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Applied Anatomy > Pathological Gait Patterns > Flashcards

Pathological Gait Patterns Flashcards

1
Q

A patient walks into the clinic. They present with reduced stance time on one leg. Shorter step length on the same leg. Longer step length on the other side, and a slightly different initial contact. What kind of gait are they displaying?

A

Antalgic gait. Painful or limping gait.

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2
Q

A patient walks into the clinic with a shuffling gait. They have decreased swing and increased stance time. Their cadence is fast, but their velocity is slow. They stop at the threshold of the door. What gait are they displaying? What disease is this typical of?

A

Festinating gait. It is typical in moderate to severe Parkinson’s. It is an issue with basal ganglia in the brain which controls fluidity and initiation of movement.

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3
Q

What activities can you recommend to a patient with Parkinson’s to help smooth their movement?

A

Tai chi, boxing, and big and loud movements have been shown to help.

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4
Q

You are doing a gait assessment on a patient, and you might describe their gait as a “drunken” gait. What gait are they most likely displaying? What might be causing it?

A

They probably have an ataxic gait. It is seen in patients who have motor control issues. They can’t control where their foot comes down. It is very uncoordinated and not symmetrical. It is typically due to cerebellar damage which majorly affects coordination.

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5
Q

One of your patients has CP. What gait might they display and why?

A

Crouch gait. It is caused by increased hip flexion, knee flexion, hip internal rotation, and dorsiflexion and adduction. It is caused by spasticity of muscles. They pull the joints into those positions. They might need surgical release to lengthen some muscles and allow for greater range of motion.

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6
Q

What parts of the gait cycle might be affected by a crouch gait?

A

Any part of the gait cycle that requires extension of joints may be impaired. Terminal swing when the knee needs to extend. Terminal stance when the hip needs to extend. Pre-swing when the plantar flexors need to push off. They might have a pelvic drop because the adductors are overactive.

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7
Q

A patient comes into the clinic, and you notice that their hip stays in a midrange position throughout the gait cycle. It stays neutral or extended. They are also plantar flexed and inverted. What are your first thoughts about what the patient may have?

A

They have an equinus gait. It can be caused by brain injury or CP. Their muscles might respond to botox to try and relax the muscles.

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8
Q

What subdivisions of gait will be affected if you cannot flex the hip very well?

A

Swing phase will be affected. Initial contact and loading response will also be affected.

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9
Q

You notice someone on the street walking with their legs really close together. They crisscross their legs when they walk. What muscles are tight, and what is this gait called?

A

Their adductors are probably really tight. This is a scissor gait.

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10
Q

You are manual muscle testing and notice that their glute max is only a 3+. You ask them to walk. What gait are you looking for?

A

Glute max lurch. They lean their trunk back to place the joint moment posterior to the hip which promotes hip extension. This allows gravity and body mass to extend the hip instead of the muscles extending the hip.

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11
Q

A teenager displays a vaulting gait. What could be the issue and what would you recommend?

A

Vaulting or circumduction are both used to clear a leg that is too long. A patient may also use a hip hike. They may need a heel lift in the other shoe to even out a leg length discrepancy.

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12
Q

A patient’s DF MMT is a 2+, and they display excessive knee flexion and hip flexion when they walk. They have…
A. Foot drop/slap
B. Steppage gait

A

B. Steppage gait
In a steppage gait, they can’t dorsiflex. Instead, they flex the knee and hip to clear the leg. Then the foot will come down either on the ball of the foot or the toes.

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13
Q

What would you recommend for a person with steppage gait?

A

AFOs tend to work well for these patients. It keeps their ankle at 90 degrees.

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14
Q

A patient scores a 3+ on their DF MMT. What gait pattern might they display?

A

Foot drop/slap. Either there are no dorsiflexors, or they are weak. If they are weak, you will notice a slap. If they are really weak or aren’t activating, they will have more of a drop.

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15
Q

Foot slap occurs during which part of gait?

A

The slap occurs during loading response because of weak eccentric dorsiflexors.

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16
Q

How would you describe genu recurvatim?

A

This is when a patient hyperextends their knee. They often do this because they are afraid it is going to buckle. They do not trust their knee. Buckling can happen due to lack of eccentric control.

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17
Q

Which type of Trendelenburg requires more energy?
A. Compensated
B. Non-compensated

A

A. Compensated Trendelenburg takes more energy.

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18
Q

What are common problems that can affect the gait pattern?

A
  • Weakness/hypotonia
  • Hypertonia/spasticity
  • Motor programming issues
  • Coordination issues
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19
Q

How does spasticity affect gait?

A

Spasticity causes the muscles to constantly be contracted. This could change the range of motion that a patient has at a joint. Spasticity could also keep a joint in flexion or extension

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20
Q

What kind of issues are common with Parkinson’s?

A

Motor programming issues.

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21
Q

What are things you should include in your assessment of gait? (think about writing the note in IP rehab)

A
  • assistive device(s)
  • level of assist
  • distance
  • kinematic variables
  • quality of movement
  • endurance
  • other: steps, threshold, surface?
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22
Q

What observations might you make about quality of a patient’s movement?

A
  • abnormal movement patterns

- compensations

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23
Q

What ways can you measure endurance?

A
  • self report
  • observation
  • RPE
  • pulse ox
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24
Q

You are writing goals for a patient’s gait. What two aspects might you focus on?

A

Velocity and endurance. You will want to increase velocity and endurance.

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25
Q

True or False

Gait velocity is linked to morbidity and mortality.

A

True!

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26
Q

The ability and time to walk 400m is a predictor for…

A

CV disease, mortality, and morbidity

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27
Q

What is variability from the normal in velocity and endurance correlated to?

A

If they have more variability from normal, they are less likely to walk as much, and their mortality rate goes up. They are also at an increased fall risk.

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28
Q

What is a normal TUG time for age matched healthy adults?

A

9.1 seconds

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29
Q

How does chronic stroke affect a TUG time?

A

Chronic stroke patients tend to be around 22.6 seconds to complete the TUG

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30
Q

How fast does someone need to be able to walk to be a safe community ambulator?

A

48 m/min (1.78 mph) is considered the norm for being able to cross a road at a red light without worrying.

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31
Q

What is considered a limited community ambulator?

A

24 m/min (.82 mph)

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32
Q

How is endurance decreased in stroke patients?

A
  • subacute or chronic CVA average 200-300 m compared to 400 m of age matched healthy elderly in 6MWT
  • steps per day: 2800-3000 community dwelling mild to moderate CVA patients compared to 5000-6000 age matched sedentary healthy
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33
Q

What are way you can increase dynamic stability in walking?

A
  • change the terrain
  • give them obstacles
  • distract them
  • include executive functions
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34
Q

What are three things you can increase in a patient’s gait if they do not ambulate very well?

A
  • Increase endurance
  • Increase dynamic stability
  • improve coordination
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35
Q

How can you help a patient improve coordination while walking?

A
  • Have the patient overcome curb heights or other things they will see in the community. This will help them become community ambulatory
  • Decrease their fall risk
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36
Q

Why might patients who have had a stroke walk less?

A

They might walk less because they are scared and don’t trust their body. It might take them a lot of energy, or they fatigue quickly.

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37
Q

If you are going to get a patient up to walk, what should you first have ready?

A
  • have the safest assistive device
  • make sure you have enough help in case the patient cannot walk
  • make sure you have everything you need and all the lines are out of the way
38
Q

How would you slowly progress a patient from lying to walking?

A

Move them from sitting up, to standing, to weight shifting, to marching in place, and then to walking.
Always watch for signs that someone may not be able to walk that day as you move through these stages.

39
Q

What does excessive and/or abrupt movement of COM/LOG increase?

A

Energy expenditure.

40
Q

In in-patient rehab, you want gait to be…
A. Functional
B. Pretty

A

A. Functional

41
Q

You can focus on making gait pretty in…
A. In-patient rehab
B. Out-patient rehab

A

B. Out-patient rehab

42
Q

You are breaking down a patient’s gait pattern. You start by concentrating on the stance phase. What are questions you might ask yourself?

A
  1. Are there overarching issues such as poor balance and/or coordination?
  2. Are joint positions WNL/WFL or do we have an issue?
  3. Is decreased muscle strength making your patient (and you!) worry? Do they have buckling, recurvatum, or decreased WS?
43
Q

Are the questions you ask yourself while looking at swing phase different from looking at stance phase?

A

No.

The only difference is looking at if they have a decreased swing time, step length, or decreased clearance.

44
Q

Do you have to finish a gait assessment in one day?

A

Nope. You can take multiple visits to complete it.

45
Q

What are strategies you can use to help you analyze gait?

A

Ask if you can video tape them walking.
Have someone else help them with ambulating while you are doing the assessment.
Start with the big picture.

46
Q

Why should you begin by observing stance phase?

A

It is where you will have the most compensation or where they will fall.

47
Q

What dictates the muscle activity requirements during gait subdivisions?

A

GRF’s dictate muscle activity requirements

48
Q

What is key during IC?

A

Positioning. If the foot crosses over the other leg, they will fall when they try to load it. If they come down and are abducted a lot, they won’t be able to load the foot.

49
Q

What are characteristics of LR?

A
  • period of highest muscle activity
  • transition of mobility to stability
  • big “trouble spot”
50
Q

What kind of control is important at the knee and pelvis during Mst?

A

Eccentric control is important at the knee and pelvis.

51
Q

What is pre-gait?

A

Pre-gait is when you go through a single subdivision of the gait cycle and then back. You would use it if getting a patient to walk is still scary, and you are concerned about a certain subdivision of gait.

52
Q

What is important during TS?

A

Eccentrics are still important, along with PF, and full hip extension.

53
Q

What is necessary during PSw?

A

Hip and knee passive flexion is necessary with active PF

54
Q

What is necessary during swing?

A
  • Ankle DF, knee flexion
  • Momentum
  • Balance in add/abd
  • Hip, knee, ankle, and foot interactions
55
Q

How are contractures named?

A

They are named by what motion they are stuck in.

56
Q

What subdivisions of gait does a hip flexion contracture or spasticity affect the most?

A

Midstance and terminal stance

57
Q

A patient is unable to achieve neutral to extended hip due to a hip flexion contracture. How might they compensate?

A

Often compensate with increased lordosis and mass LE flexion.

  • mass flexion severely limits progression
  • they need good quad strength to prevent knee flexion
58
Q

What is limited by a hip flexion contracture or spasticity?

A
  • The patient will be unable to achieve neutral to extended hip
  • limits propulsion
  • limits step length
59
Q

A patient comes in, and you notice they have a scissor gait. What might be tight?

A

They might have spastic adductors.

60
Q

A patient has a knee flexion contracture or spasticity. What subdivisions of gait will be most limited?

A

IC, LR, and MSt.

61
Q

How does a knee flexion contracture affect IC?

A

An inability to extend the knee at IC may decrease heel contact.

62
Q

What is increased at LR due to a knee flexion contracture?

A

Shock is increased at LR.

63
Q

What muscles need to be strong if a patient has a knee flexion contracture?

A

They need to have strong quads to prevent knee flexion.

64
Q 
Function will be impaired in a knee flexion contracture that is...
A. >20 deg
B. >15 deg
C. >10 deg
D. >30 deg
A

C. >10 deg

65
Q

How does a knee flexion contracture affect terminal stance?

A

The patient will be unable to achieve knee extension for good propulsion.
It could also be a problem with generating momentum. If you don’t generate enough momentum, you might not be able to fully extend the knee.

66
Q

How many subdivisions of gait does an excessive PF contracture impact?

A

5 of 8 subdivisions

  • progression during stance will be limited
  • substitutions/compensations may occur during swing
  • if you can’t get to a dorsiflexed or neutral foot, you will mess up a lot of the gait cycle
67
Q

You are observing a patient walking. You notice they tend to make contact with the low heel or forefoot. They don’t have a heel rocker. Their knee hyperextends during terminal stance. What gait deviation do they probably have?

A

Excessive PF due to contracture or spasticity.
In IC and LR, it has these effects.
The knee hyperextends/recurvatum because the tibia is driven posteriorly by the GRF/BW. Instead of the knee hyperextending, the heel may stay off the ground.

68
Q

What might a PF contracture cause in MSt?

A
  • loss of ankle rocker limits progression. The ankle cannot get into dorsiflexion
  • Excessive knee hyperextension leads to hip and trunk flexion to shift COM: knee recurvatum. The trunk is compensating
  • Heel-off is premature because the foot wants to stay plantar flexed
69
Q

You notice that a patient doesn’t have an appropriate forefoot rocker in terminal stance. Their step length is also shortened. What might be a cause? What would you recommend?

A

The cause could be an excessive PF contracture. You want to get the patients to a neutral foot or dorsiflexion. You can serial cast these patients to help them get to dorsiflexion.

70
Q

A patient is dragging their toes during mid-swing. What kind of contracture might they have? What compensations might you notice?

A 
They might have a PF contracture.
The could compensate with:
- hip hike
- increased hip and knee flexion (steppage gait: usually due to weakness not lack of ROM)
- circumduction
- vaulting
- lateral lean
71
Q

A patient has a hip extensor MMT of 4-. What might you see in their gait?

A
  • may cause buckling at the hip at LR or early MSt
  • may not decelerate LE appropriately
  • compensatory hyperlordotic lumbar spine
  • may compensate with posterior trunk lean (this is in a glute max gait)
  • If severely weak, may shift COM and rely on Y ligs
72
Q

You notice a patient has a right pelvic drop that is more than the norm. What muscle is weak and what do they have?

A

The left hip abductors are weak. They have a left Trendelenburg.

73
Q

If someone has a Trendelenburg and they lean over the weak side, what is this called?

A

This is a compensated Trendelenburg.

74
Q

A patient has weak hip flexors. What kind of compensations might you observe in their gait?

A
  • they may compensate with trunk posterior lurch for increased momentum
  • may use adductors - ER at the hip to pull through using the adductors.
75
Q

A patient has a quad MMT of 3+ or 4. What kind of compensations in gait might you see?

A
  • momentum will extend the knee for IC, but it might buckle during LR and MSt
  • they may compensate by maintaining extension in LR and MSt. Purposeful recurvatum.
  • may lean trunk forward to change line of gravity at the knee
76
Q

You notice a patient is displaying decreased co-contraction at the knee. Their knee is instable. They also have excessive hip flexion and knee extension or recurvatum which is causing an anterior pelvic tilt and compensatory lumbar lordosis. What might be weak?

A

They might have weak hamstrings.

77
Q

Weak gastrocs can cause?

A

Knee recurvatum

78
Q

A patient has a PF MMT of 4. What might you see in Midstance?

A
  • may have decreased eccentric control of the ankle rocker, so they get excessive ankle rocking
  • they may have an increased demand on their quads d/t decreased tibial stability. Decreased tibial stability causes a flexed knee posture.
79
Q

How doe weak plantar flexors affect terminal stance?

A

Heel rise is limited or non-existent which leads to no knee extension. The knee is flexed throughout

80
Q

Which subdivision of gait is most affected by weak plantar flexors?

A

Pre-swing is most affected because you are getting ready to push off. Weak PF will cause decreased propulsion from TSt. You get passive PF via knee flexion, and this results in decreased step length.

81
Q

A patient has a DF MMT of 3+. What subdivision of gait will be most affected and why?

A

IC and LR.

  • unable to make contact with the heel, may contact with toes or flat foot
  • if heel contact IS made, unable to eccentrically control PF. This will result in a foot slap
82
Q

How does weakness in the dorsiflexors affect mid-swing?

A

The toes may drag, and you will see similar compensations as you would in a PF contracture.

83
Q

What might you see in terminal swing if a patient has weak dorsiflexors?

A

The patient may be unable to get their foot in neutral to prepare for IC.

84
Q

True or False
Strengthening exercises that are not task specific do not always improve walking even if they improve ability to generate force.

A

True!

85
Q

What is the best way to strengthen a patient to improve gait?

A

You want to strengthen task specifically. Use closed chain for gait instead of just doing open chain stuff. Make sure that the strengthening is relevant to gait. Start with exercises in quadruped. Go to short kneeling and tall kneeling. Then progress to single leg kneeling. These are called developmental strengthening.

86
Q

You have a patient who is very unstable. What will you strengthen first?

A

You want to strengthen the core first. You can’t produce distal mobility without proximal stability. The better developed the proximal muscles are, the more refined the movement is in the distal parts of the body.

87
Q

What is pivotal for efficient biomechanical function to maximize force generation and minimize joint loads in all types of activities?

A

Core stability

88
Q

Which direction does the body generate force?

A

The body generates force proximally to distally. This creates interactive moments that move and protect distal joints.

89
Q

What are the benefits of pre-gait activities?

A
  • allows for concentration on particular muscles or muscle groups, eccentrically, concentrically, ad isometrically
  • motor learning and planning
  • coordination
  • facilitation, inhibition
  • can focus on “trouble spots” of gait cycle
90
Q

What are strategies you can use to progress a patient when gait training?

A
  • change the assistive device
  • give less assistance
  • change the surface or increase distance
  • add high level activities
  • add in functional tasks and dual tasks

Applied Anatomy (13 decks)

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