Gait & abnormal patterns of trunk and LE Flashcards
atypical gait patterns may be the result of ?
poor trunk control
instability
weakness
ROM deficits
presence of abnormal firing
patterns
abnormal tone
compensations for lack of specific movement components or muscle control
fear or sensory/visual/perceptual problems
what percentage of the gait cycle is stance phase?
60%
what is normal cadence?
~ 90 step/minute
what are abnormal movement patterns influenced by?
1- loss of postural control
2- loss of motor control
3- motor return
4- gravity and biomechanics
5- sensory, visual perceptual problems
what are consequences of problems?
1- loss of joint and soft tissue mobility
2- alterations in biomechanical alignment
3- pain/edema
4- loss of function
loss of postural control:
TRUNK:
- falls into gravity, forward or laterally. Weight of limbs fall and “pull” on the trunk
- in sitting the trunk “falls” into a posterior pelvic position
- in standing, the pelvis “falls” anteriorly, posteriorly or laterally
HEAD AND NECK:
- forward head, use of cervical extension to see
UE:
-falls into gravity
LE:
-pelvis lists downward, falls into hip and knee flexion
what are characteristics of movement patterns for postural control?
little to no movement, use of momentum and other body parts to initiate movement; hanging in “WBing”” positions.
what are associated problems to loss of postural control?
soft tissue tightness, overstretch
orthopedic mal-alignment
lack of stability in WBing
what tx for loss of postural control?
protection of joints
support of limbs
facilitation of active movement
alignment in weight bearing
teach how to accept weight before putting on full body weight
build in stabiliiy
imbalance of motor return:
TRUNK:
- imbalanced muscle activity to hold trunk upright, usually have extensors, not balanced by flexors.
- asymmetrical alignment, rib cage rotation.
HEAD & NECK:
-asymmetrical alignment: lateral flexion, contralateral rotation
UE:
-hyperextension, IR, elbow flexion
LE:
- pelvis elevated and anteriorly tilted
- hip flexion and knee hyperextension
what are characteristics of movement patterns for imbalance of motor return?
movement characterized by “posturing” in UE
“shortening” of trunk with rib cage rotation and “hip hiking” of the LE
movement patterns initiated proximally
what are consequences of imbalance of motor return?
soft tissue tightness
orthopedic map-alignment
lack of stability in WBing
“posturing” with movement
loss of function
what tx should be used for imbalance of motor return?
alignment of joints in movement and WBing
teach alternate muscles and movement patterns
balance of muscle activity for stability in movement in space
inappropriate firing patterns:
TRUNK:
-may appear more symmetrical, however, stand with more extensor control move with more use of flexors
UE:
-movement characterized by proximal initiation of movement with humeral ABD, IR
LE:
- pelvis elevated or level
- anteriorly tilted in standing
- posterior in function
what are characteristics of movement patterns for inappropriate firing patterns?
movement characterized by “all or none”
initiation of movement is characterized by over-firing of entire limb and trunk with excessive distal firing
inability to “separate” limbs and trunk
what are consequences of inappropriate firing patterns?
soft tissue tightness
orthopedic malalignment
“stiffness” in movement
lack of disassociation
loss of function
what tx should be used for inappropriate firing patterns?
freedom and ease of movement
teach disassociation of trunk and limbs
mobility
sensory/perceptual problems:
“inaccurate” perception of body in space; X midline
TRUNK:
- “pushes” backward or to the involved side or to the less involved side
- inability to move forward regardless of initiation- upper or lower trunk
UE:
- inability to move toward the limb and accept weight
LE:
- inability to “actively” accept weight on the limb
- collapsing into “WBing” limb
- may push away from less involved side
what are characteristics of movement patterns for sensory/perceptual problems?
movement characterized by limited ability to move forward or accept weight on the affected limbs
“hugging the walls” during ambulation; inability to function in open space
what are consequences of sensory/perceptual problems?
soft tissue tightness
orthopedic map-alignment
fear of movement
stiffness in movement
inability to move body forward over the limbs
loss of function
what tx should be used for sensory/perceptual problems?
provide a “safe environment” that allows for gradual movement challenges
strong, organized sensory input, slow movement
how to understand abnormal movement patterns?
a problem solving analysis of the performance of functional task requires an understanding of normal movement and an understanding of the patient’s problem to determine:
1- what movement components are necessary for the functional task?
2- what movement components the patient has that are normal?
3- what movement components are missing?
4- what movement components are abnormal or used to compensate for missing components
what are consequences of problems left untreated?
lack of functional movement
- -> soft tissue tightness
- -> orthopedic map-alignment
- -> pain, discomfort, fear
- -> loss of function
