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נארו > Quiz 3: Gait > Flashcards

Quiz 3: Gait Flashcards

1
Q 
Gait 
-fundamental to
-requires 
-constraints
type of activity
-what domains used to look at it (4)
A
  • fundamental human locomotion
  • requires correct sequencing of multiple forces
  • multiple temporal and spatial constraints
  • can be looked at across various domains:
    1. pathology: muscles that impair walking
    2. impairment: muscles, nervous system
    3. functional limitation: DF strength, PF spasticity
    4. disability: how do I get to work, how do I shop
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2
Q

Gait Evaluation

  • what does examination of gait reveal?
  • how can it be used
  • what does the deviation suggest
A
  • examine of gait reveals the effects of impairments on functional activities
  • gait can be highly diagnostic
  • the deviation suggests the intervention, how the impairment affects gait
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3
Q

Basic Gait Review

A
  • what is normal
  • what is deviation from normal-what is happening vs what should be happening
  • deviation may represent the nervous systems best attempt to solve problems (ie walk with foot drop so compensate with circumduction)
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4
Q

Basic Gait Phases
stance
swing

A

Stance:
HS–>loading–>heel off (push off)

swing:
early–>middle–>late

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5
Q

What gait segments do we look at?

A

ankle, knee, hip, pelvis, trunk, scapula, armswing, head

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6
Q

Kinematics

A

Kinematics: description of movement (without respect to force)

  • angular displacement
  • velocity
  • distance
  • stride width
  • stride length
  • step length
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7
Q

Kinetics

A

forces producing movement

-force plates

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8
Q

What do we look at in a gait evaluation? (2)

A

look at each phase and each segment and note deviations from normal

do findings of impairments (range, strength, spasticity, sensation) explain gait findings?

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9
Q

Ankle/Foot: Critical Gait Components

A
  1. Heel Strike
  2. Smoot transition from heel strike to foot flat
  3. heel off to toe off (push off)
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10
Q

What deviations can occur at the foot/ankle?

A

Foot slap –> foot drop –> foot drag

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11
Q

Foot Slap
-what is it

  • cause (3)
  • UMN vs LMN
A

it is audible: can be seen and heard
unsmooth transition from HS–>FF–>TO

  1. ankle plantarflexion contracture
  2. plantarflexion spactisity/tightening/shortened gastroc or achilles
  3. dorsiflexion weakness (cannot control lifting the toes concentrically or eccentrically thus get the slap)

(stroke, incomplete SCI, MS)
UMN: spasticity of plantar flexors
LMN: flaccidity of the dorsiflexorss: not lift toes and foot slaps

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12
Q

Foot Drop

  • what is it
  • Cause (2)
A

foot does not dorsiflex and comes up during gait

  1. can be limited in active or passive dorsiflexion
  2. can have a contracture in plantarflexion past neutral
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13
Q

Foot drag

A

foot drags because cannot dorsiflex
foot drag is worse than foot slap because in foot slap get heel strike but in foot drag the foot does not clear and more likely to trip

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14
Q

Risk of Foot slap/Drop/drag

A
  • falls risk
  • worse on uneven terrain
  • gait deviation may not present when walking in a clinic on even ground
  • may not present on shorter tests (we need to be provocative, ie 6th minute in the 6MWT)
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15
Q

Foot Drag Compensations (6)

A
  1. circumduction
  2. contralateral vaulting
  3. hip hiking
  4. contralateral trunk lean
  5. hip ER
  6. trunk extension
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16
Q

circumduction compensation

A

foot drag compensation: swing foot out to side

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17
Q

contralateral vaulting compensation

A

foot drag compensation: up on tip toes (hypertrophy) to clear the other foot

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18
Q

hip hiking compensation

A

foot drag compensation: ipsilateral quadratus lumborum to clear that foot

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19
Q

contralateral trunk lean compensation

A

foot drag compensation: lean to the other side to use passive tension to clear the foot

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20
Q

hip ER compensation

A

foot drag compensation: look like ER of involved leg to use adductors but trying to bring foot forward and it pivots on the floor and then swing it

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21
Q

trunk extension compensation

A

foot drag compensation: to bring the foot forward

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22
Q

Tx for foot drag: (5)

A
  1. stretch plantarflexors
  2. strengthen dorsiflexors
  3. task specificity
  4. medication (baclofenn, tizanidine,)
  5. bracing/splinting, night splints , AFO

tell patient to pay attention to gait
*ashworth scale will not always show it bc not provocative

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23
Q

AFO: pros and cons

A

it is a last resort for foot drag because it locks the foot in place so it blocks motion, causes muscle weakness and worse contractures

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24
Q

Gait Deviations: Knee

  • critical components at the knee (2)
  • deviations (2)
A
  1. knee flexion during heel off: if not, will drag the foot even if good DF
  2. smooth transition of knee flexion to extension during stance

Deviations:

  1. absent or inadequate knee flexion at heel off
  2. extension thrust
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25
Q

absent or inadequate knee flexion at heel off
-cause (2)
tx (3)

A

cause:
1. quadriceps spastisity (co-contraction)
2. hamstring weakness

tx:
1. medical
2. learn to activate hamstrings without activating quads (prone, bend knee)
3. stretch quads and strengthen hamstrings

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26
Q

extension thrust at the knee

  • cause
  • tx
A

cause:
1. plantarflexion spasticity/contracture (knee snaps back when travel through(–this is NOT genu recurvatum, knee hyperextension past physiological neutral but can cause genu recurvatum)

–cannot get dorsiflexion once the weight is over the knee and the force moment snaps the knee back

tx: stretch the plantarflexors

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27
Q 
Gait Deviations at the Hip
Critical components (5)
A
  1. flexion during swing
  2. extension during stance (hip extension force for push off from back leg)
  3. neutral adduction and abduction during stance
  4. ER during swing
  5. IR during stance
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28
Q

Gait Deviations at Hip (5)

A
  1. inadequate flexion during swing
  2. Trandelenburg
  3. Scissoring Gait
  4. Gluteus Maximus Lurch
  5. Inadequate Hip Extension
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29
Q

Trandelenberg

  • what is it
  • cause
  • compensation
  • treatment
A
  • cause: stance phase weakness of hip abductors resulting in closed chain adduction (need abductor to hold neutral)
  • –weakness of gluteus medius/TFL
  • -less frequently: spasticity of adductors

compensate with ipsilateral trunk lean

  • treatment: strengthen gluteus medius
  • –open chain: SLR
  • –closed chain: stand at the parallel bars go in and out of trandelenburg eccentrically
  • –closed chain: resist side step at the hip
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30
Q

scissoring gait

  • what is it
  • -cause
  • -treatment
A

often occur with weakness of abductors: trandelenberg
–in swing phase do more hip adduction during flexion so leg crosses over midline

  • –cause:
    1. spasticity of adductors
    2. weakness of abductors

tx:
1. stretch adductors
2. strengthen abductors

31
Q

gluteus maximus lurch

  • what is it
  • cause
  • compensation
  • tx
A

–inadequate mid to late stance hip extension (trunk extension to drive hip extension)

  • cause: 1. hip extensor weakness 2. hip flexor contracture (psoas, sitting)
  • compensation: trunk extension
  • tx: 1. walk behind them and support their trunk
    2. strengthen gluteus maximus
    3. resist walking forward at ASIS
32
Q

Inadequate hip extension

  • what is it
  • cause
  • compensation
  • tx
A

do not fully extend hip during gait, looks like they are sitting when they walk

  • hip extension in gait is the most critical determinant of stability to prevent falls
  • tx: resist walking with gait belt over ASIS to stimulate, get a powerful push off with every step (often not weak but do because more stable)
33
Q

in gait critical determinants of stability to prevent falls are:

A
  1. most important: strength of push off (hip extension)
  2. heel strike
  3. medial – lateral stability
34
Q

Unilateral Pelvic Retraction

  • what is it
  • cause
  • compensation
  • tx
A

retraction of hemi pelvis

cause: 1. weakness or atrophy in trunk extensors
2. weakness or atrophy in hip protractors

usually part of a larger hemiplegic pattern
(common in stroke, especially cortical shock)

tx: because it is depressed and retracted: anterior elevate pelvis, forward and anterior (because it is depressed and retracted)

35
Q

excessive trunk flexion

-cause

A

cause:
1. trunk extension weakness
2. contracture of hips/ abdominal muscles

36
Q

diminished or absent trunk rotation

A

cause:
* **parkinsons disease
- contracture of trunk flexors
- spinal stenosis
- lumbar compression fractures

37
Q

What are 2 gait deviations at the trunk?

A
  1. excessive trunk flexion

2. diminished or absent trunk rotation

38
Q

what is a gait deviation at scapula?

A

scapular protraction

39
Q

scapular protraction

  • cause (3)
  • tx (2)
A

cause:

  1. unilateral: hemiplegia
  2. bilateral: postural fault, poor posture
  3. bilateral parkinson gait

tx:

  1. stretch protractors of the scapula (pec)
  2. strengthen retraction of scapula (rhomboid)
40
Q

gait deviations of the arms: (2)

A
  1. absent or diminished armswing

2. unilateral excessive armswing

41
Q

absent or diminished armswing

-cause

A

cause:

  1. unilateral: hemiplesia (called flail arm/flail shoulder) [can also be antalgic]
  2. bilateral: Parkinsons (usually unilateral to bilateral)
42
Q

unilateral excessive armswing

-cause

A

cause:

  1. hemiballismus (it is like a pendulum)
  2. loss of ability to terminate movement at a specific point
43
Q

head gait deviation (1)

A

gait deviation of forward head

44
Q

deviation forward head

  • -why is this an issue
  • -when does this happen
  • -what commonly causes
A

–COG is in front of them, increases falls risk and requires constant firing at the toe flexors and gastroc,
–patient thinks he needs to look at the floor to not fall.
this is common in parkinsons disease and in cases where patients are scared of tripping
–common in prolonged positioning

45
Q

Name 5 specific gait syndromes

A
  1. parkinsonian gait
  2. cerebellar gait
  3. hemiplegic gait
  4. multiple sclerosis
  5. tabes dorsalis
46
Q

Parkinsonian Gait

8 components

A
  1. cervical hyperextension (to get face off floor)
  2. absent armswing (arms close to body)
  3. flexed trunk
  4. absent trunk rotation
  5. shuffling (bilateral, toe first, initial contact)
  6. festination
  7. tremor
  8. freezing
47
Q

festination

A

leads to falls, start to walk and then steps get shorter and shorter and faster and faster: tell the patient to look up to break the cycle (common in parkinsons)

48
Q

freezing:

A

in parkinsons
doorway or threshold is a visual stimulus to stop them
tell the patient to look at a distant object
(goad and halter: being pushed and pulled in equal and opposite directions

–they are trying to move so dont tell them to try harder

49
Q

cerebellar gait

–2 components

A

wide based: wide BOS for balance

ataxic: uncoordinated gait

50
Q

hemiplegic gait: (6)

A
  1. unilateral pelvic retraction (pelvis)
  2. foot drag (ankle/foot)
  3. possible extension thrusts (knee)
  4. possible tredelenberg (hip)
  5. unequal step lengths
  6. diminished stance time on the involved leg
51
Q

Multiple Sclerosis gait

A

anything is possible but worsens over time due to fatigue
therefore we need tests to be fatiguing
pattern: a slow down over time (ie 6mwt – slow down more at the 6th minute)

52
Q

Tabes Dorsalis

A

“stamping gait” (syphalis)
stamping feet to increase sensory feedback due to dorsal column damage
loss of proprioception, slam foot with each step for feedback from the damaged dorsal column information

53
Q

steppage gait

A

ankle plantarflexion contraction

–a compensation for foot drop by flexing the hip more

54
Q

hip gait deviations: (5)

A
  1. inadequate flexion during swing
  2. trandelenberg
  3. scissoring gait
  4. gluteus maximus lurch
  5. inadequate hip extension
55
Q

gait deviations: knee (2)

A
  1. absent or inadequate knee flexion at heel off

2. extension thrust

56
Q

gait deviations at ankle: (4)

A

foot slap
foot drop
foot drag
steppage gait

57
Q

Inadequate flexion at hip during swing

A

Hip flexor weakness
Hamstring tightness

extend trunk and use passive tension of anterior structures (hip flexors and abs) swing phase to bring the leg forward

tx: strengthen hip flexors
tx: stretch hamstrings

note: lack of hip flexion is cocomitted with foot drop so need to correct this to help with that as well

58
Q

hip hiking

A

caused by any impairment that limits the ability of the LE to functionally shorten

ie weak hip flexors

compensation: contralateral pelvis elevates during swing phase to clear the advancing leg –Quadratus Lumborum

59
Q

weak gluteus maximus

A

weak hip extensors

compensation: backwards lean of the trunk during early stance phase to shift the line of gravity behind the hip to reduce the demands of the hip extensors

60
Q

weak hip abductors

A
  1. contralateral pelvic drop because unable to stabilize pelvis with the weak gluteus medius
  2. trunk leans over ipsilateral side in stance phase
    =trendelenburg
61
Q

genu recurvatum

A

paralysis of the quadriceps, plantarflexor contracture, or hamstring weakness causes this ultimately where there is hyperextension of knee (see during stance phase)

62
Q

hamstring weakness

A

hamstring is unable to slow down the swing and so the knee will snap into extension

63
Q

weak quadriceps

A

patient leans forward at the hip to bring the COG forward so the line of force will fall anterior to the knee and force it into extension (need quad contraction normally to prevent the knee from buckling when the line of force falls behind the knee when going into stance)

64
Q

weak dorsiflexors

A 
foot flat
equinnus gait
foot slap
foot drop
steppage gait
65
Q

weak gastroc/soleus

A

no heel rise at push off, causes a short step length on the good side

66
Q

hip or knee flexor contracture

A

knee or hip is in flexion causing the a crouched gait (lumbar lordosis and reduced stride length)

67
Q

hip circumduction

A

caused by any impairment that reduces ability of the LE to shorten in swing and instead does a circular arc to clear the advancing leg

68
Q

vaulting

A

for any impairment that doesn’t allow LE to shorten in swing – rise up on tip toes of stance foot to clear the advancing limb

69
Q

hemiplegic gait

A

depends on severity and spasticity

  • no Reciprical armswing
  • extension synnergy in LE: hipp adduction, IR, ankle platnarflexion and inversion
  • step length is longer on involved side and shorter on good side
70
Q

ataxic gait

A

cerebellar dysfunction

-gait lacks coordination causing jerky and uneven movements, poor balance, walk with a wide BOS, movements appear exaggerated and pts have a hard time walking in a straight line

71
Q

parkinsonian gait

A

LE and trunk flexion, elbows partially flexed without armswing, short stride length, shuffling gait with flat feet and weight forward on toes, festinating (feet try to keep up with forward leaning trunk) (starts slow and increases in speed with difficulty stopping)

72
Q

scissor gait

A

hip adductor spasticity
most seen during swing
BOS is narrow
trunk may lean over stance leg while other leg trys to swing

73
Q

antalgic gait

A

when LE is painful, stance phase is shortened

–a shortened (often abducted) stand phase on the involved side causes a rapid and shortened step on the good side

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