Neurologic Gait Assessment Flashcards
What’s the difference between orthopedic and neurologic gait?
Musculoskeletal
- Muscular, ligamentous, tendinous (sprains and tears) pathology
- Pain: antalgic
- Soft tissue injury
- Joint pathology
Neurologic
- Peripheral nerve pathology/injury
- Guillain Barre
- CNS: loss of central motor control (synergies, ataxia, spasticity)
What are 6 impairments found in neurologic disorders?
- Abnormal tome
- Loss of selective motor control (synergies, ataxia, weakness, & tremor)
- Sensory loss (proprioception, tactile)
- Alignment (pelvis, axial, spine, head)
- Balance or postural control
- Contractures (gastroc-soleus, hamstrings)
Name some additional problems that are found in neurologic conditions?
- walking speed
- cognition
- timing of muscular activation: co-activation, longer activation time along with asymmetry
- visual awareness/scanning
Which side does the PT stand on when gait training a patient with an ortho condition?
- The “good” or strong side
Which side does the PT stand on when gait training a patient with a neurological condition?
- The “bad” or involved side
Taking safety into consideration, when is it appropriate to initiate gait training?
- Pt has the ability to stand on involved limb and partial weight bear on involved limb (cognition, postural control of trunk and head, equilibrium/protective response)
- Parallel bars for involved limb instability (unable to weight bear or load)
- Cane or quad: if individual can properly advance
- Neurologic clients: stand on involved side, wide BOS, and move with patient
CVA patients will likely experience changes in which gait characteristics?
In gait spatial temporal characteristics
- reduced step and stride length
- increased cadence
- changes in step width
Name specific problems CVA patients experience throughout each gait cycle phase?
- IC: loss of heel contact
- LR: knee wobble
- MS: Knee hyperextension
- TS: loss of hip extension
- PreSwing: no heel off, no knee flexion
- Initial/Mid Swing: lack of knee flexion
- Terminal Swing: loss of hip & knee ext, loss of dorsiflexion
As a therapist what would you include in your written note?
- level of assistance and assisted device
- surface and distance traveled
What are the most important determinats in gait in persons with CVA?
- SLS on affected side: affected limb duration increases contralateral step length (SETS UP WHOLE GAIT CYCLE)
- Single limb advancement: knee flexion during mid swing allows for ease of foot clearance and prevents swing limb deviation and decreases duration of swing
- Plantar flexion range of motion
- Standing balance
What are some early gait characteristics in Parkinson’s disease?
Early disease markers
1. Reduced step length
2. Amplitude of arm swing: earliest gait detection
3. Interlimb asymmetries
4. Increased duration in double time
5. Reduced gait width
What are some later gait characteristics in individuals with Parkinson’s disease?
Later disease markers
- shuffling steps: festinating gait
- freezing of gait (FOG)
When would you perform a gait analysis in a Huntington’s patient?
You would only perform a gait analysis if there is a consistent gait pattern. If there is NOT a consistent gait pattern do NOT perform a gait analysis.
What are some pediatric gait deviations?
- scissoring gait
- crouch walking
- hyperextension low tone
- toe walking (no CNS injury)
- equinus gait
What is equinus gait in pediatrics?
- unable to effectively weight bear
- does NOT prosses balance or postural control
- significant equinus (toe walking due to weakness and abnormal tone)
- hip IR
- tibial torsion
