Pathological Gait Patterns Flashcards
A patient walks into the clinic. They present with reduced stance time on one leg. Shorter step length on the same leg. Longer step length on the other side, and a slightly different initial contact. What kind of gait are they displaying?
Antalgic gait. Painful or limping gait.
A patient walks into the clinic with a shuffling gait. They have decreased swing and increased stance time. Their cadence is fast, but their velocity is slow. They stop at the threshold of the door. What gait are they displaying? What disease is this typical of?
Festinating gait. It is typical in moderate to severe Parkinson’s. It is an issue with basal ganglia in the brain which controls fluidity and initiation of movement.
What activities can you recommend to a patient with Parkinson’s to help smooth their movement?
Tai chi, boxing, and big and loud movements have been shown to help.
You are doing a gait assessment on a patient, and you might describe their gait as a “drunken” gait. What gait are they most likely displaying? What might be causing it?
They probably have an ataxic gait. It is seen in patients who have motor control issues. They can’t control where their foot comes down. It is very uncoordinated and not symmetrical. It is typically due to cerebellar damage which majorly affects coordination.
One of your patients has CP. What gait might they display and why?
Crouch gait. It is caused by increased hip flexion, knee flexion, hip internal rotation, and dorsiflexion and adduction. It is caused by spasticity of muscles. They pull the joints into those positions. They might need surgical release to lengthen some muscles and allow for greater range of motion.
What parts of the gait cycle might be affected by a crouch gait?
Any part of the gait cycle that requires extension of joints may be impaired. Terminal swing when the knee needs to extend. Terminal stance when the hip needs to extend. Pre-swing when the plantar flexors need to push off. They might have a pelvic drop because the adductors are overactive.
A patient comes into the clinic, and you notice that their hip stays in a midrange position throughout the gait cycle. It stays neutral or extended. They are also plantar flexed and inverted. What are your first thoughts about what the patient may have?
They have an equinus gait. It can be caused by brain injury or CP. Their muscles might respond to botox to try and relax the muscles.
What subdivisions of gait will be affected if you cannot flex the hip very well?
Swing phase will be affected. Initial contact and loading response will also be affected.
You notice someone on the street walking with their legs really close together. They crisscross their legs when they walk. What muscles are tight, and what is this gait called?
Their adductors are probably really tight. This is a scissor gait.
You are manual muscle testing and notice that their glute max is only a 3+. You ask them to walk. What gait are you looking for?
Glute max lurch. They lean their trunk back to place the joint moment posterior to the hip which promotes hip extension. This allows gravity and body mass to extend the hip instead of the muscles extending the hip.
A teenager displays a vaulting gait. What could be the issue and what would you recommend?
Vaulting or circumduction are both used to clear a leg that is too long. A patient may also use a hip hike. They may need a heel lift in the other shoe to even out a leg length discrepancy.
A patient’s DF MMT is a 2+, and they display excessive knee flexion and hip flexion when they walk. They have…
A. Foot drop/slap
B. Steppage gait
B. Steppage gait
In a steppage gait, they can’t dorsiflex. Instead, they flex the knee and hip to clear the leg. Then the foot will come down either on the ball of the foot or the toes.
What would you recommend for a person with steppage gait?
AFOs tend to work well for these patients. It keeps their ankle at 90 degrees.
A patient scores a 3+ on their DF MMT. What gait pattern might they display?
Foot drop/slap. Either there are no dorsiflexors, or they are weak. If they are weak, you will notice a slap. If they are really weak or aren’t activating, they will have more of a drop.
Foot slap occurs during which part of gait?
The slap occurs during loading response because of weak eccentric dorsiflexors.
How would you describe genu recurvatim?
This is when a patient hyperextends their knee. They often do this because they are afraid it is going to buckle. They do not trust their knee. Buckling can happen due to lack of eccentric control.
Which type of Trendelenburg requires more energy?
A. Compensated
B. Non-compensated
A. Compensated Trendelenburg takes more energy.
What are common problems that can affect the gait pattern?
- Weakness/hypotonia
- Hypertonia/spasticity
- Motor programming issues
- Coordination issues
How does spasticity affect gait?
Spasticity causes the muscles to constantly be contracted. This could change the range of motion that a patient has at a joint. Spasticity could also keep a joint in flexion or extension
What kind of issues are common with Parkinson’s?
Motor programming issues.
What are things you should include in your assessment of gait? (think about writing the note in IP rehab)
- assistive device(s)
- level of assist
- distance
- kinematic variables
- quality of movement
- endurance
- other: steps, threshold, surface?
What observations might you make about quality of a patient’s movement?
- abnormal movement patterns
- compensations
What ways can you measure endurance?
- self report
- observation
- RPE
- pulse ox
You are writing goals for a patient’s gait. What two aspects might you focus on?
Velocity and endurance. You will want to increase velocity and endurance.
True or False
Gait velocity is linked to morbidity and mortality.
True!
The ability and time to walk 400m is a predictor for…
CV disease, mortality, and morbidity
What is variability from the normal in velocity and endurance correlated to?
If they have more variability from normal, they are less likely to walk as much, and their mortality rate goes up. They are also at an increased fall risk.
What is a normal TUG time for age matched healthy adults?
9.1 seconds
How does chronic stroke affect a TUG time?
Chronic stroke patients tend to be around 22.6 seconds to complete the TUG
How fast does someone need to be able to walk to be a safe community ambulator?
48 m/min (1.78 mph) is considered the norm for being able to cross a road at a red light without worrying.
What is considered a limited community ambulator?
24 m/min (.82 mph)
How is endurance decreased in stroke patients?
- subacute or chronic CVA average 200-300 m compared to 400 m of age matched healthy elderly in 6MWT
- steps per day: 2800-3000 community dwelling mild to moderate CVA patients compared to 5000-6000 age matched sedentary healthy
What are way you can increase dynamic stability in walking?
- change the terrain
- give them obstacles
- distract them
- include executive functions
What are three things you can increase in a patient’s gait if they do not ambulate very well?
- Increase endurance
- Increase dynamic stability
- improve coordination
How can you help a patient improve coordination while walking?
- Have the patient overcome curb heights or other things they will see in the community. This will help them become community ambulatory
- Decrease their fall risk
Why might patients who have had a stroke walk less?
They might walk less because they are scared and don’t trust their body. It might take them a lot of energy, or they fatigue quickly.