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KINES II Midterm > Impairments that interfere with walking (Ebook 3) > Flashcards

Impairments that interfere with walking (Ebook 3) Flashcards

1
Q

Gait deviations that occur in all phases of motion demonstrate issues with what?

A

flexibility of the joint

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2
Q

gait deviations observed in almost all phases with excessive stiffness, jerk or wobble

A

check hypertonicity using modified ashworth

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3
Q

if the individual aligns the GRF so that they can rely on passive structures during stance phases what should be checked?

A

hypotonicity - utilizing qualitative descriptions of muscle tone
ALSO strength should be assessed

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4
Q

if individual has difficulty with anti-gravity motion during SLA

A

strength of muscles activated during SLA should be assessed

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5
Q

Impaired muscle activation should be checked if there is

A

insufficient amplitude of muscle activity; if they have difficulty moving through their entire ROM or moves excessively during the task

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6
Q

impaired muscle activation is confirmed using…

A

EMG or observation

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7
Q

if the individual has difficulty getting sufficient amplitude of motion during SLA or stabilizing joint during, but their strength is still intact

A

assess timing of muscle activation

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8
Q

if they have a stiff or arrhythmic pattern their _____________ should be assessed

A

sequencing of muscle activity; using EMG or observation

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9
Q

proprioception should be examined if…. using kinesthetic joint testing

A
  • 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
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10
Q

vestibular function should be further examined if

A
  • 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
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11
Q

Pain should be assessed using VAS if…

A
  • less time in SLS (especially TSt)
  • limits motion during phases of high joint moment
  • grimaces during walking
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12
Q

shortened gastroc/soleus (-15 degrees ankle dorsiflexion)

A
  • 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
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13
Q

compensatory strategies for a shortened gastroc

A
  • excessive hip and knee flexion
  • contralateral vault
  • hip hike
  • hip abduction aka circumduction
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14
Q

Shortened gastroc/ soleus (-30 degrees of ankle dorsiflexion)

A
  • 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
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15
Q

shortened hamstring + popliteal angle of >45 degrees

A
  • lacks extension
  • walk with excessive hip and knee flexion during stance phases (except PSw)
  • TSw puts hamstrings in max stretch–> difficult for this person
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16
Q

shortened iliopsoas with Thomas test >10 degrees

A
  • 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
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17
Q

hypertonicity of gastroc-soleus

A
  • excessive plantarflexion through gait pattern
  • compensatory mechanism observed to clear swing limb
  • knee wobble may be observed at WA
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18
Q

hypertonicity of hamstrings

A
  • excessive knee flexion during stance phases and at TSw

- excessive hip flexion and ankle dorsiflexion during stance phases

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19
Q

hypertonicity of quads

A
  • 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
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20
Q

hypertonicity of iliopsoas

A
  • difficulty with TSt
  • excessive hip flexion at TSt
  • anterior pelvic tilt
  • limb is unloaded during SLA (jerky motion may be observed at the thigh)
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21
Q

weak TA

A
  • greatest difficulty with SLA
  • forefoot contact or foot slap
  • excessive plantarflexion during SLA + compensatory strategy (hip hike, contralateral vault, knee flexion, hip circumduction)
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22
Q

weak gastroc/soleus

A
  • 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
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23
Q

weak quads

A
  • 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
24
Q

weak hamstrings

A
  • difficulty with TSw (not able to decelerate tibia resulting in knee hyperextension or past retract)
25
Q

weak iliopsoas and rectus femoris

A
  • 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)
26
Q

weak iliopsoas, rectus, and adductor longus

A
  • 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
27
Q

weak glut max

A
  • difficulty with WA

- compensated patterns: leans trunk back during WA phases (aligns GRF behind hip at WA and reduces load on glut max)

28
Q

small strength impairment with glut max

A
  • forward trunk lean in WA of reference limb
  • creates head bobbing motion
  • moves into compensated glut max pattern
29
Q

significant glute max weakness

A

compensatory backward trunk lean gait pattern

30
Q

weak glute med

A
  • difficulty with SLS
  • contralateral drop with small impairment
  • substantial weakness= lateral trunk lean to reduce load
31
Q

ankle pain

A
  • 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)
32
Q

knee pain with flexion

A
  • 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
33
Q

knee pain with extension

A
  • excessive knee flexion at MSt and TSt
  • excessive hip flexion and dorsiflexion at SLS
  • shortened time in SLS noted
34
Q

hip pain

A
  • 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

35
Q

proprioception deficits

A
  • walk with excessive variability
  • pre-position limb in extended position during stance phases
  • excessive plantarflexion and knee extension to ensure stable limb stance
36
Q

vestibular deficits

A
  • limited head motion
  • avoid cervical rotational motions or cervical flexion/extension motoins
  • excessively small or large BOS
  • difficulty walking in straight path
37
Q

inability to control multiple DOF

A

related to coordination deficits

38
Q

excessively large step width

A

time in SLS and hip abduction during stance phases should be examined

39
Q

excessively narrow step width

A

hip adduction and the amount of pelvic drop during SLA should be examined

40
Q

problems with foot progressions ankle

A

check foot, leg and thigh rotation in transverse plane (position of patella relative to foot angle should be noted as well)

41
Q

limited step length

A

SLS like midstance and terminal stance should be examined closely
- consider hip flexion and knee extension at TSw

42
Q

slow pace

A
  • limited time in SLS phases

- MSt and TSt should be examined closer

43
Q

if heel off occurs in all stance phases consider…

A

heel pain

44
Q

forefoot contact + excess plantarflexion in SLA

A

weak TA, poor activation or timing of TA, impaired sequencing between TA and gastroc-soleus

45
Q

forefoot + knee hyperextension during WA

A

weak quads

46
Q

forefoot contact + excess plantarflexion in all phases

A

consider shortened gastroc

47
Q

excess plantarflexion during all phases + knee wobble + forefoot contact

A

hypertonicity of gastroc soleus

48
Q

if foot slap occurs and is audible

A

consider weak TA

49
Q

foot flat contact + excess plantarflexion during SLA

A

weak TA, poor activation, impaired sequencing

50
Q

knee hyperextension during WA + foot flat contact

A

weak quads

51
Q

excess plantarflexion during all phases + foot flat contact

A

shortened gastroc

52
Q

excess plantarflexion during all phases + knee wobble + foot flat

A

hypertonicity of gastroc-soleus

53
Q

with excessive variability and locking knee and hip in extension + excess plantarflexion

A

consider impaired proprioception

54
Q

weak gastroc soleus if…

A

excessive dorsiflexion occurs during SLS phases with hip and knee flexion

55
Q

shortened hamstrings or iliopsoas if…

A

excessive dorsiflexion occurs during all stance phases along with excessive hip and knee flexion

KINES II Midterm (1 decks)

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