Gait Interventions

Question 1

Factors affecting gait intervention

Answer 1

• Developmental considerations
• Child has never walked
• Child walks with abnormal gait pattern –usually due to compensatory strategies acquired to accommodate for neuromuscular and musculoskeletal impairments
• Child lost ability to walk due to illness, surgery, etc.

Question 2

“Why can’t my child walk?”

Answer 2

• Neuromuscular impairments
• Musculoskeletal impairments
• Sensory impairments
• Compensatory Strategies

Question 3

Limitations in Ambulatory Capacity

Answer 3

• Absence of basic locomotor patterns for progression
• Inability to maintain appropriate posture for orientation and stability
• Inability to adapt posture and movement

Together –affect long-term viability

Question 4

Neuromuscular Impairments

Answer 4

• atypical tone
• paralysis/weakness
• decreased coordination

Question 5

Musculoskeletal impairments

Answer 5

• weakness
• loss of ROM
• contractures
• changes in alignment: torsional malalignment - “lever arm dysfunction”

Question 6

Hip flexors MMT < 2+ compensatory patterns

Answer 6

• posterior pelvic tilt
• circumduction
• contralateral vaulting
• abduction of hip

Question 7

hip abductor weakness affect on gait

Answer 7

trendelenburg

Question 8

hip extensor weakness affect on gait

Answer 8

forward trunk lean

Question 9

knee extensors 3+ to 4 affect on gait

Answer 9

difficulty controlling knee flexion during loading results in hyperextension of knee
- can result in toe drag

Question 10

knee flexor weakness affect on gait

Answer 10

lack of control of knee in swing
decreased stability of knee in stance

Question 11

plantar flexor weakness affect on gait

Answer 11

hyperextension in stance
decreased knee flexion in swing
persistent flexion in stance
Crouch gait

Question 12

dorsiflexor weakness affect on gait

Answer 12

toe drag

Question 13

sensory impairments

Answer 13

• somatosensory impairments
• visual deficits
• vestibular deficits
• perceptual and cognitive impairments

Question 14

Pre-Walking Skills

Answer 14

• Weight Bearing
• Facilitation and handling activities to promote dissociation, weight shift, proximal balance
• balanced flexion/extension through reciprocal creeping and kicking

Question 15

Techniques to increase trunk stability for walking

Answer 15

• weight bearing
• bouncing
• approximation
• pushing
• pulling
• sit ups
• prone extension

Question 16

Treadmill Training

Answer 16

• the earlier we start and the more steps they get in, the more impact we have for helping them walk at an earlier age

Question 17

Does strength training along improve gait speed?

Answer 17

not necessarily

Question 18

Common gait abnormalities in children with cerebral palsy

Answer 18

• In toeing/Internal femoral Torsion
• Trendelenburg-like gait pattern
• Crouched gait posture
• Genu recurvatum
• Toe Walking
• Pes Planus/Pes Valgus
• Ataxia, uncoordinated movement pattern

Question 19

Impairments that result in internal femoral torsion in children with CP

Answer 19

• bone deformity
• spasticity
• contractures
• muscle imbalance (retained fetal alignment, abductor weakness)

Question 20

Physical Therapy treatment for femoral torsion in children with CP

Answer 20

• Positioning
• Bracing –soft and rigid orthotics
• Relaxation/Inhibition Techniques
• Early Weight Bearing Experiences
• PROM/Stretching techniques (myofascial release) * Strengthening of weak muscles
• Gait training on level and unlevel surfaces

Question 21

Trendelenburg- Like gait in children who have CP

Answer 21

Potential Impairments:
* Muscle Tightness
* Muscle weakness
* Increased muscle tone
* Contractures

Question 22

Physical Therapy Treatment for a Trendelenburg Gait Pattern - Strengthening

Answer 22

Gross motor activities to promote single limb stance

Question 23

Physical Therapy Treatment for a Trendelenburg Gait Pattern - Gait Training

Answer 23

• Stepping onto higher/lower surfaces
• Stepping ovre obstacles

Question 24

Crouched gait in children who have CP

Answer 24

Potential impairments:
* Contractures
* Muscle Tightness
* Muscle weakness
* Increased muscle tone

Question 25

Physical Therapy Treatment for Crouched Gait in Children with CP

Answer 25

- Positioning - Serial Casting - Bracing- Soft or rigid orthotics - PROM/stretching/myofacial release - Strengthening Exercises - Gait training in corrected alignment

Question 26

Genu Recurvatum in children who have CP

Answer 26

Potential impairments: * Contractures * Muscle Tightness * Muscle weakness * Increased muscle tone

Question 27

Physical Therapy Treatment for Genu Recurvatum in children with CP

Answer 27

* Soft tissue techniques (tone vs tightness) * Strengthening * Bracing * Support of joint: soft orthotic, taping, etc. * Gait training in corrected alignment

Question 28

Toe Walking in Children with CP

Answer 28

Potential Impairments: * Hypertonicity * Contracture * Balance and sensory dysfunction * Persistent knee flexion

Question 29

Idiopathic Toe Walking

Answer 29

Potential Impairments * Tightness (Possible: congenitally short tendon/myopathic disorder) * Sensory processing deficits * Balance deficits

Question 30

Physical Therapy Treatment for Toe Walking

Answer 30

* Stretching (Positioning/Casting) * Strengthening * Balance and movement * Bracing * Gait training in corrected alignment * Sensory stimulation – surfaces, textures, movement

Question 31

Pes Planus/Pes Valgus in children with CP

Answer 31

Potential Impairments: * Bony deformity * Contractures * Tightness * Weakness * Hyper/hypotonicity

Question 32

Physical therapy treatment for Pes Planus and Pes Valgus in children with CP

Answer 32

* Stretching * Strengthening * Neurological techniques for inhibition * Bracing * Gait training in corrected alignment

Question 33

Ataxia/Uncoordinated Movement Patterns

Answer 33

Potential Impairments: * Visual impairments * Balance deficits * Decreased coordination * Atypical muscle tone * Muscle imbalance * Proximal muscle weakness

Question 34

Physical Therapy Treatment for Ataxia

Answer 34

* Relaxation techniques * Strengthening of trunk and proximal extremities * Coordination activities that work on timing -metronome * Balance activities * Gait training on level and unlevel surfaces * Visual fixation

Question 35

Assistive devices used with children who have CP

Answer 35

* Crutches –lofstrand crutches, Canadian crutches * Walkers –posterior walkers, partial wt. supported walkers * Gait Trainers

Question 36

Common Gait abnormalities in Children with DS

Answer 36

* Crouched gait * Wide based gait * Genu Recurvatum * Pes Planus * Causes of gait abnormalities: hypotonia, joint laxity, hypermobility, weakness

Question 37

Treatment for gait abnormalities in children who have Down syndrome

Answer 37

*Facilitation techniques *Muscle strengthening *Orthotic intervention *Gait training on level and unlevel surfaces

Question 38

Common gait abnormalities in children with Myelomenigocele

Answer 38

*Crouched gait *Wide based gait *Genu recurvatum *Pes planus *Trendelenburg gait

Question 39

Physical therapy treatment for gait abnormalities in children with MM

Answer 39

* Positioning * Stretching * Strengthening * Orthotic Intervention * Gait Training on level and unlevel surfaces * Sensory activities –vary surfaces, textures

Question 40

Assistive Devices used with Children who have MM

Answer 40

* Walkers –forward walkers, posterior walkers * Lofstrand crutches * Straight canes * Parapodiums * Wheelchairs * Mobile parallel bars * Mobile standers