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Royal College 2023 > Gait > Flashcards

Gait Flashcards

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1
Q

Dual decline in gait and cognition (JAMA 2022) has what impact on cognition?

A

Dual decline in gait and cognition = higher risk of dementia than those with either alone

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2
Q

What is motoric cognitive risk syndrome?

A

A pre dementia syndrome
1. Slow gait speed
2. Subjective memory complaints
With or without cognitive or functional impairment

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3
Q

What can MCR predict?

A
  1. Cognitive decline
  2. Falls
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4
Q

What are the 4 criteria for MCR?

A
  1. Subjective cognitive complaints
  2. Presence of slow gait (1+ SD)
  3. Preserved mobility
  4. Absence of dementia
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5
Q

What is a cut off for normal gait speed?

A

<0.8 m/s over a 4 m track

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6
Q

Those with MCR are at increased risk for…

A
  1. AD and VD
  2. Frailty, falls, disability, mortality
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7
Q

Normal gait: step length, cadence, width, pattern

A

Length = 0.8 m
Cadence = 2 steps/sec
Width = 1-3 inches
Pattern = normal

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8
Q

Normal changes to gait with aging

A
  1. Dec arm swing
  2. Wide based
  3. Inc stride width variability
  4. Inc double stance time
  5. Decrease gait speed
  6. Dec balance on one foot
  7. Dec processing speed
  8. Dec muscle and joint motion proprioception
  9. Decrease tactile sensitivity in feet
  10. Decrease muscular force
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9
Q

Gait findings in vascular cognitive impairment

A
  1. Dec speed
  2. Dec step length
  3. Inc step asymmetry and variability
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10
Q

What is gait apraxia and what are the clinical features?

A

Inability to properly use lower limbs to walk, lack of sensory impairment or motor weakness

Features:
1. Reduced velocity
2. Short, hesitant steps
3. Wide base
4. Poor balance
5. Start hesitation
6. Freezing
7. Absence of rescue responses

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11
Q

Causes of gait apraxia

A
  1. NDD = AD, vascular, FTD
  2. Multi infarct strokes
  3. Subcortical VaD
  4. NPH
  5. LBD
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12
Q

What are the components of a mobility assessment?

A
  1. Non ambulatory - bed, transfer
  2. Ambulatory - 4 m gait speed, TUG, 6 min walk
  3. Vigorous/balance - sit balance, stand balance (Romberg, tandem stance, balance one leg, retropulsion), dynamic balance (chair/transfer, turning, tandem gait)

Specific tests: SPPB, BBS, POMA, functional reach, dual task gait

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13
Q

What is dual task gait?

A

Walking while performing 3 tasks:
1. Count backwards by ones
2. Count backwards by 7s
3. Naming animals

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14
Q

What are 3 adverse outcomes for low gait speed?

A
  1. Cognitive impairment
  2. Falls
  3. Functional impairment
  4. Institutionalization
  5. Hospitalization
  6. Mortality
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15
Q

What are the 4 components of TUG?

A
  1. Get up from chair with armrest
  2. Walk to line 3 m with best gait aid
  3. Turn around
  4. Walk to chair and sit down again
    Can try 1 time before measurement
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16
Q

5 limitations to the TUG test

A
  1. TUG score not a significant predictor of falls
  2. Variability - variable footwear and surface, differ when they use arms vs. not, doesn’t account for use of gait aid
  3. Static data
  4. Conflicting cut off
  5. Doesn’t assess cause of impairment
17
Q

5 performance measures to help assess balance

A
  1. POMA
  2. SPPB
  3. Berg Balance Scale
  4. Functional Reach Test
  5. TUG
18
Q

What is included in the POMA?

A

Assess gait and balance

Balance
- Sitting balance
- Rise from chair
- Attempts to rise
- Immediate standing balance 5 sec
- Standing balance
- Nudged
- Eyes closed
- 360 degree turn
- Sitting Down

Walking
- Initiation
- Step length and height
- Foot clearance
- Step symmetry
- Step continuity
- Path
- Trunk
- Walking stance

19
Q

What are three ways in which using a cane improves walking?

A
  • Improve stability when balance disorder is secondary to neurodeficit or moderate leg weakness; by:
  • Redistributing weight from a lower leg / joint that it weak or painful
  • Increasing the base of support
  • Providing tactile/proprioceptive information about the ground by transmitting stimuli from the arm and hand for patients with visual or neuropathic deficits
  • Increases self-confidence (reduces fear of falling)

Royal College 2023 (79 decks)

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