Gait and rotational profile Flashcards
Asking a pt to speed up during gait analysis will __________ gait deviations
increase
What are the 5 attributes of ambulation
Stability in stance
foot clearance in swing
prepositioning of the foot for initial contact
adequate step length
energy conservation
When does the first rocker come into play?
Initial contact/ loading response
When does the second rocker come into play?
Midstance
When does the 3rd rocker happen?
heel rise/ terminal stance
When does the 4th rocker happen?
Preswing
Excessive hip flexion is a gait deviation in what plane?
Sagittal
Excessive adduction (scissoring) is a gait deviation in what plane?
Coronal/frontal
Malrotation of the hip is a gait deviation in what plane?
Transverse
In CP, the hip ____, __________and _____ are overactive compared to their antagonists
Flexors, internal rotators, and adductors
What is compensated Trendelenburg gait?
Lean toward opposite side of pelvis drop
What is a potential cause of circumduction gait
inadequate hip flexor or knee flexor, excessive hip IR, or ankle plantarflexion
spasticity in adductors causes what kind of gait
scissoring
Stance phase errors are associated with _____
Swing phase errors are associated with _____
abnormal position or malrotation
Inadequate ROM or weakness
Excessive knee flexion causes increased demand on __________ and leads to increased energy expendature
Quads and HIp extensors
Excess knee flexion drives the ground reaction force __________-
posteriorly
What is the most common swing phase deviation?
Decreased knee flexion, stiff leg gait pattern
Why do children with CP often have a stiff leg gait pattern
Use of rectus femoris to augment hip flexion
Because rectus femoris is busy working at the hip it is stiff at the knee
The most common stance error at the ankle caused by excessive plantarflexion is _____
an excessive plantarflexion/knee ext couple
when plantarflexors fire it helps pull the knee into ext
If a pt has excessive knee ext/plantarflexion couple, the ________ rocker is absent
First rocker
What happens during an excessive knee ext/plantarflexion couple
Gastroc stretches prematurely at both ends of muscle, it contracts prematurely causing hyperext in midstance d/t plantarflexor tightness
a crouched gait is often due to a weak ________
soleus
In hemiplegic CP, you often see what foot position
What about Diplegic CP?
Hemi: Overactivity of the post tib/gastroc causes equinovarus/calcaneal inversion
Di: Overactiviy of peroneus brevis and gastroc causes equinovalgus (calcaneal eversion)
When would you want to do a rotational profile on a child
if they have excessive intoeing or outtoeing
how much hip IR/ER is normal
45 to 60 each way
Ryder/Craigs test tests for what
femoral anteversion
How much anteversion is normal
15 of IR
How do you measure the thigh-foot angle
Draw a line down the thigh, and a line down the foot
What does the foot configuration angle tell you
if theres a curve in the foot (metatarsus adductus?)
kids are normally born with excessive _______ at the hip
excessive antiversion
however normal WB will straighten this out
if a child doesnt get enough WB growing up, they keep excessive antevesion
What is considered miserable malignment?
NOT Knee valgus
Femur is rotated IN
Tibia is rotated OUT
What is “Squinting patella”?
Malrotation of the femur/tibia causing the patella to be positioned inward
T or F: Coping responses are functional solutions to impairments that make walking difficult
T, however they increase energy expenditure
What is considered the standard of care for objectively measuring gait abnormalities in CP
IGA Instrumented gait analysis
Kinematic data is ______
Kinetic data is __________
Kinematic- ROM data
Kinetic- Force plate data (weight)
how much knee flexion is needed for gait
60
What is considered a normal GDI?
100=normal
10=standard deviation
What uses more energy for gait: GFMS level 1, or GFMS level 3?
Level 3 uses more energy
Child able to climb stairs holding railing
may need wheeled mobility over long distance
GMFCS level 2
Child using handheld AD indoors
May climb stairs with assistance
GMFCS level 3
Child uses mobility that requires physical assistance or powered mobility in most settings
GMFCS level 4
What is considered the standard of care for determining whether a child with CP gets a surgery to fix gait?
Motion Analysis
(except for GMFCS level 5, they might get a surgery just to improve pain, remember they do not ambulate)
Primary impairment vs secondary impairment vs coping response
Toe walking child w/ weak dorsiflexors and a plantarflexers contracture
primary: dorsiflexion weakness
secondary: now they have a plantarflexor contracture
coping response: toe walking
don’t give kids a surgery for coping responses!
What happens if we over lengthen a patients gastroc/soleus
Pt will lose the Plantarflexion/knee extension couple
Now they are stuck in crouch gait
Hemiplegic CP is associated with Calcaneal ______ and equino____
Inversion
Varus
Diplegic CP is associated with Calcaneal _______ and equino_____
Eversion
valgus
What hip is dropping in R Trendelenburg gait?
the R hip, d/t left hip abductor weakness
source: dr. bickleys email to mikela
in R compensated trendelenburg, which pelvis is dropping? Which way is the pt leaning?
R hip is dropping
L lean
What muscles are overactive in hemiplegic CP
Post tib and gastroc -> calc inversion + equinovarus
What muscles are overactive in diplegic CP?
Peronus brevis + gastroc -> Calcaneal eversion + equinovalgus
