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S3 - Clinical Practice 2 > Week 10- Gait Deviations > Flashcards

Week 10- Gait Deviations Flashcards

1
Q

What are the parts of stance phase?

A
  • IC
  • LR
  • MSt
  • TSt
  • PSw
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2
Q

What are the parts of swing phase?

A
  • ISw
  • MSw
  • TSw
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3
Q

Progression of gait over the supporting foot requires __ rockers. What are they?

A

3

  • First Rocker (Heel)-Motion of the foot from a DF to PF position during LR to achieve foot flat.
  • Second Rocker (Ankle)-Closed chain advancement of the tibia into a DF position over a fixed foot during MSt.
  • Third Rocker (Forefoot)-Begins when COP is over the mets and heel lift occurs in TSt/PSw.
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4
Q

First Rocker is motion of the foot from a ___ to ___ position during ____ to achieve ________.

A
  • DF to PF
  • LR
  • foot flat
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5
Q

Second Rocker is the closed chain advancement of the tibia into ____ position over a fixed foot during _____.

A
  • DF

- MSt

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6
Q

Third Rocket begins when ____ is over the mets and heel lift occurs in ___/___.

A
  • COP

- TSt/PSw

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7
Q

Stance Phase: IC

  • The instant the foot hits the ground.
  • Critical event = ___________
  • Opposite limb = ____/_____
A
  • heel first contact

- TSt/PSw

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8
Q 
Stance Phase: IC
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 20° flexion
-Major muscles = extensors
Knee
-Position = 0-5° flexion
-Major muscles = quadriceps
Ankle
-Position = 0°
-Major muscles = pretibials
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9
Q

Stance Phase: LR

  • Shock is absorbed as forward momentum is preserved. Foot flat position is achieved.
  • Critical events = __________
  • Opposite limb = ______
A
  • hip stability, controlled knee flexion, ankle PF

- PSw

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10
Q 
Stance Phase: LR
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 20° flexion
-Major muscles = extensors, abductors
Knee
-Position = 15° flexion
-Major muscles = quadriceps
Ankle
-Position = 5° PF
-Major muscles = pretibials
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11
Q

Stance Phase: MSt

  • The body progresses over the foot in a controlled manner. First instance of single limb support.
  • Critical events = __________
  • Opposite limb = ______
A
  • controlled tibial advancement

- ISw/MSw

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12
Q 
Stance Phase: MSt
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 0° 
-Major muscles = abductors
Knee
-Position = 5° flexion
-Major muscles = quadriceps ->quiet
Ankle
-Position = 5° DF
-Major muscles = gastroc/soleus
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13
Q

Stance Phase: TSt

  • Progression over the stance limb continues past the forefoot. Body is ahead of stance limb.
  • Critical events = __________
  • Opposite limb = ______
A
  • controlled ankle DF with heel rise

- TSw

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14
Q 
Stance Phase: TSt
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 20° extension
-Major muscles = none
Knee
-Position = 5° flexion
-Major muscles = none
Ankle
-Position = 10° DF
-Major muscles = gastroc/soleus
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15
Q

Stance Phase: PSw

  • Rapid unloading of the limb with weight transfer to opposite limb, starting the second period of double limb support.
  • Critical events = __________
  • Opposite limb = ______
A
  • passive knee flexion to 40°, ankle PF, 60° MTP ext

- IC/LR

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16
Q 
Stance Phase: PSw
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 10° extension
-Major muscles = adductors
Knee
-Position = 40° flexion
-Major muscles = none
Ankle
-Position = 15° PF
-Major muscles = none -> tib ant
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17
Q

Swing Phase: ISw

  • The thigh begins to advance as the foot leaves.
  • Critical events = __________
  • Opposite limb = ______
A
  • hip flexion, knee flexion

- LR/MSt

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18
Q 
Swing Phase: ISw
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 15° flexion
-Major muscles = flexors
Knee
-Position = 60° flexion
-Major muscles = flexors
Ankle
-Position = 5° PF
-Major muscles = pretibials
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19
Q

Swing Phase: MSw

  • The thigh begins to advance as the foot leaves.
  • Critical events = __________
  • Opposite limb = ______
A
  • continued hip flexion, foot clearance

- MSt

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20
Q 
Swing Phase: MSw
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 25° flexion
-Major muscles = flexors
Knee
-Position = 25° flexion
-Major muscles = flexors
Ankle
-Position = 0° DF
-Major muscles = pretibials
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21
Q

Swing Phase: TSw

  • The leg reaches out to achieve step length.
  • Critical events = __________
  • Opposite limb = ______
A
  • knee extension

- TSt

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22
Q 
Swing Phase: TSw
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 20° flexion
-Major muscles = extensors
Knee
-Position = 5° flexion
-Major muscles = quadriceps
Ankle
-Position = 0° DF
-Major muscles = pretibials
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23
Q

Why do we analyze gait?

A
  • Identify deviations in gait in order to address with intervention.
  • Determine functional ambulation capability across variety of environments.
  • Assess balance, safety, endurance, energy expenditure as it relates to walking.
  • Determine need for assistive devices/orthotics.
  • Evaluate the effectiveness of your interventions; describe how your interventions impacted gait.
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24
Q

The goal of analyzing gait is to identify _________ and design appropriate __________ to treat impairments (function/participation limitations.

A
  • deviations

- interventions

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25
Q

What are some abnormalities that can cause gait deviations?

A
  • Pain
  • Joint and/or muscle ROM limitation
  • Muscular weakness/paralysis
  • Impaired motor control
  • Neurological involvement (UMN or LMN)
  • Impaired balance
  • Leg length discrepancy
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26
Q
  • A single impairment may result in a number of ___________.
  • A single deviation may be caused by multiple __________.
  • Deviations are often ____________ to make gait more effecient.
A
  • deviations
  • impairments
  • compensations
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27
Q

Ways to make analyzing gait easier?

A
  • Analyze from bottom-up/top-down
  • Work in segments
  • Identify reference limb
  • Select a plane to start in (look at all)
  • Work in phases
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28
Q

Can deviations in one joint be due to impairments/deviations in other joints above/below it?

A

Yes

-not just weak tib anterior could cause toe drag

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29
Q

What is an Antalgic Gait?

A

Compensatory gait adopted to remove or decrease the discomfort caused by pain in the lower leg, pelvis, lumbar spine.

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30
Q

What are the characteristic features of an Antalgic Gait?

A
  • Decreased stance phase duration on affected limb.
  • Lack of weight shift laterally over stance limb to keep weight off the involved limb.
  • Decrease in stance phase in affected side will result in decrease in swing phase of uninvolved limb and thus shortened step length on uninvolved side.
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31
Q

What are some hip deviations we can see with gait?

A
  • Forward Trunk Lean
  • Decreased Hip Extension
  • Gluteus Maximus Gait/ backward trunk lean
  • Hip Drop
32
Q

With gait deviations, what 3 things do you ask yourself?

A
  • What could be tight?
  • What could be weak?
  • What could be hypomobile joint wise?
33
Q

What are some causes of Forward Trunk Lean?

A
  • Result of weak quadriceps (decreases flexor movement of knee)
  • Tight hip flexors
  • Weak lumbar/hip extensors
  • Hypomobile joint capsule
34
Q

What are some causes of Decreased Hip Extension?

A
  • Tight hip flexors
  • Decreased joint mobility
  • Weak glutes
35
Q

Gluteus Maximus Gait:

  • What is glute max role during IC of gait?
  • If glute max is weak, how will my body compensate?
A
  • Contracts atinitial contact, slowing forward motion of trunk by resisting flexion of the hip and initiating extension.
  • Trunk will quickly shift posteriorly during initial contact to try and offset forward momentum, this requires less muscle strength to maintain the hip in extension during stance phase.
36
Q

Hip Drop (Trendelenberg Gait):

  • What might you see with weak gluteus medius?
  • How would we compensate?
A
  • Hip drop on contralateral side

- Trunk lean, hip hike

37
Q

What are some hip deviations we can see with gait?

A
  • Knee Hyperextension (genu recurvatum)
  • Decreased Knee Extension
  • Excessive Genu Valgum (knock knee)
  • Excessive Genu Varum (bow leg)
38
Q

What are some causes of Knee Hyperextension?

A
  • Quadriceps weakness (thrust to create bony lock)
  • Hamstring weakness
  • Increased tone of quadriceps
  • Compensation for plantarflexion contracture or spasticity
39
Q

What are some causes of Decreased Knee Extension?

A
  • Quadriceps weakness (unable to straighten knee)
  • Knee joint hypomobility
  • Hamstring contracture or stiffness
  • Strategy to avoid heel rocker
40
Q

Patients with Decreased Knee Extension will see difficulty with what?

A

Going down stairs because we need to straighten knee to reach for the next step.

41
Q

What are some causes of Excessive Genu Valgum?

A
  • Bony deformity (arthritis)
  • Pain
  • Excessive foot pronation
  • Glute med weakness
  • Excessive femoral adduction
  • Ipsilateral trunk lean
42
Q

Does Excessive Genu Valgum result in increasing or decreasing BOS?

A

Increasing

43
Q

What are some causes of Excessive Genu Varum?

A
  • Degenerative changes
  • Pain
  • Bony deformity
44
Q

Does Excessive Genu Varum result in increasing or decreasing BOS?

A

Decreasing

45
Q

What are some foot/ankle deviations we can see with gait?

A
  • Excessive PF (equinus gait)
  • Increased DF (calcaneal gait)
  • Equinovarus gait (club foot)
  • Foot Drop (foot slap)
  • Foot Flat
  • Excessive Supination
  • Excessive Pronation
  • Inadequate Push-off
46
Q

What are some causes of Excessive PF?

A
  • Tib ant weakness
  • Plantarflexion contracture
  • Hypomobility of talocrural joint
  • Compensation for short leg/short stride length
  • Painful heel/avoiding heel rocker
47
Q

With Excessive PF gait, what point of the body will land at IC?

48
Q

What might Excessive PF gait make difficult?

A

Walk/run without tripping

49
Q

What are some causes of Increased DF?

A
  • Contracture tib anterior
  • Weakness gastroc
  • Hypomobility talocrural joint
50
Q

What deviations would we expect with someone with Increased DF?

A

Walking on heel (heel walking)

51
Q

Equinovarus Gait (club foot) presents as ankle _________ and subtalar __________.

A
  • PF

- inversion

52
Q

How will patients with Equinovarus Gait (club foot) be walking?

A

On outside of the foot

53
Q

What are some causes of Foot Drop?

A

-DF weakness caused by paralysis of common peroneal nerve

54
Q

What will a Foot Drop Gait look like?

A

foot slaps ground due to weakness

55
Q

What muscles would you MMT with Foot Drop?

56
Q

What muscles do you worry about becoming too tight with Foot Drop?

57
Q

How might someone compensate for Foot Drop Gait?

A
  • Steppage gait
  • Circumduction
  • Vaulting
58
Q

What are some causes of Foot Flat Gait?

A
  • Weak dorsiflexor
  • Limited ROM
  • Hypomobility
  • Normal immature gait pattern (neonatal)
59
Q

What are some causes of Excessive Supination?

A
  • Hypomobility of subtalar and/or midtarsal joints
  • Spastic invertors or intrinsic foot muscles
  • Weak evertors
  • Genu varum
60
Q

What part of the foot will someone with Excessive Supination likely land on?

A

Excessive lateral contact of foot during stance with varus position of foot.

61
Q

What are some causes of Excessive Pronation?

A
  • Foot intrinsic muscle weakness
  • Posterior tibialis weakness
  • Hip abductor weakness
  • Hypomobility of subtalar and/or midtarsal joints
62
Q

What part of the foot will someone with Excessive Pronation likely land on?

A

Excessive medial contact of foot during stance with valgus positon of foot.

63
Q

What are some causes of Inadequate Push-off?

A
  • Result of weak plantar flexors
  • Tight/spastic dorsiflexors
  • Hypomobile talocrural joint
  • Pain in forefoot
64
Q

What are some pelvis deviations we can see with gait?

A
  • Excessive Anterior Pelvic Tilt

- Excessive Posterior Pelvic Tilt

65
Q

What are some causes of Excessive Anterior Pelvic Tilt?

A
  • Weak hip extensors
  • Hip flexion contracture
  • Abdominal muscle weakness
  • Limited hip extension ROM
66
Q

What is a normal Anterior Pelvic Tilt?

67
Q

Excessive Anterior Pelvic Tilt can lead to lumbar ________ and ____ back pain.

A
  • lordosis

- low

68
Q

What are some causes of Excessive Posterior Pelvic Tilt?

A
  • Most commonly caused by tight hamstrings
  • Hip flexor weakness (post tilt acts as substitution)
  • Low back pain
  • Limited lumbar extension ROM
69
Q

What are the 2 types of Leg Length Discrepancies?

A

Anatomical LLD
-Legs are ACTUALLY different lengths as confirmed with x ray or tape measure.
Functional LLD
-Functional LLD means on x-ray the leg lengths are equal, but for some reason they appear longer. Could be due to tightness, weakness, compensation, etc.

70
Q

What are some compensations for LLD?

A
  • Circumduction
  • Hip Hiking
  • Steppage Gait
  • Vaulting
71
Q

What are some other abnormal gaits we can see?

A
  • Trunk Lean (waddling gait)
  • Abnormal BOS
  • Hemiplegic Gait
  • Sensory Ataxic Gait
  • Festinating Gait
72
Q

What are some causes of Trunk Lean (waddling gait)?

A
  • Tight IT band
  • Contralateral hip abductor weakness
  • Limited hip or knee flexion- leans to contralateral side to compensate to clear foot
  • Commonly seen with pain in hip related to arthritis
73
Q

Clinical Correlations of a Widened BOS:

  • Results in more _________ movements of the trunk (= less efficient gait)
  • May indicate ____________ or fear of falling
  • Observed with decreased ____________, cerebellar ataxia, etc.
A
  • lateral
  • imbalance
  • proprioception
74
Q

How does Hemiplegic Gait present?

A

-Hip into extension, adduction, and medial rotation
-Knee in extension
-Ankle in drop foot with plantar flexion and inversion, present during both stance and swing phases
-Spastic muscles won’t allow hip and
knee to flex to clear the floor
-Patient often performs circumduction
-Usually with no reciprocal arm swing
-Step length tends to be lengthened on
involved side and shortened on uninvolved side

75
Q
  • Sensory Ataxic Gait is often seen in individuals with _______ disorders.
  • It is defined as presence of abnormal and ___________ movements.
A
  • cerebellar

- uncoordinated

76
Q

What is Festinating Gait most often seen in?

A

Parkinson’s Disease, but can be seen in other basal ganglia diseases.

77
Q

Festinating Gait:

  • Because of rigidity all the joints will want to flex ________
  • Displaces COG ________
  • In order to keep the COG within the BOS, patient will _______ their steps
  • In an attempt to avoid losing their balance due to their anterior COG they walk ______ as if chasing the COG
A
  • forward
  • anteriorly
  • shuffle
  • faster

S3 - Clinical Practice 2 (13 decks)

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