Gait in Aging Adults Flashcards
What physiological system changes can effect the gait of an aging adult?
What other physiological (non-systemic) factors can contribute?
- MSK Changes
- Higher level neural processes
- Sensory and perceptual changes
- Individual sensory systems
Non-systemic
- Specific and individual pathologies
- Adaptive and anticipatory mechanisms
- Intricately related to balance responses
What psychological factors could contribute to the gait of aging adults?
depression self-efficacy/confidence appearance older adult's perception of his/her mobility anxiety or fear perceived risk of community mobility access to barriers in community
How does speed differ in a normal aging gait compared to a pathological gait?
normally an aging adult can keep their ability to vary their gait under their own volition
In pathological gait a person loses their ability to speed up or slow down their gait speed on demand
How does step/stride length differ in a normal aging gait compared to a pathological gait?
normally an aging adult’s step and stride length becomes smaller but symmetrical
in pathological gait there is a significant shortening of step and stride length but the steps are non-symmetrical
How does step width differ in a normal aging gait compared to a pathological gait?
Normally the width averages 1-4 inches
In pathological gait width is either greater than 4 in or smaller than 1 in or there is a great amount of variability
How does toe clearance differ in a normal aging gait compared to a pathological gait?
there is little toe clearance normally
in pathological gait the toe clearance is either very large or they are tripping over their toe due to no clearance, sometimes both
How does single limb support differ in a normal aging gait compared to a pathological gait?
Normally there is equal stance time in both legs in an aging adult
Pathological single limb support would be unequal stance time (antalgic pattern) or short, shuffled steps
How do the ankle/foot joint mechanics differ in a normal aging gait compared to a pathological gait?
Normally there is a slight decrease in force at push off and/or slight decrease in plantarflexion and dorsiflexion ROM
Pathological mechanics would be too large/too small toe clearance (or both) as well as forefoot or flatfoor contact during initial contact (excess PF or DF)
How do the knee joint mechanics differ in a normal aging gait compared to a pathological gait?
Normal knee mechanics are 5 deg. of flexion during weight bearing to 60 deg of flex. during swing limb advancement
Pathologic: limited or excessive flexion, wobbling, extension thrust (weight bearing will increase valgus/varrus moments)
How do the hip joint mechanics differ in a normal aging gait compared to a pathological gait?
Normal: 15-20 deg flexion during weight acceptance and 15-20 deg of apparent hyperext. at terminal stance
Pathologic: limited flex or ext (past retract), meaning visible forward then backward movement of thigh during terminal swing, excessive abduction or adduction, excessive ER or IR
How do the pelvis joint mechanics differ in a normal aging gait compared to a pathological gait?
Normal: 5 deg fwd rotation during weight acceptance and 5 deg of bwd rotation at terminal stance/pre-swing (iliac crest on reference limb is greater than or equal to iliac crest on opposite side during mid-stance)
Pathologic: limited or excess rotation fwd or bwd (pelvic drop or hiking)
What gait speed correlates to the “function” zone of the aging adult? “Frail” zone? “Failure” zone?
Function- .9-1.4 m/sec
Frail- .3-.8 m/sec
Failure- under .3 m/sec
What 6 minute walk distance correlates to the “function” zone of the aging adult? “Frail” zone? “Failure” zone?
Function- 300-500 m
Frail- 200-299 m
Failure- under 200 m
What 30 second chair rise rep count correlates to the “function” zone of the aging adult? “Frail” zone? “Failure” zone?
Function- 8-14 steps
Frail- under 8 steps
Failure- unable to perform
What time to climb ten stairs correlates to the “function” zone of the aging adult? “Frail” zone? “Failure” zone?
Function- 9-30 sec. with or without rails
Frail- 31-50 sec. w/ rails
Failure- unable to perform
What floor to stand time correlates to the “function” zone of the aging adult? “Frail” zone? “Failure” zone?
function- 11-30 seconds with or without help
Frail- over 30 seconds with help
Failure- unable to perform
What is the calculated critical speed for crossing a street?
1.14 m/s
What functional tests can help asses gait speed?
TUG and Gait speed test
What functional tests can help asses gait endurance?
6-minute and 2-minute walk tests
What functional tests can help asses gait balance?
Tinetti
Berg Balance
4 square Step Test
What functional tests can help asses gait dual tasking?
TUGcognitive and TUGmanual
True or Fasle: Gait speed can be seen as a vital sign
True
What is the objective use of a cane?
What are the consideration for prescribing a cane to a patient?
Objective: enhances stability through weight redistribution and compensates for losses in vision and proprioception
Consideration:
- appropriate for pts who need balance and stability assist w/ minimal WB shift (up to 25%)
- coordination needed to use effectively (may not be appropriate for older pt w/ cognitive or coordination impairments)
What is the objective use of crutches?
What are the consideration for prescribing crutches to a patient?
Objective: permits significant WB shift from legs to arms
Considerations
- permits more WB shift (50% or more) than a cane
- less stable than a walker
- requires good balance
- can lead to brachial plexus injuries if misused
- loftstrand crutches permit hand use and reaching
What is the objective use of a walker?
What are the consideration for prescribing a walker to a patient?
Objective: offers great stability and significant WB shift from legs to arms
Considerations:
- provides more WB shift (50% or more) than a cane but with more stability than crutches
- difficult on stairs
- great stability but hard to manuever
- rearwheel is less stable but easier to propel for pts. with poor upper body strength
- allows large BOS for patients w/ one functional arm
- platform walkers are heavy and require a lot of energy but permit weight bearing thru the humerus
What do multi-factorial impairment-based interventions focus on? How to they do this?
Focus on:
- reducing deviation
- improving gait efficiency, safety, and endurance
By incorporating:
- specificity of training
- task-orientated training
- dual-tasking
- task and environmental constraints
- rehab of ALL the components
What do flexibility training interventions try to achieve?
they try to change what you can and adapt/compensate for what you can’t and address obvious structural limitations caused by pathology or surgical procedures
What do strength/power/agility training interventions try to achieve?
- achieve mobility with stability prior to emphasizing increased velocity
- target PF, DF, quads, abductors, and extensors; UE strength in lats and triceps when patient is using an AD
- pre-gait activities can be done to focus on strength and control
What is the definition of dual task training?
The concurrent performance of two tasks that can be performed independently and have distinct and separate goals
What motor factors can be changed to increase dual-tasking in gait?
What cognitive factors can be changed?
Motor: multi-directional, balancing, external cueing, and carrying/picking up/reaching for an object
Cognitive: listening to music or radio, verbal fluency, answering autobiographical questions, subtracting by 3s, visual-spatial task of pattern matching
