Gait Deficits Flashcards
what is a major problem among persons of all ages with neurological pathologies such as CVA, TBI, MS, cerebellar disease, developmental delay, down syndrome, spina bifida, CP
falls
associated with impaired balance, loss of postural control mechanisms (impaired hip, stepping, and ankle strategies)
falls
pathologies can affect what aspects of gait
- sensory
- motor
- perceptual
- cognitive
what can result from sensory impairments on gait
- may result in gross ataxia
- may result in difficulty initiating certain phases of gait and inability to adapt to environmental demands (feedforward/feedback)
- may alter sensory weighting for postural control (vision, somatosensory, vestibular deficits; lack of success in certain environments)
- may alter body schema/spatial relations
- pain or perception of pain may alter gait quality
how can cognitive and perceptual deficits effect gait
- reduced cognitive reserve = reduce motor ability
- impair dual task ability
- impair safety awareness
dementia (cognitive deficits) may impair what
dual task ability and perception
CVA/TBI (cognitive deficits) may impair what
safety awareness (inability to assess safe walking conditions, lack of self-awareness into deficits)
what is correlated to falls
gait speed
the slower the gait speed =
the higher the risk of falls
what is the normal adult gait speed
1.3 m/s
pts with neurological injuries tend to ambulate slower due to
sensory or motor and/or cognitive or perceptual deficits
what other factors can predict community function besides gait speed
balance, self-efficacy, depression and fatigue (assessed via FGA, FES, depression scales)
what gait speed is needed to be a community ambulator
0.8 m/s
what time is used to determine how long it will take a pedestrian to cross a street when determine traffic signals
1.2 m/s
gait characteristics of cerebellar lesion
- wide BOS
- staggering/drunk
- path deviation
gait characteristics of PD (basal ganglia lesion)
- slow speed
- short, shuffling steps (festination)
- en bloc turning
- freezing episodes
uncoordinated gait
ataxia
common gait deviations in individuals with neurologic disorders at the foot and ankle
- toe contact with floor during swing (toe drag)
- inadequate DF with swing
- IC with forefoot
- M-L instability in midstance
common gait deviations in individuals with neurologic disorders at knee
- inadequate knee flexion in swing
- hyperextension of knee in stance to compensate for quad weakness or lack of motor control/stability of knee
- excessive knee flexion during stance
common gait deviations in individuals with neurologic disorders at hip
- ER
- hiking during swing to clear foot
- circumduction
- inadequate hip flexion in early swing
- inadquate extension in stance
- drop of unaffected side of pelvis during affected stance phase (glut med weak)
common gait deviations in individuals with neurologic disorders at pelvis
- pelvic retraction on hemiplegic side
common gait deviations in individuals with neurologic disorders at trunk
- forward flexion of trunk to compensate for weak knee extensors during stance
- lateral flexion of trunk to compensate for weak hip abductors during stance
ROM of hip needed for gait
- 25 def flexion (IC, LR, MSw, TSw)
- 15deg ext (TSt)
- some rotation and abd/add
ROM of knee needed for gait
- full ext 0deg
- 60deg knee flexion (initial swing)
ROM of ankle needed for gait
- 15 deg PF (pre-swing)
- 10deg DF (terminal stance)
-5 deg DF required to clear toes during swing phase
ROM of foot needed for gait
- 50deg ext of great toe (pre swing)
IC made with forefoot
forefoot contact
IC made with forefoot AND hindfoot
flatfoot contact
rapid PF after initial contact (heel strike); audible sound; cannot control tibialis anterior
foot slap
excessive inversion of calcaneous or forefoot in any phase
excessive inversion/pes cavus
excessive eversion of calcaneous or forefoot in any phase
excessive eversion/pes planus
inadequate 1st MTP extension in preswing
inadequate MTP extension
clawed toes with or without hammer toes
excessive IP flexion
foot contact with ground during swing phase
toe drag
excessive ankle PF of stance limb to help advance swing limb
contralateral vault
inadequate extension of hip in stance phase
inadequate extension/crouched gait
less than normal hip flexion for any phase
inadequate flexion
more than normal hip flexion in swing phase
excessive flexion/steppage gait
position of femur with excessive rotation
medial/lateral rotation of hip
abduction of femur beyond neutral
abduction
adduction of femur beyond neutral
adduction/scissoring gait
thigh abduction and flexion followed by adduction during swing phase
circumduction
> 5 deg drop of iliac crest of swing limb during stance on the reference leg
contralateral drop/trendelenberg
elevation of iliac crest of reference limb above neutral during swing phase
pelvis hike
> 5deg backward rotation during terminal stance and may continue t/o phases
excessive backward rotation of pelvis/retracted pelvis
> 5deg forward rotation during mid and terminal swing
excessive forward rotation/protracted pelvis
any excessive tilt at pelvis
excessive anterior/posterior pelvic tilt (APT/PPT)
