Week 2 Flashcards
1
Q
What is pathologic gait?
A
Impairment of an individual’s ability to walk
2
Q
What is pathologic gait typically associated with?
A
Typically associated with altered mechanics and reduced efficiency
3
Q
What mechanisms contribute to
pathologic gait?
A
- Impaired Motor Control
- Abnormal Range of Motion
- Impaired Sensation
- Pain
4
Q
How can impaired motor control contribute to pathologic gait when impairments are of a peripheral origin?
A
There will be weakness
5
Q
How can impaired motor control contribute to pathologic gait when impairments are of a central origin?
A
There will be: • Weakness • Hypertonicity • Lack of selective control • Apraxia • Ataxia • Rigidity
6
Q
How does the clinical assessment of strength relate to walking ability?
A
• Walking ability commonly exaggerated by inability of strength tests to identify upper
levels of normal strength
• Strength grade of 3/5 – equivalent of single unilateral heel rise – required for normal gait although endurance likely
impaired
7
Q
How can abnormal range of motion contribute to pathologic gait?
A
It can either be too little or too much
8
Q
How can elastic contracture affect range of motion and gait?
A
- From inactivity or increased stiffness of bulky tissues
* Yield to forceful stretch
9
Q
How can rigid contracture affect range of motion and gait?
A
- May arise from muscle shortness
- May be enhanced by scarring from trauma or surgery
- Resistant to considerable force
10
Q
How might impaired sensation contribute to pathologic gait?
A
- Inconsistent gait pattern
- Prevents prompt substitution
- Includes perceptual deficits
11
Q
How might pain contribute to pathologic gait?
A
- Slowed walking speed
- Shortened stance phase on the painful limb
- Tendency to stiffen the limb to avoid joint excursion
- Absence of forceful foot contact or push-off
12
Q
How do primary impairments and compensatory actions relate: primary deviations?
A
Gait deviation occurring as a
direct result of a readily
associated impairment
13
Q
How do primary impairments and compensatory actions relate: secondary deviations?
A
Gait deviation occurring as a secondary consequence of a more distant or obscure impairment. (THINK REGIONAL INTERDEPENDENCE)
14
Q
How can we address pathologic gait clinically?
A
Problem Solving Approach
Problem Identification –> Cause Identification –> Treatment
15
Q
How do we go about Problem
Identification?
A
Patient History + Physical
Examination + Observational
Gait Analysis
16
Q
What is involved in Cause Identification?
A
• Consider possible causes of deviations observed • Determine likely causes based on results of impairment testing
17
Q
What are the major deviations of the ankle to consider in gait analysis?
A
Excess Plantar Flexion • Foot Flat Contact • Forefoot Contact • Heel Off • Drag • Foot Slap Excess Dorsiflexion • No Heel Off
18
Q
Why does excess plantar flexion arise in gait?
A
- Limitations in ankle DF ROM
- Pretibial muscle weakness
Depending on the phase of gait
19
Q
Why does excess dorsi flexion arise in gait?
A
Calf muscle weakness
20
Q
How does Excess Plantar Flexion affect Initial Contact?
A
- Foot Flat Contact
- Forefoot Contact
21
Q
What does foot flat contact involve?
A
Initial contact by the entire plantar surface of the foot
22
Q
What does forefoot contact involve?
A
Initial contact with the ground by the forefoot
23
Q
What does Excess Plantar Flexion affect in Initial Contact?
A
The heel rocker mechanism, which progresses through loading response, limiting the forward momentum of the tibia and shock absorption
24
Q
What is a heel off deviation?
A
When excess plantar flexion and forefoot only contact the ground and moves into stance, especially if it occurs throughout stance
25
____ might occur as an antalgic compensation for a painful heel during stance
*Heel off deviation* might occur as an antalgic compensation for a painful heel during stance
26
What does it mean when a heel off deviation occurs only later in stance?
It manifests as pre mature heel rise, it is more likely secondary to excess knee flexion as when knee extension ROM is very limited
27
What does heel off contribute to?
A smaller weightbearing surface, which leads to a reduced BOS and increased pressure on the metatarsal heads
28
What happens if the heel does contact the ground and Excess Plantar Flexion persist as a primary deviation due to limitations in ankle DF ROM or deficits in proprioception?
Knee hyperextension is likely to result, especially in mid stance and terminal stance
29
Excess PF in stance may occur as a secondary deviation in response to ____
Quad weakness
30
What are the consequences of Excess
| Plantar Flexion in swing?
A drag
31
Why may excess PF persist in swing?
Due to pretibial muscle weakness or due to limitation in ankle DF ROM
32
What does drag most commonly involve when due to the persistence of excess PF?
Toe contact with the ground in mid or terminal swing, which may injure the toes or led to balance disruptions
33
What are the strategies used to avoid drag in compensating for a relatively long swing limb, as occurs with excess PF?
- Hiking of the pelvis
- Excess flexion of the hip
- Excess flexion of the knee
- Contralateral vaulting
34
What is Contralateral Vaulting?
Rising of the forefoot of the contralateral stance limb during swing limb advancement of the reference limb
35
What does contralateral vaulting lead to?
Increased demands of the PFs of the contralateral limb
36
In what phase of gait is excess PF due to a rigid contracture present and why?
All of them. Due to the fact that rigid contractures do not necessarily yield to external forces, including those generated by bodyweight and reactions with the ground
37
What should the interventions of excess PF due to a rigid contracture be focused on?
Improving ankle mobility, before improvements in the gait pattern can be expected
38
What will need to be addressed first in a patient who has excess PF due to a rigid contracture and pretibial weakness?
Mobility will need to be restored, before pretibial strengthening will be likely to reduce the occurrence of excess PF
39
In what phase of gait is excess PF due to an elastic contracture present and why?
```
Initial contact: Yes
Loading response: yes/no
Mid-stance: yes/no
Terminal stance: yes/no
Pre-swing: yes/no
Initial swing: yes
Mid- swing: yes
Terminal swing: yes
```
Elastic contractures yield to varying degrees to the application of external forces. This is why they can be overcome in part during stance by bodyweight and ground reaction forces
40
What should the interventions of excess PF due to an elastic contracture be focused on?
Focused mobility or flexibility exercises are likely to result in changes of the gait pattern affected by an elastic contracture much more rapidly than an excess PF due to a rigid contracture
41
In what phase of gait is excess PF due to pretibial weakness present and why?
```
Initial contact: Yes
Loading response: no
Mid-stance: no
Terminal stance: no
Pre-swing: no
Initial swing: yes
Mid- swing: yes
Terminal swing: yes
```
Appears only in the swing phase, leading into IC, because this is when the pretibial muscles are active in facilitating foot clearance
42
What should the interventions of excess PF due to pretibial weakness be focused on?
Pretibial strengthening
43
What is a foot slap?
A manifestation of pretibial muscle weakness, which involves uncontrolled PF at the ankle joint after heel contact. The sole of the foot rapidly comes in contact with the ground after IC. Only occurs if pretibial muscles are strong enough to provide heel first contact in Initial Contact (MMT: 3-/5)
44
What does a foot slap produce and how?
It produces shock absorption, by limiting knee flexion, while also reducing forward momentum of the tibia
45
How does Excess Dorsiflexion affect
| stance/ weight acceptance?
It is secondary to excess hip or knee flexion, and serves to rapidly translate the body forward through loading response which reduce limb stability
46
What drives excess DF in single limb support?
Excess hip or knee flexion and inadequate extension of the toes
47
What is excess DF occurring as a primary deviation due to?
Calf muscle weakness, as weakened PFs are unable to restrain the forward advancement of the tibia, which may interfere with heel rise, leading to reduced progression over the forefoot and decreased step length in the contralateral limb
48
What is it referred to as when excess DF entirely disrupts normal heel rise in terminal stance?
No heel off
49
What does excess DF commonly lead to, regardless of when it occurs?
Increased demands on the hip and knee extensors, as efforts are made to maintain limb stability
50
Can No Heel Off affect the swing period
| of gait?
Yes, especially when it is due to calf muscle weakness, it may result in limited knee
flexion which can limit limb clearance, leading to drag especially in Initial Swing
51
How does no heel off affect the swing period of gait when due to excess PF?
Drag more frequently occurs in mid or terminal swing.
52
How does no heel off affect the swing period of gait when due to limited knee flexion?
Drag more typically occurs in initial swing, because adequate knee flexion during initial swing is essential for adequate clearance of the foot
53
In what phase of gait does the greatest amount of knee flexion occur?
Initial swing
54
Inadequate knee flexion in initial swing may stem from ___
Inadequate PF occurring in terminal stance and pre- swing
55
What happens if the tibia is not pushed up under the femur, early in swing limb advancement?
Insufficient knee flexion may result and drag of the toes in initial swing may occur
56
What are the major deviations of the
| foot to consider in gait analysis?
* Excess Inversion
| * Excess Eversion
57
What are the major deviations of the
| toes to consider in gait analysis?
* Inadequate Extension
| * Clawed or Hammered Toes
58
How does Excess Inversion affect gait?
* Reduced shock absorption in Weight Acceptance
* Decreased limb stability in Single Limb Support
* Reduced clearance of foot in Swing Limb Advancement
59
How does Excess Eversion affect Swing Limb Advancement?
```
• May be caused by selective weakness
of anterior tibialis or hypertonicity of
peroneal muscles
• Interferes with foot position for Initial
Contact
```
60
In what population does excess foot inversion during gait mostly occurs?
In individuals with a neuromuscular dysfunction
61
What does excess foot inversion involve?
Greater than normal inversion of the rear foot for a specific phase of gait
62
What does excess foot eversion involve and what is it also known as?
Also known as excessive pronation. Involves greater than normal eversion of the rear foot for a specific phase of gait
63
What causes excess inversion of the foot?
May be caused by over activity of the inverters of foot, varus contracture, or variation in skeletal structural alignment, such as internal torsion of the tibia
64
What does excess inversion lead to?
A loss of foot function as a supple adapter in weight acceptance
65
How does excess eversion affect weight acceptance/ stance?
Leads to rotatory strain of the mid foot and knee
66
What are the causes of excess eversion in weight acceptance/ stance and in single limb support?
- Posterior tib muscle weakness
- Variations in muscle alignment such as rearfoot valgus deformities
- PF contracture (just in single limb support)
67
How does Excess Eversion affect Single
| Limb Support?
- PF contracture leading to limitations in ankle DF ROM can be viewed as a driver for over pronation of the foot
- Increased DF of the oblique midtarsal joint, which promotes over pronation
- Interferes with the function of the midfoot and the fore foot as a rigid lever, which is essential for the function of the fore foot rocker
68
Where does the vector of pull of the anterior tibialis lie in reference to the subtalar joint axis?
Medial
69
Where does the vector of pull of the extensor digitorum longus lie in reference to the subtalar joint axis?
Lateral
70
What happens when the anterior tibialis is weak and extensor digitorum longus isn't?
The foot is pulled laterally into eversion as active dorsiflexion is attempted during swing, which then interferes with foot positioning for initial contact
71
What does inadequate extension of the toes involve?
The occurrence of less metatarsal phalangeal extension than normal for a specific phase of gait.
72
How does Inadequate Extension of the
| toes affect the gait pattern?
Not likely to interfere with weight acceptance, but does interfere with single limb support, especially terminal stance and swing limb advancement, particularly pre-swing
73
What causes inadequate extension of the
| toes?
Limited metatarsal phalangeal joint extension ROM or toe flexor hypertonicity
74
What does inadequate extension of the
| toes promote?
A loss of heel rise as a secondary deviation in terminal stance and especially in pre-swing
75
What does inadequate extension of the
| toes interfere with?
Forward progression and decreased step length of the contralateral limb
76
What do clawed toes involve?
Flexion of the proximal and distal interphalangeal joints
77
What do hammered toes involve?
Flexion of the proximal interphalangeal joints and extension of the distal interphalangeal joints
78
What causes clawed/hammered toes?
Toe flexor or extensor hypertonicity or an imbalance of long toe extensors and intrinsic foot muscles
79
Clawed/hammered toes may occur in response to what?
Weak PFs, as the long toe flexors are used to compensate for the primary ankle PF weakness
80
How do Clawed or Hammered toes affect
| Single Limb Support?
Interfere with single limb support, especially terminal stance and swing limb advancement, particularly pre-swing
81
What are the major deviations of the knee to consider in gait analysis?
- Limited Flexion/Hyperextension/Extension Thrust
- Excess Flexion/Contralateral Excess Flexion
- Varus
- Valgus
- Wobbling
82
What does limited knee flexion involve?
Less than normal knee flexion for a specific phase of gait
83
When may hyperextension of the knee occur?
During weight acceptance
84
What does hyperextension of the knee involve?
Positioning of the knee beyond neutral extension
85
What does an extension thrust of the knee involve?
Forceful motion of the knee towards extension
86
What may cause limited knee flexion, hyperextension, or extension thrust of the knee in weight acceptance/stance?
- Weakness or hypertonicity of the quads
- Impaired proprioception
- Knee pain
87
What may limited knee flexion, hyperextension, or extension thrust of the knee in weight acceptance/stance occur secondary to?
Fore foot contact
88
What is the presence of limited knee flexion, hyperextension, or extension thrust of the knee associated with?
- Decreased shock absorption
- Reduced forward momentum of the tibia
- Potential injury to the posterior capsule of the knee joint
89
Why does increased knee extension
| occur with quadriceps weakness?
Limiting knee flexion occurs as a compensation to decrease the magnitude of the induced flexion torque upon the knee that typically occurs during loading response, which in turn reduces the magnitude of the reactionary torque that the quads needs to produce to maintain limb stability
90
What does moving into knee extension beyond neutral do?
It tends to relocate the vertical ground reaction force vector more anteriorly relative to the knee joint axis, which results in an induced knee extension torque, so that knee stability is maintained through loading response by the posterior capsular ligamentous structures of the knee, controlling against further knee extension rather than in quads controlling against knee flexion
91
Does Hyperextension or Extension Thrust of the knee occur in Single Limb Support?
No, unless hypomobility of the knee is developed.
92
Hyperextension and extension thrust of the knee occurring through mid stance and terminal stance commonly occurs secondary to...?
Excess PF of the ankle or as a result of impaired proprioception
93
What does hyperextension and extension thrust of the knee result in during single limb support?
Results in forward mid of the tibia being reduced and potential injury to the posterior capsule of the knee joint
94
How does Limited Flexion of the knee in Swing Limb Advancement occur?
When profound limits in knee flexion ROM is present as with hypertonicity of the quads or severe contracture.
It may also result from impaired motor control, or as an antalgic compensation
95
How does Limited Flexion affect Swing
| Limb Advancement?
It interferes with foot clearance, especially in initial swing, leading to drag of the toes. It is also likely to increase energy cost
96
What does Excess Flexion of the knee involve?
It involves greater than normal knee flexion for a specific phase of gait
97
What causes Excess knee Flexion in Weight
| Acceptance and Single Limb Support?
Limitations in knee extension ROM whether due to a knee flexion contracture or knee flexor hypertonicity and may also occur as a secondary deviation in response to excess DF of the ankle or excess flexion of the hip
98
When may excess knee flexion in weight acceptance be seen as an antalgic compensation?
When knee extension is painful
99
In weight acceptance, excess knee flexion may occur secondary to what?
Secondary to decreased contralateral stance limb stability or as an intentional maneuver to lower a shorter contralateral limb in terminal stance
100
How does Excess knee Flexion affect Weight Acceptance and Single Limb Support?
It results in increased demands of the PFs, quads and hip extensors as well as decreased limb stability
101
What causes excess knee flexion in swing
| limb advancement?
Limited knee extension ROM, whether due to knee flexion contracture or hamstring hypertonicity.
102
What causes excess knee flexion in swing
| limb advancement, through mid swing and especially into terminal swing?
May be due to an inability to selectively extend the knee, while maintaining a flexed hip or quad weakness
103
When excess flexion of the knee occurs intentionally, what does it allow?
It allows for fore foot or foot flat initial contact, and results in decreased step length of the reference limb and it may interfere with heel first contact
104
What is Excess Contralateral Flexion?
Knee flexion greater than normal during loading response, mid stance or terminal stance of the contralateral limb, while swing limb advancement is occurring with the reference limb
105
Why may excess contralateral flexion of the knee occur?
Intentionally to lower a shorter reference swing limb to the ground
106
What does excess contralateral flexion of the knee do?
It relatively lengthens the reference limb and interferes with foot clearance and limb advancement. And increases energy demands on the contralateral stance limb
107
When do varus and valgus knee deviations occur?
Only during single limb support
108
What is a varus knee deviation?
A medial angulation of the tibia relative to the femur
109
What is a valgus knee deviation?
A lateral angulation of the tibia relative to the femur
110
What causes a varus or valgus knee deviation?
- Joint instability, where insufficiency of the MCL will be associated with a valgus deviation and LCL with a varus deviation.
- Bony deformities due to advanced knee joint may also result in the deviations, with valgus deviations being associated with lateral compartment degeneration and varus deviations with medial compartment degeneration
111
Varus or valgus knee deviations may occur secondary to what?
Secondary to frontal plane deviations of the rear foot, with excess eversion being associated with valgus deviation of the knee, and excess inversion being associated with varus deviation of the knee
112
What may valgus deviation of the knee occur secondary to?
Secondary to an ipsilateral lateral trunk lean
113
What do valgus and varus deviations of the knee result in?
- Decreased limb stability
- May require compensation proximal or distal to the knee
- May contribute to knee pain
114
What does wobbling of the knee involve?
Alternating flexion and extension of the knee during a single phase of gait
115
When in the gait cycle does wobbling occur?
Weight Acceptance and Single Limb Support
116
What causes wobbling?
- Spasticity of the quads or PFs
| - Impaired proprioception as its often associated with cerebellar lesions
117
What does wobbling result in?
Reductions in forward momentum, limb stability and balance
118
What are the major deviations of the hip
| to consider in gait analysis?
* Limited Flexion
* Past Retract
* Excess Flexion
119
What are the minor deviations of the hip
| to consider in gait analysis?
* Adduction
* Abduction
* Internal Rotation
* External Rotation
120
What does limited flexion of the hip involve?
Less than normal hip flexion for a specific phase of gait
121
Why does limited hip flexion occur in weight acceptance?
It is commonly intentional to decrease demand on hip extensors or It may be caused by the achievement of only limited hip flexion in terminal swing
122
How does Limited Flexion of the hip
| affect gait?
It may disturb the normal knee flexion and ankle PF that occurs in loading response
123
What causes limited hip flexion in swing limb advancement?
- Hip flexor weakness
- Impaired motor control
- Severely limited hip ROM
- Hamstring inflexibility
- Hip extensor hypertonicity
124
Limited hip flexion may be caused as a secondary deviation due to...?
Foot drag or past retract
125
Why may limited hip flexion occur intentionally?
In order to decrease demand on the hip extensors in loading response of the subsequent step
126
Ultimately, what does limited hip flexion interfere with?
The ability to clear the foot, and advance to the swing limb
127
What does limited advancement of the swing limb result in?
It reduces forward momentum and decreases step length
128
What is past retract?
A visible forward and backward movement of the thigh during terminal swing. The hip flexes to the required degree, but begins to extend prior to initial contact
129
What does past retract lead to?
Limited flexion of the hip, occurring in terminal swing and subsequently initial contact
130
What may causes past retract?
- An inability to selectively extend the knee, while the hip is flexed
- Impaired proprioception
- Hamstring hypertonicity
- May be performed intentionally to position the limb for initial contact, when there is excess PF of the ankle or to decrease demand on the quads and hip extensors, to help achieve a stable knee in loading response, which results in decreased step length
131
What does hip excess flexion involve?
Greater than normal hip flexion in a specific phase of gait
132
What causes excess hip flexion in weight acceptance/stance and single limb support?
- Hip flexion contracture
- Secondary to excess flexion of the knee
- As an antalgic compensation or secondary to no heel off (only in single limb support)
133
What does excess hip flexion in weight acceptance/stance and single limb support result in?
- Increased demands on the hip and knee extensors, as well as decreased limb stability
- Decreases in step length on the contralateral side (only in single limb support)
134
What causes excess hip flexion in swing limb advancement?
Commonly intentional to clear the foot in the presence of limited knee flexion, excess PF or a longer swing limb
135
Excess hip flexion in swing limb advancement may assist with limb clearance at the expense of ____
Excess hip flexion in swing limb advancement may assist with limb clearance at the expense of *increased energy expenditure*
136
What is Adduction of the hip as a gait deviation?
A deviation in normal walking gait, if it is observed to occur beyond neutral
137
What causes Adduction of the hip as a gait deviation regardless of when it occurs in gait?
Adductor hypertonicity or contracture
138
What does adduction of the hip result in during stance?
A decreased width of the BoS and may decrease limb stability
139
What does adduction of the hip result in during swing?
It may increase the relative length of the limb, which may interfere with limb clearance
140
What is Abduction of the hip as a gait deviation?
A deviation in normal walking gait, if it is observed to occur beyond neutral
141
What causes Abduction of the hip as a gait deviation regardless of when it occurs in gait?
- It may be due to an abduction contracture.
- In swing, it may also be due to a long reference limb, s it may be compensatory to allow for clearance of the longer limb
142
What does abduction of the hip result in during stance?
An increased width of BoS
143
What does abduction of the hip result in during swing?
A decrease relative leg length, and assist with limb clearance
144
What is Internal Rotation of the hip as a gait deviation?
A deviation of the patellars, facing medially
145
What causes Internal Rotation of the hip as a gait deviation regardless of when it occurs in gait?
- Femoral anteversion
- Limited ER of the hip, whether due to internal rotation contracture or internal rotator hypertonicity
- In stance, it may occur intentionally to increase knee stability in the presence of quad weakness
146
What does Internal Rotation of the hip result in?
A toe in position, which increases the relative length of the foot, impairs forward progression, and in stance it may increase stress on the lateral knee during forward progression of body weight
147
What is External Rotation of the hip as a gait
| deviation?
A deviation of the patellars, facing laterally
148
What causes External Rotation of the hip in weight acceptance and single limb support?
- Femoral retroversion or limited IR ROM
| - Secondary deviation allowing, forward progression in stance, in the presence of limited ankle DF
149
What does External Rotation of the hip result in?
- A toe out position, which increases the width of the BoS and decreases the length of the fore foot lever.
- May also result in stress of the medial knee during forward progression of body weight
150
What causes External Rotation of the hip in swing limb advancement?
It is commonly intentional to advance the limb as a substitution for weak hip flexors or to functionally shorten the limb. It may help with limb clearance
151
What are the major deviations of the pelvis
| to consider in gait analysis?
- Hike
- Ipsilateral Drop
- Contralateral Drop
- Lack of Forward Rotation
- Lack of Backward Rotation
- Excess Backward Rotation
152
What is a Hike of the pelvis?
The elevation of one side of the pelvis, above neutral approximating the pelvis to the ipsilateral shoulder
153
When does the hike of the pelvis occur and why?
During swing limb advancement. It is generally intentional to clear the swing limb
154
What may the hike of the pelvis be observed with?
With a long reference limb, whether occurring structurally or functionally due to excess PF of the ankle or limited flexion of the hip or knee
155
What does the hike of the pelvis lead to?
While likely to assist with limb clearing, it may lead to increased energy cost
156
What is an Ipsilateral Drop of the pelvis?
A depression of one side of the pelvis, increasing its distance from the ipsilateral shoulder
157
What does an ipsilateral drop of the pelvis involve?
The iliac crest on the reference limb being lower than that on the opposite limb
158
When does an ipsilateral drop of the pelvis most commonly occur in stance?
During periods of double limb support, and is commonly compensatory for a shortened reference limb
159
What does an ipsilateral drop of the pelvis contribute to and why?
LBP, due to the compensatory spinal motions that occur to accommodate
160
What causes an ipsilateral drop of the pelvis toward the reference limb during swing limb advancement?
- Abductor weakness
| - Intentional to lower a shortened reference limb for contact
161
What causes an ipsilateral drop of the pelvis toward the contralateral limb during swing limb advancement?
Adductor spasticity
162
What does an ipsilateral drop of the pelvis serve to do?
While it serves to increase the relative length of the reference limb, it may lead to decreased contralateral limb stability in stance and increased energy cost
163
What is a contralateral drop of the pelvis commonly known as?
Trendelenburg gait
164
What does a Contralateral Drop of the pelvis involve?
The iliac crest on the contralateral side, being lower than that on the side of the reference limb
165
When is a contralateral drop of the pelvis considered abnormal?
If the pelvis tilts laterally greater than 5 deg
166
In what population is a contralateral drop of the pelvis common?
In individuals with a multitude of disorders, and especially in patients following total hip arthroplasty using a posterolateral surgical approach
167
What causes a contralateral drop of the pelvis in weight acceptance and single limb support?
- Hip abductor weakness or adductor spasticity
| - May also be intentional to lower the contralateral limb for initial contact
168
What does an contralateral drop of the pelvis serve to do?
To increase the relative length of the contralateral limb, but it may lead to decreased reference limb stability in stance and increased energy cost
169
What is a Lack of Forward Rotation of the
| pelvis?
Less than normal forward rotation of the pelvis for a specific phase of gait
170
What causes a Lack of Forward Rotation of the pelvis in weight acceptance or swing limb advancement?
The pelvis remaining retracted, most commonly due to a control issue or lack of backwards rotation of the pelvis in the contralateral limb.
171
What causes a Lack of Forward Rotation of the pelvis in loading response?
A compensation to induced demands on the quads and hip extensors
172
What does a Lack of Forward Rotation of the pelvis ultimately lead to?
Decreased step length
173
What is a Lack of backward Rotation of the
| pelvis?
Less than normal backward rotation of the pelvis for a specific phase of gait
174
What causes a Lack of backward Rotation of the pelvis in weight acceptance or swing limb advancement?
Impaired motor control of the trunk and pelvic muscles
175
What does a Lack of backward Rotation of the pelvis result in?
Decreased step length of the opposite limb due to effects occurring at terminal stance
176
What is Excess Backward Rotation of the
| pelvis?
Greater than normal backward rotation of the pelvis for a specific phase of gait. Not considered a major deviation
177
When is Excess Backward Rotation of the
| pelvis particularly relevant?
In single limb support and early swing limb advancement
178
When is Excess Backward Rotation of the
| pelvis a secondary deviation?
When excess PF of the ankle, calf weakness, no heel off, or excess hip flexion is present
179
What may Excess Backward Rotation of the
| pelvis be associated with?
Reduced forward progress and limb advancement, especially in swing limb advancement
180
What are the major deviations of the trunk
| to consider in gait analysis?
- Backward Lean
- Forward Lean
- Lateral Lean
- Rotation Back
- Rotation Forward
181
What is a backward lean of the trunk commonly known as?
- Lurching gait pattern
| - Glut max lurch
182
What is Backward Lean of the trunk?
A backward position of the trunk, relative to vertical
183
What causes a backward lean of the trunk in weight acceptance or single limb support?
It is commonly intentional to decrease demand on the hip extensors in the presence of hip extensor and especially glut max weakness
184
What does a backward lean of the trunk lead to?
Decreased forward momentum and increased energy cost
185
What causes a backward lean of the trunk in swing limb advancement?
Commonly intentional to advance the limb in swing, especially due to hip flexor weakness
186
What may a backward lean of the trunk lead to?
Increased energy cost
187
Why does Backward Lean of the trunk
| occur with gluteus maximus weakness?
It limits hip flexion by serving to decrease the magnitude of the induced flexion torque upon the hip, that typically peaks during loading response, which in turn reduces the magnitude of the reactionary torque the hip extensors need to produce in order to maintain limb stability
188
What does leaning the trunk back from neutral tend to do?
It tends to relocate the center of mass of the body more posteriorly. This shifts the vertical ground reaction force vector more posterior relative to the hip joint axis, which then results in a induced hip extension torque so that hip stability is maintained through loading response by the anterior capsular ligamentous structures of the hip, controlling against further hip extension rather than glut max controlling against hip flexion
189
What is Forward Lean of the trunk?
A forward position of the trunk relative to vertical
190
What causes a forward lean of the trunk in weight acceptance or single limb support?
- May be caused by limited trunk extension ROM
- Very commonly occurs as a secondary deviation due to excess hip flexion as when hip extension ROM is limited
- May also occur intentionally in order to decreased demands on the quads or to progress over an excessively PF ankle
- May be intentional due to abdominal pain, use of an UE walking aid that is likely too short, or in an effort to substitute visual input from impaired proprioception
191
What may a forward lean of the trunk result in?
Improved stability and or forward progression, but leads to increased demands upon the extensors of the trunk and hip, while also contributing to increased energy cost
192
What does a lateral lean of the trunk commonly occur in conjunction with and what is it commonly called?
Occurs in conjunction with a contralateral pelvic drop
- Fully compensated trendelenburg gait
193
What is Lateral Lean of the trunk?
The leaning of the trunk to one side relative to vertical
194
What causes a Lateral Lean of the trunk?
Commonly caused by profound ipsilateral hip abductor weakness
195
Where does the direction of the lateral lean of the trunk typically occur?
Towards the same side of the hip abductor weakness
196
Why may a lateral lean of the trunk occur intentionally?
- To clear the swing limb as a compensation for a relatively shorter stance limb or it may occur as an antalgic compensation.
- May also occur ipsilateral to the use of a walking aid that is too short
197
What does a lateral lean of the trunk lead to?
Decreased forward momentum and increased energy cost
198
What are Rotation Forward and Rotation
| Back of the trunk?
Gait deviations that commonly occur in individuals using a walking aid out of sequence with lower extremity movement
199
What does rotation forward of the trunk involve?
Forward rotation greater than neutral on the reference side, as compared to what will be expected at a specific phase of gait
200
What does rotation backward of the trunk involve?
Backward rotation greater than neutral on the reference side, as compared to what will be expected at a specific phase of gait
201
What is the most common cause of Rotation Forward and Rotation Back of the trunk?
- The inappropriate use of a walking aid, in which an individual moves an assistive device in phase with the ipsilateral lower extremity. (The upper extremity with the walking aid and the lower extremity on the same side advance forward and backward at the same time)
- May also occur due to the inability to dissociate trunk movements from pelvic or limb movements
202
What causes of Rotation Forward and Rotation Back of the trunk in terminal stance?
May occur secondary to excess PF of the ankle
203
What causes of Rotation Forward and Rotation Back of the trunk in swing?
May be intentional to facilitate limb advancement
204
What does rotation backward of the trunk lead to?
Decreased stability in forward progression, while increasing energy cost
