Neuromuscular Unit 8 Gait Flashcards
What are the requirements of Normal Gait?
- Progression
- Stability (Posture)
- Adaptation
When assessing gait, what should you put in the Objective/FIM Statement?
- Distance
- Terrain
- Assistive Device
- Level of Assistance
“Pt amb 100’ on even tile with RW with minimal assistance”
When assessing gait, what should you put in the Observational Analysis?
- Temporal Factors
- RLA Analysis
When assessing gait, what should you put in the Outcome Measures?
- Speed
–10 meter walk test - Function:
–Functional Gait Assessment
–Dynamic Gait Index (DGI) - Endurance:
–2 min or 6 min walk test - Gait/Balance:
–Tinetti
With Distance and Temporal Factors, what is Step Length?
When Initial Contact of one foot to Initial Contact of opposite foot
With Distance and Temporal Factors, what is Stride Length?
When Initial Contract of one foot to the following Initial Contact of same foot
With Distance and Temporal Factors, what is step width?
Horizontal distance between heels of each foot
With Distance and Temporal Factors, what is Cadence? What is the normal?
The number of steps per unit time
(Normal: 112.5 steps/min)
With Distance and Temporal Factors, what is Velocity?
What is the normal?
The average horizontal speed of body
(Normal: 1.46 m/s)
In the Gait Cycle, when is the leg mostly extended and longer?
In Stance Phase
In the Gait Cycle, when is the leg mostly flexed and shorter?
In Swing Phase
What is the greatest change in degrees at the hip?
Pre-swing going to Initial-swing (25°)
What is the greatest amount of change in Knee Flexion in gait?
From Terminal Stance to Preswing
Going from 0° to 40° of flexion
What are the Requirements for Loading Response?
This is a combination of Eccentric motion into knee flexion, PF to allow for foot flat to occur and appropriate shock absorption
- Hip: 20° of flexion {Ecc Hip Ext}
- Knee 15 ° of flexion: This is a 15° change into flexion from initial contact (0° flx) {Ecc quads}
- Ankle 5° PF: This is a 5° change into PF (0°) (Ecc DF)
What are the requirements for Mid Stance?
Most static Phase in Gait
This is the coordination of the Extensors (Trunk extensors, glutes, and quads) and a co-contraction of eccentric ankle plantarflexors
- Pelvis, Hip, Knee: 0°
- Ankle: 5° DF: This is a 10° change from 5° PF to DF {Ecc PF}
What are the requirements for Terminal Stance?
Forward/Medial weight shift, with increase hip extension and ankle DF;
still requires co-contraction of hip/knee extensors;
Eccentric control of PF to slow tibia into DF
- Hip: 20° of extension (20° change from 0°)
- Knee: 0°
- Ankle: 10 degrees of DF (5° change from 5° DF to 10°)
It important to have the 20° of Extension in hip
What are the requirements for Pre-Swing?
Depression of the ilium;
Knee Release;
Metatarsal WB with 15° PF;
ASIS should be pointed forward and should not be deviated in the frontal plane
- Hip: 10° of extension (10° change into flexion; from 20° of extension)
- Knee: 40° of flexion (40° change from 0°)
- Ankle: 15° of PF (25° change into PF; from 10° of DF)
What are the requirements for Initial Swing - Mid Swing?
- Co-contraction of hip/knee flexors
- Created by extension moment in the hip prior (facilitation of GTO)
- DF is initiated at initial swing and progressed into mid-swing for foot clearance
- In Initial swing the hip is flexed at 15° and has a 10° change going into Mid-swing (25° of Flexion)
- In initial swing the knee is flexed at 60° and has a 35° change going into Mid-swing (25° of flexion)
Eccentric Hamstring is in charge with Initial swing to Mid Swing, the body is essentially applying the brakes
What are the requirements for Terminal Swing - Initial Contact?
- Coordinated hip flexion, Terminal knee extension and ongoing ankle DF that was activated at Initial-Mid swing
- The only difference between terminal swing and initial contact from a movement standpoint is that there is a point of contact with initial contact
From Terminal Swing to Initial contact the degrees are the same:
Hip: 20° of flexion
Knee: 0° of flexion
Ankle: 0°
What are Gait Abnormalities with Mid to Terminal Stance?
- Increased Hip Flexion (Forward Trunk)
- Increased Hip Extension (Backward Trunk)
- Increased Knee Flexion (Knee Buckle)
- Increased Knee Extension (Knee Hyperextension/Genu Recurvatum)
What are causes of Gait Abnormalities with Pre swing throughout swing phases?
- Lack of Hip Flexion
- Lack of Knee Flexion
- Lack of Dorsiflexion
Lack of knee flexion and DF are due to weakness of the Flexors and hypertonicity of the Extensors
With Gait Abnormalities with Pre swing throughout swing phases, what are common compensations? Why are these compensations happening?
- Circumduction (weak hip FLX and increase in ADD)
- Vaulting (Excessive PF)
- Foot Drag/Foot Drop (No DF)
- Steppage Gait Good Hip Flexion (Lack of DF)
What is a common gait abnormality in Initial Contact?
Lack of heel strike, due to lack of DF
What is a common gait abnormality in Loading Response?
Foot slap, due to Excessive PF
With Gait, what are 3 Abnormal Motor Impairments?
- Abnormal Tone
- Weakness/Paresis
- Abnormal Synergies
In Gait if a person has Abnormal Tone what would the result and compensation be if they have PF Spasticity?
- In Initial Contact they have lack of heel strike/forefoot contact
- In Initial Swing to Terminal Swing they will have lack of DF throughout
Compensation:
- They will have Trunk/Knee/Hip Flexion (Shortened Stance Time
- They may have Circumduction, Hip Hike, Steppage Gait
In Gait if a person has Abnormal Tone what would the result and compensation be if they have Quadriceps Spasticity?
- In Mid/Terminal Stance they have Excessive knee extension
- In Pre- to Mid-Swing they have lack of knee flexion
(they would no longer have longer leg)
Compensation:
- They may have shortened Stance Time/Forward Trunk Flexion
- They may have Circumduction/Hip Hike/Contralateral Vaulting
(Because flexors are most likely weak)
In Gait if a person has Abnormal Tone what would the result and compensation be if they have Hamstring Spasticity?
- In Terminal Swing they have lack of knee extension
- In Mid and Terminal Stance they have excess knee flexion
Compensation
- They may have Forward Lean/Crouched Posture
- Shortened Stance time/Forward trunk flexion
In Gait if a person has Abnormal Tone what would the result and compensation be if they have Adductor Spasticity?
- Pre to Mid Swing they have increased hip ER and lack of hip flexion
Compensation
- They may have Circumduction / Scissoring Gait
In Gait if a person has Abnormal Tone what would the result and compensation be if they have Hip Flexor Stiffness?
- In Mid to Terminal Stance they have increased hip flexion
Compensation
- They may have shortened stance time with deceased contralateral step length
In Gait if a person has Weakness/Paresis what would the result and compensation be if they have PF weakness?
- In Mid and Terminal Stance they’ll have a knee buckle
- In Pre-Swing they have lack of PF
Compensation
- Backward Trunk lean
- Hip ER or Hip flexion
In Gait if a person has Weakness/Paresis what would the result and compensation be if they have DF weakness?
- In Initial Swing through Initial Contact they would have lack of DF (Foot drag)
- In Loading Response they would have lack of eccentrics leading to a foot slap
Compensation
- They’ll have Ipsilateral Hip Hike, Circumduction/Steppage; Contralateral Vaulting
- Forward Trunk
In Gait if a person has Weakness/Paresis what would the result and compensation be if they have Quadriceps weakness?
- In Mid and Terminal Stance they would have a knee buckle or Hyperextension
Compensation
- They’ll have a forward trunk lean; shortened step length
In Gait if a person has Weakness/Paresis what would the result and compensation be if they have Hip Flexor weakness?
- In Pre to Initial Swing they would have lack of hip flexion
Compensation
- They’ll have forward lean; Circumduction with Adductor Longus
In Gait if a person has Weakness/Paresis what would the result and compensation be if they have Hip Extensor weakness?
- In Mid-Stance they would have increased hip flexion
Compensation
- They’ll have a backward lean; shortened step length
In Gait if a person has Weakness/Paresis what would the result and compensation be if they have Hip Abductor weakness?
- In Mid-Stance they would have contralateral Pelvic Drop
Compensation
- They’ll have a T-Gait Pattern
