neurological gait

Question 1

kinematics vs. kinetics

Answer 1

1. kinetics: forces producing movement

2. kinematics: description of movement; velocity or distance or stride length (nothing to do with force)

Question 2

ankle/ foot necessities for gait (3)

Answer 2

1. heel first initial contact
2. smooth transition to foot flat
3. heel off -> toe off (push off)

Question 3

what is the main deviation at ankle/ foot?
3 names
why do we care?

Answer 3

main deviation is diminished clearance in swing...
1. foot slap
2. foot drop
 these both can lead to 
3. foot drag

these create a huge falls risk

Question 4

2 things to remember while testing gait

Answer 4

1. worsens on uneven terrain
2. may not be present inside or on shorter tests

these should be provacative tests

Question 5

what causes the ankle/foot deviations?

and what are these secondary to? (3)

Answer 5

1. ankle plantarflexion contracture/ tightness in gastroc or heel cord
2. plantarflexion spasticity = UMN
3. dorsiflexor weakness = can be LMN

Question 6

**what contributes most to stability during gait?

Answer 6

1. push off in stance phase** = comes from hip extension

Question 7

foot drag compensations (6)

Answer 7

1. circumduction (swinging foot to side)
2. contralateral vaulting (tip-toes of other foot)
3. hip-hiking (QL)
4. contralateral trunk lean
5. hip ER (pivoting on toe of uninvolved side)
6. trunk extension

Question 8

treatments for foots drag
what we do (2)
meds (2)
last resort

Answer 8

1. stretch PF** a lot** 30-60s/hr
2. strengthen DF
   all with task specificity
   meds:
   if due to spasticity- baclofen or tizanidine

bracing as last resort because immobilizes foot

Question 9

knee necessities during gait (2)

Answer 9

1. knee flexion at heel off

2. smooth transition of knee flexion -> extension during swing

Question 10

2 gait deviations at knee and what they are secondary to

Answer 10

1. absent or inadequate knee flexion at heel off
   
   • secondary to spasticity at quads or weakness of hamstrings
2. extension thrust (as you travel thru stance, knee snaps back into ext ** not genu recuvatum)
   
   • secondary to PF spasticity or contractures

Question 11

some treatment options for knee gait deviations (2)

Answer 11

1. stretch quads

2. activate hamstrings

Question 12

two reasons we don’t like orthodics (AFOs)

Answer 12

1. can make contracture worse

2. cause weakness secondary to immobility

Question 13

critical components of hip during gait (4)

Answer 13

1. flexion during swing
2. extension during stance* most important thing for stability during gait
3. neutral aB/aDduction during stance
4. ER during swing/ IR during stance

Question 14

usual compensation for lack of hip flexion during swing

concomitant with…

Answer 14

1. trunk extension during swing

2. concomitant with foot drop

Question 15

trendelenberg
 def and 2 muscles that cause this
 unlikely but occasional cause
 compensation
 treatment

Answer 15

1. def- stance phase weakness of hip aBductors (glut med or TFL)
2. rarely from spasticity of aDductors
3. compensation is ipsilateral trunk lean
4. treatment- strengthen glut med in closed chain position

Question 16

scissoring gait
what it looks like
secondary to (2)

Answer 16

1. swing phase hip aDduction -> flexion
   secondary to:
2. spasticity or (2) weakness of aBductors therefore can be UMN or LMN

Question 17

glut max lurch
what it looks like
secondary to (2)
compensation

Answer 17

1. lurching gait because of inadequate mid -> late stance hip extension

secondary to:

1. hip extensor weakness
2. hip flexor contracture

compensation = trunk extension

Question 18

gait deviation for pelvis (1)
secondary to (2)
what these are caused by
treatment

Answer 18

1. unilateral pelvic retraction
2. secondary to weakness or atrophy in hip protractors/ and trunk extensors
3. usually part of larger hemiplegic pattern so common in stroke during cortical shock
4. treatment- PNF

Question 19

2 gait deviations for trunk and what they are secondary to

Answer 19

1. excessive trunk flexion- b/c of weakness in extensors or flexion contracture from prolonged positioning
2. diminished absent rotation- parkinsonism

Question 20

scapula gait deviation (1)
causes if unilateral vs. bilateral
treatment

Answer 20

deviation = protraction

unilateral= stroke/ hemiplegia
bilateral = postural or PD

treatment- stretch protractors or strengthen retractors

Question 21

arm gait deviation (2)
unilat vs. bilat
and other disease for excessive arm swing

Answer 21

deviation=  absent or diminished arm swing
unilateral = stroke/ hemiplegia or antalgic
bilateral = parkinsonism

or
deviation = excessive arm swing from huntingtons

Question 22

forward head posture causes (3)

Answer 22

1. prolonged positioning
2. afraid of falling (but this increases falls risk)
3. PD

Question 23

parkinsonian gait (8)

Answer 23

1. flexed trunk
2. cervical hyperextension
3. shuffling (bilat toe first)
4. festination - shorter and shorter and faster and faster => falls
5. absent arm swing
6. absent trunk rotation
7. tremor
8. freezing (at doorways or threshold)

Question 24

cerebellar gait (2)

Answer 24

1. wide BOS

2. ataxic (disordered)

Question 25

hemiplegic gait (6)

Answer 25

1. unilateral
2. foot drag
3. possible extension thrust
4. possible trendelenberg
5. pelvic retraction
6. unequal step lengths and diminished time in stance on involved leg.

Question 26

MS gait

Answer 26

1. anything is possible but worsens with fatigure- 6mwt- will slow down over time

Question 27

tabes dorsalis

Answer 27

a.k.a. syphilis

stamping feet to increase sensory feedback due to dorsal column damage

Question 28

3 biggest contributors to gait

Answer 28

1. Push off in stance
2. Heel strike
3. Med/ lat stability