Gait Test 2 Flashcards
Causes of impaired feedback (4)
- Proprioceptive (joint position)
- Vestibular, balance
- Foot sensory
- Visual
Mass flexor and extensor patterns
Lack of selective muscle control, loss of finely coordinated pattern
- Flexors or extensors all fire together, often post stroke
Spasticity, application to gait
Muscle overreacts to passive stretch (clonus, beating pattern twitching if stretched too quickly)
- Rapid knee flexion in pre swing stretches Rec Fem, overactivity can block knee flexion
Muscle weakness affects which phases?
- Dorsiflexors, Plantarflexors, Inverters
- DF- loading response, swing phases
- PF- mid and terminal stance, pre swing
- Invertors - stance phases
15º plantar flexion contracture means??
- most common ankle contracture, comfort position w lowest intraarticular pressure
- can’t DF, can PF beyond 15º
Arthrogenic weakness
- Swelling/pain increases intraarticular pressure in joint, reflex inhibition so can’t activate muscle
- cause of quads weakness
Penalty of knee flexion contracture
Increased quads demand, fatigue, PFJ pain?
- 15º contracture, significantly increases demand!
hip flexion contracture - postural compensations
- resting position 30-60º FL
- 15º contracture not noticeable- increased lumbar lordosis and anterior pelvic tilt
- Trunk flexion, lordosis, or mass flexion posture
Two highest muscle demands in gait
- Isometric Hip extensors in loading response keep trunk upright
- Eccentric Plantarflexors in terminal stance
Global observations of gait instability (3)
- trunk movement
- variable step length
- variable foot placement
Global Compensations for Gait Instability (6)
- Wide BOS, slow velocity, increased DLS time, reliance on vision, increased frontal plane motion, heavy reliance on assistive device
Consequences of weak calf (gastroc, soleus)
- Excessive DF in MS, TS, PSw –> quads overuse, excessive lowering of COM
- Inadequate knee extension in MS, TS –> quads overuse, decreased stance progression and stride length
Potential consequences of weak quads
- Excessive PF in MS/TS- compensatory, push off –> decreases stance progression
- Inadequate knee flexion in LR –> decreases shock absorption
- Excessive knee extension in stance –> stresses post. knee
- Inadequate knee extension in mid/terminal swing –> decreased limb adv, stride length, preparation for stance
- Inadequate hip flexion in LR –> decreases shock abs, heel rocker
- Excessive hip flexion in pre/mid swing- past retract maneuver –> hip FL overuse
General Causes of Abnormal Gait (5)
- Decreased joint mvt (joint stiffness, elastic or rigid contracture)
- Weakness (excessive motion or avoidance)
- Pain (avoidance) / - Impaired feedback / - Impaired motor control
Excessive PF in IC - causes and penalty
Causes: DF weakness / contracture / excessive PF activity / reduce heel rocker 2º weakness or balance / heel pain
Penalty: reduce stance progression (lose heel rocker)
Excessive PF in midstance and terminal stance
Causes, penalty, compensations
- Cause: short steps / contracture / excessive PF activity- pushing off to compensate for extensor weakness
- Penalty: decreased stance progression (compensates w/ knee HE OR early heel rise OR midfoot pronation)
Excessive PF in swing phases - causes, penalty, comp
- Cause: DF weakness / contracture / excessive PF activity
- Penalty: decreased foot clearance –> will increase hip or knee FL
Excessive DF in initial contact/loading response
Cause and penalties
- Cause: AFO or prosthetic foot usu. set 5-8º DF
- Penalty: quads overuse/increased knee FL / increased heel rocker launches forward
Excessive DF in mid/terminal stance and pre swing - cause, penalties
- Cause: weak calf
- Penalty: quads overuse / excessive COM lowering
Excessive pronation causes (5)
- compensatory for limited DF or hypomobile subtalar
- hypermobile rearfoot/midfoot
- inverter weakness / - dynamic knee valgus / - structural rearfoot/forefoot varus
Causes of limited pronation (4)
- hypomobile rearfoot 2. medial point of contact 3. dynamic splinting, holding self there 4. structural cavus foot
Penalties of excessive pronation vs. limited pronation
- Excessive: stress on inverters / plantar fascia / intertarsal ligs / hallux valgus / increased tibia rotation and stress on knee
- Limited: poor shock absorption
Inadequate knee flexion in loading response - causes and penalty
- Causes: weak quad OR hip ext / pain avoidance / excessive quad activity / decreased heel rocker
- Penalty: decreased shock absorption
Inadequate knee flexion in pre and initial swing
- Causes: weak hip flexors / pain avoidance / excessive quad activity
- Penalty: decreased foot clearance
Excessive extension in mid/terminal stance - causes and penalty
- Causes of HE: weak quads / pain avoidance / excessive quad activity / compensation for excessive PF
- Penalty: stresses posterior knee
Excessive knee flexion in pre/initial swing - causes and penalty
- Cause: compensation for excessive PF / abnormal motor control, flexor pattern
- Penalty: overuse of hip flexors, BF short head
Inadequate knee extension in mid/terminal stance - causes and penalties
- Causes: contracture of knee OR hip / excessive DF 2º weak calf / excessive hamstring activity
- Penalties: quads overuse / decreased stance progression, stride length
Inadequate knee extension in mid/terminal swing - causes and penalties
- Cause: contracture of knee / weak quad / excessive hamstring activity / purposefully reduce heel rocker 2º weak/balance/heel pain
- Penalty: decreased preparation for stance / limb advancement / stride length
Dynamic valgus in stance - cause/penalty
- Cause: weak hip ABD or ER
- Stresses knee - PFJ, MCL, pes anserine, IT Band
Dynamic varus in stance - cause/penalty
- Cause: pelvic drop 2º weak hip ABD
- Stresses knee - LCL, IT band, medial compression
Excessive knee rotation in stance - cause/penalty
- Cause: excessive pronation OR weak hip ER making whole leg internally rotate
- Stresses knee - PFJ, MCL, pes anserine, IT band
Inadequate hip flexion in loading response - cause/penalty
- Cause: weak quads or hip ext / decreased heel rocker
- Penalty: decreased shock absorption
Inadequate hip flexion in pre to terminal swing - cause/penalties
- Cause: weak hip flexors / pain avoidance
- Penalties: decreased limb advancement / stride length / foot clearance
- may compensate with excessive knee flexion or circumduction
Excessive hip flexion in pre to mid swing - cause/penalty
- Cause: past-retract maneuver (weak quad/amputee) / compensate for excessive PF or inadequate knee FL to clear foot
- Penalty: hip flexor overuse
Inadequate hip extension in mid/terminal stance - cause/penalty/compensation
- Cause: contracture of knee or hip, tight hip flexors
- Penalty: decreases stride length
- Compensate- excessive ant pelvic tilt and backward rotation, circumduction
3 possible effects of weak hip ABDuctors in stance
- Excessive hip Add, knee valgus –> stresses ITB, medial knee, lateral hip
- Pelvic drop –> knee varus stress, spine stress (facet compression, paraspinal/QL overuse)
- Trunk lean over weak side –> facet compression on concave weak side, ecc muscle overuse on convex side
Average Comfortable Gait Speed from 20’s to 70’s
About 80 m/min
Why does slow gait speed require more muscular effort? (5 reasons)
- more active swing phase
- lose stabilizing influence of arm swing
- larger frontal plane COM excursion
- more variable foot placement
- increased dynamic instability- need postural muscle synergies
Minimum gait velocity for household ambulation, limited community ambulation, full community
- household 48 m/min
