gait Flashcards
in swing phase you have; pre swing
the position limb for swing
the initial swing swing is when?
foot clearance of the floor
limb advancement from trailing position
what is when the limb advance and foot clears the floor
mid swing
a complete limb advancement and preparation for stance
terminal stance
in the stance phase what is the inital contact?
position of the limb start to stance
when in stance phase what is shock absorption, weight-bearing stability, and forward progression
loading phase
what is the progression of COG over BOS and limb and trunk stability?
mid stance
what is terminal stance in when there is progression of COG beyond BOS and supporting foot
terminal stance
gait is typically impaired following CVA why?
weakness, sensory loss, impaired balance, and loss of confidence
*Important to observe ankles, knees, hips, trunk, UE from all planes of movement
*Time, distance, cadence, velocity should all be measured and recorded
Gait speed is used in predicting a patient’s ability to ambulate in different environments
what are common gait deviation post-stroke; abnormal gait?
-Slow speed
-Asymmetrical, uneven step and stride lengths
-Reduced stance time on affected limb
-Decreased push-off force on affected limb
-Use of synergy patterns to advance limb
-Impaired balance with UE and LE posturing
-Reliance on adaptive equipment
-Spasticity requiring compensatory advancement
what are some classifications of walking handicaps after a stroke?
-Physiological walker
Walks for exercise only either at home or in therapy
-Limited household walker
Relies on walking for home activities
Requires assist for other walking activities
-Community walker
Unlimited distance outside
look to Power point for chart
what abnormal gait:
paresis is a primary contributor to disordered gait?
-Affects the number, type and frequency of motor neurons essential for force production for gait
-Primary impairment after corticospinal pathology
why does the Muscles act concentrically to generate movement and force and eccentrically to control the motion?
Ability to propel the body forward and control the body going forward
what are two ways spasticity can impact gait?
-Inappropriate activation of a muscle at points during the gait cycle when it’s rapidly being stretched
Produces increased stiffness and the freedom of the muscle to move rapidly
Inability to selectively recruit muscles is a contributing factor to abnormal gait why
-Associated with abnormal coupling of muscles resulting in abnormal synergies which manifest as either total extension or total flexion
-Synergistic patterns are associated with reduced stability and poor locomotion
Overactivity of muscles unrelated to?
spasticity can affect progression in gait and postural control
HS overactivity is common
Inability to time and scale muscle activity during gait can
can give way to ataxic gait which
is
Staggering, veering, irregular stepping, and high steppage
or
Delay in movement of the knee and ankle through the gait cycle
Coactivation of antagonist muscles during gait is common post CVA and is
Is seen in both paretic and non paretic limb
Impaired reactive balance strategies contributes to
instability in gait and stance (see previous lecture)
*Impaired proactive balance strategies are impaired
Decreased ability to modify gait characteristics in response to terrain and slope changes are
-Slower gait speed and increased variability in gait
When walking downhill, people with stroke shorten their step length which causes reduced walking speed
Not able to increase step length when walking up hill
what are some abnormal sensory input can result in ataxia
Can be due to peripheral or central proprioceptive pathways
Person has no awareness of where their leg(s) are in space
Reduced modulation of reflex activity throughout the gait cycle
Vision is critical to balance strategies during gait how does it leads to abnormal gait
Individuals with vision impairment tend to walk slower and use more auditory cues
Hemianopsia can have an impact on the person’s ability to perceive potential threats to stability
Loss of vestibular input in adulthood can produce gait ataxia and difficulty stabilizing the head in space due to?
Longer double stance support
Can cause impaired vision and oscillopsia
what can body image deficits cause?
Ipsilateral trunk lean towards the stance leg
Inappropriate foot placement and difficulty in controlling the COM relative to the changing BOS of the feet
Unilateral spatial neglect tend to veer to the opposite side or bump into objects on the affected side
Pain can alter the movement pattern used for gait
Antalgic gait is a gait pattern that results from pain in the back or Les, compensatory strategies include
Reduce WB time on painful limb (shortened stance of gait)
Avoid impact loads
Reduce joint excursions (limiting knee flexion during stance)
Side bending over a painful hip to bring the COM closer to the joints center of rotation which reduces the need for hip abductor activity
what happens with plantarflexors
Studies show reduced activation of the PF is associated with strong hyperextension at the knee in stance and lack of knee flexion for swing
Reduced energy during preswing of gait has been largely associated with reduced use of PFs
PF recruitment in the paretic limb has been shown to be significantly reduced compared to non-paretic limb or controls
Compensation for the reduction in PF recruitment gives increased knee and hip moments of the paretic limb
PF paresis is one of the many contributing factors contributing to knee hyperextension
Spasticity in the plantar flexors is also a common problem following CVA and neurologic injury.
Plantarflexion and abnormal gait
Spasticity primarily occurs in the early party of stance phase of walking secondary to stretching of the gastroc
Shortening of the muscle before the body is ahead of the foot causes knee hyperextension
Also causes inability for the gastroc to generate enough force for push-off
Spasticity is associated with reduced gait speed however the effects are of spasticity are increased with faster speeds
Spasticity will impact foot position
Limit DF and prevent heel strike at IC
-If IC is made with a flat foot = knee hyperextension
-Reduced forward foot clearance = toe drag
Excessive gastroc and posterior tibilalis activation produce inversion and equinovarus foot position?
Plantarflexors
how does the quads affect abnormal Gait?
-Weak quads = difficulty controlling knee flexion during loading and midstance
-Compensation is hyperextension of the knee during midstance or forward trunk lean to bring GRF anterior to the knee
-If hyperextension continues into preswing, it prevents the knee from moving freely during swing phase = slow progression and toe drag
-Spasticity can also give excessive knee extension
-During IC, there is a brief knee flexion to absorb shock and can trigger spasticity that can cause hyperextension of the knee
-Spasticity can lead to stiff knee gait
15.8 The effect of plantarflexor spasticity in gait.
(A) When initial contact is made with a flat foot, the ground reaction force (GRF) vector is anterior to the knee, producing knee extension.
(B) Spastic plantarflexors affect forward foot clearance during swing; the subsequent consequence is toe drag.
A combination of excessive activity of the TS and posterior tibialis muscle produces
inversion and an equinovarus foot position,
Hip flexors and abnormal gait?
-Weakness primarily affects swing phase
-Assist in progression to produce a hip flexor moment at the initiation of swing
-Knee flexion for swing is lost if there is inadequate hip flexion = toe clearance is reduced of lost and can result in a shortened step
-Compensatory strategies used to achieve foot clearance without adequate hip flexion
*Posterior tilt of the pelvis and activation if the abdominals
*Circumduction (hip hike)
*Contralateral vaulting
*Leaning the trunk laterally
Hip extensors can cause
-Critical to control head, arms, and trunk
-Weakness can result in forward trunk lean so to compensate, patient leans backwards to bring the COM behind the hips
-TA are active to prevent falling backwards
how does Hip abductors vs abnormal gait?
-Weakness can result in contralateral pelvic drop (Trendelenburg)
-Common compensation is a lateral shift of the COM over the stance leg with lateral lean of trunk towards stance leg
-Weakness results in instability in the frontal plane
how does hamstring affect gait?
-Spasticity produces excessive knee flexion which can lead to a crouched-gait pattern
-In terminal swing, excessive activation of hamstrings prevents the knee from fully extending
-Excessive knee flexion from spasticity can increase the demand on the quads to prevent collapse
how does hip adductors affect gait
-Spasticity produces a contralateral drop of the pelvis during stance
-Can also result in scissoring gait which can also reduce the BOS and stability
TUG
*Pt seated in a standard chair with armrests is instructed to stand and walk toward a line 3 meters (10 feet) away, turn and walk back and return to seated position.
*Start on “Go”
*Start with back against chair.
*May use Assistive Device (AD), but no physical assist.
Cutoff Scores:
<10-12 Sec normal healthy adult
12-20 sec average frail elderly adult.
>14 Sec Fall Risk for Stroke population
10 meter walk test
*A clear pathway of at least 10 m (32.8 ft) in length in a designated area
over solid flooring is required.
- Measure and mark the start and end point of a 10-m walkway.
- Add a mark at 2 m and 8 m (identifying the central 6 m which will be timed).
-Total time to ambulate is recorded in m/s
DGI
*Examines a patient’s ability to perform steady state walking and variations on command.
8 items/conditions
4 -point scale (0-3)
3: no gait dysfunction
0: severe impairment.
*Possible score 24
*Strong fall-risk predictor, a score below 19 is indicative of fall Risk.
8 conditions
Gait on level surface, change in gait speed, gait with vertical head turns, gait with horizontal head turns, gait pivot and turn, stairs, step over obstacle, step around obstacle
FGA
*Used to assess postural stability during walking and assesses an individual’s ability to perform multiple motor tasks while walking.
*10items/conditions
*4 -point scale (0-3)
-3: no gait dysfunction
-2: Mild impairment
-1: Moderate impairment
-0: severe impairment.
*Possible score 30
*Strong fall-risk predictor, a score below 22 is indicative of fall Risk.
*10 conditions
—Gait on level surface, change in gait speed, gait with vertical head turns, gait with horizontal head turns, gait pivot and turns, gait with eyes closed, backwards walking, step over obstacles, gait with narrow BOS
6 MWT
*assesses distance walked over 6 minutes as a sub-maximal test of aerobic capacity/endurance.
*May stand to rest but cannot sit down.
*Test only if appropriate level of activity tolerance
