Gait Analysis & Neurological Assessments Flashcards
Phases of the Gait cycle
Stance Phase
Swing Phase
Accounts for 60% of the gait cycle
Stance phase
Accounts for 40% of the gait cycle
Swing phase
It is when the foot comes in contact with the ground
Initial contact (Heel Strike)
Initial contact to the time when the contralateral foot leaves the ground
Loading Response (LR/Foot Flat)
The time when the ipsilateral heel leaves the ground to the time of the contralateral foot initial contact with the ground
Terminal stance (TSt)
From the time that the contralateral heel leaves the ground to the time that the ipsilateral heel leaves the ground
Midstance (MSt)
Time when the contralateral foot initial contact with the ground to the time that the ipsilateral foot leaves the ground.
Pre-swing (PSw/Toe-off)
The time from when the foot leaves the ground to ipsilateral foot alignment with the contralateral ankle
Initial swing (ISw/Acceleration)
The time from ankle and foot alignment to the wing leg tibia becoming vertical
Midswing (MSw)
The time from the tibia reaching a vertical position to the initial contact of the swing foot to the ground
Terminal swing (TSw/Deceleration)
Weight acceptance of initial contact (heel strike)
10%
Weight loading of load response (foot flat) and midstance (single-leg stance).
40%
Terminal stance (heel off) and Pre-swing (toe off) weight loading
10%
Occurs when the foot is lifted off the floor
Initial swing (ISw/Acceleration)
The swing leg is adjacent to the weight-bearing leg
Midswing (MSw)
Swinging leg slows down in preparation for initial contact with the floor.
Terminal swing (Deceleration)
What is the distance between both feet called? What is the normal distance between both feet?
Base (Step width)
5-10 cm (2-4 in)
It is the distance between successive contact. What is its normal parameter?
Step length
72 cm (28 in)
It is the distance between successive points of foot-to-floor contact of the same foot. What is its normal parameter
Stride length
144 cm (56 in)
It is the angle of the toe out of the foot. What is its normal parameter?
Fick angle
7 degrees (2nd MTT as landmark)
Side-to-side movement of the pelvis during walking. What is its normal parameter?
Lateral pelvic shift
2.5-5 cm (1-2 in)
Lessens the angle of the femur with the floor and lengthens the femur. What is its normal parameter?
Pelvic rotation
8 degrees in total (4 anteriorly/4posteriorly)
Normal center of gravity
5 cm (2 in) anterior to s2
The number of steps per min. What are its normal parameters
Cadence
90-120 steps/min
111 steps/min (M)
W are usually 6-9 steps higher than M
Scalar quantity
Walking speed
Vector quantity
Walking velocity
Functions of the Determinants of Gait
Increase the efficiency and smoothness of the pathway of gait
Decreases vertical and lateral displacement of COG
Decrease energy expenditure
Amount of ankle joint motion required for normal gait
10 DF
20 PF
The stance phase on the affected leg is shorter as the patient attempts to remove the weight on the affected leg.
Antalgic (Painful) Gait
Patient thursts the thorax posteriorly at initial contact to maintain the hip extension of the leg. Presents with weak hip extensors
Gluteus Maximus Gait
Forward flexion of the trunk with strong plantar flexions causes the knee to extend.
Quadriceps Avoidance (Forward Lurching) Gait
The patient lifts the knee higher than normal to avoid dragging the toes against the ground. At initial contact, the foot slaps the ground.
Steppage or Drop Foot Gait
Contralateral side of the affected hip droops because the ipsilateral hip abductors can not stabilize or prevent the droop.
Gluteus Medius (Trendelenburg) Gait
The paraplegic leg swings outwards and ahead in a circle or pushes it ahead.
Hemiplegic or Hemiparetic (Circumduction) Gait
The patient tends to have a broad base due to poor sensation or poor muscle coordination. The patient watches their feet while walking.
Ataxic Gait
The neck, trunk, and knees are flexed with characterized shuffling or short rapid steps.
Parkinsonian Gait
Patient may lean forward and walk progressively faster as though unable to stop.
Festination (Parkinsonian Gait)
The patient laterally shifts to the affected side causing the pelvis to tilt down on the affected side; causing a limp.
Short leg (Painless Osteogenic) Gait
The patient presents with ER, flexion, and adduction of the hip and has difficulty in swing-through. This is seen in patients with Legg-Calve-Perthes Disease (LCPD).
Psoatic Limp Gait
Result of spastic paralysis of hip adductor muscles. Knees are drawn together so that legs can be swung forward only with great effort.
Scissors/Scissoring Gait
Pelvis must be elevated by exaggerated plantar flexion of the opposite ankle and circumduction of the stiff leg to provide toe clearance
Arthrogenic (Stiff knee or hip) Gait
Results in lumbar lordosis and extension of the trunk combined with knee flexion to get the foot on the ground.
Hip flexion contracture gait
Presents with excessive ankle dorsiflexion from last swing phase to early stance phase of the uninvolved leg and early heel rise on the involved side during terminal stance.
Knee flexion contracture gait
Results in knee hyperextension and forward bending of the trunk with hip flexion
Plantar flexion contracture gait (Toe drag & Knee thrust)
Weight-bearing is primarily on the dorsolateral or lateral edge of the foot. Weight-bearing on the affected limb is decreased
Equinus Gait (Toe Walking)
Decrease or absence of push-off. The stance phase is less and presents with a shorter step length on the unaffected side.
Plantar Flexor Gait
CN I
Olfactory
Sensory (Afferent)
Olfaction
CN II
Optic
Sensory (Afferent)
Vision
CN III
Oculomotor
Motor (Efferent)
Turns Eye UDI
Constricts pupil
Accommodates Lens
CN IV
Trochlear
Motor
Intorsion of the Eye
CN V
Trigeminal
Both
Face sensation
Cornea sensation
Anterior tongue sensation
Muscles of mastication
Dampens sound (Tensor Tympani)
CN VI
Abducens
Motor (Efferent)
Turns Eye out
CN VII
Facial
Both
Ant. tongue taste
Facial expression
Dampens sound (stapedius)
Tearing (lacrimal gland)
Salivation (submandibular & sublingual glands)
CN VIII
Auditory/Vestibulocochlear
Sensory
Balance (Semicircular canals, utricle, sacule)
Hearing (organ of Corti)
CN IX
Glossopharyngeal
Both
Post. tongue taste
Post. tounge sensation
Oropharynx sensation
Salivation (Parotid gland)
CN X
Vagus
Both
Thoracic and abd viscera
Larynx and Pharynx
Decrease HR
Increase GI motility
CN XI
Spinal Accessory
Motor (Efferent)
Head movements (SCM & Trapz)
CN XII
Hypoglossal
Motor (Efferent)
Tongue shapes & movement
Sharp/dull discrimination
Pain perception
Ability to distinguish warm or cool stimuli
Temperature awareness
Determines the perception of tactile touch input
Touch awareness
The therapist’s fingertip or a double-tipped cotton swab is used.
Pressure awareness
Test for awareness of movement
Kinesthesia awareness
Examines joint position sense and awareness of joints at rest
Proprioceptive awareness
Requires a tuning fork that has 128 Hz
Vibration perception
Superficial sensations
Pain perception
Temperature awareness
Pressure awareness
Touch awareness
Deep sensations
Kinesthesia awareness
Proprioception awareness
Vibration perception
Determines the ability to recognize the form of an object by touch
Stereognosis perception
Determines the ability to localize the touch sensation on the skin
Tactile localization
Determines the ability to perceive two points applies to the skin simultaneously
Two-point discrimination
Determines the ability to perceive simultaneous touch stimuli
Double simultaneous simulation
Determines the ability to recognize letters, numbers, or designs written on the skin
Graphesthesia
Determines the ability to differentiate among various textures
Recognition of texture
Determines the ability to recognize different weights
Barognosis
Combined cortical sensation
Stereognosis perception
Tactile localization
Two-point discrimination
Graphesthesia
Recognition of texture
Barognosis
No increase in muscle tone
MAS Grade 0
Slight increase in muscle tone manifested by a catch and release at end of ROM
MAS Grade 1
Slight increase in muscle tone, manifested by a catch followed by minimal resistance
MAS Grade 1+
More marked increase in tone through most of ROM but joint is easily moved
MAS Grade 2
Considerable increase in muscle tone passive movement is difficult
MAS Grade 3
Affected part is rigid in flexion or extension
MAS Grade 4
Response is absent
DTR Grade 0
Slight reflex but depressed; low normal
DTR Grade 1+
Normal, typical reflex
DTR Grade 2+
Brisk reflex, possibly but not necessarily abnormal
DTR Grade 3+
Very brisk reflex, abnormal, conus
DTR Grade 4+
UMNL Affectation
CNS problem
Hypertonic, Hyperflexia, Spastic
LMNL Affectation
PNS problem
Hypotonic, Hypoflexia
Stroking of the lateral aspect of the foot
Babinski Reflex
Stroking of the lateral side of the foot beneath the lateral malleolus
Chaddock Reflex
Stroking of the anteromedial tibial surface
Oppenheim’s reflex
Squeezing of the calf muscles firmly
Gordon’s reflex
Organic Hemiplegia
Increased muscle tone and tendon reflex in the paralyzed limbs
Passive flexion of the lower limb
Brudzinski’s reflex
Flicking of the terminal phalanx of one of the 3 medial fingers
Hoffman’s (Digital) reflex
Tapping the plantar surface of the toes
Rossolimo’s reflex
Squeezing the Achilles tendon in the middle third
Schaeffer’s reflex
