Gait Analysis Flashcards
5 Attributes of Ambulation
Stability in stance
Foot clearance in swing
Pre-positioning of foot for IC
Adequate step length
Energy conservation
The 5 Attributes of Ambulation are challenged in the child with ___.
CP
Rockers
1: Heel Rocker (IC to LR)
2: Ankle Rocker (Mid Stance)
3: Forefoot Rocker (Heel Rise)
4: Toe Rocker (Pre-Swing / most anterior margin of medial forefoot and great toe)
T or F: Gait abnormalities at the hip can AND do occur in all three planes.
T
Hip Deviations (Coronal Plane)
Excessive Adduction (Scissoring)
Can be caused by adductor tightness and / or abductor weakness
Hip Deviations (Transverse Plane)
Malrotation (e.g., hip IR)
May be due to bony deformity (Anteversion) or can be secondary to over activity of internal femoral rotators (Adductors)
What muscles at the Hip are often over active in children with CP?
How does this lead to compensatory movements?
Flexors / Adductors / IRs
Muscular imbalance around the hip may result in weakness and / or bony deformity –> inadequate power generation –> compensatory movements
Compensatory Movements in Response to Muscular Imbalance at the Hip
Weight shifts of upper body
Compensated Trendelenburg (R Trendelenburg - R hip drop due to L hip abductor weakness / lateral flexion at the trunk to the L)
Hip Circumduction - due to inadequate hip and / or knee flexors, excessive IR or ankle PF
Stance Phase Knee Deviations
Recurvation
Excessive knee flexion
Knee flexion drives the GRF ___. What are the implications of this related to muscular demand / extension moments?
posteriorly
This reduces or prevents the normal knee extension moment
Increased demand on quads and hip extensors (increased energy expenditure)
What is the most common Swing Phase Knee Deviation?
Decreased Knee Flexion
Children wiht CP often use Rec Fem to augment hip flexion - this results in loss of KF during swing which results in a Stiff Knee Gait Pattern
What are the three major categories of foot / ankle deviations?
Excessive PF
Excessive DF
Bony deformity - malformation
Excessive PF during stance primarily affects which of the following phases of the Gait Cycle?
IC
Mid Stance
What are the consequences of excessive PF in Stance?
Loss of forward progression
Shortened step length
Loss of stance phase stability
Increased PF at IC creates a loss of which rocker?
Ankle (1st)
What is the most common Stance Phase error at the ankle caused by excessive PF?
Excessive PF Knee Extension Couple
PF Knee Extension Couple (During Normal Gait)
During 2nd rocker GRF falls in front of the knee and in front of the ankle (creating knee extension and ankle DF)
Action of the ankle PFs controls the position of the GRF
Stabilizes the knee first and later the hip
PF Knee Extension Force Couple Abnormalities
Normal 1st rocker is absent because of excessive PF at IC
Gastroc contracts prematurely because it is stretched prematurely at both ends
Knee hyperextension in Midstance often caused by PF tightness
What gait pattern is associated with a weakened / over lengthened Soleus (excessive DF)?
Crouch Gait
Weak Soleus relative to over activity of hip flexors and HS
Soleus no longer able to restrain the forward advancement of the Tibia
What is the role of the Soleus muscle during typical gait?
Acts to assist knee extension by retarding second rocker (stopping forward progression of the Tibia)
Moves the GRF in front of the knee
T or F: Function of the normal PF Knee Extension couple is impaired in both excessive PF and DF.
T
Where does the GRF fall in the presence of Crouch Gait?
Behind the knee
In front of the hip / ankle
Increases flexion moment at all joints
Excessive DF causes the “heel cord” to lengthen over time. Why is this? How does this impact the Quads?
Weakness and continuous stretch
Increase demand on quads
How does excessive DF impact Terminal Stance?
Loss of heel rise and less power generated
Loss of energy and momentum further impairs swing phase knee mechanics
T or F: Malrotation of the foot ONLY occurs with excessive PF.
F
Occurs with both excessive PF and excessive DF
Malrotation of the foot results in ___ ___ instability.
Stance Phase
Malrotations of the Foot (Hemiplegic CP)
Over activity of the Post Tib and Gastroc is common
Foot and ankle put in an equinovarus position (calcaneal inversion)
Malrotations of the Foot (Diplegic CP)
Over activity of Fibularis Brevis and Gastroc is common
Puts foot and ankle in an equinovalgus position (calcaneal eversion)
Excessive PF in Swing - What does it look like / what is it possibly caused by?
Foot drop / toe drag
Possibly caused by: Anterior Tib weakness / gastroc tightness / over activity / inadequate knee flexion during swing
Lever Arm Dysfunction
Adversely affects moment (Moment = Force * Distance)
Decreasing moment decreases power that can be generated / absorbed in direct proportion to the length of the Lever Arm
___ ___ Dysfunction can be the source of many gait deviations in CP.
Lever Arm
Lever Arm Dysfunction Types
Malrotation
Loss of stable fulcrum
Loss of bony rigidity
Shortening of the lever arm
Lever Arm Dysfunction (Malrotation) Example
External tibial rotation / out-toeing
GRF moves posterior and lateral from normal position relative to the knee (loss or reduction in normal knee extension moment)
Valgus and ER torques create further Lever Arm dysfunction and increasing difficulty with gait
Lever Arm Dysfunction (Loss of a Stable Fulcrum) Example
Hip Subluxation
Stable pivot point upon which the IR and ER moments of the Femur can add are impaired
Poor abductor muscle control
Lever Arm Dysfunction (Loss of Bony Rigidity) Example
Pes Planovalgus
Subluxation of Talus on Calcaneus
Foot can no longer act as an efficient rigid lever arm during Terminal Stance when heel comes off ground
Lever Arm Dysfunction (Shortening of the Lever Arm) Examples
Coxa Brevia (shortening of Femoral Neck) / Coxa Valga (increased Femoral Neck Shaft Angle) of Hip
Both cases reduce the distance to the center of the hip joint
Reduction of the magnitude of the moment the hip abductors can generate
Contractures and Bony Deformities are considered ___ Impairments.
Secondary
Coping Responses
Movements used to compensate for primary and secondary impairments in order to maintain function
Upper body shift to compensate for hip abductor weakness / LLD
Usually increase energy expenditure
What is considered the “standard of care” for measuring / diagnosing gait abnormalities in patients with CP?
Instrumented Gait Analysis (IGA)
Gait Deviation Index (GDI)
Analyzing motion of pelvis and LEs during gait
Calculates amount a subject’s gait deviates from an average norm profile
Represents deviation as a single number
GDI Typical vs. Atypical Scores
Typical = 100 (SD = 10)
Atypical = 50
Stability in Stance can be challenged by ___.
Abnormal foot position - creates unstable WB surface
Compromised balance - lack of trunk and lower body motor control
Foot Clearance in Swing can be challenged by ___.
Inadequate hip motion
Inadequate knee motion
Insufficient ankle DF
Pre-Positioning for IC can be challenged by ___.
Inadequate foot positioning in terminal swing
Adequate Step Length can be challenged by ___.
Inadequate knee extension in Terminal Swing
Unstable foot on the stance side
Inadequate PF push off on the stance side
The key to efficient gait is ___ ___.
energy conservation
Which patient is using less energy, a GMFCS Level 1 or a Level 3?
Level 1
Energy Conservation Mechanisms
Minimizing excursion of the COG (pelvic rotation, coordinated knee and ankle motion)
Controlling forward momentum (eccentric contraction of the Soleus during Midstance)
Active or passive transfer of energy between non-adjacent body segments (coordination and timing and control of the muscles - MAJOR role of 2-jt mms)
Functional Assessment Questionnaire (FAQ)
Measures one’s ability to walk and perform daily activities
Can be used for ALL walking abilities
Used in children with CP
Goal Outcomes Assessment List (GOAL)
Patient-reported OM questionnaire
Ambulatory children 6-18 years
Addresses ALL domains of WHO-ICF
Both parent and children complete
Assesses effectiveness of intervention in children with CP
