Gait Assessment Flashcards
What are the 4 components of swing phase?
- Pre swing
- Initial swing
- Mid swing
- Terminal swing
What is pre swing?
position limb for swing
What is initial swing?
- foot clearance of the floor
- limb advancement from trailing position
What is midswing?
- limb advancement
- foot clearance from floor
What is terminal swing?
- complete limb advancement
- preparation for stance
What are the four phases of stance?
- initial contact
- loading response
- midstance
- terminal stance
What is initial contact in stance?
- positioning of the limb to start stance
What is loading response?
- shock absorption
- weight-bearing stability
- forward progression
What is midstance?
- progression of COG over BOS
- limb and trunk stability
What is terminal stance?
- progression of COG beyond BOS
What are some traits that impact gait after a CVA?
- weakness
- sensory loss
- impaired balancce
- loss of confidence
What should we observe about gait after a CVA?
- ankle, knees, hips, trunk, UE from all planes of movements
What should be recorded and measured regarding gait after a CVA?
- time
- distance
- cadence
- velocity
What is gait speed used to predict?
patients ability to ambulate in different environments
What are some common gait deviations post stroke?
- slow speed
- asymmetrical, uneven step and stride lengths
- reduced stance time on affected limb
- decreased push off force on affected limb
- use of synergy patterns to advance limb
- impaired balance with UE and LE posturing
- reliance on adaptive equipment
- spasticity requiring compensatory advancement
What is a physiological walker?
walks for exercise only wither at home or in therapy
What is a limited household walker?
relied on walking for home activities but requires assist for other walking activities
What is a community walker?
unlimited distance outside
What is the gait speed of a household walker?
< 0.40 m/s OR <0.49 m/s
What is the gait speed of a limited community walker?
0.40-0.80 m/s
OR
0.49-0.92m/s
What is the gait speed of a community walker?
> 0.80
OR
0.92 m/s
What is a primary contributor to disordered gait?
paresis
What aspects of force production does paresis impact?
- the number, type and frequency of motor neurons essential for force production for gait
Paresis is the primary impairment after ______________ pathology
corticospinal
What do muscles act concentrically to do?
generate movement
What do muscles act eccentrically to do?
control the motion
What two ways can spasticity impact gait?
- inappropriate activation of a muscle at points during the gait cycle when it’s rapidly being stretched
- produces increased stiffness and the freedom of the muscle to move rapidly
Inability to ______ _______ muscles is a contributing factor to abnormal gait
selectively recruit
What is abnormal selective recruiting associated with?
abnormal coupling of muscles resulting in abnormal synergies which manifest as either total ext or total flx
What can affect progression in gait and postural control?
overactivity of muscles unrelated to spasticity
What kind of overactivity is common?
HS
The inability to time and scale muscle activity during gait can give way to …
ataxic gait
What is ataxic gait?
staggering, veering, shaking, irregular stepping and high steppage
- delay in movement of the knee and ankle through the gait cycle
What coactivation in common post CVA?
of antagonist muscles in both paretic and nonparetic limb
Impaired _________ _______ strategies contribute to instability in gait and stance
reactive balance
What is impaired with balance post CVA?
proactive balance strategies
What is there a decreased ability to do in response to terrain and slope changes post CVA?
modify gait
- slower gait speed and increased variablility
- shorten step length downhill causing reduced walking speed
- not able to increase step length walking uphill
What can result in ataxia with sensory loss?
abnormal sensory input!
- can be due to peripheral or central proprioceptive pathways
- the person has no awareness of where their legs are in space
- reduced modulation of reflex activity throughout the gait cycle
What is critical to balance strategies during gait?
vision
What do those with vision impairement tend to do?
walk slower and use more auditory cues
What can have an impact on a persons ability to percieve potential threats to stability?
hemianopsia
Loss of ________ _______ during adulthood can produce gait ataxia and difficulty stabilizing the head in space
vestibular input
no vestibular input does what to gait?
longer double stance support
- can cause impaired vision and oscillopsia
Body image deficits can cause…
- ipsilateral trunk lean towards stance leg
- inappropriate foot placement and difficulty in controling COM relative to the changing BOS of the feet
- unilateral spatial neglect tend to veer to the opposite side of bump into objects on the affected side
____ can alter the movement pattern used for gait
PAIN
What is antalgic gait?
a gait pattern that results from pain in the back or legs
What are compensatory strategies for antalgic gait?
- reduce WB time on the painful limb
- avoid impact loads
- reduce joint excursions (limiting knee flexion during stance)
- side bending over a painful hip to bring the COM closer to the joints center of rotation which reduces the need for hip abductor activity
What happens with reduced activation of the PFs?
- strong hyperextension at the knee in stance and lack of knee flexion with swing
What is associated with reduced use of PFs?
reduced energy during preswing of gait
PF activation is reduced in paretic limb? T/F
true
What is a compensation for reduction in PF recruitment?
increased knee and hip moments of paretic limb
What is the main factor contributing to knee hyperextension?
PF paresis
When does spasticity in the PFs occur?
common problem post CVA and neurological injury
When does spasticity in PFs primarily occur?
in the early part of stance phase of walking secondary to stretching of the gastroc
Shortening of what before the body is ahead of the foot causes knee hyperext?
the muscle
spastic PFs also impact the …
gastroc, causes inability to generate enough force for push-off
What is spasticity associated with?
reduced gait speed, effects of spasticity are increased with faster speeds
What will spasticity impact about foot position?
- limit DF and prevent heel strike at IC
- if IC is made with a flat foot - knee hyperextention
- reduced foot clearance = toe drag
Excessive gastroc and post tib activation produces what?
inversion and equinovarus foot position
Weak quads cause what?
difficulty controlling knee flexion during loading and midstance
What is the compensation for weak quads?
hyperext of the knee during midstance or forward trunk lean to bring GRF anterior to knee
If hyperext of knee continues into preswing, it prevents?
the knee from moving freely during swing phase = slow progression and toe drag
What can also give excessive knee extension?
spasticity, stiff knee gait
What can happen during IC that triggers spasticity?
breif knee flx to absorb shock which can cause hyperext of the knee
Weakness in hip flexors effects what phase of gait?
swing
What can we do with weak hip flexors?
assist in progression to produce a hip flexor moment at the initiation of the swing
What is lost with inadequate hip flexion?
knee flexion for swing, = toe clearance is reduced or lost and can result in a shortened step
What are some compensatory strategies used to achieve foot clearance without adequate hip flx?
- posterior tilt of pelvis and activation of abs
- circumduction (hip hike)
- contralateral vaulting
- leaning the trunk laterally
What can weakness in hip extensors cause?
forward trunk lean so patient leans back to compensate, bringing COM behind hips
What can hip ABD weakness result in?
trendelenberg gait
What is a common compensation of hip ABD weakness>
lateral shift of COM over the stance leg with lateral lead of trunk towards stance leg
What can hip ABD weakness result in instability in what plane?
frontal
What can spasticity in the hamstrings cause?
excessive knee flexion which can lead to a crouched gait pattern
What does excessive action of hamstrings in terminal swing do?
prevents the knee from fully extending
What does excessive knee flexion from spasticity do?
increases demand on quads to prevent collapse
What does spasticity in the hip ADDs produce?
- a contralateral drop of the pelvis during stance
- scissoring gait, reduces BOS and stability
What are some outcome measures for gait?
- timed up and go (TUG)
- 10-meter walk test
- 6 minute walk test
- functional gait assessment/ dynamic gait index
What is the TUG?
pt seated in a standard chair with armrests, instructed to stand, walk towards a line 3 meters (10 feet) away, turn and walk back and return to a seated positon
- start on go
- start with back against chair
- may use AD but no physical assist
What are cutoff scores for TUG?
- <10-12 - normal healthy adult
- 12-20 secs average frail elderly adult
> 14 SEC = FALL RISK FOR STROKE POPULATION
What is a 10 m walk test?
- a clear pathway of at least 10 m in length
- solid flooring
- measure and mark the start and end
- add a mark at 2 m and 8m
- total time to ambulate is recorded in m/s
What is DGI?
examines a patients ability to perform steady state walking and variations on command
- 8 items/conditions
- 4 point scale (0-2)
> 3= no gait dysfunction
> 0= severe impairement
- possible scoe 24
- strong fall-risk predictor, a score below 19 is indicative of fall risk
What is the FGA?
- Used to assess postural stability during walking and assesses an individual’s ability to perform multiple motor tasks while walking.
- 10items/conditions
- 4 -point scale (0-3)
3: no gait dysfunction
2: Mild impairment
1: Moderate impairment
0: severe impairment. - Possible score 30
- Strong fall-risk predictor,
- score below 22 is indicative of fall Risk!
10 conditions
- Gait on level surface, change in gait speed, gait with vertical head turns, gait with horizontal head turns, gait pivot and turns, gait with eyes closed, backwards walking, step over obstacles, gait with narrow BOS
What is the 6MWT?
- assesses distance walked over 6 minutes as a sub-maximal test of aerobic
capacity/endurance. - May stand to rest but cannot sit down.
- Test only if appropriate level of activity tolerance
