Upright mobility deficits

Question 1

factors contributing to functional upright mobility - individual variables

Answer 1

age
prior experience
motor abilities
diagnosis
motivation
primary impairments
secondary impairments

Question 2

factors contributing to functional upright mobility - mobility tasks

Answer 2

walking
stairs
inclines
curbs
obstacles
single or dual task

Question 3

factors contributing to functional upright mobility - regulatory features

Answer 3

surface conditions
object characteristics
changes in regulatory conditions between attempts

Question 4

factors contributing to functional upright mobility - environmental variables

Answer 4

moving or stationary environment
changes in regulatory conditions between attempts

Question 5

examination of gait/upright mobility

Answer 5

observational gait analysis
digital video recording
outcome measures (10MWT speed 6MWT endurance, FGA, DGI, FIM, HiMAT)
instrumented systems (GAITRite, VICON)

Question 6

3 essential requirements for successful locomotion

Answer 6

progression
upright/postural control
adapting to the environment

Question 7

4 biomechanical subcomponents of gait

Answer 7

propulsion
stance control
limb advancement/swing
postural/lateral stability

Question 8

propulsion

Answer 8

redirect falling COM to kinetic energy; drivers: plantarflexors; greatest* metabolic cost of walking

if PF impaired - might see hip hike, hip flexor compensation, opposite leg boost

Question 9

stance control

Answer 9

maintenance of upright posture; passive vs active support

Question 10

limb advancement/swing

Answer 10

progression of non WB limb to accept weight; drivers - hip flexors

Question 11

postural/lateral stabiltiy

Answer 11

altered foot position to reduce lateral COM movement

Question 12

stroke - common gait deviations in ankle/foot during stance (4)

Answer 12

foot slap (loading response - weak DF eccentrically, spastic PF)

forefoot/flat foot contact (initial contact, could be weakness or spasticity)

equinus gait (heel does not touch ground, PF contracture, )

no/decreased heel off (decreased propulsion, terminal stance..preswing?,)

Question 13

stroke common gait deviations in foot/ankle during swing

Answer 13

foot drop/drag (weak DP, spastic PF or contracture, inadequate hip/knee flexion

persistent equinus

Question 14

stroke common gait deviations in knee during stance (2)

Answer 14

excessive kne flexion (midstance)
- poor propioception, weak quads/knee ext, spastic hs, weak hip ext)

hyperextension (midstance)
- weak quads, spastic quads

Question 15

stroke common gait deviations in knee during swing (2)

Answer 15

decreased flexion (initial/midswing)
- weak HS, spastic quads, poor hip ext

inadequate knee extension at terminal swing/initial contact
- weak quads, spastic HS

Question 16

stroke common gait deviations in hip during stance (2)

Answer 16

poor hip position
- weak hip, flexed posture, spastic HS

trendelenburg gait
- weak hip abductors

Question 17

stroke common gait deviations in hip during swing (4)

Answer 17

decreased hip flexion
- difficulty advancing leg, spastic HS

hip hike
- QL muscle, damage to L3,4 what deviations would u see?)

abnormal substituitions (circumduction, scissoring)

Question 18

stroke common gait deviations in trunk/pelivs during stance (3)

Answer 18

increased trunk flexion
lateral trunk flexion
pelvic drop (hip ABD)

weakness or spasticity

Question 19

what is trendelendburg gait

Answer 19

weak hip abductors
opposite side pelvis drops

Question 20

stroke common gait deviations in trunk/pelvis during swing (2)

Answer 20

decreased (forward pelvic rotation)
- paretic side you will see pelvic retraction

backward trunk lean
- lacking hip flexor strength to swing leg forward

Question 21

common gait deviations seen in stroke overall

Answer 21

decreased WB over hemiparetic leg

unequal step/stride length; narrows BOS

decreased cadence/abnormal timing

Question 22

intervention focus for propulsion deficit

Answer 22

reduced speed/symmetry

Question 23

intervention focus for stance control deficit

Answer 23

buckling, hip/knee collapse

Question 24

intervention focus for limb advancement/swing deficit

Answer 24

limited paretic step length/speed

Question 25

intervention focus for postural/lateral stability deficit

Answer 25

balance difficulty, reduced speed

Question 26

overall assessment/intervention for deficits in biomechanical subcomponents

Answer 26

focus on biomechanical subcomponents of gait (vs kinematics) and improving walking speed over varied distances

Question 27

common gait deviations in PD

Answer 27

reduced armswing with asymmetry

festinating (short) gait (anteropulsive/retropulsive)

freezing of gait (FOG) - hardwood to carpet, turning, doorways

difficulty turning or changing directions

Question 28

initial motor symptoms in PD affects what %

Answer 28

about 13-33%

Question 29

common gait deviations in MS

Answer 29

gait changes secondary to muscle weakness, spasticity, fatigue, altered sensation, impaired balance, visual problems, and/or FEAR OF FALLING

• toe drag, genu recurvatum, circumduction
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