Gait & abnormal patterns of trunk and LE

Question 1

atypical gait patterns may be the result of ?

Answer 1

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

Question 2

what percentage of the gait cycle is stance phase?

Answer 2

60%

Question 3

what is normal cadence?

Answer 3

~ 90 step/minute

Question 4

what are abnormal movement patterns influenced by?

Answer 4

1- loss of postural control

2- loss of motor control

3- motor return

4- gravity and biomechanics

5- sensory, visual perceptual problems

Question 5

what are consequences of problems?

Answer 5

1- loss of joint and soft tissue mobility

2- alterations in biomechanical alignment

3- pain/edema

4- loss of function

Question 6

loss of postural control:

Answer 6

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

Question 7

what are characteristics of movement patterns for postural control?

Answer 7

little to no movement, use of momentum and other body parts to initiate movement; hanging in “WBing”” positions.

Question 8

what are associated problems to loss of postural control?

Answer 8

soft tissue tightness, overstretch

orthopedic mal-alignment

lack of stability in WBing

Question 9

what tx for loss of postural control?

Answer 9

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

Question 10

imbalance of motor return:

Answer 10

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

Question 11

what are characteristics of movement patterns for imbalance of motor return?

Answer 11

movement characterized by “posturing” in UE

“shortening” of trunk with rib cage rotation and “hip hiking” of the LE

movement patterns initiated proximally

Question 12

what are consequences of imbalance of motor return?

Answer 12

soft tissue tightness

orthopedic map-alignment

lack of stability in WBing

“posturing” with movement

loss of function

Question 13

what tx should be used for imbalance of motor return?

Answer 13

alignment of joints in movement and WBing

teach alternate muscles and movement patterns

balance of muscle activity for stability in movement in space

Question 14

inappropriate firing patterns:

Answer 14

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

Question 15

what are characteristics of movement patterns for inappropriate firing patterns?

Answer 15

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

Question 16

what are consequences of inappropriate firing patterns?

Answer 16

soft tissue tightness

orthopedic malalignment

“stiffness” in movement

lack of disassociation

loss of function

Question 17

what tx should be used for inappropriate firing patterns?

Answer 17

freedom and ease of movement

teach disassociation of trunk and limbs

mobility

Question 18

sensory/perceptual problems:

Answer 18

“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

Question 19

what are characteristics of movement patterns for sensory/perceptual problems?

Answer 19

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

Question 20

what are consequences of sensory/perceptual problems?

Answer 20

soft tissue tightness

orthopedic map-alignment

fear of movement

stiffness in movement

inability to move body forward over the limbs

loss of function

Question 21

what tx should be used for sensory/perceptual problems?

Answer 21

provide a “safe environment” that allows for gradual movement challenges

strong, organized sensory input, slow movement

Question 22

how to understand abnormal movement patterns?

Answer 22

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

Question 23

what are consequences of problems left untreated?

Answer 23

lack of functional movement

• -> soft tissue tightness
• -> orthopedic map-alignment
• -> pain, discomfort, fear
• -> loss of function