Pathological Gait Intro

Question 1

What are the 4 major causes of Pathological Gait?

Answer 1

Abnormal joint ROM

Impaired motor control

Impaired sensation

Pain

Question 2

Abnormal Joint ROM as a Mechanism

Answer 2

Excessive / limited (spasticity)

Joint contractures - elastic / rigid

Bony malalignments

Compensatory postures

Question 3

Impaired Motor Control as a Mechanism

Answer 3

Peripheral and central origin

Spasticity

Lack of selective control - timing / sequencing

Primitive locomotive patterns - mass flexion / extension

Change in muscle phasing

Question 4

Impaired Sensation as a Mechanism

Answer 4

Impaired proprioception - inconsistent gait pattern / inability to use stronger muscles to sub for weaker muscles

Perceptual deficits

Balance disorders - motor control vs. sensory factors

Question 5

Pain as a Mechanism

Answer 5

Primary vs. Secondary cause of gait deviation

Reactions to pain can cause muscle weakness and or deformity - reduced activity / protective reflex / resting postures

Question 6

Hypothesis Driven Exam / Eval

Answer 6

Perform movement analysis

Identify deviations / movement system dysfunction

Hypothesize cause of each deviation

Test your hypothesis

Evidence-based interventions to address movement dysfunction

Re-eval

Question 7

Problem Solving Approach

Answer 7

Problem ID: Observational gait analysis, impairment testing / determine significance of deviations based on how they affect each functional task

Cause ID: Consider all possible causes contributing to major problems / refer to torque demands, muscle activity, joint positions

Treatment: Interventions / ADs / Orthotics / Prosthetics

Question 8

Contralateral Vaulting Deviation

Answer 8

Excessive PF on one side to hike / advance contralateral lower limb during swing phase

Question 9

Hammered Toe

Answer 9

Bend in the middle of the joint

Question 10

Hemiplegia Stance Phase Deviations

Answer 10

Decreased hip / knee extension

Knee hyperextension

Knee crouching

Decreased weight shift / stance time

Question 11

Hemiplegia Swing Phase Deviations

Answer 11

Hip ER / circumduction / hiking / pelvic retraction

Decreased hip and knee flexion

Toe out / toe drag

Lateral trunk lean

Contralateral vaulting

Question 12

What gait patterns characterize Spastic Diplegic Cerebral Palsy?

Answer 12

Crouch Gait

Scissoring Gait

Question 13

What characterizes Spinal Bifida?

Answer 13

Flaccid Paralysis

Question 14

Parkinson’s Disease Gait Deviations

Answer 14

Short step length

Increased stance duration

Festinating / Propulsive gait pattern

Decreased arm swing / trunk motion

Forefoot / flat foot contact

Forward trunk lean

Difficulty with transitions

Question 15

Things to Consider When Discussing Orthoses vs. Prostheses

Answer 15

Orthoses: Recovery vs. compensation / when to brace?, how early is too early? / determine what is important to your patient / how will an orthosis impact the 3 functional tasks?

Prostheses: Does benefit outweigh the cost? / how will a prosthesis impact the 3 functional tasks?

Question 16

What are some potential causes of a narrow BOS during gait?

Answer 16

Adductor spasticity

Decreased proprioception

Question 17

Weak glutes could translate to what standing posture?

Answer 17

Backward lean with arms up - “hanging on Ys”

The above position inactivates the glute muscles

Question 18

What can be increasingly difficult when the patient is experiencing a decrease in glute strength?

Answer 18

Walking unassisted