Impairments That Interfere With Walking Flashcards
Deviations of impaired proprioception?
- the individual aligns the GRF such that they can rely on passive structures during stance phases to ensure stability during these phases
- wide BOS
- excessive variability
Deviations observed with an impaired vestibular function?
- the individual has limited head motion
- wide BOS
- limited time in single limb stance
- poor reactive balance
- having greater difficulty in conditions of low light
- surfaces with an incline
- surfaces that are compliant
Deviations observed with pain?
- reduced time in single limb stance
- limited motion during phases which have a high joint moment
- grimaces during walking
What is the impairment if that individual:
- compensation with knee hyperextension during WA phases and Midstance to keep the flat foot on the ground
- foot flat contact
- excessive ankle plantarflexion at LR, MSt, and TSt
- early heel off during late Midstance
- excessive plantarflexion during swing limb advancement along with a compensatory strategy to clear the swing limb
Shortened gastroc/soleus with -15 degrees of ankle dorsiflexion motion
What is the impairment if the individual:
- compensates with a heel off through all stance phases
- excessive plantarflexion along with a compensatory strategy to clear the swing limb during swing limb advancement
- forefoot contact
- plantarflexion during all phases of gait
shortened gastroc/soleus with -30 degrees of ankle dorsiflexion motion
What is the impairment if the individual:
- excessive hip and knee flexion during all stance phases except for preswing
- terminal swing will be particularly problematic as the hamstrings will be on maximal stretch
Shortened hamstrings with popliteal angle of at least 45 degrees (lacks knee extension)
What is the impairment if the individual:
- walks with excessive hip flexion, along with knee flexion and dorsiflexion during all stance phases
- has an anterior pelvic tilt
- terminal stance will be particularly problematic as the iliopsoas will be on maximal stretch
Shortened iliopsoas with a Thomas test of at least 10 degrees (lacks hip extension)
What is the impairment if the individual:
- has excessive plantarflexion throughout the gait pattern
- a compensatory mechanism observed to clear the swing limb
- knee wobble observed at WA
Hypertonicity of gastroc-soleus
What is the impairment if the individual has:
- excessive knee flexion during stance phases and at terminal swing
- excessive hip flexion and ankle dorsiflexion during stance phases
Hypertonicity of hamstrings
What is the impairment if the individual has:
- difficulty with swing limb advancement, particularly at preswing and initial swing
- limited knee flexion at LR, preswing, and initial swing
- limited hip flexion at LR, preswing, and initial swing
- knee wobble at LR and preswing
Hypertonicity of quadriceps
What is the impairment if the individual has:
- difficulty with terminal stance
- excessive hip flexion at terminal stance
- anterior pelvic tilt
- as the limb is unloaded during swing limb advancement, there is a jerky motion at the thigh
Hypertonicity of iliopsoas
What is the impairment if the individual has:
- greatest difficulty with swing limb advancement
- forefoot contact or a foot slap
- excessive plantarflexion during swing limb advancement (foot drop)
- compensatory strategy to clear the swing limb
Weak Tibialis anterior
What is the impairment if the individual has:
- difficulty stabilizing the limb in single limb stance
- excessive dorsiflexion along with knee flexion and hip flexion in Midstance and terminal stance
- has difficulty pushing the knee forward using plantarflexion during preswing
- excessive dorsiflexion and limited knee and hip flexion at preswing
Weak gastroc-soleus
What is the impairment if the individual has:
- greatest difficulty with loading response
- forefoot contact
- extensor thrust at loading response
- forward trunk lean
- subtle knee hyperextension at LR
- excessive knee flexion at terminal swing
Weak quadriceps
What is the impairment if the individual has:
- greatest difficulty at terminal swing
- unable to decelerate the tibia
- knee hyperextension or a past retract at terminal swing
Weak hamstrings
What is the impairment if the individual has:
- difficulty with swing limb advancement
- limited hip and knee flexion at preswing but most problematic at initial swing
- external hip rotation during swing limb advancement
- foot drag or a compensatory strategy to clear the swing limb (hip abduction or hip hiking)
Weak iliopsoas and Rectus femoris
What is the impairment if the individual has:
- greatest difficulty with swing limb advancement
- relies on abdominals to advance the swing limb
- limited hip and knee flexion throughout swing limb advancement
- hip flexion is accomplished through a past retract mechanism
- forward trunk lean and abdominals contracted at preswing
- quickly moves trunk back with abdominals active during initial swing and midswing
- trunk lean pulls pelvis into posterior tilt, pulling the thigh to a flexed position
Weak iliopsoas, rectus femoris, and adductor longus
What is the impairment if the individual has:
- greatest difficulty with WA
- forward trunk lean in WA (unilateral impairment))
- head bobbing (unilateral impairment)
- leans trunk back at WA (compensated gait pattern and bilateral impairment)
Weak gluteus Maximus
What is the impairment if the individual has:
- greatest difficulty with single limb phases
- contralateral pelvic drop
- lateral trunk lean toward the reference limb to reduce the load requirement on the impaired muscle
Weak gluteus medius
What is the impairment if the individual has:
- difficulty moving the joint into dorsiflexion and bearing weight during single limb support phases
- excessive plantarflexion during Midstance and terminal stance
- excessive hip flexion at terminal stance
- limits dorsiflexion in terminal stance
- limits time in single limb support
Ankle pain
What is the impairment if the individual has:
- difficulty with rapid knee flexion
- limited knee flexion at LR and again at preswing and initial swing
- limited hip flexion at LR and preswing
- a compensatory strategy to clear the limb will be needed at initial swing and midswing
Knee pain with knee flexion
What is the impairment if the individual has:
- difficulty with rapid knee extension
- excessive knee flexion at Midstance and terminal stance
- excessive knee flexion, excessive hip flexion, and dorsiflexion in single limb support
- shortened time in single limb support
Knee pain with knee extension
What is the impairment if the individual has:
- difficulty with hip extension, particularly in terminal stance
- excessive hip flexion at terminal stance along with limited step length and shortened time in single limb support
Hip pain
What is the impairment if the individual:
- walks with excessive variability
- frequently pre-position the limb in an extended position during stance phases to ensure a stable limb during stance
Proprioception deficits
What is the impairment if the individual:
- walks with limited head motion
- frequently avoid cervical rotational motions or cervical flexion/extension motions
- excessively large or excessively small base of support
- may have difficulty walking in a straight path
Vestibular deficits
If the individual has the inability to simultaneously control multiple DOF, what is this impairment related to?
Coordination deficits
An excessively large step width suggests that what should be examined more closely?
Time in single limb stance, as well as hip abduction during stance phases
An excessively narrow step width suggests close examination of what?
Hip adduction and amount of pelvic drop during swing limb advancement
An excessively positive foot progression angle, insufficient positive foot progression angle, or negative foot progression angle suggests close examination of what?
Foot, leg, and thigh rotation in transverse plane
A limited step length suggests close examination of what?
- Single limb stance phases such as Midstance and terminal stance
- consider amount of hip flexion and knee extension at terminal swing
Slow paced walking patterns are related to what?
Limited time in single limb support phases; therefore Midstance and terminal stance should be examined more closely
