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E&M > Gait > Flashcards

Gait Flashcards

1
Q

Why Gait Analysis

A

Comparison to normal

Develop hypotheses as to underlying mechanisms causing observed dysfunction

Classification of severity of disability

Prediction of future status (gait speed prosthetic non-se)

Determine need for devices/equipment (adaptive/orthotic/prosthetic, assistive/protective/supportive) and effectiveness/fit of selected devices/equipment

Assess effectiveness of intervention

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2
Q

Observational Gait Analysis

A

Advantages - easy to perform in any clinical environment, time efficient, low cost, initial impression can be gleaned

Disadvantages - tendency to focus on eye gross deviations while overlooking subtle ones, depends on experience and individual bias, reliability and validity and interrater assessments, qualitative

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3
Q

Systematic Gait Analysis

A

Anatomical sequence of observation to sort multiple events at different jts (start at foot and move up, right before left)

Phasing of gait (swing vs. stance)

Stay focused and organized - don’t jump ahead

When referring to pelvis/trunk (reference to stance leg)

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4
Q

Reliability of OGA

A

Low to moderate reliability

To improve reliability - videotape clients (can slow down or pause tape, avoid client fatigue by repetitive walking)

Training

Experience

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5
Q

Developmental Acquisition

A

11-15 months - avg onset of independent walking

24 months - consistent heel strike, push off absent

30-36 months - reciprocal arm swing

BOS decreases after 4-5 months of independent walking (abd decreases first, ER last component to decrease)

Temporal phasing (swing to stance) - 50/50

Mature walking pattern by 4-5 years of age

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6
Q

Gait Changes Noted in Elderly

A

Mild stiffness, greater proximally (decreased rotation at pelvis and trunk)

Decreased arm swing (increased shoulder ext and elbow flex) - guard position

Decreased speed (decreased jt velocity)

Increased cadence - more steps

Decreased step length (decreased swing excursion, increased stance phase and double support time)

Stride width is increased (hip abd increased, greater toeing out) - increased BOS to keep balance

Increased toe-floor clearance (sl. stoppage)

Decreased heel strike (less DF thru/out)

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7
Q

5 Pathological Mechanisms

A

Deformity (includes decreased ROM)

Muscle weakness

Sensory loss

Pain - antalegic gait

Impaired motor control

All of these can happen in combinations

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8
Q

Pathological Mechanisms: Deformity - Contracture

A

Structural change w/in fibrous connective tissues of muscle, ligaments, or joint capsule following inactivity or scarring (inactivity or limited mobility)

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9
Q

Ankle-PF Contracture

A

Most common

Obstructs progression of leg during stance, inhibits foot clearance

Toe touch walking

Hyperext of knee

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10
Q

Knee Flex Contracture

A

Inhibits advancement of thigh

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11
Q

Knee Ext Contracture

A

Increases energy expenditure due to compensations to clear floor

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12
Q

Hip Flexion Contracture

A

Most common

Increases strain on back and hip extensors

Anterior pelvic tilt, lumbar lordosis is accentuated

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13
Q

Pathological Mechanisms: Muscle Weakness

A

Disuse

Neurological impairment

Strength-when patient tests 5/5

Gait deviations

  • Decreased speed
  • Substitutions
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14
Q

Pathological Mechanisms: Sensory Loss

A

Proprioceptive impairments

Light touch and deep pressure

Gait deviations

  • Decreased speed
  • Substitute by locking knee
  • Hitting the floor loudly
  • Visual monitoring of legs/feet
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15
Q

Pathological Mechanisms: Pain

A

Attempt to reduce compressive & shear forces

Excessive tissue tension leads to deformity and weakness

Deformity-moves into position of comfort of intra-articular pressure

  • Ankle 15° plantarflexion
  • Knee 30-45° flexion
  • Hip 30° flexion

Weakness-secondary to joint swelling which causes disuse atrophy

Pain shuts off any muscle

Pain – results in muscle loss and deformity/decreased ROM

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16
Q

Pathological Mechanisms: Impaired Motor Control - Spasticity

A

Obstructs yielding quality of eccentric muscle activity during stance

Soleus/gastroc cause persistent ankle plantarflexion-loss of ankle rocker

Hamstrings limits effective terminal swing and restricts thigh advancement in stance

Hip flexors restrict progression in mid and terminal stance

Quadriceps inhibits pre-swing prep for limb advancement

Spasticity brings leg back

Jt going fast - spasticity wants to slow it

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17
Q

Pathological Mechanisms: Impaired Motor Control - Decreased Selective Control

A

Timing

Intensity

Muscles active at the wrong time

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18
Q

Pathological Mechanisms: Impaired Motor Control - Primitive Locomotor Patterns

A

Massed extension

Massed flexion

Keep in synergy

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19
Q

Pathological Mechanisms: Impaired Motor Control - Impaired Phasing

A

Due to control errors and spasticity

Action of muscles are prolonged, curtailed, premature, delayed, continuous, and/or absent

Results in substitutions

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20
Q

Gait Speed

A

If energy requirements are increased, speed is adjusted - too slow or too fast

Realize that

  • Arm swing is related to velocity (normally, no arm swing during slow walking)
  • UEs assist w/ balance
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21
Q

Propulsive Gait

A

CO2 poisoning, drug side effects

Stooped rigid posture w/ head and trunk flexed forward

Parkinson’s gait - short rapid steps (festinating), rigidity w/ no arm swing, difficulty w/ starting, stopping, turning

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22
Q

Steppage Gait

A

Exaggerated hip and knee flex w/ foot drop or foot slap

Ankle DF weakness (peroneal nerve damage, polyneuropathy, polio, MS, herniated disc L5, GBS)

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23
Q

Waddling Gait

A

Toes pointed out, wide BOS

Duck-like walk that may appear in childhood or later in life

Congenital hip dysplasia, muscular dystrophy, spinal muscular atrophy

Through whole gait cycle

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24
Q

Ataxic Gait

A

Cerebellar disorders, severe sensory deficits of LEs

Wide BOS, uncoordinated mvts, lurching/staggering, increased trunk mvts and variable foot placement

Wide base and negative base periods

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25
Q

Spastic or Scissoring Gait

A

CVA, TBI, SC trauma, meningomyelitis, MS, CP

Secondary to hypertonicity of LEs (higher energy requirements, unsteady)

Over-activity of hip adductors w/ narrow, crossing BOS

Negative space 
Negative BOS
Leg has to go in front and over 
Can get friction burns between knees 
Adduction and IR with extension synergy 
Over-activity of hip adductors – weakness in glut med
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26
Q

Hemiplegic Gait

A

UE (shoulder adduction and flexionelbow, wrist, and finger flexion)

LE (extensor synergy: hip extension, add., IR; knee extension; ankle plantarflexion with inversion (equinovarus); flexor synergy: hip flexion, abd., ER; knee flexion; ankle dorsiflexion)

Slow velocity, dec. stance time on involved limb and step length on uninvolved side

Difficulty with limb stability (knee collapse or knee hyperextension)

Difficulty with limb clearance (decreased flexion, toe drag)-substitute with hip hiking/circumduction

Difficulty with limb advancement (decreased knee extension, pelvic retraction)

Swing phase - leg comes up and out

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27
Q

Glut Max Gait (Lurching)

A

Backward lurch of trunk just after initial contact

Hyperextension of hip with forward ‘protrusion’

Vector behind hips and pushes them forward – glut max

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28
Q

Gluteus Medius/Trendelenberg Gait

A

Uncompensated - contralateral pelvic drop at initial contact of affected side

Compensated - lateral trunk flex/lean, steppage gait

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29
Q

Antalgic Gait - Hip

A

Avoidance of WB on affected side

Stance - decreased stance phase, trunk lurch toward painful hip, heel strike avoided to prevent jarring and excess loading

Swing - flexed, ER, abd (relaxed jt capsule)

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30
Q

Antalgic Gait - Knee

A

Maintained in slight flexion throughout

Avoidance of heel strike

Toe walking on affected side

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31
Q

Antalgic Gait - Foot and Ankle

A

Stride length shortened

Normal heel-to-toe lost

  • Forefoot avoid toe off
  • Ankle or hindfoot avoid heel strike
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32
Q

Gait Deviation: Swing - Excessive Hip Flexion

A

Foot drop

Flexor synergy (control problem)

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33
Q

Gait Deviation: Swing - Limited Hip Flexion

A

Decreased step length

Decreases knee flexion

Weak hip flexors (grade 2+ is sufficient)

Extensor spasticity

Pain

34
Q

Gait Deviations: Swing - Circumduction

A

BOS is normal

Weak hip, knee, and/or ankle flexors

Only occurs during swing

35
Q

Gait Deviations: Swing - Hip Hiking (Pelvic Mvt)

A

Lack of knee flexion and/or ankle DF

Compensation for extensor spasticity of swing leg

Leg length discrepancy

36
Q

Gait Deviations: Swing - Limited Knee Flexion

A

Pain (avoid shearing and compressive forces)

Decreased range

Weak knee flexor/lack of pressing flexion

Extensor spasticity

Proprioceptive deficit

37
Q

Gait Deviations: Swing - Lacks Knee Ext in Terminal Swing

A

Flexor synergy

Weak quads

Knee flex contracture

Decreased gait velocity

Proprioceptive deficits

38
Q

Gait Deviations: Swing - Excessive Knee Flexion

A

Flexor synergy

39
Q

Gait Deviations: Swing - Limited Ankle DF

A

Weak DF - result in decreased ROM

Decreased range

Spasticity

Proprioceptive deficits

40
Q

Gait Deviations: Swing - Toe Drag

A

Weakness of DF and toe extensors

Spasticity of PFs

Inadequate hip/knee flex

Stay in PF position

41
Q

Gait Deviations: Initial Contact - Limited Hip Flex

A

Weak hip flexors or glut max

Decreased range

42
Q

Gait Deviations: Initial Contact - Excessive Hip Flex

A

Hip and/or knee flexion contracture

Spasticity in hip flexors

Weakness in soleus/gastroc (allows tibia to travel forward - see inc. hip and knee flex)

43
Q

Gait Deviations: Initial Contact - Excessive Knee Flex

A

Knee flex contracture (mvt is same through gait cycle)

Hamstring spasticity (muscle turns on and off, changes through gait sped)

Weakness in quads (collapse)

Impaired proprioception

Leg length discrepancy (to shorten contralateral longer leg)

Pain

44
Q

Gait Deviations: Initial Contact - Excessive Ankle PF

A

Dependent on severity - foot slap, low heel strike, flat foot contact, forefoot contact

Weak DFs

Extensor spasticity

PF contracture

Leg length (to lengthen short ipsilateral leg)

Painful heel (toes first)

Fixed DF (fixed ankle orthosis)

Glut med/max problems - usually ankle PF

Little weakness in tib ant - less heel strike
Flat foot - don’t use tib ant

Toe-heel gait - don’t DF - touch w/ toe, then heel, hyperext at knee

45
Q

Gait Deviations: Loading - Excessive Hip Flex w/ APT

A

May lean trunk backwards to compensate

Weak hip extensors

46
Q

Gait Deviations: Loading - Knee Hyperextension

A

Weak quads

Impaired proprioception

Spastic quads/PFs

Compensation for PF contracture

47
Q

Gait Deviations: Loading - Excessive Knee Flexion

A

Knee flex contracture

Spastic hamstrings

Impaired proprioception

48
Q

Gait Deviations: Stance - Lateral Trunk Lean

A

Lateral trunk lean toward stance leg, contralateral pelvic drop

May look like hip hike in stance (hip hike only occurs in swing)

Painful hip

Weak glut med of stance

49
Q

Gait Deviations: Stance - Backward Trunk Lean, APT

A

Weak glut max on stance leg

50
Q

Gait Deviations: Stance - Forward Trunk Lean

A

Compensation for quad weakness

Hip and/or knee flex contracture

51
Q

Gait Deviations: Stance - Limited Hip Extension

A

Hip flexion contracture/arthrodesis

Spasticity in hip flexors

52
Q

Gait Deviations: Stance - Hip Abduction

A

Contracture of glut med

53
Q

Gait Deviations: Stance - Hip Adduction

A

Spasticity in hip adductors (also in flexors)

54
Q

Gait Deviations: Stance - Excessive Knee Flex

A

Knee flex contracture

Flexor synergy

Flexor withdrawal reflex

Weak PFs

55
Q

Gait Deviations: Stance - Excessive DF, no heel off

A

Weak PFs (eccentric)

Hip and/or knee flex contractures

56
Q

Gait Deviations: Push-Off - Limited Knee Flex

A

Spasticity in quads and/or PFs

57
Q

Gait Deviations: Push-Off - Early Heel Rise

A

Spasticity of PFs

Decreased DF range

58
Q

Gait Deviations: Push-Off - Lack of Roll Off

A

PF weakness

Forefoot pain

Limited forefoot motion

59
Q

Excessive PF

A

Limb is longer - toe drags/catches

Stance - loss of progression - shortened stride length and reduced gait velocity

Swing - obstructs limb advancement - substitutions as result of increased limb length and body effort, shortened step length

Initial contact - low heel contact (decreased rocker), forefoot > 20 places forefoot lower than heel

Loading - decreased heel rocker, decreased knee flex (hyperext knee)

Midstance - inhibits tibial advances - compensations: premature heel-off (faster gait speed), knee hyperext, forward trunk lean (slower gait speeds)

Midswing - toe drag - compensations: increased hip flex w/ knee flex, circumlocution, lateral trunk lean (hip hike), contralateral vaulting

60
Q

Excessive DF

A

Slower walking speed, excessive knee flex, crouched position

Stance - shortened step length, increased quad demand

Loading (throws body forward - need to have good quads) - increased flex moment, contact w/ foot flat and eliminating normal PF

Midstance - instability at onset of single limb support, increased quad demand

Preswing - prolonged heel contact

61
Q

Soleus Weakness

A

Cause excessive DF

Soleus holds tibia back during gait - stabilizes tibia to have controlled loading

Weak soleus - tibia goes forward way too fast

62
Q

Excessive Inversion (Varus)

A

Lateral forefoot loading

Premature heel-off in mid stance

Causes - overactivity of soleus, PF contracture, tib ant/toe extensor, flexor hallicus/flexor digitorum activity (toe clawing), weakness of perennials (muscle imbalance)

63
Q

Excessive Eversion (Valgus)

A

Shortened heel on at IC

Excessive DF secondary to unlocking of mid tarsal jts

Center of pressure moved medially in terminal stance and preswing

Causes - weakness in invertors

Pronation, unstable foot

Foot loses arch and goes in other direction - rocker bottom foot

Some so locked - resting on navicular

64
Q

Inadequate Knee Flex

A

Loading - limits shock absorption, absent knee flex is usually substitutive for quad weakness (hyperext)

Pre-Swing - makes toe-off harder, lift LE by increasing hip flexion (increased DF and heel contact prolonged)

Initial swing - toe drag (circumduction, hip hiking, vaulting on opp side)

65
Q

Excessive Ext (Recurvatum)

A

Extensor thrust - snapping action

Dynamic retraction to substitue for weak quads (grade 3+ to 4) - by soleus to retract tibia, by glut max to retract femur, used to maintain speed and endurance

66
Q

Quad Weakness

A

Terminal swing - fast retraction of hip (glut max) will extend knee

Loading - knee flex avoided, tibial advancement by soles and/or glut max

Stance - hyperext used to increase heel contact, may see forward trunk flex to increase anterior vector

Pre-swing - knee ext maintained until other foot is fully loaded (double support increased to feel safer)

67
Q

Inadequate Extension

A

Shortened step length

Increased quad demand

Inappropriate actions of hamstrings - spasticity, substitution for glut max (see mild loss of knee flex due to action of tibia)

Soleus weakness - tibia advances too fast (also see ankle DF and sustained heel contact)

Hamstrings give resistance - knee comes back into flex after it’s kicked out (at very high speed, usually from mid swing to terminal swing)

68
Q

Genu Valgum

A

Lateral tilt of distal tibia w/ lateral displacement of foot (knock knees)

Distance b/w feet is greater than at knees

False impression of valgus - hip IR, add and knee flex

Seen in RA

69
Q

Genu Varus

A

Medial tilt of distal tibia w/ medial displacement of feet (bowleg)

Distance b/w knees greater than at feet

False impression of varus caused by hip ER, abd and knee flexion

Seen in OA

70
Q

Inadequate Hip Extension

A

Mid-stance - modifies alignment of hip.thigh, compensations - lumbar lordosis (adults < 15, children 30 hip flex), knee flex (reduces body progression/increased demand on quads)

Increased demand of hip extensors

Terminal stance - body advancement and step length shortened, thigh unable to trail

Hip flex tightness - cause lots of problems

30 degrees - crouched gait

Lordosis - if there is 15 degrees, get hip flex contracture (occurs first, anterior pelvic occurs)

71
Q

Inadequate Hip Flexion

A

Decreased step length and speed

Substituions - posterior pelvic tilt (uses abs if hip flexors are weak), circumlocution, hip hiking, voluntary excessive knee flex, contralateral vaulting and lateral lean of trunk to opp side

72
Q

Excessive Adduction

A

Scissoring gait - part of extensor synergy (assoc w/ hip flex and IR), narrow BOS, blocks progression of swing leg

Adductor contracture - does not correct thru gait cycle

Abductor weakness < 3 - corrects in preswing s weight is transferred to opposite limb

Adductor use as hip flexor - medial displacement of tight in swing

73
Q

Excessive Abduction

A

Wide BOS

Increased stance stability (balance impairments) - requires greater effort to shift weight from one limb to another

During swing, action increases floor clearance - circumduction substitutes for decreased hip flex

Other causes - abduction contracture, short leg (along w/ ipsilateral pelvic drop to lengthen leg)

Waddle gait

74
Q

Excessive Rotation - External

A

ER or IR - limited PF length (avoid stretch)

Weak IR

Backward pelvic rotation

Overactive glut med

Compensate for quad weakness

Use adductors as hip flexor

Using peroneals/fibulari as PFs

75
Q

Excessive Rotation - Internal

A

ER or IR - limited PF length (avoid stretch)

Weak ER

Forward pelvic rotation

Medial hamstring over activity

Adductor over activity (w/ hip flex, hip adductors cause IR)

Anterior abductor activity (TFL, ant GM)

Quad weakness (IT band and lateral knee ligaments resist flex of knee)

76
Q

Pelvic Tilt

A

Anterior - weak hip extensors, hip flex contracture

Posterior - substitute action for limited hip flex

77
Q

Pelvic Hike and Drop

A

Hike - assist foot clearance, substitute for weak hip

Contralateral drop - weak hip abductors, hip adductor contracture or spasticity (at mid stance - pelvis is drawn as femur assumes vertical)

Ipsilateral drop - contralateral abductor weakness, short limb, calf muscle weakness (decreases heel rise - short limb), scoliosis

Uncompensated - drop

Compensated - ipsilateral lean to weak side

78
Q

Excessive Pelvic Rotation

A

Forward - advance limb when hip flexors are weak, also IR but doesn’t cross neutral line

Backward - in terminal stance, calf muscle weakness results in lack of heel rise (shortened limb) - not good push off, pelvis retracts more

Lack of rotation - rigid spine w/ stiff gait

79
Q

Backward Lean

A

Hip extensor weakness - begins at loading and continues through stance, bilateral (during entire stride)

Inadequate hip flex - assist limb advancement when lumbar spine is immobile or abs are weak (use pelvis to kick forward)

80
Q

Forward Trunk Lean

A

Ankle PF - anterior vector moves forward over area of foot support

Quad weakness - anterior vector moves forward to force knee ext

Glut max weakness - pelvis falls forward and trunk follows (first APT, then trunk leans forward)

81
Q

Ipsilateral Trunk Lean

A

Toward stance limb - compensate for weak hip abduction (begins w/ loading and ends at terminal stance), hip adductor contracture - to correct, trunk leans to stance limb (if ITB tightness, will see trunk flex also), short limb, scoliosis

Toward swing limb - impaired body image (incompatible w/ stability), assist during swing to clear limb

82
Q

Excessive Trunk Rotation

A

Increased energy cost

Causes - synergy (no counterbalance forward rotation of ipsilateral trunk), walking aid synergy (trunk follows cane), arm swing (excessive arm swing used to assist balance)

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