assessing gait in older adults

Question 1

gait cycle:

phases of weight acceptance

Answer 1

initial contact

loading response

Question 2

gait cycle:

SL support phases

Answer 2

midstance

terminal stance

Question 3

gait cycle:

limb advancement phases

Answer 3

• preswing
• initial swing
• midswing
• terminal swing

Question 4

Common gait changes with age:

temporal

Answer 4

• decreased step and stride length

- increased stance and DL support time

Question 5

Common gait changes with age:

spatial

Answer 5

• decreased step and stride length

- increased step width

Question 6

Common gait changes with age:

kinematic/postural

Answer 6

• decreased excursion of movement at LE joints
• decreased reliance on ankle kinetics and power
• less upright posture

Question 7

T/F: abnormal gait associated w/progressive risk of institutionalization and death

Answer 7

True

Question 8

Slow gait speeds:

Answer 8

• defining feature of frailty
• fall pts slower than age match peers
• worse performance across all cog domains

Question 9

effect of complex dual task on gait in MCI and AD groups compared to healthy

Answer 9

1. significant decrease in gait velocity
2. increased stride time
3. increased stride variability

Question 10

stride length in AD group compared to healthy controls

Answer 10

decreased mean value and greater CoV

Question 11

gait variability:

step length and # of steps

Answer 11

reduced mean value for all CDRs compared to CHI at UP, FP, SP, and dual-task conditions

Question 12

Gait and cognition

Answer 12

• decreased gait and cognition=high risk for dementia
• cognitive domains have critical impact on gait
• MCRS
• strong need to integrate cog demands w/gait and mobility training

Question 13

Motoric Cognitive Risk Syndrome (MCRS)

Answer 13

slowed gait and subjective cog impairment

• 2-3x more likely to develop dementia than those w/o MCRS

Question 14

Predictive value of gait speed:

> 1.2 m/s

Answer 14

extremely fit

can cross street safely

Question 15

Predictive value of gait speed:

> 1 m/s

Answer 15

Healthy older population w/ lower risk of hospitalization or adverse health events

independent in ADLs

Question 16

Predictive value of gait speed:

< 1 m/s

Answer 16

• increased risk for cog decline within 5 years

- increased risk for death/hospitalization within 1 year

Question 17

Predictive value of gait speed:

< 0.8 m/s

Answer 17

• limited community ambulator

- increased risk of mortality, mob/ADL disability in 2 years

Question 18

Predictive value of gait speed:

< 0.7 m/s

Answer 18

increased risk of death, hospitalization, institutionalization, and falls

Question 19

Predictive value of gait speed:

< 0.4 m/s

Answer 19

• functional dependence

- severe walking disability

Question 20

Predictive value of gait speed:

< 0.2 m/s

Answer 20

extremely frail

highly dependent

Question 21

FIM determinant of highest level locomotion

Answer 21

150 ft

Question 22

Conservative estimate of distances walked at superstores

Answer 22

2000 ft

Question 23

Gait speeds required to safely cross the street

Answer 23

.49 - 1.32 m/s

Question 24

Things to consider for functional ambulation

Answer 24

• time constraints
• ambient conditions
• terrain
• external physical load
• attentional demands
• postural transitions
• traffic level

Question 25

T/F: Clinical gait training focuses on getting from point A to point B

Answer 25

False MUST include more

Question 26

Assistive Device considerations

Answer 26

1. find best device on stability-mobility continuum 2. proper adjustment, use, and footwear 3. energy cost 4. resistance of use 5. environmental barriers

Question 27

Assessing Hait

Answer 27

1. Dx and relevent comorbidities 2. social Hx including PLOF 3. Body system screening 4. Observational gait analysis 5. Instrumental gait analysis 6. level ground vs stairs 7. gait speed 8. outcome measures

Question 28

Specific assessment for gait

Answer 28

- ROM - Strength - Motor Control - Joint P! - Coordination - Somatosensation - Vestibular - Proprioception

Question 29

Assessing Gait: | Stair Negotiation

Answer 29

- requires greater ROM and muscle strength - ascending vs descending - usual pace walking speed and SLS time best - safety, handrails, step-to, AD, physical assist

Question 30

Geriatric Gait Interventions

Answer 30

1. flexibility 2. strength 3. power 4. agility 5. CV training 6. multimodal training

Question 31

Interventions: | Strength

Answer 31

LE strength associated with improved gait speed and function

Question 32

Interventions: | Power

Answer 32

rapid bursts needed for motor control

Question 33

Interventions: | CV training

Answer 33

aerobic exercise enhances functional endurance

Question 34

Intervention: | Specificity of training

Answer 34

what is the goal?

Question 35

Intervention: | training speed

Answer 35

increase of as little as 0.1 m/s can reduce disability and mortality

Question 36

Intervention: | progressing task and environment

Answer 36

1. reactive, predictive, and anticipatory control 2. obstacle courses 3. dual task

Question 37

Intervention: | obstacle courses and stair training

Answer 37

- altered terrain - obstacle avoidance - steps - ramps

Question 38

Intervention: | Directional training

Answer 38

- backward and lateral stepping - turning 90/180/360 degrees - backward walking slower than 4 m/s may increase fall risk

Question 39

Intervention: | Dual Task

Answer 39

- reduction in gait speed w/simple vs complex dual task - increased gait variability leads to decreased postural stability examples: counting backwards, animal naming