Week 3 Flashcards
Define locomotion
An individual’s capacity to move from one place to another (point A to B)
Define gait
The manner in which a person walks
(cadence, step length, stride length, speed and rhythm)
Define ambulation
the act, action, or an instance of moving about or walking
What is the foundation of movement analysis?
Gait analysis
What is the purpose of gait analysis?
1) To assess deviation from normal or less efficient pattern
2) To identify dysfunction that could lead to (functional decline, an increased fall risk, ROM and/or strength loss)
3) Identify impairments that impact gait (Poor balance, Lack of endurance or energy expenditure, Altered motor control, Reduced safety)
4) Help diagnose movement dysfunction (mechanism of gait deviation, impact of impairment on function)
5) Establish if the gait deviations could be characteristic or diagnostic of a larger clinical picture (Parkinson’s)
List important steps when assessing gait/locomotion
1) Observes patient from all directions
2) Analyze gait/locomotion characteristics with and without use of assistive, adaptive, orthotic, prosthetic or protective devices
3) Check the effects of various terrain and environments
4) Identify deviations and their effect on gait/locomotion
5) Hypothesize and verify cause(s) of deviations through specific examination (e.g. MMT, ROM, muscle tone, flexibility, pain)
What are the divisions of the gait cycle?
Stance: constitutes approximately 60% of the gait cycle and is defined as the interval in which the reference foot is in contact with the ground
Swing: comprises approximately 40% of the gait cycle and occurs when the reference limb is not in contact with the ground
What is a Double limb support/stance?
when both limbs are in contact with the ground at the same time
What is a Single limb support/stance?
It arises between the two double limb stance periods
Explain the stance phase
1) initial contact: the moment in time when the outstretched limb first hits the ground (heel strike)
2) loading response: body weight is rapidly accepted onto the outstretched limb (foot flat)
3) Midstance: body weight progresses forward over a single stable limb usually when the leg is underneath the trunk
4) terminal stance: the heel rises from the ground, the leg achieves a “trailing limb” posture, and the trunk advances well in front of the reference foot. (Heel off)
5) Pre-swing: 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. (Toe off)
Explain swing phase
1) initial swing: lifting of the foot from the ground reflects the onset of the first phase of swing. (Acceleration)
2) midswing: the thigh continues to advance into flexion
3) terminal swing: further thigh flexion is curtailed; however, the knee continues to extend until it observationally appears neutral. (Deceleration)
What phases are double/single limb?
1) Initial double limb stance: initial contact, loading response
2) Single limb stance: mid stance, terminal stance
3) Terminal double limb stance: pre swing
Label the stances
1) initial contact
2) Loading response
3) mid stance
4) terminal stance
5) pre swing
List some gait variables
1) Spatial, Temporal
2) Symmetry, Planes of movement
3) Assistive Device, Level of Assistance, Environment
Describe step length and step time
1) Step length: distance between the heel contact to the point of the heel contact of the other foot
2) Step time: time to complete one step
Describe stride length and stride time
1) Stride length: stride length is the distance between the point of contact of the heel and the next contact of the same heel
2) Stride time: time to complete one stride
Describe cadence and velocity
1) Cadence: number of cycles in a period of time (steps/min)
2) Velocity: Distance covered in a period of time (m/s), gait speed
What is the normal toe out angle?
angle of the foot (5 – 13 deg)
What is closely linked to overall function?
Gait speed
List assistive device considerations of effects on pt’s mobility and stability
1) Attention and neuromotor demands
2) Interference with limb movement during balance recovery
3) Metabolic demands
4) Change in center of gravity from S2 to more anterior-superior which results in postural changes
What are the levels of the functional independence measure?
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)
List the various weight bearing statuses
1) Full weight bearing (FWB)
2) Partial weight bearing (PWB) – an established % of FWB
3) Touch down weight bearing (TDWB): Can put foot on the ground for balance but not put any weight on it
4) Toe-Touch weight bearing (TTWB): Toe can be on the ground (not commonly used)
5) Weight bearing as tolerated (WBAT): Up to the discretion of the patient
6) Non-weight bearing (NWB): Usually have foot elevated
Define balance, static balance, and dynamic balance
1) Balance: all forces acting on the body are balanced (equilibrium). COM is within stability limits and boundaries of BOS
2) Static balance: maintaining the COM within a fixed BOS
3) Dynamic balance: maintaining the COM within a moving BOS
Explain Reactive/Proactive
1) Reactive: postural control occurs in response to external forces acting on the body displacing the COM or moving the BOS (moveable platform)
2) Proactive: (anticipatory) postural control occurs in anticipation of internally generated, destabilizing forces imposed on the body’s own movements (catching a weighted ball).
What has been shown to be a greater predictor of falls than an actual hx of previous falls?
Fear of falling
Loss of balance can lead to restriction of movement, which can cause?
1) Deconditioning and debilitation
2) increased risk of falls
3) secondary problems due to sedentary lifestyle
How does the body control balance?
Sensory information from these sources
1) Vision
2) Somatosensation (surface changes, BOS changes)
3) Vestibular (gravity, acceleration, linear and angular head and eye movement)
What can you ask to determine which system is the body primarily relying on for balance in a given task?
Which system is now “inaccurate” and take it out
Ex: (eyes close = elimination of vision) (standing on a foam pad = elimination of somatosensory)
What are the balance strategies?
1) ankle strategy: involves shifting the COM forward and back by moving the body (legs and trunk) as a relatively fixed pendulum about the ankle joints
2) hip strategy: involves shifts in the COM by flexing or extending at the hips
3) stepping strategy: realigns the BOS under the COM by using rapid steps or hops in the direction of the displacing force, for example, forward or backward steps.
List some environmental aspects that can affect balance
*surface instabilities (slippery, compliant, inclines, moving surfaces, height differentials, sudden tilts)
*body perturbations (sudden pushes, pulls, or stops)
*reduced surface area (narrow short path)
*obstacle contact (uneven surfaces or loose objects)
*resistance (snow, mud, water)
*aberrant visual input (darkness, distorted input)
Falls (inpatient setting)
1) 3.3 - 11.5 falls per 1000 pt days
2) 75% unwitnessed
3) 50% elimination related
4) many due to altered mental status from medications
Falls (community setting)
1) Prevalence = 35%
2) 1 out of 5 falls results in injury (broken bones or TBI)
3) Occurs during normal daily activities
4) Underreported
How to assess fall risk?
1) # of falls in past 6 months
2) Frequency
3) Events that precede or cause the fall
4) Medications and or change in medications?
5) Change in condition (dizzy, light-headed)
6) Change in eyesight correction?
7) # of losses of balance
8) Environment
Define surface anatomy
External features of the body identified for understanding characteristics, conditions and internal structures
Define palpation
Use of touch for medical purposes
List the effects of palpation
1) non verbal communication
2) therapeutic effect of touch (reducing pain, anxiety, cortisol levels)
3) psychological implication (interpersonal connection)
4) risk of touch (cultural/personal preferences, age, sex/gender differences)
Describe the types of touch
1) Light Touch: Used to feel for superficial structures such as skin and subcutaneous fat.
oGentle, fingertips glide over the skin.
2) Moderate Pressure: Used for identifying muscles, tendons, and bony landmarks.
oFingers sink slightly deeper to assess underlying structures.
3) Deep Pressure: Used to assess deeper structures and tissues. Requires more force, using palms or thumbs.
What are the principles of palpation?
1) Slow and Deliberate Movements: Avoid rushing; accuracy improves with careful palpation.
2) Consistency: Be systematic in approach, moving from superficial to deeper layers.
3) Feedback information: Stay attuned to variations in tissue texture, resistance, and responsiveness.
4) Communication: Always communicate with the patient about discomfort or sensitivity during palpation.
What are the aspects of skin palpation?
1) Thin layer, soft, and pliable
2) Moves freely over underlying structures
3) Tenderness
4) Texture
5) Temperature
6) Moisture
What are the factors of navigating tissue under the skin?
*Subcutaneous Fat: Feels soft and spongy; varies in thickness depending on body region and individual.
*Muscle: Firm, with some elasticity. Contracted muscles feel firmer, while relaxed muscles are softer.
*Tendons: Rope-like, firmer than muscles, usually feels like taut bands.
*Ligaments: Tough, less elastic, and feels like firm, dense bands.
*Bones: Solid, hard structures beneath muscles and tendons, easily palpable in superficial regions (e.g., elbow, shin).
*Nerves: Large nerves can feel like a thick movable string, like a guitar string
*Pulses: Rhythmic beat/pulse. Can feel strong or faint depending on location and depth.
How do you interpret what you feel?
*Fat: Soft and moves easily.
*Muscle: Feels firm when contracted, or with increased tension/tone; more pliable when relaxed.
*Tendon: Firm, cord-like structures, easily felt when tensed.
*Ligament: Tough, more rigid compared to tendons.
*Bone: Hard, unyielding, clearly felt especially over superficial areas.
What are the key palpation landmarks?
1) bony prominences
2) tendons and ligaments
3) muscles
List palpation techniques
*One-Handed Palpation: Ideal for smaller, superficial structures.
*Two-Handed Palpation: Used for deeper, larger structures, providing stability and control.
*Cross-Fiber Palpation: Moving fingers perpendicular to muscle fibers to distinguish muscle and tendon.
What is the clinical significance of palpation?
*Assessment: Identifying inflammation, swelling, or abnormal lumps.
*Therapeutic Guidance: Assisting in manual therapy and treatment modalities.
*Diagnostic Support: Pinpointing areas of pain, tension, or abnormality.
Define kinematics
Study of motion without regard to the forces creating that motion.
Define Arthokinematics
Movement of joint surfaces in relation to each other
Components:
*Spin – rotary motion
*Roll – rotary motion
*Glide/Slide – translatory motion
Explain the convex/concave rules
*Concave surface moving on a Convex surface will roll and glide in the same direction (of the angular motion)
*Convex surface moving on a Concave surface will roll and glide in opposite directions
What are the grades of Arthrokinematics?
Grades 0-6
0: Ankylosed (immovable)
1: Considerable hypomobility
2: Slight hypomobility
3: Normal
4: Slight hypermobility
5: Considerable hypermobility
6: Unstable
