Lecture 58 - Gait 2 Flashcards
What are 3 age related changes that affect gait
- Changes in sensory (eg. fine touch, proprioception), visual (eg. acuity, brightness sensitivity), and auditory (eg. reduced awareness of environment) processing
- 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 - Changes in CNS
-Loss of brain cells = increased central processing limitations
- Altered neurotransmitter production = altered movement patterns
What are 6 typical gait parameter changes in older adults
- Decreased gait velocity (normal gait until 70 years old and 15% decline in gait per decade)
- Cadence doesnt change but stride length decreases = decreased gait speed
- Decreased step/stride length
- Increased stance time and double-limb support time
- Increased gait variability (unstable gate pattern)
- Decreased excursion/ROM of hip, knee, ankle
T or F: Healthy people can increase their gait speed as they age
T
What are 6 vital signs (which ones are classic)
- HR (classic)
- Respiration (classic)
- Temperature (classic)
- Blood Pressure (classic)
- Pain
- Gait velocity
What are 2 assumptions on gait speed
- Individuals have a self-selected (comfortable ) walking speed (most energy efficient and minimized metabolic cost)
- Individuals have the ability to increase walking speed (have functional reserve and they can meet changing demands of activity and environment
Why is walking speed considered a vital sign (compare vital sign to walking speed)
What 4 outcomes can walking speed be used for as a functional vital sign
Can walking speed stand alone as the only predictor of functional abilities?
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
T or F: Walking speed is not predicitive
F, it is
Can walking speed determine your dependence on ADL’s and IDL’s?
Yes, the slower the walk speed the more dependency you need and the less tasks you can perform
What are some areas to address in rehabilitation to improve walking speed if abnormal?
What settings can walking speed be assessed in? and is it easy and accurate to assess?
Compare gaining 0.1 m/s vs losing 0.1 m/s in walk speed on health status?
Is this a meaningful change
Yes, it is a meaningful change as she increased her walk speed by 0.23 m/s following a stroke.
What are 5 important concepts to consider when interpreting walk speed
- The absolute value
- Change in functional status
- Change in mobility aid use
- 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)
- The values needed to meet physical demands that require the individual to be independent or return to previous living situation
List 5 pathological mechanisms that impact walking
- Deformity
- Muscle weakness
- Sensory loss
- Pain
- Impaired central motor control
Deformity
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)
Muscle Weakness
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)
Sensory Loss
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)
If there is sensory loss what happens if the motor neurons are intact vs impaired
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
What are the problems with sensory assessments
They are limited and insensitive
Pain (normal vs abnormal forces)
OA: Osteoarthritis
Impaired Central motor control
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
What are 7 examples of pathological gait
Describe Trendelenburg gait (weakness)
OA = osteoarthritis
Describe antalgic gait (painful gait)
OA = osteoarthritis
Describe Parkinsonian Gait (impaired motor control)
Describe cerebellar ataxic gait (impaired motor control)
Describe frontal gait disorder (impaired motor control)
Describe steppage gait (weakness)
Describe psychogenic gait (atasia-abasia)
