Higher Level Gait disorder Flashcards
describe the upper body movement during the gait cycle
Trunk twists around a vertical axis
Pelvis rotates (12)
Upper trunk in opposite direction
Arms out of phase with legs
gait parameters
stance phase
swing phase
stance time
swing time
cadence
step length
stride length
step time
gait cycle
stride time
average gait velocity
function of Mesencephalic locomotor region
receives afferents from basal ganglia, limbic system, sensorimotor cortex, and connects spinal circuitry via reticulospinal tract.
function of Pontine locomotor regions
postural tone
function of subthalamic region
modulation of locomotor patterns
function reticular formation
temporal and spatial co-ordination of movement
purpose of basal ganglia
Initiation and termination of movement
purpose of cerebral cortex
Motor planning
Visuomotor
co-ordination
Cognitive aspects of motor control
gait pattern is the integration of what cognitive abilities
Attention, planning and memory
Integration of motor, perceptual and cognitive processes
what afferent feedback is received during gait
Somatosensory
Visual
Vestibular
what is reduced regarding age related changes in gait
Velocity (norm 1.5m/s)
Step/stride length
Arm swing
Pelvic rotation
Heel-strike
Reaction time
what is increased regarding age related changes in gait
Double support time (norm 60% gait cycle)
Cadence (norm 110 steps/min)
Time needed to travel
what is the anatomical correlation of higher level gait disorder
higher - cortex different patterns cautious, parkinsonian, ataxic,
higher -subcortical - spastic, magnetic, gait ignition failure, disequilibrium
characteristics of higher level gait disorder
Difficulties with initiation
Shuffling gait
Bradykinesia
Freezing
Demonstrate wide BOS +/-
Deteriorating postural responses/ balance
Tendency to retropulsion
higher level gait disorder descriptors
Gait apraxia
Frontal ataxia
Frontal disequilibrium
Frontal gait disorder
Subcortical disequilibrium
‘Marche a petit pas’
Vascular pseudoparkinsonism
Senile Gait
Lower body Parkinsonism
Ateriosclerotic Parkinsonism
Cautious gait
Isolated gait ignition failure
pathophysiology of higher level gait disorder
Vascular/Ischaemic processes
Disruption of the neural pathways
Frontal lesions
Diffuse cerebral disease
Multiple lacunar infarcts
Basal ganglia infarcts
middle level gait disorder causes
Cerebellar disorders
Spasticity with corticospinal dysfunction
Bradykinetic, dystonic, and choreic gaits with basal ganglia disorders
what gait patterns are middle level gait disorder
Paraplegic Gait
Hemiplegic Gait
Cerebellar ataxic Gait
Parkinsonian Gait
Choreic Gait
Dystonic Gait
gait and balance assessment for gait disorder
Head, Trunk, UL, LL (hip, knee, ankle, foot).
Swing and stance phase (observe different components)
Turning: Balance / stability
Alignment / symmetry
Weight transfer
BOS
Cadence
Associated reactions
describe gait pattern
t/f
safety awareness
what abnormalities may be detected in a gait analysis
Slowness of walking
Decreased stride length
En-bloc turning
Retropulsion
Shuffling gait
Inadequate heel strike
Inadequate foot clearance
Loss of arm swing
implications for physio with gait disorder
strategies for gait initiation and turning difficulties
improve postural alignment and balance training - enhance balance reaction, core stability, postural alignment
gait traing - T/F, stepping practice
dual task theory
People often have trouble performing two relatively simple tasks concurrently
Evidence from studies of healthy volunteers has suggested that there may be an identifiable cognitive function responsible for dual
decerebrate model
Weight support
Active propulsion
Improved co-ordination of stepping patterns
Note- only when ES is applied to an important area in the brainstem- mesencephalic locomotor region
Cerebellum - vital for correction of central pattern generator activity
decorticate model
External stimulus not required to produce locomotion
Reasonably goal directed
Cortex important in skills such as walking over uneven terrain/navigation- use of vision recognition pathways in the cortex
