Lecutre 7: Gait Analysis , Common Examples Of Patholigc Gait And Rotational Profile Flashcards
1
Q
- A 15-year-old patient is demonstrating a right compensated Trendelenburg gait pattern.
- Which hip abductor is weak?
- Which direction is the lateral trunk flexion?
- Which hemipelvis will drop?
A
left
left
right
named after the side the pelvis is dropping
2
Q
What are the 2 planes that are easiest to see in gait analysis
A
Sagittal and coronal
3
Q
What view is the sagittal and coronal
A
Side
Front
4
Q
What percent is swing phase and stance phase
A
40%
60%
5
Q
When is there double limb support in gait
A
Loading response and pre swing
6
Q
What are the 5 attributes of ambulation
A
- Stability in Stance
- Foot Clearance in Swing
- Pre-positioning of the foot for initial contact
- Adequate Step length
- Energy Conservation
7
Q
What and when is the first rocker
A
Heel rocker
IC to LR
8
Q
What and when is the 2nd rocker
A
Ankle rocker
Midstance
9
Q
What and when is the 3rd rocker
A
Forefoot rocker
Heel rise (terminal stance)
10
Q
What and when is the 4th rocker
A
Toe rocker
Pre swing
11
Q
What plane is excessive trunk motion seen in
A
Coronal (frontal)
12
Q
What can excessive adduction in gait be caused by
A
Adductor tightness and/or abductor weakness
13
Q
What is malrotation
A
Excessive internal hip rotation
14
Q
Anteversion causes excessive hip __
A
IR
15
Q
Often in CP what is usually over active relative to their antagonist
A
HF
ADDuctors
IR
16
Q
Inadequate power generation caused by mm imbalance can result in what
A
Compensatory movements or coping responses
17
Q
What may compensate for the muscular imbalance around the hip
A
Weight shifts of the upper body
18
Q
If a patient has L glute med weakness what way will the pelvis drop and what way will they trunk lean
A
R and L
19
Q
Hip circumduction can be from inadequate …..
A
HF and/or KF
Excessive IR
Ankle PF
20
Q
Stance phase knee deviation errors are usually from what
A
Abnormal position, malrotation or both
21
Q
Swing phase knee deviation errors are usually from what
A
Inadequate ROM and/or weaknesss
22
Q
What can be the cause if patient has decreased dynamic knee flexion during mid swing
A
Excessive knee flexion
23
Q
What are one of the most common stance phase knee deviations
A
Excessive knee flexion
24
Q
Where does knee flexion drive the ground force reaction
A
Posteriorly
25
If ther is **excessive knee flexion** in **stance** what does this **increased** demand on
The quads and hip extensors —> increased energy expenditure
26
What is the **most common** **knee deviations** in **swing** phase
Decreased knee flexion
27
What do children with CP often use to augment hip flexion
Rectus fempris —> 2 joint mm flex’s the hip and extends the knee
28
Since teh rectus femoris also functions as a knee extensors when there is decreased knee flexion during swing what does it result in
Stiff knee gait pattern
29
What is **stiff knee gait pattern**
Inadequate knee flexion during midswing
30
Is stiff knee gait a swing or stance phase deficit
Swing
31
What are the 3 major categories of foot/ankle deviations
• Excessive plantar flexion
• Excessive dorsiflexion
• Bony Deformity: malrotation
32
What does **excessive PF** during **stance** phase affect primarily
IC and midstance —> disrupts 1st rocker (heel rocker)
33
Are are the consequences of **excessive PF in stance**
Loss of forward progession , shortened step length, loss of stance phase stability
34
If there is **increased PF** at IC what ankle rocker is lost
1st
35
what is the **Most common stance phase** errors at the ankle caused by **excessive PF**
excessive PF knee extension couple
36
In typical gait, during second rocker the ground
reaction force falls in ___ of the ___ and in
___ of the ankle creating knee extension and
ankle DF
Front of the knee
Front
37
The **PF knee extension force couple** , first stabilizes where and then later where
Knee and later the hip
38
If there is excessive plantar flexion at IC then what rocker is absent
First
39
**Knee hyperextension** in **midstance** is often caused by what
PF tightness
40
What goes with **crouch gait**
Excessive DF
41
If someone has a weak soleus , due to over activity of hip flexors and hamstrings what will happen at the foot and what will it result in
Foot will DF excessively and a crouch gait will result
42
In a typical gait what does teh soleus act to do
Assist in knee extension by stopping the forward progression of the tibia and moving the GRF in front of the knee
43
What is present with a **calcaneal gait**
Excessive DF
44
What is excessive with **crouch gait with a calcaneal gait**
Hip flexion
Knee flexion
Dorsiflexion
45
There is an increased demand on what mm during crouch gait
Quads
46
Where is the GRF during crouch gait at the knee, hip and ankle
Behind the knee , in front of the hip and ankle , causing a flexion moment
47
What can malrotation of the foot be caused by
Varus or valgus foot deformities
48
There will be ___ phase ___ with **malrotation** of the foot
Stance
Instability
49
What is the **malrotation** of the foot for a **hemiplegic CP**
Over activity of the post TiB and gastroc —> puts foot and ankle in equinovarus position (calcaneal inversion)
50
What is the malrotation of the foot for a **diplegia CP**
Over activity of the peronus brevis and gastroc —> puts foot and ankle in an equinovalgus position (calcaneal eversion)
51
What will happen during **swing** if there is **excessive PF**
Foot drop , toe drag
52
What is the **foot progression angle**
Have patient walk and see where their feet are positioned
normal is ER of 0-10°
**never IR**
53
What kind of **dysfunction** can be the source of many gait deviations in **CP**
Lever arm dysfucntion
54
What are th 4 levers arm dysfucntion types
1). Malrotation
2). Loss of Stable Fulcrum
3). Loss of bony rigidity
4). Shortening of the lever arm
55
During **malrotation** what is impaired or lost
Power and movement generation
56
Does internal or external rotation cause out toeing
External
57
**Hip subluxation** results in the loss of what
Stable fulcrum bc the femoral head is not completely covered by the acetablum
58
When u lose a stable fulcrum , there is poor ___ mm control
Abductor
59
What is a **loss of bony rigidity**
Pes valgus foot (pronated)
60
What is **pes planovalgus**
Subluxation of talus on calcaneus
61
What is **coxa brevia**
True shortening of the neck of the femur
62
What is **coxa valga**
The neck shaft angle of the femus is increased
63
Coxa brevia and coxa valga result in ____ in the distance to the center of the hip joint
Reduction
64
What is the **6** measurements of the **rotational profile**
* Foot Progression Angle
* Medial and Lateral Hip
rotation
* Ryder’s Test – test for
hip anteversion
* Thigh-foot Angle
* Transmalleolar axis-
thigh angle
* Foot Configuration
65
What is the normla IR and ER of the hip
45-50°
66
What does ryders test look at
Hip anteversion
67
Should thigh foot angle be IR or ER
Always ER
68
With **anteversion** how does teh Q angle change
Increases … >20°
69
With **retroversion** how does teh Q angle change
Decreased (<15°)
70
Anteversion is femur ___ rotation
Retroversion is femur ___ rotation
IR
ER
71
What is a squinting patella
When the patella is moved medially
72
What has become the **standard of care** to objectively measure and diagnose the primary gait abnormalities in **CP**
Motion analysis
73
What plane does the motion analysis really see
Transverse plane
74
What is the difference between the kinematic and kinetic for motion analysis
Kinematics is the ROM
Kinetic is the force plat giving us info from ground reaction force plates
75
In the **frontal** plane what are the 2 joint motions we can see
Pelvic obliquity
Hip abduction/adduction
76
In the **sagittal** plane what are the 4 joint motions we can see
* pelvic tilt
* hip flexion/extension
* knee flexion/extension
* DF/PF
77
In the **transverse** plane what are the 2 joint motions we can see
Pelvic rotation
Hip rotation
78
Is IR of the foot progression okay
No never ,
79
What is • A method derived to calculate the amount a subject’s gait deviates from an average normal profile, and to represent this deviation as a single number
Gait deviation index (GDI)
80
What is a typical gait deviation index
100 and a SD of 10
81
What is a big joint issue in people with UMN issues
2 joint muscles (hammy , gastroc and rectus fem)
82
Foot clearance in swing can be challenged by what 3 things
• Inadequate hip motion, and/or
• Inadequate knee motion, and/or
• Insufficient ankle DF
83
What is the key to efficient gait
Energy conservation
84
What does **controlling forward momentum** occur by
Eccentric contraction of the soleus during midstance
85
If someone develops a PF contracture from anterior TiB weakness what kind of impairment is that
Secondary bc the primary impairment is weal ant TiB
86
What is a standardized assessment tool used to measures a persons ability to walk and perform daily activities
Functional assessment questionnaire
87
What questionnaire covers several domains including gait function, mobility, activities of daily living, pain, physical activities, appearance,
use of assistive devices, and self-esteem
Goal outcomes assessment list
88
What questionnaire covers several domains including gait function, mobility, activities of daily living, pain, physical activities, appearance,
use of assistive devices, and self-esteem
