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NPTE Final Frontier > GAIT: Abnormal > Flashcards

GAIT: Abnormal Flashcards

1
Q

Tightness vs Weakness

A

Contracture will DEC in the ROM of OPP motion
- Ex. FLOP–> Hip flex contracture will lead to DEC hip EXT (same side) and==> DEC in step length on OPP side

Weakness will cause DEC in ROM of SAME motion (MMT scores)
- Ex. Weak hip flexors will cause DECd hip flex and dec in step length on same side—> COMPENSATIONS: ABDs, excessive knee flexion, Trunk lean

Magent Theory: Trunk leans towards WEAK mm’s

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2
Q

Tightness vs Weakness

A

Contracture will DEC in the ROM of OPP motion
- Ex. FLOP–> Hip flex contracture will lead to DEC hip EXT (same side) and==> DEC in step length on OPP side

Weakness will cause DEC in ROM of SAME motion (MMT scores)
- Ex. Weak hip flexors will cause DECd hip flex and dec in step length on same side—> COMPENSATIONS: ABDs, excessive knee flexion, Trunk lean

Magent Theory: Trunk leans towards WEAK mm’s

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3
Q

Practice!
PT notices pt experiencing early toe-off during TSt (EARLY==Limtd ROM somewhere). Which IDs a likely cause and intervention?

A

Hip Flex contracture, Prolonged stretch
*Stick to your plane! Here is SAGITTAL!

NOTE: if Gastroc is tight== early HEEL off in MSt

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4
Q

MM Activity in Gait Reminder
Group: Hip ABDs

A

Name: Glute med/min, TFL
Stance: ECCentric–> stab. pelvis

Hand/arm trick holding UP pelvis!

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5
Q

MM Activity in Gait Reminder:
Group: Hip ADDs

A

Name: Add longus/brevis, Gracilis, Add mag (horiz/vert heads)
Early and Late Stance: CONCentric–> Stab. pelvis

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6
Q

Practice!
PT eval 26yo female basketball player with vague dx of R. knee pain. Pt performs jump landing as shown–> Lands in EXCESSIVE R knee VALGUS. PT Tx should focus on?

Stick to your plane!! Asking about FRONTAL here bc watching from front

A

Strengthening R. Glute med
- Strengthen PROXIMAL BEFORE DISTAL
- Proximal stabilization CRUCIAL for knee pain
- NO VMO strengthening for PRO at ankle, valgum @ knee— DON’T DO IT!!!

Valgus @ knee usually d/t hip or ankle

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7
Q

MM Activity in Gait Cycle
Glute Max

A

Stance: ECCentric– decelerates forward momentum
PSw:– CONCentric– hip EXT

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8
Q

MM Activity in Gait Cycle: Erector Spinae

Think “Erect posture”

A

Heel strike thru Toe-off– All of stance
Maints trunk posture

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9
Q

Magnet Theory for Trunk lean
YOU CAN ONLY USE THIS FOR WHICH PHASE OF GAIT???

A

STANCE!!!!!

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10
Q

Practice!
74yo retired contractor walks w/ backward trunk LEAN (think MAGNET THEORY-STANCE) when in stance on LLE. MOST LIKELY cause?

A

Weak hip EXTs left side during stance.
Magnet Theory in STANCE:
- trunk goes toward WEAK mms

Magnet Theory: Stance
- Weak Muscle–> Trunk
- Anterior–> Anterior lean (sag plane)
- Posterior–> Post lean (sag plane)
- Lateral–> Lateral lean (frontal plane)

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11
Q

Causes of Backward Lean
(3):

A
  1. Weak hip EXTs (stance)
  2. Rigid hip flexion contracture (stance)== Hip flexors TIGHT which makes Exts WEAK
  3. WEAK hip flexors (swing)– therefore lean BACKWARDS to get more clearance== assists w/ PPT to advance limb in swing

see pics and READ!

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12
Q

Practice!
74yo contractor walks to tx room. Pt presents w/ backward trunk lean during SWING (think WEAK hip flexors–cheating to clear foot).

A

Hip flexor weakness
trying to cheat to clear foot d/t weak hip flexors
Backward Trunk Lean:
- Stance==> G. max weakness; Hip flexors tight (lordosis present bc APT bc hip flexors pulling into APT)
- Swing==> Hip flexors weak

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13
Q

Muscle Activity in Gait Cycle
Group: Ankle

A

Name: Peroneus longus and brevis
Stance:
- CONCentric contraction–> maint med/lat stability of foot; maintain arch

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14
Q

Muscle Activity in Gait Cycle
Group: Foot INtrinsics

A

Stance:
- CONCentric contraction–> support Plantar fascia

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15
Q

Practice!
PT checks A/PROM ankle ROM. Pt lacks 10degs of passive ankle DF. Same limitation of 10degs present whether knee extended OR flexed (=soleus mm is prob bc gastroc is 2jt mm). MOST likely contributing?

A

Soleus
1 jt mm so knee pos won’t matter**

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16
Q

HIP gait deviations:
(4):

A
  1. Inadequate EXT (IMPORTANT)–slide on this
  2. Excessive or Inad. flexion
  3. Excessive ADD.
  4. Excessive ABD.
17
Q

HIP gait deviations:
IMPORTANT ONE:
Inadequate EXTENSION

A
  1. Hip flexion contracture aka tight hip flexors– FLOP– Opp side short step length
  2. +Thomas test, APT= Lordosis= Ext spine= Counternutation sacrum–> LACES–> Lordosis- APT- Counternutation- Ext spine
18
Q

Practice!
55 yo pt referred after MVA lesioning L. INF gluteal nerve (G. max innervation, so G. max will be WEAK). Gait deviation?

MAGNET THEORY IN STANCE!

A

POSTERIOR lean of trunk occurs @ L. foot IC
Magnet theory!–stance only

19
Q

Excessive Knee EXT causes:
(2):

A
  1. Quad Weakness (bc quads supposed to control that EXT)
  2. Excessive Ankle PF (remember excess. ankle PF assocd with Knee hyperEXT (“PE class”)

Remembe Red High Heels David!
- Ankle PF–> Knees lock out–> Pelvis anterior–> LS lordosis–> TS kyphosis–> FHP

Pelvis & Ankle alignment FOLLOW ea.other!
Ex. High heels== Ankle PF & forward trunk lean– APT– knee goes into hyperEXT and kyphotic posture

20
Q

Practice!
Pt presents w/ knee pain. PT notices pt has excessive ankle PF w/ excessive APT (go TOGETHER!!!). Correlated motion @ knee jt?

A

HyperEXT
PE class
- HyperEXT + APT + LS lordosis
- Think David in Red High Heels****

21
Q

Ankle Deviations
Foot
All first, listed

A
  1. Excessive INversion
  2. Excessive Eversion
  3. Premature Heel-off
  4. Delayed Heel contact
  5. Toe drag
  6. Foot Slap
22
Q

Ankle Deviations in Gait
Foot
Excessive INversion

A

SUPINATION
IPAD

23
Q

Ankle Deviations in Gait
Foot
Excessive Eversion

A

Pronation
- P. DEAB

24
Q

Ankle Deviations in Gait
Foot
- Premature Heel-Off

Premature ALWAYS ==TIGHTNESS

A

MSt
- Tight gastroc
End of stance
- Tight hip flexors

25
Q

Ankle Deviations in Gait
Foot
- Delayed Heel Contact

A

Land toes FIRST, THEN heel
- Tight PFs OR Weak DFs

26
Q

Ankle Deviations in Gait
Foot
- Toe Drag

A

Too much PF or Weak DFs

27
Q

Ankle Deviations in Gait
Foot
- Foot Slap

A

Weak DFs (ECCentrically)

28
Q

Ankle Deviations in Gait
Ankle

A

Excessive PF
Excessive DF

29
Q

Excessive PlantarFlexion

Think David in High Heels== HIGHER heel==> SLOWER walk

A
  • Causes loss of progression== shortened stride length/reduced velocity (higher heel==slower walk)
  • LOW heel contact @ IC and forefoot contact instead
  • 3 Substitutions:
    1. Premature heel off (premature=weak)
    1. Knee hyperEXT (PE class)
    1. Forward trunk lean**
30
Q

Practice!
PT observes 67yo female walk–notes forward trunk lean w/ knee hyperEXT (2 dead giveaways). LIKELY contributing cause?

A

Ankle PF contracture (just think EXCESS PF)
PE class= excess PF assocd w/ knee hyperEXT==APT==LS lordosis==TS kyphosis==FHP
Other answers:
- excessive DF== excess knee flexion
- quad spasticity== NO bc knee hyperEXT usually WEAK QUADS
- Ankle PF weakness== weak toe-off

31
Q

AD placement (SPC ex.)

A

OPP OF BAD SIDE–> so GOOD SIDE

32
Q

The Hip– DJD

A

Adding Cane on OPP side (aka if its R. hip DJD)
Review Foundations!
see pics

Note: L. side cane balances out effort from R. hip (bad side)

33
Q

Practice!
58yo underwent THA on LEFT side w/ posterolat approach (no IR, ADD, trunk/hip flex >90deg). Gait training program. Cane/crutch what side?

OPP OF BAD SIDE—> GOOD SIDE!

A

R. hand to DEC activity in L. hip ABDs
- We want to DEC force of L. ABDs–> “Assistive device” to HELP (assist)– dec force of activity in mm’s on BAD side

Hold cane on R. side– C/L side in order to DEC mm activation on IL side

DEC torque/stress/demands on I/L (bad) side

33
Q

Practice!
58yo underwent THA on LEFT side w/ posterolat approach (no IR, ADD, trunk/hip flex >90deg). Gait training program. Cane/crutch what side?

OPP OF BAD SIDE—> GOOD SIDE!

A

R. hand to DEC activity in L. hip ABDs
- We want to DEC force of L. ABDs–> “Assistive device” to HELP (assist)– dec force of activity in mm’s on BAD side

Hold cane on R. side– C/L side in order to DEC mm activation on IL side

DEC torque/stress/demands on I/L (bad) side

NPTE Final Frontier (19 decks)

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