Lecture 21: Age-Related changes to gait

Question 1

Four Locomotor functions of gait

Answer 1

1) Shock absorption
2) Stance stability
3) Propulsion
4) Energy conservation

Question 2

Muscle activity when loading the stance extremity. What absorbs shock when loading the joint

Answer 2

Shock absorption

Question 3

Determined by ground reaction force vectors (GRFVs), ligament and joint support, and muscle activity

Answer 3

Stance stability

Question 4

Forward, push off, momentum from swing

Answer 4

Propulsion
* mainly comes from the momentum from swing phase

Question 5

Thought to be maximized by selective muscle recruitment and the determinants of gait

Answer 5

Energy conservation

Question 6

Question 7

Beginning of stance when heel or some other portion of foot contacts ground. Component of initial double limb stance

Answer 7

Inital contact

Question 8

Body weight rapidly loads onto lead limb from trailing limb. Hip remains stable, knee flexes to absorb shockm and forefoot lowers to ground. Immediately follows inital contact and is final component of intital double limb stance. Ends when opposite limb lifts from ground for swing

Answer 8

Loading response

Question 9

Turnk progresses from behind to in front of ankle over single stable limb. First half of single limb support. Starts when contrlatearl foot lifts from ground for swing

Answer 9

Mid stance

Question 10

Trunk continues forward progression relative to foot. Heel rises from ground and limb achives trailing limb posture. Second half of single limb support. Ends with contraltaeral intital contarct

Answer 10

Terminal stance

Question 11

Body weight rapidly unloads from reference limb and reference limb prepares for swing during this terminal double limb stance period. Starts with contralatearl inital contact and ends at ipsilatearl limb toe off

Answer 11

Pre swing

Question 12

Starts when reference foot lifts from ground. Hip knee and ankle rapidly flex for clearance and advancement during this itital 1/3 of swing

Answer 12

Itital swing

Question 13

Thigh continues advancing, knee begins to extend, and ankle achieves neutral posture during this middle 1/3 of swing

Answer 13

mid swing

Question 14

During this final 1/3 of swing, knee achieves max extension and ankle remains at neutral in preparation for heel first intital contact. Ends when foot contacts ground

Answer 14

Terminal swing

Question 15

What two times does weight acceptance happen during a noraml gait cycle?

Answer 15

Inital contact
Loading response

Question 16

Single limb support happens during what two times in gait

Answer 16

Mid and terminal stance

Question 17

Stance phase is made up of what two thigns

Answer 17

Weight acceptance

Single limb support

Question 18

Swing phase is limb advancement made up of what 4 things

Answer 18

1) Preswing
2) Initial swing
3) Mid swing
4) Terminal swing

Question 19

Question 20

Answer 20

Question 21

Stance phase is what % of the gait cycle?

Answer 21

60

Question 22

Swing phase is what percent of gait cycle?

Answer 22

40%

Question 23

The moment when the foot contacts the ground
* stance phase or swing phase

Answer 23

Initial contact
* Stance phase

Question 24

When weight is rapidly transferred onto the stance limb. This is the first period of double support
* stance or swing phase

Answer 24

Loading repsonse

Stance

Question 25

When body progresses over a single, stable limb
* stance phase or swing phase?

Answer 25

Mid stance
* stance phase

Question 26

Progression over the stance limb continues. The bod moves ahead of the limb, and weight is transferred onto the forefoot
* stance or swing phase

Answer 26

Terminal stance
* stance

Question 27

A praid unloading of the stance limb occurs as weight is transgerred onto the contralateral limb
* stance or swing

Answer 27

Pre swing

swing

this is the second period of double limb support

Question 28

The thigh begins to advance as the foot comes up off the floor
* stance or swing

Answer 28

Initial swing
* swing

Question 29

The thigh continues to advance as the knee begins to extend and the foot clears the ground in forward progression
* stance or swing

Answer 29

Mid swing

swing

Question 30

The knee extends; the limb prepares to contact the ground for initial contact
* stance or swing

Answer 30

Terminal swing
* swing

Question 31

PT’s
* Clear an older adult for safe discharge
* Assess mobiltiy concerns

Safe ambulation requires:
* The ability to appropriately and sometimes quickly accelerate and decelerate
* engage proactive and reactive balance control mechanisms
* Address myriad different environment and specific task demands

Question 32

Criteria for frality

Answer 32

1) Unintentional weight loss of 10 lbs or more in the last year
2) Self reported exhaustion (3 ot more days)
3) Grip strength in lowest 20% (<23 lbs women, <32 men)
4) walking speed <0.8 m/s
5) Low level activity
* 270 kcal/wk women
* 383 kcal/wk men
* equivalent to sitting quitelt or lying down for majority of the day

need 3/5 = frail

Prefrality is presence of one or two of these characteristics

Question 33

Reactive balance:
* think tripping and having to react

Proactive:
* inticipatory
* see something thats going to be in way and alter your path - proactively adjust

NOTE: You really need both to ambulate sucessfully

Question 34

gait speed has ben termed a functional vital sign
* usually a 20m pathway with a central 10m marked (because it takes time to speed up and slwo down)

standard goal for gait used to be 150 meters
* not used anymore
* medicare issues
* if they can walk this far they wont get them in kind of assitive device

Question 35

what gait speed is needed to cross interactions?

Answer 35

0.21 - 0.89 m/s

mean = 0.49 m/s

Question 36

what is the goal when presciribing an assitive device?

Answer 36

Least assitive restrictive device
* dont get them a wheel chair when all they need is a cain

Question 37

PT is responsible for prescription of assistive devices
* Instruction and practice
* energy consumption
* Some individuals may need some convincing

Question 38

Typical changes with aging

Sensory:
* Visual and auditory changes
* Diminished input from somatosensory, proprioceptive, and vestibular systems

Motor:
* decreased motor neuron conduction velocity
* Decreased motor fibers
* Connective tissue stiffness - think about myofibirils decreasing

Central NS:
* Decreased reaction time
* Motor learning deficits

Question 39

Typical gait changes

1) increased stance time, wider BOS

Decreased forward prpulsion, because we have decreased step length

decreases ROM and the sagittal plane except hip flexion - due to froward lean / you lose hip strategy so need more hip flexion

Question 40

NOTE: Decreased gait speed jas preceded cognitive decline and dementia

Depressive symptoms decrease gait speed

Neural plasticity and activity based interventions

Question 41

typical gait in older adults

decreased step length = increased cardience

more steps you take = more ability to fall

increased variability of gait - will be fast and slow
* need to make sure older adults can sustain speeds (think 6 minute walk test)

decreased excursion of movement at lower extremity joints EXCEPT HIP FLEXION WHICH IS INCREASED

decreased ankle startaegy

Question 42

community mobility requirements

gait speed 0.8+

Question 43

Question 44

Question 45

Question 46