Test 1: Module 3 (Gait and Balance)

Question 1

Gait

Answer 1

defined as the manner in which a person walks (e.g., cadence, step length, stride length,
speed and rhythm)

Question 2

Ambulation

Answer 2

the act, action, or an instance of moving about or walking

Question 3

What is the purpose of gait analysis?

Answer 3

1. To assess deviations from “normal” or less efficient pattern
2. Identify dysfunction that could lead to:
   
   • functional decline
   • an increased fall risk
   • ROM and/or strength loss,
     etc.
3. Identify impairments that impact gait:
   
   • Poor balance
   • Lack of endurance or
     energy
     expenditure
   • Altered motor control
   • Reduced safety
4. To utilize our knowledge of deviations from normal gait to help define our goals and develop a POC
5. To assist with diagnosis of movement dysfunction
6. To assess whether noted gait deviations could be characteristic or diagnostic of a larger clinical picture (ex parkinson’s)

Question 4

Stance

Answer 4

One period of the gait cycle

constitutes approximately 60% of the gait cycle and is defined as the interval in which the
reference foot is in contact with the ground

Question 5

Swing

Answer 5

One period of the gait cycle

comprises approximately 40% of the gait cycle and occurs when the reference limb is not in
contact with the ground

Question 6

Breakdown the stance phase

Answer 6

initial contact (heel strike), represents the moment in time when the outstretched limb first hits the ground

loading response (foot flat), body weight is rapidly accepted onto the outstretched limb

midstance, body weight progresses forward over a single stable limb usually when the leg is underneath the trunk

terminal stance (heel off), the heel rises from the ground, the leg achieves a “trailing limb” posture, and the trunk advances well in front of the reference foot.

Pre-swing (toe off), the last phase of stance. During pre-swing, body weight transfers from the trailing limb to the contralateral lead limb, which is experiencing initial contact and loading response.

Question 7

Breakdown the swing phase

Answer 7

initial swing (acceleration), lifting of the foot from the ground reflects the onset of the first phase of swing,

midswing, the thigh continues to advance into flexion

terminal swing (decceleration), further thigh flexion is curtailed; however, the knee continues to extend until it
observationally appears neutral.

Question 8

What are gait variables?

Answer 8

Things that impact spatial and temporal components of gait

Question 9

What are gait patterns?

Answer 9

Things that impact symmetry and planes of movement

Question 10

What are pt centered variables?

Answer 10

Assistive device, level of assistance, WB status and environment

Question 11

Step length and step time

Answer 11

distance between the heel contact to the point
of the heel contact of the other foot

time to complete one step

Question 12

Stride length and stride time

Answer 12

stride length is the distance between the point of contact of the heel and the next contact of the same heel

time to complete one stride

Question 13

Cadence and velocity

Answer 13

Cadence = steps/min (number of cycles in a period of time)

velocity = m/s (Distance covered in a period of time)

Question 14

Base of support and toe out

Answer 14

base of support = step width

toe out = angle of the foot (5-13 deg)

Question 15

What closely ties to overall function?

Answer 15

Gait speed

Question 16

Type of Assistive Devices

Answer 16

Walkers, crutches, canes

Question 17

How do assistive devices effect a pt’s mobility and stability?

Answer 17

• Attention and neuromotor demands
• Interference with limb movement during balance
  recovery
• Metabolic demands
• Change in center of gravity from S2 to more anterior- superior which results in postural changes

Question 18

LEVELS OF ASSISTANCE
(FUNCTIONAL INDEPENDENCE MEASURE)

Answer 18

7 = Independent: safe & timely, no device
6 = Modified independence: device without supervision, more than reasonable time, or
concern for safety
5 = Supervision or set up (also known as stand by assist – SBA)
4 = Minimal assistance (min A): patient performs 75% or more of effort
3 = Moderate assistance (mod A): 50 – 74% of effort
2 = Maximal assistance (max A): 25 – 49% of effort
1 = Total assistance: < 25% of effort or assist of 2 persons (also known as dependence)

Question 19

Weight Bearing Status

Answer 19

• Full weight bearing (FWB)
• Partial weight bearing (PWB) – an established % of FWB
• Touch down weight bearing (TDWB): Can put foot on the ground for balance but not put any weight on it
• Toe-Touch weight bearing (TTWB): Toe can be on the ground (not commonly used)
• Weight bearing as tolerated (WBAT): Up to the discretion of the patient
• Non-weight bearing (NWB): Usually have foot elevated

Question 20

What do you document in gait?

Answer 20

Gait activity
Spatial/Temporal Variables
Level of Assistance
Assistive device
Weight bearing
Environment
Postural Deviation

EX. Patient ambulated 100 ft on a flat surface in the clinic hallway using a Rolling Walker, Mod I.
Patient exhibited forward trunk lean and forward head posture throughout the gait cycle. Pt
showed decreased step length bilaterally with a wide BOS, slow cadence with prolonged double stance time, using a step-through pattern.

Question 21

Balance

Answer 21

is the condition in which all the forces acting on the body are balanced (in equilibrium)
such that the center of mass (COM) is within the stability limits, the boundaries of the BOS.

Question 22

Reactive Balance

Answer 22

postural control occurs in response to external forces acting on the body (e.g.,
perturbations) displacing the COM or moving the BOS (e.g., moveable platform, therapy ball)

Question 23

Proactive Balance

Answer 23

(anticipatory) postural control occurs in anticipation of internally generated, destabilizing forces imposed on the body’s own movements (e.g., catching a weighted ball)

Question 24

HOW DOES THE BODY CONTROL BALANCE?

Answer 24

The brain integrates sensory information from multiple sources:

• Vision (lighting, movement of self or environment)
• Somatosensation (Surface changes and irregularities; BOS changes)
• Vestibular (gravity, linear and angular head and eye movement)

The body’s position in space and orientation to its base of support is constantly monitored to produce an adaptive strategy to maintain balance

Question 25

BALANCE
STRATEGIES

Answer 25

ankle strategy
hip strategy
stepping strategy

Question 26

Common risk factors across settings

Answer 26

Impaired gait/balance/ADL, LE weakness, dizziness,
hypotension, impaired vision, > 4 prescription medications,
depression, cognitive impairment

Question 27

ASSESSING FALL RISK

Answer 27

1. # of falls in past 6 months (incidence or episodes)
2. Frequency (# of incidence within a given time)
3. Events that precede or cause the fall
   
   • Medications and or change in
     medications?
   • Change in condition (dizzy,
     light-headed)
   • Change in eyesight
     correction?
4. # of losses of balance
5. Environment

Question 28

Purpose of balance examination

Answer 28

1. Balance in fundamental to daily activities
2. Balance is central to a sense of stability and well being
3. Fear of falling is a greater indicator of falls than actual hx of previous falls
4. Loss of balance can lead to restriction in movement, which can cause:
   - deconditioning and debilitation
   - increased fall risk
   - secondary problems due to sedentary lifestyle