Pathological and Other Abnormal Gaits Flashcards
What tasks must be achieved in order to maintain “normal” gait patterns?
- Each leg supports BW w/o collapsing
- Balance in SLS
- Swing limb must advance in order to take over supporting role
- Sufficient power generated to advance trunk and limbs
What can abnormal gait patterns result from?
- Pain
- Musculoskeletal impairments (weakness, contracture, ROM)
- CNS dysfunction
What can abnormal gait patterns result from?
- Pain
- Musculoskeletal impairments (weakness, contracture, ROM)
- CNS dysfunction
What are some pathological reasons why lateral trunk bending would occur?
- Painful Hip
- Hip Abductor Weakness
- Abnormal Hip Joint
- Wide walking base
- Unequal leg length
- Scoliosis
- Adductor Contracture
When a pt has a painful hip, which side would they laterally bend?
They want to reduce pain by bringing COM closer, so they lean towards the painful limb.
When a pt has unequal leg length, which side do they laterally bend?
Lean away from the swinging leg
When a pt has an adductor contracture, which side do they laterally bend?
Tight adductor makes pelvis on the opposite side drop, so compensation is to lean towards the stance limb.
How does lateral trunk bending help a pt with pathological conditions?
- Shifting the trunk reduces the demand on the hip abductors
- Shifting the trunk reduces the compressive forces associated with hip abductor activity
- Shifting the trunk assists moving the COM towards stance side to increase single limb stance stability.
What are some pathological reasons why lateral trunk bending would occur?
- Painful Hip
- Hip Abductor Weakness
- Abnormal Hip Joint
- Wide walking base
- Unequal leg length
- Scoliosis
- Adductor Contracture
How does lateral trunk bending help a pt with pathological conditions?
- Shifting the trunk reduces the demand on the hip abductors
- Shifting the trunk reduces the compressive forces associated with hip abductor activity
- Shifting the trunk assists moving the COM towards stance side to increase single limb stance stability.
What is the Trendelenburg sign?
opposite hip drop
What is Trendelenburg gait?
The pt compensates for weak hip abductors by shifting COM towards the affected side. The result is a gait with a lateral lurch towards the affected side.
-If both sides are affected, this is a bilateral lateral lurch or “waddling” gait.
How does anterior trunk bending help a pt with pathological conditions?
- Moves the GRF vector in the front of the knee during LR to reduce need for knee extensors
- Moves weight forward over stance foot to compensate for limited ankle DF
What are some pathological reasons why anterior trunk bending would occur?
- Weak quads
- Painful quad contraction
- Pes equinus deformity
- Hip extensor weakness
- Hip Flexion Contracture
Why would a pt anterior bend if they had hip extension weakness?
They wouldn’t have the hip extensors to keep them up, so they would need to bend forward.
How does anterior trunk bending help a pt with pathological conditions?
- Moves the GRF vector in the front of the knee during LR to reduce need for knee extensors
- Moves weight forward over stance foot to compensate for limited ankle DF
How does posterior trunk bending help a pt with pathological conditions?
- During stance, it moves the GRF behind the hip joint, reducing the demand on the hip extensors
- During swing, a quick thrust of the trunk backwards may be used to propel the swing limb forward
What are some pathological reasons why posterior trunk bending would occur?
- Weak hip extensors
- Weak hip flexors
- Spasticity of hip extensors
Why would a pt posterior bend if they had hip flexor weakness?
Need hip flexors in initial swing, and if you’re having trouble with propulsion to bring the hip forward, you might lean back to whip it through.
What is increased lumbar lordosis associated with in the hip?
Hip flexion contracture
What event in the gait cycle is lumbar lordosis used?
terminal stance to compensate for decreased hip extension.
What are some compensations for functional leg length discrepancy?
- Circumduction
- Hip Hiking
- Steppage gait
- Vaulting
What are some ways that leg length discrepancy shows up in gait?
- Foot drop (lack of ankle DF)
- Mechanical locking of the knee in extension (reduced knee flexion during swing)
- Extensor spasticity
- Anatomical leg length discrepancy
What is circumduction, and when does it usually occur?
- Circular pattern of swing leg
- may compensate for weak or painful hip flexors
What is hip hiking?
Swing limb side of pelvis is elevated
What is Steppage gait?
Exaggerated hip and knee flexion during swing phase
What is vaulting?
Rise up on toes of stance leg to increase swing limb clearance
When does abnormal hip rotation occur?
- Problem with muscles producing hip rotation (spasticity or weakness)
- Problem with foot contact ( pes varus or valgus)
- Compensation for another problem (weak quads)
What is another way that abnormal hip rotation is manifested?
“toe in” or “toe out”
Abnormal foot alignment may manifest as?
Compensations at the hip (ex. pes varus or valgus)
-leads to rotation of the whole limb when WB
Abnormal foot alignment may manifest as?
Compensations at the hip (ex. pes varus or valgus)
-leads to rotation of the whole limb when WB
What does excessive knee extension in stance result from?
- Quad weakness
- Knee pain
- Had pushing back on thigh to prevent collapse
Why would a pt with quadriceps (knee extensor) weakness have excessive knee flexion in stance?
-Maintaining extension reduces the load on the extensor, but may lead to excessive stretch on the posterior capsule.
What other abnormality does excessive knee extension accompany?
Anterior Trunk lean
What does excessive knee flexion result from?
- Knee flexion contracture
- Hip flexion contracture
- Knee flexor spasticity
- Knee pain and joint effusion
- Compensation for leg length discrepancy
Define foot slap.
An audible contact of the forefoot with the floor during loading response due to poor eccentric control of the DF
Define toe drag.
Failure to DF the ankle to a neutral position for adequate clearance during swing phase
Define toe drag.
Failure to DF the ankle to a neutral position for adequate clearance during swing phase
Define pes calcaneus
extreme DF
Define pes equinus
extreme PF
Define equinovarus
lateral border loading
-Foot is inverted and PF
define pes valgus
weight bearing on medial border of foot
Why would a pt be stamping?
They may have sensory loss, so impact creates vibration feedback regarding foot contact.
Why would a pt have forefoot IC?
heel pain or PF contracture
Why would a pt have insufficient push off?
- Triceps surae weakness
- Achilles tendon problem/pain
- Forefoot pain
- Intrinsic foot muscle weakness (loss of rigid lever)
- Any foot deformity
What happens during insufficient push off?
- Premature toe off (before full hip extension
- shorter stance duration on affected side
- shorter swing time and step length on opposite side
- asymmetric timing
What is abnormal walking base?
Around 50-130mm
What is narrowing of walking base usually caused by?
Scissoring gait
What is widening of walking base usually caused by?
- Abducted hip deformity
- Knee valgus deformity
- Compensation for instability/ fear of falling
What are some causes of short step length?
- weak push-off prior to swing
- weak hip flexors at toe-off and initial swing
- excessive deceleration of leg in terminal swing
- knee flexion in TSw prior to IC
- Inadequate pelvic rotation
- pain in contralateral side
What is antalgic gait?
Gait modification that reduces the time spent on the painful limb
What are some irregular rhythmic disturbances?
- cerebellar ataxia
- loss of foot sensation/proprioception
- athetosis
Why are Assistive devices used?
- Increased stability by increasing BOS
- Reduced limb loading on painful limb
- Generate a moment (using a walker in front generates a trunk/hip extension moment)
