pathological gait

Question 1

What are the 5 requirements for normal gait to occur

Answer 1

Phase stability
Swing phase clearance
Adequate foot pre-positioning
Adequate step length
Energy conservation

Question 2

What does damage to the motor cortex cause

Answer 2

Spasticity

Question 3

What does damage to the cerebellum cause

Answer 3

Ataxia

Question 4

What does damage to the basal ganglia cause

Answer 4

Dyskinesia

Question 5

What is the difference between spasticity and rigidity

Answer 5

Spasticity is an increase in muscle contraction that occurs in response to stretch and can be abolished by posterior root section
Rigidity is sustained involuntary contraction that is not dependent upon stretch and is not abolished by posterior root section

Question 6

What are 4 factors other than abnormal tone that can contribute to gait abnormalities

Answer 6

Loss of selective muscle control
Dependence on primitive patterns
Imbalance of agonists/antagonists
Deficient equilibrium reactions

Question 7

Give examples of abnormal growth seen in neuro conditions

Answer 7

Generalised body growth deformity (e.g. cerebral palsy)
Limb length discrepancy
Muscle shortening (due to abnormal tone)
Iatrogenic 
Torsional abnormality

Question 8

What are two main causes of weakness

Answer 8

LMN lesions

Reciprocal inhibition due to abnormal tone

Question 9

Causes of increased oscillation of the pelvis with anterior lean and hyper-lordosis

Answer 9

Contracture/spasticity of hip flexors
Contracture/spasticity of hamstrings
Weakness of hip extensors/anterior abdo muscles
Balance compensation for distal muscle weakness
Use of walking aids

Question 10

Causes of pelvic tilt

Answer 10

Contraction/spasticity of hamstrings

Fixed lumbar kyphosis

Question 11

Causes of decreased hip extension in terminal stance

Answer 11

Contracture/spasticity of flexors
Inability to transfer weight onto forefoot (pain, muscle weakness/spasticity)
Poor knee extension of the contralateral limb in swing
Slow walking

Question 12

What are 2 ways of compensating for persistent hip flexion

Answer 12

Flexed knees

Anteriorly tilted pelvis

Question 13

Causes of plantarflexion in terminal swing/initial contact

Answer 13

Weak/inactive dorsiflexors
Contracture/spasticity of plantarflexors
Contracture/spasticity of hamstrings

Question 14

Causes of varus/valgus of the hindfoot or forefoot at ground contact

Answer 14

Imbalance between invertors and evertors of the foot

Fixed skeletal deformity of the foot

Question 15

Causes of toe flexion in swing

Answer 15

Inactive toe extensors

Spastic toe flexors

Question 16

Cause of hallux extension in swing

Answer 16

Weakness of tibialis anterior = extensor hallucis longus takes over action

Question 17

Causes of increased pelvic oscillation in the frontal plane with excessive arm motion

Answer 17

Weakness of the pelvic/trunk musculature

Question 18

Causes of Trendelenburg gait

Answer 18

Weak abductors

Spastic adductors in stance

Question 19

How can leg length discrepancy present at the pelvis

Answer 19

Persistent pelvic drop to the short side

Question 20

Causes of increased hip abduction in swing

Answer 20

Foot clearance compensation for restricted knee/ankle motion

Inactive adductors or abductor/adductor imbalance

Question 21

Causes of increased hip adduction in stance

Answer 21

Femoral anteversion
Weakness of abductors
Spasticity of adductors
Compensation for upper trunk movement over the pelvis

Question 22

Causes of forefoot adduction in stance/swing

Answer 22

Imbalanced activity of tibialis anterior, extensor digitorum and tibialis posterior

Question 23

Causes of hindfoot valgus

Answer 23

Inactive tibialis posterior
Overactive peronei
Secondary to mid-foot break

Question 24

Cause of supination in terminal stance

Answer 24

Compensation for restricted dorsiflexion

Question 25

Causes of pronation in terminal stance

Answer 25

External foot progression

Question 26

Causes of increased pelvic rotation with protraction at initial contact

Answer 26

Limited hip rotation
Femoral anteversion
A mechanism to increase step length when sagittal plane motion is limited
Asymmetrical rotation (e.g. hemiplegia or scoliosis)

Question 27

Causes of shoulder girdle rotation in the transverse plane

Answer 27

Mechanism to improve balance

Question 28

Causes of internally rotated hip

Answer 28

Secondary to pelvic position
Secondary to femoral anteversion
Secondary to internal rotator contracture/limited arc of motion

Question 29

Causes of internally directed patella

Answer 29

Secondary to internally rotated hip

Secondary to femoral anteversion

Question 30

What is the normal foot progression angle

Answer 30

10 +/-5 degrees externally rotated during stance and swing

Question 31

Where does the problem lie if the FPA and patella are both internal

Answer 31

The femur

Question 32

If the patella is internal but the FPA is external, what may be present

Answer 32

External tibial torsion

Question 33

Causes of internal foot alignment

Answer 33

Protracted pelvis
Internally rotated hip
Internal tibial torsion
Forefoot adduction