Week 4 Gait 1 Flashcards
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Where to start with pts with neurological gait? – Look to see where there deviations are and start to address those
People want their walking to improve – aesthetically, physically, etc
If people aren’t able to walk there is a psychological burden. Pts can feel useless as well.
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Ambulation: A Prerequisite for Daily Activity
Requirements of community ambulation:
Cross streets, step on/off moving walkways, up/down curbs, go in/out of automatic doors, walk around furniture, etc.
Speed of - m/s allows function in varying environmental and social contexts
***Only 7% of patients post stroke can walk 500m at this speed!
We as able body humans have to walk at least 1.1-1.5 m/s to be able to do these things in the community to do these things in a safe and healthy manner.
1.1-1.5;
VIDEO
When assessing neurological gait, start simple and just list deviations.
Absent L heel strike – heel never hits the ground
Forward trunk lean throughout the GAIT cycle
Shortened step length bilaterally – right foot doesn’t take as big of a step compared to the left
Left foot supination during swing
Decreased left knee flexion during swing
Decreased left hip flexion during swing
Decreased bilateral hip extension in stance phase
Potential compensatory Trendelenburg when right limb is in stance
Increased left knee flexion in stance
Normal BOS is roughly 12 cm, his is increased.
He probably takes 16 steps / min – most people take 90-100 steps / min
When looking at step length, compare how much further one foot goes compared to the other foot. Ex – does the left foot get a lot further than the right foot when walking?
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Basic Tasks of Gait
Weight acceptance Single limb stance ~(40/60)% of gait Limb advancement ~(40/60)% of gait
These tasks are a production of a locomotor rhythm
The major requirements for successful walking include (1) support of body mass by the LEs, (2) production of locomotor rhythm, (3) dynamic postural control of the moving body, (4) propulsion of the body in the intended direction, and (5) adaptability of the locomotor response to changing environmental and task demands.(401)
Have to be able to accept weight on your limb or you buckle.
Walking by nature is supposed to be effortless and have a rhythm to it and you need these three components ^^^
60; 40;
Terminology used in the clinic and during documentation
Stance phase is roughly 60% of gait
A lot of the gait cycle is (concentrically/eccentrically) based.
A lot of gait issues are in the (swing/stance) component of their GAIT.
eccentrically; stance;
(Stride/Step )– one foot compared to the other
(Stride/step) – right foot distance covered compared to the next step with the right.
Step; stride
ROM Requirements:
Hip:
_ degrees extension (terminal stance) > _ degrees flexion (prior to initial contact)
20; 30
ROM Requirements:
Knee:
_ degrees of extension (terminal stance) > _ degrees flexion (mid-swing)
0; 60;
ROM Requirements
Ankle:
_ degrees plantarflexion (pre-swing) > _ degrees dorsiflexion (mid to terminal stance)
20; 10
ROM Requirements
MTP:
_ degrees of extension (pre-swing)
60
COMMIT THIS SLIDE AND NEXT SLIDE TO MEMORY
Rom is a huge factor in peoples walking.
Big ticket ROM requirements ^^
Roughly get 50 degrees of total motion in the hip during gait
You need roughly 60 degrees of motion at the knee. Have to get _ degrees of knee extension when walking. Walking will be impaired if you lack the motion to do the task.
Individuals that have a stroke or SCI have ROM deficits. They may show signs of contracture/pain that may limit their ROM.
(Ankle/Knee) is the highest of priorities for joints when it comes to walking.
Lacking (PF/DF) ROM is when pts start to get in trouble with walking.
0; Ankle; DF
Strength Requirements
Hip
Stance:
Glut max - (concentric/eccentric)
Glut med - (concentric/eccentric)
Hamstrings - (concentric/eccentric)
Swing:
Iliopsoas - (concentric/eccentric)
eccentric; eccentric; eccentric; concentric
Strength Requirements
Knee
Stance:
Hamstrings - (concentric/eccentric)
Quadriceps - (concentric/eccentric)
Swing:
Hamstrings - (concentric/eccentric)
eccentric; eccentric; eccentric
Strength Requirements
Ankle
Stance:
(Dorsiflexors/Plantarflexors)
Midstance - (concentric/eccentric)
Terminal stance - (concentric/eccentric)
Swing:
Tibialis anterior - (concentric/eccentric)
Peroneals - (concentric/eccentric)
Plantarflexors; eccentric; concentric; concentric; concentric;
Take home message of this slide – Need more (concentric/eccentric) strength to be able to walk
If you are doing strengthening with someone to improve walking, bias the strength training to (concentric/eccentric).
Majority of stance phase is (concentrically/eccentrically) loading – controlling a fall.
Plantarflexors – PFs are working (concentrically/eccentrically) when it is mid-terminal stance. When the tibia has to advance over the ankle during mid-terminal stance they are being lengthened. They are (concentrically/eccentrically) working during push off. They have to double dip – strong enough to eccentrically be loaded and they switch to concentrically pushing into swing phase.
eccentric; eccentric; eccentrically; eccentrically; concentrically;
Cardiovascular - When someone has a stroke they have to pump out 2x the metabolic output to do the same things as someone who is healthy. With walking they will be challenged from a fatigue perspective.
Orthopedic – individuals are at risk for pain – think of compensations that can occur with someone
Integumentary – think of the skin and how if an individual places all of their weight on the ball of their foot and the demands that are placed on their integumentary system based on compensations
Classic – shuffling gait in Parkinson’s
Hemiplegic stroke – walk like Ronnie (dude in the video)
When you think of the deviation, ask yourself why do they have those deviations?
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“the nervous system is trying to solve a problem”
Systems – people look at ankles > knees > hips > trunks or you can do it the opposite manner, just stay consistent with yourself
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If someone doesn’t have the ROM, that is where a potential deviation can come from.
Look at GAIT deviations on an impairment level and then look to see how you’d treat that.
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Impairments – (strength/ROM / vision/pain) will be for 90% of gait impairments
Vision – individuals with strokes may have vision deficits
Balance
Pain – if something hurts or you tore something you probably walk differently – if someone has pain contributing to their gait impairments, have to address it.
Cognition – what they believe they can or can’t do has a huge impact on their walking
Sensation – if you can’t feel where your limb is at it is hard to take appropriate lengths
strength/ROM
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Assistance levels – 50 feet max assist versus 50 feet supervision is different
As a therapist, if you’re going to start to look at GAIT, you need data to backup if someone is getting better or not.
Video benefits – deviations start to become habit for people and they’ll have no idea they are doing these things
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Jump in class system led to greater QOL improvement
Gait velocity is a (bad/powerful) predictor of function and prognosis post-stroke. (Schmid, et al., 2007)
The faster they walked the (less/more) likely they’ll be a participant in their community. The slower they walked the (less/more) likely that they’ll be home bound.
Most of us are walking 1.1-1.5 m/s.
powerful; more; more;
Article from the optional reading
If someone is walking at a slower speed, can make walking faster part of your goal.
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2MWT – 2 minute walk test
6MWT – 6 minute walk test
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How far they walked, how much assistance they needed, over what surface
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Include all of the objective measures
Have to show that someone can get better –need baseline measures
Who, what, how much, why, and functional
Ex:
The pt will walk/ambulate 50 feet on a level tile surface to facilitate independecnce to participate in the community OR walk in the house without caregiver support.
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This was an FYI
Coo
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A – person will present with knee flexion in stance versus hyperextension
B - pre-tib – anterior tibialis –
C - Need 3+/5 to not buckle . If you have weak quads you might hyper extend. C is correct!!!!
C
