Lecture 7 Flashcards
Normal Gait Cycle Phases
- Initial Contact
- Loading Response
- Midstance
- Terminal-stance
- Pre-swing
- Initial Swing
- Mid-swing
- Terminal Swing
Initial Contact in Gait Cycle
- Heel makes contact with the ground
- Objective: Position foot for loading & begin shock absorption
Loading Response in Gait Cycle
- Body weight is transferred onto the leg
- Shock absorption, controlled knee flexion
- Foot fully contacts the ground
Midstance in Gait Cycle
- Body weight moves directly over the supporting foot
- Contralateral leg in swing phase
- Tibia advances over stationary foot
Terminal-Stance in Gait Cycle
- Heel begins to lift off as body moves ahead of foot
- Weight shifts to forefoot
- Hip extension occurs
Pre-swing in Normal Gait Cycles
- Rapid unloading of the limb
- Toe pushes off ground
- Knee starts to flex for swing phase
Initial Swing in Gait Cycle
- Foot leaves the ground
- Hip flexion, knee flexion, and ankle dorsiflexion to clear foot
Mid-swing in Gait Cycle
- Thigh continues advancing
- Knee extends, foot clears the ground
Terminal Swing in Gait Cycle
- Knee fully extends
- Leg prepares for initial contact again
How much does walking speed decline in the elderly?
0.7% per year along with significant changes in cadence and step length
What does the aging population exhibit in their gait?
- Lower knee extension at heel-strike
- Knee flexion during swing phase
Hypokinetic-rigid Gait Disorders
- Characterized by shuffling with reduced step height and stride length
- Reduced arm swing and slow turning
- Festination: rapid, small steps to keep up with forward-leaning trunk
- Ataxic features: wide stance, variable step timing and size
- Seen in conditions like Parkinson’s, cerebrovascular disease, and ventricular enlargement
Cautious Gait
- Slow walking, wide base, short strides
- Minimal trunk movement, flexed knees and elbows
Careless Gait
- Overly fast, confident walking
- Often due to confusion or delirium in older adults
Post-Anoxic Encephalopathy Gait:
- Bouncing gait and stance
- Seen in post-anoxic states and Parkinson’s, linked to excessive trunk movement and falls
Dystonic Gait:
Toe-walking due to involuntary muscle contractions causing abnormal postures
Psychogenic Gait Disorder:
- Often caused by drug side effects
- Includes extrapyramidal symptoms, sedation, orthostatic hypotension, ataxia, and behavioral issues
Pathological Gait in Alzheimers
Pathological Gait in Parkinsons
Pathological Gait in Multiple Sclerosis
Pathological Gait in Amyotrophic Lateral Sclerosis
Pathological Gait in Huntingtons Disease
Pathological Gait in Diabetic Peripheral Neuropathy
Pathological Gait in Post-stroke
What are the stages of gait assessment?
- Observation
- Gait Cycle Breakdown
- Documentation
Observation in Gait Cycle
- Observe patient while they stand still
- Observe gait cycle as the walk from side, anterior & posterior view
- Analyze any observed gait deviations.
Gait Cycle Breakdown in Gait Assessment
Divide gait cycle into its phases and for each phase, observe:
- Joint movement
- Muscle activation
- Foot placement
Documentation in Gait Assessment
- Record all observations and abnormal findings
- Pay attention to foot wear (can contribute to abnormal gaits.
What can we think about through each gait phase?
- Muscles
- Joint movement
- Ligaments
- Hypermobility
- Hypomobility
- Quality of motion
Hemiplegic Gait
- Unilateral weakness
- Arm is flexed, internally rotated and adducted
- Affected leg makes semicircular motions
Diplegic Gait
- Debilitated involvement on both sides where lower extremities are worse
- Walks with affected toes, pulling both legs and narrow base
Neuropathic Gait
- A drop in foot (attempt to lift leg high)
Choreiform Gait
- Jerky, involuntary, irregular movements
Myopathic Gait
- Weakness in Hip Girdle muscles
- Drop contralateral side of the pelvis
Ataxic Gait
- Body of patient may drop back and forth
Parkinsonian Gait
- Suffer from bradykinesia and rigidity
- Head and neck bent down
- Knees flexed
- Upper extremity is in flexion and has extended fingers
