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CP2 > Gait Deviations > Flashcards

Gait Deviations Flashcards

1
Q

Progression of gait over the supporting foot requires what?

A

Rockers

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2
Q

What is the first rocker?

A

First – motion of foot from dorsiflexed to plantarflexed position during LR to achieve foot flat

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3
Q

What is the Second rocker?

A

Second - Closed chain advancement of the tibia into a dorsiflexed position over a fixed foot during MSt

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4
Q

What is the Third rocker?

A

Third - Begins when center of pressure is over the mets and heel lift occurs in TSt/PSw

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5
Q

What is the critical event of initial contact?

A

Heel first contact

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6
Q

What stance is the opposite limb in during initial contact?

A

TSt/PSw

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7
Q

What position is the hip during IC? What major muscles?

A

20 flexion

Extensors

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8
Q

What position is the knee during IC? What major muscles?

A

0-5 flexion

Quads

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9
Q

What position is the ankle during IC? What major muscles?

A

0

Pretibials

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10
Q

What is/are the critical event of LR?

A

Hip stability, controlled knee flexion, and ankle PF

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11
Q

What stance is the opposite limb in during LR?

A

PSw

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12
Q

What position is the hip during LR? What major muscles?

A

20 flexion

Extensors, abductors

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13
Q

What position is the knee during LR? What major muscles?

A

15 flexion

Quads

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14
Q

What position is the ankle during LR? What major muscles?

A

5 PF

Pretibials

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15
Q

What is/are the critical event of MSt?

A

Controlled tibial advancement

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16
Q

What stance is the opposite limb in during MSt?

A

ISw-MSw

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17
Q

What position is the hip during MSt? What major muscles?

A

0

Abductors

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18
Q

What position is the knee during MSt? What major muscles?

A

5 flexion

Quads are quiet

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19
Q

What position is the ankle during MSt? What major muscles?

A

5 DF

Gastroc-soleous

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20
Q

What is/are the critical event of TSt?

A

Controlled ankle DF with heel rise

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21
Q

What stance is the opposite limb in during TSt?

A

TSw

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22
Q

What position is the hip during TSt? What major muscles?

A

20 ext

None

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23
Q

What position is the knee during TSt? What major muscles?

A

5 flexion

None

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24
Q

What position is the ankle during TSt? What major muscles?

A

10 DF

Gastroc-soleus

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25
Q

What is/are the critical event of PSw?

A

Passive knee flexion to 40, ankle PF, 60 MTP ext

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26
Q

What stance is the opposite limb in during PSw?

A

IC - LR

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27
Q

What position is the hip during PSw? What major muscles?

A

10 Ext

Adductors

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28
Q

What position is the knee during PSw? What major muscles?

A

40 flexion

None

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29
Q

What position is the ankle during PSw? What major muscles?

A

15 PF

None (Tib Ant)

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30
Q

What is/are the critical event of ISw?

A

Hip flexion, knee flexion

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31
Q

What stance is the opposite limb in during ISw?

A

LR - MSt

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32
Q

What position is the hip during ISw? What major muscles?

A

15 flexion

Flexors

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33
Q

What position is the knee during ISw? What major muscles?

A

60 flexion

Flexors

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34
Q

What position is the ankle during ISw? What major muscles?

A

5 PF

Pretibials

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35
Q

What is/are the critical event of MSw?

A

Continued hip flexion, foot clearance

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36
Q

What stance is the opposite limb in during MSw?

A

MSt

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37
Q

What position is the hip during MSw? What major muscles?

A

25 flexion

Flexors

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38
Q

What position is the knee during MSw? What major muscles?

A

25 flexion

Flexors

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39
Q

What position is the ankle during MSw? What major muscles?

A

0 DF

Pretibials

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40
Q

What is/are the critical event of TSw?

A

Knee extension

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41
Q

What stance is the opposite limb in during TSw?

42
Q

What position is the hip during TSw? What major muscles?

A

20 flexion

Flexors

43
Q

What position is the knee during TSw? What major muscles?

A

5 flexion

Quads

44
Q

What position is the ankle during TSw? What major muscles?

A

0 DF

Pretibials

45
Q

Why do we analyze gait?

A
  • Identify deviations to address with intervention
  • Determine functional ambulation capability across variety of environments
  • Assess balance, safety, endurance energy expenditure
  • Need for AD/orthotics
  • Describe how interventions impacted gait
46
Q

Abnormality in gait may be caused by what?

A
  • Pain
  • Joint and/or muscle ROM limitation
  • Muscular weakness/paralysis
  • Impaired motor control
  • Neurological involvement (UMN or LMN)
  • Impaired balance
  • Leg length discrepancy
47
Q

T/F Deviations are often compensations attempting to make gait more efficient

48
Q

When analyzing gait, how can you be systematic?

A
  • Analyze from bottom up (toes to head) or top to bottom (head to toes)
  • Work in segments
  • Identify a reference limb
  • Select a plane to start in (for example, sagittal plane first, then frontal plane), but look from all planes
  • Work in phases; this will require the patient to walk back and forth several times
49
Q

What is antalgic gait? How does it affect stance phase on affected side? Step length of uninvolved side? Lateral shift?

A
  • Compensatory gait adopted to remove or decrease the discomfort caused by pain in the lower leg, pelvis, or lumbar spine
  • Decrease in stance phase in affected side will result in decrease in swing phase of uninvolved limb and thus shortened step length on uninvolved side
  • Lack of weight shift laterally over the stance limb to keep weight off the involved limb
50
Q

What are the causes of the hip deviation forward trunk lean?

A
  • Result of weak quadriceps (decreases flexor movement of knee)
  • Hip flexor contractures
  • Weak lumbar or hip extensors
  • Hypomobile joint capsule
51
Q

What are the causes of the hip deviation decreased hip extension?

A
  • Tight hip flexors
  • Decreased joint mobility (posterior roll/anterior glide tightness)
  • Weak glutes
52
Q

What is glute max role during initial contact of gait?

A

Contracts at initial contact, slowing forward motion of trunk by resisting flexion of the hip and initiating extension

53
Q

If glute max is weak how will my body compensate?

A
  • Gluteus Maximus Gait/backward trunk lean (“rocking horse gait”)
  • Trunk will quickly shift posteriorly during initial contact to try and offset forward momentum, this requires less muscle strength to maintain the hip in extension during stance phase
54
Q

What might you see with weak gluteus medius?

A

Hip drop contralateral side

55
Q

How would we compensate with weak glute medius?

A

Trunk lean

Hip hike

56
Q

What is the name for knee hyperextension during gait?

A

Genu recurvatum gait

57
Q

What are the possible causes of knee hyperextension during gait?

A
  • Quadriceps weakness
  • Hamstring weakness
  • Increased tone of quadriceps
  • Compensation for plantarflexion contracture or spasticity (tight gastroc)
    1. When stretch gastric – knee straight and foot dorsi flexed (essentially Midstance)
    2. Tibia progresses forward -> spastic wants to get out so tibia hyperextends to decrease dorsiflexion and decrease stretch on gastroc
58
Q

What are possible causes of decreased knee extension?

A
  • Quadriceps weakness (unable to straighten knee)
  • Knee joint hypomobility
  • Hamstring contracture or stiffness
  • Strategy to avoid heel rocker (to stop advancement of knee)
59
Q

With decreased knee extension, we will see difficulty doing what on stairs?

A

Going down stairs

60
Q

What is excessive genu valgum?

A

Knock knee gait

Both knees face each other widening base of support (BOS)

61
Q

What are potential impairments/sources of genu valgum?

A
  • Boney deformity
  • Pain
  • Excessive foot pronation
  • Glute med weakness
  • Excessive femoral adduction
  • Ipsilateral trunk lean
62
Q

What is excessive genu varum?

A

Bow leg gait

Both knees face outwards

63
Q

What are potential impairments/sources of genu varum?

A

Degenerative changes
Pain
Boney deformity

64
Q

What is equinus gait? What point of body will land at initial contact?

A

Excessive PF during gait

Toes

65
Q

What might be the causes of equinus gait?

A
  • Tib ant weakness
  • Plantarflexion contracture
  • Hypomobility of talocrural joint (posterior glide hypomobility)
  • Compensation for short leg/short stride length (essentially making leg longer)
  • Painful heel/avoiding heel rocker
66
Q

What might equinus gait make it difficult to do?

A

Walk and run without tripping

67
Q

What is calcaneal gait?

A

Increased DF

68
Q

What might cause calcaneal gait?

A
  • Contracture tib anterior
  • weakness gastric
  • hypomobility talocrural joint (anterior glide hypomobility)
69
Q

What deviations would you expect with calcaneal gait?

A

Walking on heel

70
Q

What is equinovarus gait?

A
  • Club foot
  • Ankle PF and subtalar inversion
  • Walk on outside of foot
71
Q

Equinovarus gait is more often seen in what age group?

A

Seen more often in children

72
Q

What is foot drop (foot slap gait) often due to?

A

dorsiflexor weakness caused by paralysis of common peroneal nerve

73
Q

What might foot drop (foot slap gait) look like?

A

Won’t be normal heel strike, instead foot comes in contact with ground as a whole with slapping sound

74
Q

What muscles would you manual muscle test for foot drop (foot slap gait)?

A

Tib anterior

75
Q

What muscle do you worry about becoming too tight for foot drop gait?

A

PF (difficulty getting into DF)

76
Q

How might someone compensate for foot drop gait?

A

Steppage gait (bigger step to clear foot)
Circumduction
Vaulting

77
Q

What is foot flat gait and what might cause it?

A
  • Entire foot contacts ground (no heel strike)
  • Weak dorsiflexors
  • limited ROM
  • hypomobility (posterior joint capsule)
  • normal immature gait pattern (neonatal)
78
Q

In excessive supination gait, what part of foot would they likely land on?

A

Excessive lateral contact of foot during stance with varus position of foot (land and stay in supination)

79
Q

What might cause excessive supination gait?

A
  • Hypomobility of subtalar and/or midtarsal joints
  • spastic invertors or intrinsic foot muscles
  • weak evertors
  • genu varum (bow legged)
80
Q

In excessive pronation gait, what part of foot would they likely land on?

A

Excessive medial contact of foot during stance with valgus position of foot

81
Q

What might cause excessive pronation gait?q

A
  • Foot intrinsic muscle weakness (helps support arch)
  • Posterior tibialis weakness (helps support arch)
  • Hip abductor weakness (collapse inward at hip)
  • Hypomobility of subtalar and/or midtarsal joints
82
Q

What might cause Inadequate push-off (during terminal stance/pre swing)?

A
  • Result of weak plantar flexors
  • Tight/spastic dorsiflexors
  • Hypomobile talocrural joint
  • Pain in forefoot (won’t want to bear weight so limit push off)
83
Q

What is normal degree of anterior pelvic tilt during gait?

A

10-30 to facilitate leg to ground

84
Q

Excess anterior pelvic tilt can lead to what two things?

A

Lumbar lordosis

Low back pain

85
Q

What are potential causes of excessive anterior pelvic tilt?

A
  • Weak hip extensors
  • Hip flexion contracture
  • Abdominal muscle weakness
  • Limited hip extension ROM
86
Q

Excessive posterior pelvic tilt is caused by what?

A
  • Tight hamstrings

- Hip flexor weakness (posterior tilt acts as a substitution to create relative hip flexion)

87
Q

Excessive posterior pelvic tilt limits what and can cause what?

A

Limited lumbar extension

Low back pain

88
Q

What is an anatomical leg length discrepancy (LLD)?

A

legs are actually different lengths as confirmed with x ray or tape measurements

89
Q

What is a functional leg length discrepancy (LLD)?

A

on x-ray the leg lengths are equal, but for some reason they appear longer could be due to tightness, weakness, compensation, etc. (glute med weakness)

90
Q

What are 4 compensations for LLD?

A
  • Circumduction
  • Hip hiking
  • Steppage gait
  • Vaulting
91
Q

What is circumduction?

A

During swing phase

Clears leg by swinging out in circular pattern

92
Q

What is hip hiking?

A

activating lateral trunk musculature

93
Q

What is steppage gait?

A

exaggerated hip and knee flexion to compensate for excess plantar flexion at the ankle

94
Q

What is vaulting?

A

Patient will rise up on stance phase toe to clear contralateral leg for swing phase

95
Q

What is waddling gait? What are the potential causes?

A
  • Someone trying to regain their balance
  • Tight IT band
  • Contralateral hip abductor weakness
  • Limited hip or knee flexion- leans to contralateral side to compensate to clear foot
  • Commonly seen with pain in hip related to arthritis
96
Q

What are the clinical correlations of widened BOS? Commonly seen in what population?

A
  • More lateral movements of trunk (less efficient)
  • May indicate imbalance or fear of falling
  • Observed with decreased proprioception, cerebellar ataxia, etc (balance concerns)
97
Q

What are the clinical correlations with narrow BOS? Commonly seen in what population?

A
  • Adduction deformity of the hip
  • Varus deformity of knee
  • Increased hip adduction (increased tone, muscle tightness) during swing causing swing limb to cross over stance limb for contact
  • Commonly observed in those with Cerebral Palsy
98
Q

If narrow BOS is severe enough, what will it be referred to?

A

Scissoring gait

99
Q

Describe the spastic pattern of hemiplegic leg?

A
  • Hip into extension, adduction, and medial rotation
  • Knee in extension
  • Ankle in drop foot with plantar flexion and inversion, present during both stance and swing phases
  • Spastic muscles won’t allow hip and knee to flex to clear the floor
100
Q

How does hemiplegic leg affect gait?

A
  • Patient often performs circumduction
  • Usually with no reciprocal arm swing
  • Step length tends to be lengthened on involved side and shortened on uninvolved side
101
Q

What is sensory ataxic gait? Often seen in patients with what disorder?

A
  • presence of abnormal and uncoordinated movements
  • Referred as ataxic because walking is uncoordinated and appears to be “not ordered”
  • Often seen in individuals with cerebellar disorders
102
Q

What is festinating gait (describe CoG and BoS)? Seen in patients with what disorder?

A
  • Displacement of CoG anteriorly
  • In order to keep CoG within BoS, patient will shuffle their steps and will walk faster in an attempt to avoid losing their balance
  • Because of rigidity all joints will want to flex forward
  • Most often seen in Parkinson’s Disease, but can be seen in other basal ganglia diseases

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