Neuromuscular 2 Unit 8 Gait Analysis Flashcards
During gait, what % are we in the Stance Phase and Swing Phase?
60% Stance Phase
40% Swing Phase
What are the advantages of Observational Gait Analysis (OGA)?
- Requires little or no instrumentation, inexpensive to use
- Yield general descriptions of gait variables
What are the disadvantages of Observational Gait Analysis (OGA)?
- Dependent on both the therapist’s training and observational skills
- Subjective and haas only low to moderate reliability
- Oberving and making accurate judgements about motions occuring simultaneously at numerous body segments
With Gait Disorders, what are the Characteristis and Usual Associated Findings of Spastic (Paraplegia)?
Gait Characteristics
- Stiff legged, scissoring (wooden soldier)
Usual Associated Findings
- Hyperrefexia, Extensor Plantar response
With Gait Disorders, what are the Characteristis and Usual Associated Findings of Cerebellar Ataxia?
Gait Characteristics
- Wide based, reeling, careening (drunken sailor)
Usual Associated Findings
- Heel-to-shin, ataxia, other cerebellar signs
With Gait Disorders, what are the Characteristis and Usual Associated Findings of Sensory Ataxia?
Gait Characteristics
- Wide based, steppage
Usual Associated Findings
- (+) Romberg, Imparied joint position sense
With Gait Disorders, what are the Characteristis and Usual Associated Findings of Hemiparetic?
Gait Characteristics
- Involved leg spastic, circumduction, often with footdrop
Usual Associated Findings
- Weakness, hyperreflexia, extensor plantar response
With Gait Disorders, what are the Characteristis and Usual Associated Findings of Parkinsonian?
Gait Characteristics
- Slow, Small steps, flexed posture, shuffling, festination
- Increased duration of stance time and double limb support and decrease in swing time
- Freezing episodes: last from seconds to minutes. Occurs during gait initiation, turns, in narrow spaces, or when approaching obstacles
Usual Associated Findings
- Tremor, rigidity, bradykinesia and postural instability
With Gait Disorders, what are the Characteristis and Usual Associated Findings of Foot Drop (uni/bilateral)?
Gait Characteristics
- High steppage pattern to clear the toes from the floor, double tap with toe strike before heel strike
Usual Associated Findings
- Foot dorsiflexor weakness
What is the Effect of Paresis/Weakness in the Plantarflexors during Gait?
- Hyperextension of the knee in stance phase
- Toe clawing
- Lack of knee flexion in the swing phase
- Prolonged heel contact
- Reduced push off
- A shorter step length
- Decreased walking speed
- Reduced leg kinetic energy during pressing, leads to an incrased knee and hip moments in the paretic limb and nonparetic limb (stroke)
What is the Effect of Paresis/Weakness in the Quadriceps during Gait?
- Forward lean of the trunk (LOG and. to knee)
- Hyperextension of the knee during midstance
- Knee remains extended during the loading response
- Toe drag
What is the Effect of Paresis/Weakness in the Hip Flexors during Gait?
- Posterior Tilt of the pelvis and activation of the abdominal muscle to advance the swing limb
- Circumduction (Hip Hike)
- Contralateral vaulting
- Trunk lurches backward and toward the unaffected stance limb
- Shortened step affect the position of the foot at initial contact
What is the Effect of Paresis/Weakness in the Hip Abductors during Gait?
- Trendelenburg Gait
- Instability of the frontal plane
What is the Effect of Paresis/Weakness in the Hip Extensors during Gait?
- Leans backward to bring the center of mass (COM) behind the hips
- Reduced gait velocity (in strokes)
What is the effect of Planterflexor Spasticity during gait?
- Hyperextension of the knee in the stance phase
- Foot Flat during initial contact
- Equinovarus foot (supinated foot) at Initial contact
- Toe drag
- A shortened stride length and reduced gait velocity
What is the effect of Quadriceps Spasticity during gait?
- Knee remains extended during the loading response
- Hyperextension of the knee in midstance
(There is no relationship between knee extensor spasticity and gait speed in patients with stroke)
What is the effect of Hip Adductors Spasticity during gait?
- Contralateral drop in the pelvis during stance
- Scissors gait
- In swing, severe medial displacement of the entire limb reducing BOS
What are the Characteristics of Ataxic Gait?
- Staggering, veering, and high steppage
- Delays in the timing of peak knee flexion during the swing phase
- Reduced, excessivley variable step, and stride length
- Anterior trunk lean to compensate for inadequate anticipatory postural adjustments
- Rapid forward progression into weight acceptance following initial contact
- Wide BOS
What is Impaired Segmental Coordination?
A reduced ability to coordinate movements between body segments, which decreases gait speed
With Impaired Segmental Coordination, what are the effects with Hemiplegia?
There will be decreased amplitude of hemiplegic arm leading to an increase of arm swing on the less affected arm
With Impaired Segmental Coordination, what are the effects with Parkinson’s?
Asymmetrically reduced arm swing
With Impaired Segmental Coordination, what are the effects with Ataxia?
The patients arms are held in a high guard position
Impaired adaptation of gait
What are Reactive Balance Problems?
Impaired stepping in response to a stance perturbation with increases fall risk
- Stepping with the paretic limb: there will be difficulties with speed and precision
- Stepping with nonparetic limb: there will be reduced ability to load the paretic limb without collapse
Impaired adaptation of gait
What is Proactive balance control required for?
- Stepping over or around obstacles
- Changing directions
- Accelerating or decelerating
What are the Gait Impairments with Proactive Balance problems?
- Slower gait speed
- Reduced toe clearance
- Increased step variability
- Mediolateral instability during crossing
How can an abnormal somatosensory input affect gait?
- They can have gait ataxia
- Wide base, stumbling, high steppage
How can an abnormal Visual input affect gait?
- Loss of visual input will affect both route finding and obstacle avoidance
- Decreased walking speed
How can an abnormal Vestibular input affect gait?
- They may have Oscillopsia: difficulty in stabilizing the head in space
- Gait ataxia and decreased walking speed
- Prolonged double-limb support
Those that have impaired Dual-Task Walking, what can this result in?
- Impaired stability in single limb stance phase of gait
- Decreased gait velocity and step length
- Significantly affects turning strategies
- Increased in mediolateral displacement and velocity of the COM
What are the Recommended OM for those PD patients in H & Y 1 - 4?
{Ceiling effect may be noted with Stage 1 and 2}
- 6 min walk test
- 10m walk test
- Functional Gait Assessment
- MDS-UPDRS Revision
What are the Recommended OM for those PD patients in H & Y 5?
- MDS-UDRS revision
- 10m modified to 2m walk test
- Freezing gait questionnaire
What are the recommended OM for those with MS with Mild Disability and an EDSS score of 0 - 3.5 (Fully Ambulatory)?
- 6 MWT
- Mini-BESTest
- Timed 25 foot walk
- Dynamic Gait Index
- TUG with dual and cognitive task
- Fatigue Descriptive scale
What are the recommended OM for those with MS with Moderate Disability and an EDSS score of 4 - 5.5?
- 6MWT
- Dynamic Gait Index
- Mini-BESTest
- Timed 25 foot walk
- TUG with cognitive and manual task
- Twelve-item MS walking scale: self report
- FIM
What are the recommended OM for those with MS with Severe Disability and an EDSS score of 6 - 7.5?
- 6MWT
- Timed 25 foot walk
- Mini-BEST est
- TUG with duel and cognitive task
- FIM
What are the recommended OM for those with MS with Very Severe Disability and an EDSS score of 8 - 9.5?
FIM
What are the Recommended OM for TBI patients?
Outpatient only:
- High Level Mobility Assessment
In/Outpatient:
- 6 min walk
- 10 meter walk
- Dynamic gait index
- Community balance
- Mobility scale
What are the Recommended OM for Stroke patients?
- 6 min walk
- 10 meter walk
- DGI
- FGA
- FIM
What are the Recommended OM for patients with Ataxia?
- 6 min walk
- 10 meter walk
- Scale for assessment and Rating of Ataxia (SARA)
Instrumental Gait Analysis
What does an Accelerometer do?
This is a device that measures cadence, step symmetry, step duration, and stride duration
Instrumental Gait Analysis
What does an Gyroscopes do?
These are light, portable devices attached to the skin and measures:
- Cadence and walking speed
- Determining number of steps and estimating stride length
What are the details that go in the Objective Statement of Gait?
- Pt ambulated…
- Distance traveled
- Terrain
- AD utilized
- Lvl of assistance
- Time
Pt. amb 25’ on even tile with a R SBQC with Min assist
What are the Stance Abnormalities during gait?
- Knee buckle/hyperextension
- Forward/backward trunk lean
- Foot slap
- T-Gait
What are the Swing Abnormalities during gait?
- Foot/toe drag
- Circumduction
- Hip Hike
- Vaulting
- Steppage
- Shuffling/Festination
With writing goals, what is the minimum distance for Full Household?
Minimum of 150’
With writing goals, what is the minimum distance for Limited Household (bathroom)?
Minimum of 50’
With writing goals, what is the minimum distance for Full Community?
Minimum of 2000’
With writing goals, what is the minimum distance for Limited Community?
300-1500’
With Goal Writing, what are the consideration we should have?
Progression
- Acute -> IP Rehab -> Outpatient
Acute - There is no minimum goal
IP Rehab - Full Household
Outpatient - Full community
With Goal Writing, what are the consideration we should have with OM?
Short Term Goal = MDC or MCID from baseline so that change is meaningful (either statistical or clinical)
Long Term Goal = Cut off score or 2nd MDC or MCID
