Lecture 58 - Gait 2

Question 1

What are 3 age related changes that affect gait

Answer 1

1. Changes in sensory (eg. fine touch, proprioception), visual (eg. acuity, brightness sensitivity), and auditory (eg. reduced awareness of environment) processing
2. Changes in motor
   - Decreased conduction velocity = reaction to balance changes
   -Peri-articular connective tissue stiffness = accommodation to uneven surface
   -Decreased muscle fibers = decrease in strength
3. Changes in CNS
   -Loss of brain cells = increased central processing limitations
   - Altered neurotransmitter production = altered movement patterns

Question 2

What are 6 typical gait parameter changes in older adults

Answer 2

1. Decreased gait velocity (normal gait until 70 years old and 15% decline in gait per decade)
2. Cadence doesnt change but stride length decreases = decreased gait speed
3. Decreased step/stride length
4. Increased stance time and double-limb support time
5. Increased gait variability (unstable gate pattern)
6. Decreased excursion/ROM of hip, knee, ankle

Question 3

T or F: Healthy people can increase their gait speed as they age

Answer 3

T

Question 4

What are 6 vital signs (which ones are classic)

Answer 4

1. HR (classic)
2. Respiration (classic)
3. Temperature (classic)
4. Blood Pressure (classic)
5. Pain
6. Gait velocity

Question 5

What are 2 assumptions on gait speed

Answer 5

1. Individuals have a self-selected (comfortable ) walking speed (most energy efficient and minimized metabolic cost)
2. Individuals have the ability to increase walking speed (have functional reserve and they can meet changing demands of activity and environment

Question 6

Why is walking speed considered a vital sign (compare vital sign to walking speed)

Answer 6

Question 7

What 4 outcomes can walking speed be used for as a functional vital sign

Answer 7

Question 8

Can walking speed stand alone as the only predictor of functional abilities?

Answer 8

No, just as blood pressure cant for heart disease. It is instead used as a general indicator to predict future events and reflect on underlying physiological processes

Question 9

T or F: Walking speed is not predicitive

Answer 9

F, it is

Question 10

Can walking speed determine your dependence on ADL’s and IDL’s?

Answer 10

Yes, the slower the walk speed the more dependency you need and the less tasks you can perform

Question 11

What are some areas to address in rehabilitation to improve walking speed if abnormal?

Answer 11

Question 12

What settings can walking speed be assessed in? and is it easy and accurate to assess?

Answer 12

Question 13

Compare gaining 0.1 m/s vs losing 0.1 m/s in walk speed on health status?

Answer 13

Question 14

Is this a meaningful change

Answer 14

Yes, it is a meaningful change as she increased her walk speed by 0.23 m/s following a stroke.

Question 15

What are 5 important concepts to consider when interpreting walk speed

Answer 15

1. The absolute value
2. Change in functional status
3. Change in mobility aid use
4. Use of rollator walking aids limits detections of initial gait and motor deficits which reduces responsiveness of test (if full-weight bearing DO NOT use walking aid)
5. The values needed to meet physical demands that require the individual to be independent or return to previous living situation

Question 16

List 5 pathological mechanisms that impact walking

Answer 16

1. Deformity
2. Muscle weakness
3. Sensory loss
4. Pain
5. Impaired central motor control

Question 17

Deformity

Answer 17

Tissues do not allow sufficient passive mobility and the person cannot attain normal postures and ROM. It could be caused by contracture (most common), abnormal joint clusters, or congenital disorders (eg. club foot)

Question 18

Muscle Weakness

Answer 18

Insufficient muscle strength to meet demands of walking caused by disuse (reduced activity from aging or surgery), muscle atrophy (neurologic compromise), or neurological impairment (CNS such as stroke or MS)

Question 19

Sensory Loss

Answer 19

Impaired proprioception and sensation due to dorsal column lemniscus dysfunction or sensory neuropathy (dont know exact position of hip, knee, ankle or foot and type of contact with floor)

Question 20

If there is sensory loss what happens if the motor neurons are intact vs impaired

Answer 20

Intact: Substitutions are utilized (eg. lock knee causing increased load in initial contact)

Impaired: Substitutions are hindered resulting in slow cautious gait and compensation for proprioception deficits with vision

Question 21

What are the problems with sensory assessments

Answer 21

They are limited and insensitive

Question 22

Pain (normal vs abnormal forces)

Answer 22

OA: Osteoarthritis

Question 23

Impaired Central motor control

Answer 23

Lesion to CNS (eg. stroke or MS) resulting in gait deficits such as muscle weakness, impaired sensory feedback, use of primitive locomotor patterns, and spasticity

Question 24

What are 7 examples of pathological gait

Answer 24

Question 25

Describe Trendelenburg gait (weakness)

Answer 25

OA = osteoarthritis

Question 26

Describe antalgic gait (painful gait)

Answer 26

OA = osteoarthritis

Question 27

Describe Parkinsonian Gait (impaired motor control)

Answer 27

Question 28

Describe cerebellar ataxic gait (impaired motor control)

Answer 28

Question 29

Describe frontal gait disorder (impaired motor control)

Answer 29

Question 30

Describe steppage gait (weakness)

Answer 30

Question 31

Describe psychogenic gait (atasia-abasia)

Answer 31