec

26
Q

Max gait speed for those in their 70s

A

Men: 207 cm/sec
Women: 175 cm/sec

27
Q

Gait speed is associated with….

A

Muscle strength, especially hip abduction and knee extension

28
Q

MCID of gait speed in patients with hip fracture?

A

0.1 m/s

29
Q

5 pathological mechanisms of gait?

A 
Deformity
Muscle Weakness
Sensory Loss
Pain
Impaired Motor Control
30
Q

Forms of deformity for pathological mechanisms of gait

A

-Contracture (ankle pf, knee flexion, knee extension, hip flexion)

31
Q

What is the definition of a contracture?

A

Structural change within fibrous connective tissues of muscle, ligaments, or joint capsule, following inactivity or scarring

32
Q

What are common contracture types? Two most common?

A

Ankle PF and Hip Flex are most common

Others are knee flexion and knee extension

33
Q

What is the deficit of an ankle-plantarflexion contracture?

A

Obstructs progression of leg during stance

Inhibits foot clearance

34
Q

What is the deficit of a knee flexion contracture?

A

Inhibits advancement of thigh

35
Q

What is the deficit of a knee extension contracture?

A

Increases energy expenditure due to compensations to clear floor

36
Q

What is the deficit of hip flexion contracture?

A

Increases strain on back and hip extensors

37
Q

What goes into the muscle weakness category of pathological mechanisms?

A
  • Disuse
  • Neurological Impairment
  • Strength (when you test 5/5, PF is 18 percent of what you need, knee is 53 percent, and hip is 18 percent)
  • Gait deviations (decreased speed and substitutions)
38
Q

What impairments fall under the pathological mechanism category of sensory loss?

A
  • Proprioceptive impairments
  • Light touch, deep pressure
  • Gait deviations
39
Q

What type of gait deviations result from sensory loss?

A

Decreased speed
Substitute by locking knee
Hitting the floor loudly (poor proprioception)
Visual monitoring of legs/feet

40
Q

Consequences of pain in gait

A
  • Attempt to reduce compressive and shear forces
  • Excessive tissue tension– deformity and weakness
  • Deformity: moves into positions of comfort of intra-articular pressure (like how the knee is more comfortable in flexion but you can get a contracture)
  • Weakness– secondary to joint selling (causes disuse atrophy)
41
Q

What are positions of comfort and intra articular pressure for ankle, knee, and hip?

A 
Ankle = 15 degrees PF
Knee = 30-45 degrees flexion
Hip = 30 degrees flexion
42
Q

What are consequences of impaired motor control in gait?

A
  • Spasticity
  • Decreased selective control
  • Primitive locomotor patterns
  • Impaired phasing
43
Q

Spasticity of lower extremity… what happens

A

Obstruction of yielding quality of eccentric muscle activity during stance

44
Q

Spasticity of soleus/gastrocnemius results in?

A

Persistent ankle plantarflexion = loss of ankle rocker

45
Q

Spasticity of hamstrings results in

A

Effective terminal swing, resists thigh advancement in stance

46
Q

Spasticity in hip flexor results in

A

Restricted progression in mid and terminal stance

47
Q

Spasticity of quadriceps inhibits…

A

Pre-swing prep for limb advancement

48
Q

What impact does impaired phasing have on the gait cycle?

A

It’s due to control errors and spasticity

  • Muscle actions prolonged, curtailed, premature, delayed, continuous, and/or absent
  • Results in SUBSTITUTIONS in specific phases.
49
Q

Arm swing is related to

A

Speed– faster gait is related to more aggressive arm swing. During slow walking, no arm swing should be seen.

50
Q

Why does hip circumduction occur? What phase does it occur in?

A
  • Occurs in swing phase

- Occurs because of weak hip, knee, and/or ankle flexor

51
Q

What is hip hiking a substitution for?

A

Lack of knee flexion or ankle dorsiflexion. Comp for extensor spasticity of swing leg. Makes sense for leg length discrepancy

52
Q

Excessive hip flexion in swing phase results in

A

Foot drop or flexor synergy

53
Q

What is involved in a flexor synergy?

A

Hip: Flexion, abduction, external rotation
Knee: flexion
Ankle: Dorsiflexion

Upper extremity: scap retraction, shoulder abduction/ER, elbow flexion, forearm supination, finger and wrist flexion.

54
Q

What is involved in an extension synergy?

A

Hip: extension, adduction, internal rotation
Knee: extension
Ankle: Plantarflexion and inversion
Toe: flexion

Upper extremity: scap protraction, shoulder adduction/IR, elbow extension, forearm pronation, wrist/finger flexion

55
Q

Backwards trunk lean/APT in stance is caused by

A

Weak glut max on stance leg

56
Q

Forward trunk lean is a compensation for….

A

Quad weakness or hip/knee flexion contracture

Morgan E&M (8 decks)

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