Impairments that interfere with walking (Ebook 3) Flashcards
Gait deviations that occur in all phases of motion demonstrate issues with what?
flexibility of the joint
gait deviations observed in almost all phases with excessive stiffness, jerk or wobble
check hypertonicity using modified ashworth
if the individual aligns the GRF so that they can rely on passive structures during stance phases what should be checked?
hypotonicity - utilizing qualitative descriptions of muscle tone
ALSO strength should be assessed
if individual has difficulty with anti-gravity motion during SLA
strength of muscles activated during SLA should be assessed
Impaired muscle activation should be checked if there is
insufficient amplitude of muscle activity; if they have difficulty moving through their entire ROM or moves excessively during the task
impaired muscle activation is confirmed using…
EMG or observation
if the individual has difficulty getting sufficient amplitude of motion during SLA or stabilizing joint during, but their strength is still intact
assess timing of muscle activation
if they have a stiff or arrhythmic pattern their _____________ should be assessed
sequencing of muscle activity; using EMG or observation
proprioception should be examined if…. using kinesthetic joint testing
- alligns the GRF to rely on passive structures during stance phases (like ankle plantarflexion and knee hyperextension) to ensure stability
- wide BOS is seen
- excessive variability of walk
vestibular function should be further examined if
- the individual has limited head motion
- wide BOS
- limited time in SLS
- poor reactive balance
- difficulty with low light
- difficulty with surface with grade and compliant surfaces
Pain should be assessed using VAS if…
- less time in SLS (especially TSt)
- limits motion during phases of high joint moment
- grimaces during walking
shortened gastroc/soleus (-15 degrees ankle dorsiflexion)
- compensates with knee hyperextension during WA and MSt to keep foot flat
- allows tibia to be posterior to vertical to maintain plantarflexion
- foot flat observed at LR, MSt and TSt
- early heel off in MSt
- SLA excessive plantarflexion + compensatory strategies to clear swing limb
compensatory strategies for a shortened gastroc
- excessive hip and knee flexion
- contralateral vault
- hip hike
- hip abduction aka circumduction
Shortened gastroc/ soleus (-30 degrees of ankle dorsiflexion)
- heel off through all stance phases
- SLA - excessive plantarflexion + compensatory strategy to clear SL
- forefoot contact will be observed
- excessive plantarflexion through all phases of gait
shortened hamstring + popliteal angle of >45 degrees
- lacks extension
- walk with excessive hip and knee flexion during stance phases (except PSw)
- TSw puts hamstrings in max stretch–> difficult for this person
shortened iliopsoas with Thomas test >10 degrees
- lacks hip extension
- walks with excessive hip flexion, knee flexion, and dorsiflexion during all stance phases
- anterior pelvic tilit
- TSt puts iliopsoas in stretch = problematic
hypertonicity of gastroc-soleus
- excessive plantarflexion through gait pattern
- compensatory mechanism observed to clear swing limb
- knee wobble may be observed at WA
hypertonicity of hamstrings
- excessive knee flexion during stance phases and at TSw
- excessive hip flexion and ankle dorsiflexion during stance phases
hypertonicity of quads
- difficulty with SLA (PSw and ISw)
- limited knee flexion at LR, PSw, and ISw
- limited hip flexion at LR, PSw, and ISw
- knee wobble at LR and PSw
hypertonicity of iliopsoas
- difficulty with TSt
- excessive hip flexion at TSt
- anterior pelvic tilt
- limb is unloaded during SLA (jerky motion may be observed at the thigh)
weak TA
- greatest difficulty with SLA
- forefoot contact or foot slap
- excessive plantarflexion during SLA + compensatory strategy (hip hike, contralateral vault, knee flexion, hip circumduction)
weak gastroc/soleus
- difficulty stabilizing the limb during SLS
- excessive dorsiflexion + knee flexion and hip flexiion at MSt and TSt
- PSw difficulty pushing knee forward using plantarflexion - excessive dorsi and limited knee and hip flexion
weak quads
- greatest difficulty with LR
- WA individual may have forefoot contact, enables extensor thrust at LR to keep GRF in front of the knee and decrease load on quads
- forward trunk lean at TSw
- knee hyperextension at LR
weak hamstrings
- difficulty with TSw (not able to decelerate tibia resulting in knee hyperextension or past retract)
weak iliopsoas and rectus femoris
- difficulty with SLA
- limited hip and knee flexion at PSw (most problematic at ISw)
- external hip rotation observed during SLA
- foot drag or compensatory strategy to clear SL (hip abduction or hip hiking)
weak iliopsoas, rectus, and adductor longus
- diffuclty with SLA
- rely on abs to advance SL
- limited hip and knee flexion through SLA
- hip flexion accomplished through past retract
- PSw forward trunk lean and abdominals contracted
- ISw and MSw quickly moves trunk back with abs active
- posterior tilt of pelvis and thigh flexed
weak glut max
- difficulty with WA
- compensated patterns: leans trunk back during WA phases (aligns GRF behind hip at WA and reduces load on glut max)
small strength impairment with glut max
- forward trunk lean in WA of reference limb
- creates head bobbing motion
- moves into compensated glut max pattern
significant glute max weakness
compensatory backward trunk lean gait pattern
weak glute med
- difficulty with SLS
- contralateral drop with small impairment
- substantial weakness= lateral trunk lean to reduce load
ankle pain
- difficulty moving into joint dorsiflexion and weight bearing in SLS
- excessive plantarflexion at MSt and TSt
- excessive hip flexion at TSt (individual limits dorsiflexion in TSt and time in SLS)
knee pain with flexion
- pain with knee flexion = limited flexion at LR and PSw/ISw
- limited hip and knee flexion at LR and PSw
- compensatory strategy needed at ISw and MSw
knee pain with extension
- excessive knee flexion at MSt and TSt
- excessive hip flexion and dorsiflexion at SLS
- shortened time in SLS noted
hip pain
- difficulty with extension at TSt
- excessive hip flexion at TSt with limited step length and shortened time in SLS common for individuals with hip pain
proprioception deficits
- walk with excessive variability
- pre-position limb in extended position during stance phases
- excessive plantarflexion and knee extension to ensure stable limb stance
vestibular deficits
- limited head motion
- avoid cervical rotational motions or cervical flexion/extension motoins
- excessively small or large BOS
- difficulty walking in straight path
inability to control multiple DOF
related to coordination deficits
excessively large step width
time in SLS and hip abduction during stance phases should be examined
excessively narrow step width
hip adduction and the amount of pelvic drop during SLA should be examined
problems with foot progressions ankle
check foot, leg and thigh rotation in transverse plane (position of patella relative to foot angle should be noted as well)
limited step length
SLS like midstance and terminal stance should be examined closely
- consider hip flexion and knee extension at TSw
slow pace
- limited time in SLS phases
- MSt and TSt should be examined closer
if heel off occurs in all stance phases consider…
heel pain
forefoot contact + excess plantarflexion in SLA
weak TA, poor activation or timing of TA, impaired sequencing between TA and gastroc-soleus
forefoot + knee hyperextension during WA
weak quads
forefoot contact + excess plantarflexion in all phases
consider shortened gastroc
excess plantarflexion during all phases + knee wobble + forefoot contact
hypertonicity of gastroc soleus
if foot slap occurs and is audible
consider weak TA
foot flat contact + excess plantarflexion during SLA
weak TA, poor activation, impaired sequencing
knee hyperextension during WA + foot flat contact
weak quads
excess plantarflexion during all phases + foot flat contact
shortened gastroc
excess plantarflexion during all phases + knee wobble + foot flat
hypertonicity of gastroc-soleus
with excessive variability and locking knee and hip in extension + excess plantarflexion
consider impaired proprioception
weak gastroc soleus if…
excessive dorsiflexion occurs during SLS phases with hip and knee flexion
shortened hamstrings or iliopsoas if…
excessive dorsiflexion occurs during all stance phases along with excessive hip and knee flexion
