Posture and Gait Assessment Flashcards
Posture (vertical line)
1) external auditory meatus
2) anterior body of C7
3) acromion of the scapula
4) middle of the glenohumeral joint
5) anterior third of the sacrum
6) center of the greater trochanter
7) just behind the center of the knee
8) 1” anterior to the lateral malleolus
Kyphosis - Lordosis
The spine has an hourglass appearance. The head is held forward, the neck is hyperextended, the thoracic spine is flexed more than usual and the lumbar spine is hyperextended so that the pelvis is tilted anteriorly. The knees are slightly hyperextended.
Swayback
The head is held forward, the neck is in slight extension. The thoracic spine is displaced backwards and the lumbar spine is flattened. This causes the pelvis to be tilted posteriorly and the hip joints are hyperextended along with the knees.
Military Back
The head is the neutral position. The cervical spine retains its normal curvature along with the thoracic spine. The lumbar spine is hyperextended and the pelvis is tilted anteriorly.
Muscles involved with Acceleration
Hip Flexor
Abnormal Acceleration
abnormal acceleration and swing with thrusting of the trunk backwards to passively swing the leg
Muscles involved with Heel Strike
Hip Extensor
Abnormal Heel Strike
Forward lurch of the trunk on heel strike and the patient compensates with excessive lordosis
Muscles involved with Stance Phase
Hip Abductors
Abnormal Stance Phase
trendelenburg (lurching) gait
Muscles involved with Heel Strike, Toe Off
Hip Adductors
Abnormal Heel Strike, Toe Off
abnormal rotation of the leg and pelvis
Muscles involved with Heel Strike, Acceleration
Knee Extensor
Abnormal Heel Strike, Acceleration
knee buckles especially in walking downstairs
Muscles involved with Deceleration, Heel Strike
knee flexors
Abnormal Deceleration, Heel Strike
knee snaps out too hard at the end of the swing and the knee buckles with the heel strike
Muscles involved with Swing Phase, Heel Strike
Foot Dorsiflexors
Abnormal Swing Phase, Heel Strike
foot drop, steppage gait, foot slaps with heel strike
Muscles involved with Toe Push-Off
Foot plantar flexors
Abnormal Foot Plantar Flexors
short step on the affected side with poor push off
Antaligic Gait
the patient favors one leg by putting as little weight as possible on it in order to reduce the pain on that side
Choreic Gait
jerky twitching and dancing gait
Huntington Disease
Rheumatic Fever
Deteriorating Tandem
worsening tandem walk while counting from 50 backwards is an early sign of Alzheimer’s disease
Drunken Gait
this is the classic wide-based staggering gait seen in cerebellar disease
Festinating Gait
shuffling (propulsion) gait with the tendency to accelerate as the patient leans forward
seen in Parkinson’s Disease
Hemiplegia Gait
the spastic leg is extended and rotated internally
the feet is inverted and plantar flexed and the limb is swung outward to keep the foot off the ground
seen in Cerebra Vascular Accident
Scissor Gait
stiff shuffling movement with the legs crossing over due to increased adductor tone seen in cerebral palsy or paraplegia
Sensory Ataxic Gait
wide-based uneven gait with high steps and slapping of the feet on the ground seen in patients with dorsal column pathology as in tabes dorsalis, vitamin b12 deficiency or diabetes mellitus
Steppage Gait
the patient has to excessively flex the hip and knee to allow the drop foot to clear the ground when walking seen with good drop (peripheral neuropathy)
Waddling (lurching) Gait
The patient leans to the same side as the weight is being placed. This is due to either paralysis of the gluteus medium and minimum muscles and may be also seen in patients with hip replacements; aka Trendelenburg gait seen in Duchenne Muscular Dystrophy and Patients with Hip Replacements
Musculoskeletal Exam
1) Explain the procedure to the patient
2) Obtain permission
3) Observe the patient’s gait while walking to the exam table
4) Place the patient in the standing position and observe the spine for any abnormal curvature
5) Palpate the spine for tenderness, muscle spasm and segmental hypo mobility
6) Observe the active and passive ranges of motion of the cervical, thoracic and lumbar regions
7) Inspect and palpate the shoulder, elbow, wrist and finger joints
8) Examine the active and passive ranges of motion of the above joints
9) Inspect the hands for swelling of joints and atrophy of muscle groups
10) Inspect and palpate the hip, knee, and ankle joint
11) Examine the active and passive ranges of motion of the above joints
12) Inspect the feet for joint swelling and deformities
13) Record findings
14) Interpret finding in the light of the history
Neck ROM Flexion
60
Neck ROM Extension
70
Neck ROM Lateral
45
Neck ROM Rotation
80
Thoracic ROM Flexion
50
Thoracic ROM Extension
30
Thoracic ROM Rotation
30
Lumbar ROM Flexion
80
Lumbar ROM Extension
35
Lumbar ROM Lateral
25
Shoulder ROM Flexion
180
Shoulder ROM Extension
50
Shoulder ROM Abduction
180
Shoulder ROM Adduction
50
Shoulder ROM Rotation
90
Elbow ROM Flexion
140
Elbow ROM Pronate / Supinate
90
Wrist ROM Flexion
90
Wrist ROM Extension
70
Wrist ROM Abduction
20
Wrist ROM Adduction
55
MCP ROM Flexion
90
MCP ROM Extension
10
MCP ROM Abduction
20
PIP ROM Flexion
90
DIP ROM Flexion
60
Hip ROM Flexion
120
Hip ROM Extension
30
Hip ROM Abduction
45
Hip ROM Adduction
30
Hip ROM Internal Rotation
40
Hip ROM External Rotation
45
Knee ROM Flexion
150
Knee ROM Rotation
5
Ankle ROM Plantar
40
Ankle ROM Dorsiflexion
20
Ankle ROM Inversion
30
Ankle ROM Eversion
20
1st MTP ROM Flexion
45
1st MTP ROM Extension
70-90
Stance Phase
heel strike: initial contact
foot flat: loading response
push off: mid-stance
acceleration: terminal stance
Swing Phase
toe-off: pre-swing
swing through: initial then mid-swing
heel strike: terminal swing
heel strike
initial contact
stance phase
foot flat
loading response
stance phase
push off
mid-stance
stance phase
acceleration
terminal stance
stance phase
toe-off
pre-swing
swing phase
swing through
initial then mid-swing
swing phase
heel strike
terminal swing
swing phase
