Gait Exam & Tx

Question 1

Describe the key elements at the following joints during stace

1. Ankle
2. Knee
3. Hip

Answer 1

1. DF > neutral > PF
2. Straight > slight flexion
3. Flexion > neutral > Hyperextension

Question 2

Describe the key elements during swing

Answer 2

All joints (ankle, knee, hip) move from extenstion to flexion

Question 3

List the 5 elements to note when assessing gait

Answer 3

1. Symmetry
2. Step pattern
3. Speed
4. Trunk posture
5. Arm swing

Question 4

List the causes of impaired heel strike - low heel, flat foot, forefoot contact (3)

Answer 4

• Ankle PF hypertonicity
• Ankle DF weakness/inactivity
• Knee lacks extension

Question 5

List the causes of impaired heel strike - excessive inversion (2)

Answer 5

• synergy (either flexion or extension)
• toe slawing/supination during stance

Question 6

List the causes of impaired heel strike - excessive eversion (2)

Answer 6

• hypotonicity
• pronation during stance

Question 7

List the causes impaired midstance - knee hyperextension (4)

Answer 7

• Ankle PF hypertonicity
• Ankle PF contracture
• Limited DF
• Quadriceps weakness

Question 8

List the causes of impaired midstance - knee flexion (3)

Answer 8

• HS hypertonicity
• HS contracture
• Quadriceps weakness

Question 9

List the causes of impaired midstance - hip flexion (4)

Answer 9

• hip flexion contracture
• hip flexion hypertonicity
• knee flexion contracture
• knee flexion hypertonicity

Question 10

List the causes of impaired terminal stance - insufficient hip extension (3)

Answer 10

• hip flexor contracture
• hip flexor hypertonicity
• hip extensor weakness

Question 11

List the causes of impaired terminal stance -insufficient toe-off

Answer 11

• PF weakness

Question 12

List the causes of impaired swing - inadequate foot clearance (4)

Answer 12

• hip flexor weakness
• knee flexor weakness
• DF weakness
• poor proprioceptive awareness

Question 13

List the causes of impaired swing - excessive ER (2)

Answer 13

• weak hip flexors (abducters compensate)
• weak hip adductors?

Question 14

List the causes of impaired swing - scissoring

Answer 14

hip adductor spasticity

Question 15

List the causes of impaired swing - inadequate knee extension (3)

Answer 15

• quadriceps weakness
• HS hypertonicity
• HS contracture

Question 16

List the causes of impaired swing - poor foot placement (2)

Answer 16

• poor coordination
• altered proprioception

Question 17

List the gait abnormalities in the following disorders

1. Stroke
2. PD
3. Cerebellar
4. CP

Answer 17

1. Unilateral; Step (length/pattern/trunk) assymmetry
2. Bilateral; Shuffling; Poor momentum control; Decreased trunk rotation; Freezing
3. Ataxic; Inconsistent foot placement
4. Crouched

Question 18

List ways to examine gait at the level of participation (2)

Answer 18

• Self report measures of mobility (questionnaires)
• Activity monitors (pedometer, accelerometer)

Question 19

List the requirements for “community ambulation” (6)

Answer 19

• 1000 ft
• Speed
• Ambient conditions
• Physical load
• Terrain
• Attentional demands

Question 20

List ways to examine gait at the functional level (4)

Answer 20

• 6 min walk
• dynamic gait index
• timed up and go
• 10 meter walk**

Question 21

List the average and max walk speeds for young and older adults

Answer 21

Young average = 1.4 m/s; max = 2.5 m/s

Older average = 1.3 m/s; max = 1.8 m/s

Question 22

List the average walking speed for the following ambulation status

1. Household (severe)
2. Limited community
3. Full community

Answer 22

1. < 0.4 m/s
2. 0.4-0.8 m/s
3. > 0.8 m/s

Question 23

Term: movement of joint

Answer 23

Kinematics

Question 24

Term: force measurement

Answer 24

Kinetics

Question 25

List STG (3) and LTG (2) for Gait

Answer 25

STG: change impairments, improve gait pattern, interim step towards LTGs LTG: functional, pt.-oriented (distance, level of assistance, AD, safety, EE)

Question 26

List strategies for improving progression (3)

Answer 26

1. Manually assistance 2. Temporary orthotic (ace-wrap) 3. Focus (facilitation, augmented feedback, exaggerate motion, increased spped demands)

Question 27

List strategies for improving stability (5)

Answer 27

- postural alignment - postural control - stance limb extensor support - stance limb foot placement and heel strike/flat foot transition - AD

Question 28

List strategies for improving adaptation (4)

Answer 28

- vary speed - obstacles - change direction - dual task

Question 29

Describe how BWSTT works (6)

Answer 29

- perhipheral sensory input processed by CNS - residual connection in damaged SC are plastic and recover - LE strength gains - CV endurance gains - Massed practice - Decreased fear

Question 30

Describe the improvements seen in those with SCI who use BWSTT

Answer 30

ASIA A: small non functional improvements Chronic Incomplete SCI: increased walking speed, distance, limb coordination, strength, EE

Question 31

Describe how BWSTT compared to other tx methods

Answer 31

BWSTT increased functional walking ability, however, there was no significant difference in improvements b/t early locomotion training/home exercise or b/t later locomotor training/home exercise Locomotor training, including the use of BWSTT was not shown to be superior to progressive exercise at home managed by a physical therapist.