Week 9: observational Gait analysis and aging gait Flashcards
What is the 4 step process for an observational task analysis?
- general observations: timing, space, gait speed, step length
- Specific deviations: using task related determinants as a guide
- Hypothesized cause: apply knowledge
- Testing hypothesis: test strength
What is the general sequence of a given activity?
- initial position
- initiation
- execution
- termination
You make the following observation:
inability to stand from sitting in a regular height chair
excessive forward lean in early execution of standing from a tall stool
what is the most likely hypothesis
knee extensor weakness
reason: pt moves the COM closer to the knee to decrease the demand moment at the knee
What are the general observation areas to focus when observing a walking pattern
- symmetry between right and left
- arm swing opposite of legs
- head and trunk posture
- impression of gait speed
what is the average gait speed?
1.4 m/s
What are the 3 functional tasks of gait?
- weight acceptance
- single leg support
- swing limb advancement
What are the 8 phases of gait?
- initial contact
- loading response
- mid-stance
- terminal stance
- pre-swing
- initial swing
- midswing
- terminal swing
what are the critical events of initial contact?
heel contact
what are the critical events for loading response
heel rocker- controlled PF
controlled knee flexion
hip/pelvic stability
What are the critical events of mid-stance
- hip/pelvic stability
- ankle rocker- controlled tibial advancement
what are the critical events of terminal stance
- forefoot rocker
- hip extension
what are the critical events of preswing
- rapid ankle pF
- passive knee flexion
what are the critical events of initial swing
- peak knee flexion
what are the critical events for midswing
- peak hip flexion
- ankle dorsiflexion to neutral
what are the critical events for terminal swing
- knee extension to neutral
what 4 key observations are in weight acceptance?
- heel first initial contact
- controlled ankle plantar flexion
- controlled knee flexion
- hip/pelvic stability
what 4 key observations are in single limb support
- hip/pelvic stability
- controlled tibial progression
- controlled heel rise
- hip extension
what 5 key observations are in swing limb advancement
- rapid ankle plantar flexion
- passive knee flexion
- hip flexion
- ankle dorsiflexion
- knee extension
how do you determine the greatest external demand moment
GFR is given by the vector and what ever joint has the greatest moment arm then use the arrow to determine if its a flexion or extension demand moment
What is a task related determinant
an element or aspect of the task that is critical to successful task performance
What are the 4 task related determinants for a sit to stand
- generate forward trunk momentum
- position center of mass over feet
- generate force to raise center of mass
- arresting momentum of center of mass
Which determinant would you expect to be most affected by impaired vestibular control of balance
- arresting momentum of center of mass
all could be impacted but the 4th is the most affected due to fine tuning of BOS over COM
people >65 years of age ___ of 3 experience a fall per year
1.
fall is the leading cause of disability and loss of independence for older adults
true
Why do falls increase in older age?
nervous sytem, musculoskeletal system, skeletal system, pulmonary, CV, ednocrine
What are the two reasons for changes in gait and increased fall risk for older adults? and which is modifiable
- genetics
- environment
- disease
environment is modifiable
older adults have changes in shape density of bone
decrease in bone mass
decrease tolerance for stress
altered joint motion
true these are all examples of skeletal changes
Does active range of motion or passive range of motion decrease more in older adults
active ROM due to the muscle tendon unit fxn is affected
Do older adults have lesser or greater demand moments at joints and why?
greater demand moments at joint because of stiff tissues
What is sarcopenia?
age associated decline in muscle mass
-related to total number of fibers decreasing
begins at age 30
Does the proximal or distal muscles of the LE lose more power in older adults?
the distal muscles loose more power
Do older adults lose more fast with or slow twitch fibers?
lose more fast twitch muscles
In older adults there is a ____ co- activation that leads to decreased effective movement production
increased
What does a co-activation mean?
relative co-activation of muscles means that both agonist and antagonist contract
What percentage of strength decreased after the fifth decade
10-15%
Is power more correlated to strength of functional ability in older adults
functional ability
Does power or strength decrease earlier and more rapid
power and it affects TUG and gait speed
Older adults have sensory changes which result in decreased proprioception, tactile sensitivity,
decreased visual threshold
decreased hair and nerve cells
yes they have decrease in somatosensory, vision and vestibular
Based on the evidence you would expect greater power generation during walking at the ____ joint for a 75-yr old than a 30-yr old person walking at similar walking speeds.
hip
hip power generation is compensating for decrease power in ankle for older adults
older adults have Increased/decreased gait speed, stride length, SLS time
decreased
older adults have increased/decreased step with variability, energy expenditure
increased
What is the average freely chosen gait speed in people age 60-80
1.2 m/s
Although step length decreases in age what one factors is similar?
step frequency (cadence)
What are 3 most common changes in gait kinematics for older adults
- decrease hip extension motion
- increase anterior pelvic tilt
- decreased ankle planar-flexion motion
Do older adults or young individuals have higher energy expenditure when walking
older
what is the recruitment of muscles greater proximal or distal
greater recruitment of proximal muscles
Most of the power generation occurs at the ankle in younger adults what joint takes over in older adults
hip
in comparing self selected walking gait of a 30 yr old and a 75 yr old person, you would expect the greatest difference in joint power to occur at the
ankle
decrease in power at the ankle in older adults they have to then compensate with the hip