Gait (Week 5--Aragaki)

Question 1

Things observational gait analysis should assess for

Answer 1

Joint ROM

Muscle function and activation

Timing

Energy requirement

Safety–fall risk

Cosmesis (general look of gait)

Question 2

Step

Answer 2

Initial contact (IC) of one limb to IC of contralateral limb

Question 3

Stride

Answer 3

IC of one limb to IC of same limb

Question 4

Cadence

Answer 4

Steps per minute

Question 5

Velocity

Answer 5

Distance per time

Normal = 3 mph

Question 6

Percentage of time spent on one leg vs. two in gait

Answer 6

80% of gait cycle single limb support

20% of gait cycle double limb support

Increased double limb support for stability in elderly and toddlers

No double limb support in running

Question 7

8 phases of gait cycle

Answer 7

Initial contact

Loading response

Midstance

Terminal stance

Pre-swing

(end of stance, beginning of swing)

Initial swing

Midswing

Terminal swing

Question 8

Stance vs. swing

Answer 8

Stance is when limb is in contact with ground (initial contact thru pre-swing)

Swing is when limb is advancing in the air (initial swing thru terminal swing)

Question 9

Important note about what muscles do during gait

Answer 9

They can either move or stabilize a limb joint

Question 10

Do all gait deviations lead to disability or functional limitations?

Answer 10

No!

But analyzing the way someone walks can give insight to person’s symptoms or disease process

Question 11

2 categories for atypical gait patterns

Answer 11

Primary

Compensatory

Question 12

History to ask about when assessing gait

Answer 12

Falls

Pain

Medical problems

Past surgeries

Question 13

What to look for on exam when assessing gait

Answer 13

Joint contractures

Muscle spasticity or weakness

Impaired sensation or balance

Also note the person’s shoes! (uneven wear pattern)

Question 14

How to observe gait

Answer 14

View subject walk from side, front and behind

Listen for abnormal or asymmetric sounds and rhythms

Describe what you see/hear and at what phase you noticed it

Question 15

Antalgic gait

Answer 15

AKA limp, hobble

Uneven weight distribution on lower limbs due to guarding from pain

May lean to one side, spend less time on painful limb and wince/groan

Question 16

Gait deviation examples

Answer 16

Foot drop: very weak or absent dorsiflexion, initial contact with plantarflexed or flat foot; may need to “high step” to clear toes

Food slap: moderately weak dorsiflexion, cannot gently decelerate foot quietly

Foot drag: unable to clear foot during swing because of inadequate dorsiflexion, knee flexion or hip flexion

Question 17

S1 radiculopathy

Answer 17

Can result in reduced strength in gastrocnemius, soleus, hamstring, and gluteal muscles

Gait abnormality is weak push off in pre-swing (last part of stance)

Question 18

Spastic hemiparesis in stroke

Answer 18

Need to compensate for functional leg length discrepancy:

Vaulting: tip toe on strong side to help raise weaker (or longer) limb

Hip hiking: raising pelvis on weak side to clear limb

Circumduction: swing weak limg in wider arc to clear foot

Steppage: exaggerated hip and knee flexion to clear forefoot

In general, foot may be varus and knee hyperextended in these cases

Question 19

Muscular dystrophy/myopathy

Answer 19

Trendelenburg gait: caused by weak gluteus medius muscle leading to drop in pelvis on opposite side; can compensate for this weakness by leaning trunk over affected hip giving a waddling appearance

Also will see lumbar lordosis (due to weak hip abductors), toe walking (weak quads so plantarflexion helps stabilize knees)

Question 20

Parkinson’s disease

Answer 20

Festinating gait: characteristic “shuffle” of Parkinson’s Disease; increased cadence, reduced step length, postural instability and forward trunk lean; appears as if they’re “chasing their center of gravity”

Question 21

Huntington’s disease

Answer 21

Chorea: dance-like maneuvering, exaaggerated writhing movements

Question 22

Cerebellar ataxia

Answer 22

Ataxic gait: lack of coordination, widened base of support, unsteady limb placement and high fall risk