Neural Control Of Gait Flashcards
Common gait problems
Antalgic gait
Lateral trunk flexion on stance - Trendelenburg
Functional leg-length discrepancy - hip hiking/ hitching/ circumduction on swing
Increased base of support/ wide base walk
Inadequate dorsiflexion/ footdrop/ lack of heel strike
Excessive knee extension/ hyperextension in stance
Increased lateral weight shift
Antalgic gait
Reduced weight bearing/ time spent on affected leg
Stance phase shortened in affected side
Corresponding increase in stance on unaffected side
Lateral trunk flexion
Trunk lean towards stance leg
Shifts centre of gravity nearer to fulcrum of stance hip
Unilateral
Bilateral - waddling gait
Due to - hip abductor weakness painful hip or leg-length discrepancy
Functional leg discrepancy
Swing leg appears/ functionally longer than stance leg
Result of reduced active or passive range of movement at the hip, knee or ankle
Common compensations - circumduction, hip hitching/hiking
Increased base of support/ wide base walk
Normal walking base - 5 to 10 cm
Common neurological causes - instability, cerebrallar ataxia, Proprioception deficits, vestibular deficits, reduced balance
Inadequate dorsiflexion/ footdrop/ lack of heel strike
Stance phase - foot slap
Swing phase - toe drag or tipping
Potential causes - weak tibialis anterior, increased tone in plantar flexors (neural), contracture/ decreased length in plantar flexors
Excessive knee extension/ hyperextension in stance
Common causes - increased tone in quadriceps, weakness in inner range of quadriceps, weak end of range hamstrings
Increased lateral weight shift
Unable to stabilise medially and therefore unable to control weight transfer during weight acceptance on stance leg
Occur to both affected and less affected side
Common hemiplegic gait problems: stance
Decreased time in stance
Reduced peak hip extension
Reduced lateral displacement of pelvis
Knee hyperextension
Increased knee flexion
Reduced plantar flexion for toe off
Common hemiplegic gait problems: swing
Prolonged swing
Reduced peak hip flexion
Reduced knee flexion - early swing
Reduced knee extension - late swing
Reduced dorsiflexion
Implications
Decreased walking speed and step length (cadence) - correlates with increased fall risk, lower survival rate and quality of life
Reduced endurance
Measuring gait capacity
Speed
Endurance
Independence
Measuring gait capacity: speed
10m walk test
Normal and fastest walking speed
Time to complete - temporal
Number of steps - spatial
Steps per minutes - cadence
Measuring gait capacity: endurance
2, 6, 12 minute walk test
Sub-maximal test of aerobic capacity/ endurance
Measuring gait capacity: independence
Functional ambulation categories
Assistance of one or two
Walking aids
Measuring functional gait
Dynamic gait index - assess postural stability during walking as well as ability to complete multiple motor and cognitive tasks whist walking
Performance - number of steps per day
Quality - lab measures, accelerometer
Treatment
Problem based
Individualised
Re-education and repetition of movement will result in neuroplastic changes
Optimise normal movement - positive neuroplastic changes
Use/ modify knowledge of exercise therapy
Identify and treat specific impairments
Functional
Creative
Treatment: examples
Facilitation of gait/ components of gait
Passive stretching/ positioning - manual stretching, weight bearing
Task specific training - e.g. sit to stand, walking
Resisted or functional strength training
Balance rehabilitation
Real world/ community ambulation
Adjuncts
Mobility aids - ensure correct height, ensure they facilitate not restrict normal gait pattern, without compromising safety.
AFOs/ foot up splints
Consider technology - FES; foot drop stimulator, robotic assisted walking
Treadmill +/- body weight support
