whats the difference between orthopedic and neurological gait
Musculokeletal
* muscular strains
* ligament sprains and tears
* pain: antalgic
* tendon pathology
* soft tissue injury
* pain syndrome
* joint pathology (osteo and rheumatoid arthritis)
Neurologic
* peripheral nerve
-Nerve pathology and injury
-guillain barre
* CNS
loss of center motor control
-synergies
-ataxia
-spasticity
Impairments in Neurological disorders
- abnormal tone
- loss of sensitive motor control (synergy, ataxia)
- sensory loss (proprioception, tactile)
- alignment (pelivis, axial spine, head on)
- balance or postural control
- contractures (gastroc-soleus)
Additional problems
* walking speed
* cognition
* timing of muscular activation: coactivation, longer activation time along with symmetry
* visual awareness (scanning)
Remember safety 1st! When to initiate gait training
- ability to stand on involved limb and PWB on involved limb with AND
-ability to understand and follow directions
-control trunk and head as a unit righting responses (head on body)
-equilibrium responses (protective responses) - parallel bars for involved limb instability (inability to WB or load)
- cane or quad if individual can properly advance
- neurologic clients: stand on involved side, wide BOS, move with pt.
Specific problems at gait phases with CVA
Results in changes in gait spatial temporal characteristics
* reduced step and stride length
* increased cadence
* changes in step width
Note writing: level of assistance & assited device
- sit to stand: supervision level
sit to stand with quad cane L UE - Gait: supervision level
left LE step to gait pattern - Gait function
A person with R hemiparesis: supervised ambulation using L quad cane w/R step to gait pattern on level surfaces x30ft.
Note writing for gait example
Gait
* A 72 yr old female with 2 month history of L CVA and R hemiparesis: supervised ambulation using L quad cane w/ R step to gait pattern on level surfaces x30 ft. Reduced step length. Gait velocity ? Norms for age ?
Gait observation
* pelvis remains retracted throughout gait cycle
Swing phase
* major problems are left ankle/foot inversion at initial swing with limited control throughout swing, maintaining knee ext throughout swing phase and reduced hip flex at terminal swing
Stance phase:
* major problems at lateral foot at contact at initial contact, knee ext during LR, inadquate hip ext (lack of trailing limb) and minimal heel off at terminal stance resulting in shorter R step length
What are the most important determinants in gait in persons with CVA
Step length and velocity
1. single limb stance on affected side: affected limb duration increases contralateral step length
2. Single limb advancement: knee flex during midstance allows for ease of foot clearance. Prevents swing limb deviations and decreases during swing.
3. plantarflexion ROM (needs enough to clear foot and have a good push off)
4. standing balance
Gait charcteristics in PD
early disease markers
* reduced step length
* amplitude of arm swing: earliest gait detection
* interlimb asymmetries
* increased duration in double time (2 feet always touching floor)
* reduced gait width
Later disease markers
* shuffling steps: festinating gait
* freezing of gait (FOG)
Huntington’s Chorea
- do not perform gait analysis ad there is no conistant pattern of movement
- do functional scale instead
- Are they independent, need assisted device, and/or high fall risk?
Pediatric gait terminology (peripheral problems- CP)
- scissoring gait: hip add, foot crosses over, hip add acting likr hip flexors
- Crouch walking
- hyperextension low tone
- toe walking (no CNS injury)
Equinus gait in pediatrics
Differences
* unable to effective WB
* doesnt possess balance or postural control
* significant equinus (toe walking due to weakness and abnormal tone)–forefoot contact throughout gait pattern
* hip IR
* tibial torsion
* PPT
* knee flex
* lack of selective control
* use rear 4 wheel walker to stand upright
