Pathological Gait

Question 1

What are the 5 preqrequisites of gait

Answer 1

Stability in stance
Clearance in swing
Appropriate pre positioning of foot for initial contact
Conservation of energy
Adequate step length

Question 2

Age of normal walking

Answer 2

9-15 months

Question 3

Mature, synchronous gait pattern

Answer 3

3. 5 years

Question 4

Heel strike

Answer 4

2-3 years

Question 5

Reciprocal arm swing

Answer 5

2 years but mature at 4 years

Question 6

Longitudinal arch development

Answer 6

3 years

Question 7

Adult gait pattern

Answer 7

7-8 years

Question 8

What are different walking speeds

Answer 8

Will increase with age.
2 years old — 1.5 ft/sec
7 years old — 2.6 ft/sec
>13 years old — 4.95 ft/ sec

Question 9

How is stability in stance challenged?

Answer 9

1. Body is top heavy ! COM is above BOS
2. Walking continually alters segmental alignment. COM is constantly moving forward and laterally relative to each support

Question 10

For stability in stance not only is a stable foot required, but the lower extremity segments must function to…

Answer 10

1. Allow advancement of the limb in swing
2. Maintain balance
3. Provide propulsion
4. Ensure appropriate position of the structures above

Question 11

What does sufficient foot clearance require

Answer 11

1. Appropriate position and power at the hip, knee, and ankle on the stance side.
2. Enough DF, knee flexion and hip flexion during swing
3. Stability of foot in stance
4. Adequate body balance

Question 12

What does appropriate pre positioning of the foot for initial contact require

Answer 12

1. Appropriate body balance
2. Stability, power, and proper position of stance limb
3. Enough DF, balance between foot investors/evertors, and knee position

Question 13

What does adequate step length require

Answer 13

1. Appropriate body balance
2. Stability and proper position of the stance lib
3. Adequate hip flexion and knee extension
4. Neutral ankle and foot position

Question 14

What does energy conservation require

Answer 14

1. Joint stability
2. Minimization of the COM excursion
3. Muscle forces optimized

Question 15

What is the relationship between step length and leg length throughout development

Answer 15

Linear relationship — bigger you get, larger step length and larger leg length

Question 16

Duration of single limb stance ____ as walking pattern matures

Answer 16

Increases

Question 17

Standing energy expenditure rate ______ with age

Answer 17

Decreases

Question 18

What is the difference between primary and secondary impairments in gait pathology

Answer 18

Primary impairments — direct result of CNS injury
Secondary impairments — compensations/mechanisms.
abnormal gait patterns typically develop due to bony deformities, loss of ROM, muscle weakness, spasticity, and/or abnormal motor control

Question 19

Do you treat the primary or secondary impairments?

Answer 19

PRIMARY!!!! You can’t treat secondary impairments because they will just come back

Question 20

What are some pertinent questions about child’s history

Answer 20

1. Medical, birth, specialist history
2. General development history — when did they start to walk
3. Any family history of walking difficulties
4. Were there any interruptions in the child’s ability to walk independently?
5. Has the child ever walked?

Question 21

What are the gait evaluation methods

Answer 21

Observation — Edinburgh Visual Gait Scale
Efficiency and practicality of walking — energy expenditure
Footprint analysis method
Gait assessment tools
Gait analysis motion analysis — 3D analysis of gait

Question 22

What is the reliability of observational gait analysis

Answer 22

Interrater reliability of video analysis is low to moderate
— more reliable at distal segments and with experienced clinicians

Question 23

How long should you observe gait?

Answer 23

At least 10 minutes of walking !!

Question 24

Energy expenditure in gait

Answer 24

• Heat rate has been shown to be an accurate and convenient estimate of EE
• Linear relationship between HR and O2 uptake during walking for normal children and children with CP
• Walking velocity = distance/time

Question 25

What is energy expenditure index

Answer 25

EEI = HRwalk - HRrest / Vavg

Question 26

What is the footprint analysis

Answer 26

Supplies — paper, powder, towel, water
Parameters — velocity, cadence, foot progression angle, BOS, toe clearance, stride length, step length

Question 27

What are some gait assessment tools

Answer 27

SWOC
DGI
FMA
FMS
GOAL
Gaitrite
Writestep

Question 28

What is the SWOC

Answer 28

Standardized Walking Obstacle Course
- measures stability and speed of gait under different circumstances.
- measures time, number of steps, and observation of stability
- designated path
- includes negotiating 3 directional turns and negotiation of barriers

Question 29

What is the FMS

Answer 29

Functional mobility scale

Question 30

What is the GOAL

Answer 30

Gait outcomes assessment list
- becoming more common in clinical practice
- part of patient reported outcome for ambulatory children with CP GMFCS 1-3
- spans all domains of ICF
- VERY HELPFUL WITH GOAL SETTING

Question 31

What are the gait abnormalities in children with CP

Answer 31

Bony abnormalities
Inadequate ROM and spasticity
Muscle weakness
Abnormal motor control
Energy expenditure