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Gait Flashcards

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1
Q

Why Gait Analysis

A

Comparison to normal

Develop hypotheses as to underlying mechanisms causing observed dysfunction

Classification of severity of disability

Prediction of future status (gait speed prosthetic non-se)

Determine need for devices/equipment (adaptive/orthotic/prosthetic, assistive/protective/supportive) and effectiveness/fit of selected devices/equipment

Assess effectiveness of intervention

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2
Q

Observational Gait Analysis

A

Advantages - easy to perform in any clinical environment, time efficient, low cost, initial impression can be gleaned

Disadvantages - tendency to focus on eye gross deviations while overlooking subtle ones, depends on experience and individual bias, reliability and validity and interrater assessments, qualitative

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3
Q

Systematic Gait Analysis

A

Anatomical sequence of observation to sort multiple events at different jts (start at foot and move up, right before left)

Phasing of gait (swing vs. stance)

Stay focused and organized - don’t jump ahead

When referring to pelvis/trunk (reference to stance leg)

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4
Q

Reliability of OGA

A

Low to moderate reliability

To improve reliability - videotape clients (can slow down or pause tape, avoid client fatigue by repetitive walking)

Training

Experience

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5
Q

Developmental Acquisition

A

11-15 months - avg onset of independent walking

24 months - consistent heel strike, push off absent

30-36 months - reciprocal arm swing

BOS decreases after 4-5 months of independent walking (abd decreases first, ER last component to decrease)

Temporal phasing (swing to stance) - 50/50

Mature walking pattern by 4-5 years of age

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6
Q

Gait Changes Noted in Elderly

A

Mild stiffness, greater proximally (decreased rotation at pelvis and trunk)

Decreased arm swing (increased shoulder ext and elbow flex) - guard position

Decreased speed (decreased jt velocity)

Increased cadence - more steps

Decreased step length (decreased swing excursion, increased stance phase and double support time)

Stride width is increased (hip abd increased, greater toeing out) - increased BOS to keep balance

Increased toe-floor clearance (sl. stoppage)

Decreased heel strike (less DF thru/out)

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7
Q

5 Pathological Mechanisms

A

Deformity (includes decreased ROM)

Muscle weakness

Sensory loss

Pain - antalegic gait

Impaired motor control

All of these can happen in combinations

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8
Q

Pathological Mechanisms: Deformity - Contracture

A

Structural change w/in fibrous connective tissues of muscle, ligaments, or joint capsule following inactivity or scarring (inactivity or limited mobility)

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9
Q

Ankle-PF Contracture

A

Most common

Obstructs progression of leg during stance, inhibits foot clearance

Toe touch walking

Hyperext of knee

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10
Q

Knee Flex Contracture

A

Inhibits advancement of thigh

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11
Q

Knee Ext Contracture

A

Increases energy expenditure due to compensations to clear floor

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12
Q

Hip Flexion Contracture

A

Most common

Increases strain on back and hip extensors

Anterior pelvic tilt, lumbar lordosis is accentuated

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13
Q

Pathological Mechanisms: Muscle Weakness

A

Disuse

Neurological impairment

Strength-when patient tests 5/5

Gait deviations

  • Decreased speed
  • Substitutions
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14
Q

Pathological Mechanisms: Sensory Loss

A

Proprioceptive impairments

Light touch and deep pressure

Gait deviations

  • Decreased speed
  • Substitute by locking knee
  • Hitting the floor loudly
  • Visual monitoring of legs/feet
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15
Q

Pathological Mechanisms: Pain

A

Attempt to reduce compressive & shear forces

Excessive tissue tension leads to deformity and weakness

Deformity-moves into position of comfort of intra-articular pressure

  • Ankle 15° plantarflexion
  • Knee 30-45° flexion
  • Hip 30° flexion

Weakness-secondary to joint swelling which causes disuse atrophy

Pain shuts off any muscle

Pain – results in muscle loss and deformity/decreased ROM

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16
Q

Pathological Mechanisms: Impaired Motor Control - Spasticity

A

Obstructs yielding quality of eccentric muscle activity during stance

Soleus/gastroc cause persistent ankle plantarflexion-loss of ankle rocker

Hamstrings limits effective terminal swing and restricts thigh advancement in stance

Hip flexors restrict progression in mid and terminal stance

Quadriceps inhibits pre-swing prep for limb advancement

Spasticity brings leg back

Jt going fast - spasticity wants to slow it

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17
Q

Pathological Mechanisms: Impaired Motor Control - Decreased Selective Control

A

Timing

Intensity

Muscles active at the wrong time

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18
Q

Pathological Mechanisms: Impaired Motor Control - Primitive Locomotor Patterns

A

Massed extension

Massed flexion

Keep in synergy

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19
Q

Pathological Mechanisms: Impaired Motor Control - Impaired Phasing

A

Due to control errors and spasticity

Action of muscles are prolonged, curtailed, premature, delayed, continuous, and/or absent

Results in substitutions

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20
Q

Gait Speed

A

If energy requirements are increased, speed is adjusted - too slow or too fast

Realize that

  • Arm swing is related to velocity (normally, no arm swing during slow walking)
  • UEs assist w/ balance
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21
Q

Propulsive Gait

A

CO2 poisoning, drug side effects

Stooped rigid posture w/ head and trunk flexed forward

Parkinson’s gait - short rapid steps (festinating), rigidity w/ no arm swing, difficulty w/ starting, stopping, turning

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22
Q

Steppage Gait

A

Exaggerated hip and knee flex w/ foot drop or foot slap

Ankle DF weakness (peroneal nerve damage, polyneuropathy, polio, MS, herniated disc L5, GBS)

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23
Q

Waddling Gait

A

Toes pointed out, wide BOS

Duck-like walk that may appear in childhood or later in life

Congenital hip dysplasia, muscular dystrophy, spinal muscular atrophy

Through whole gait cycle

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24
Q

Ataxic Gait

A

Cerebellar disorders, severe sensory deficits of LEs

Wide BOS, uncoordinated mvts, lurching/staggering, increased trunk mvts and variable foot placement

Wide base and negative base periods

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25
Spastic or Scissoring Gait
CVA, TBI, SC trauma, meningomyelitis, MS, CP Secondary to hypertonicity of LEs (higher energy requirements, unsteady) Over-activity of hip adductors w/ narrow, crossing BOS ``` Negative space Negative BOS Leg has to go in front and over Can get friction burns between knees Adduction and IR with extension synergy Over-activity of hip adductors – weakness in glut med ```
26
Hemiplegic Gait
UE (shoulder adduction and flexionelbow, wrist, and finger flexion) LE (extensor synergy: hip extension, add., IR; knee extension; ankle plantarflexion with inversion (equinovarus); flexor synergy: hip flexion, abd., ER; knee flexion; ankle dorsiflexion) Slow velocity, dec. stance time on involved limb and step length on uninvolved side Difficulty with limb stability (knee collapse or knee hyperextension) Difficulty with limb clearance (decreased flexion, toe drag)-substitute with hip hiking/circumduction Difficulty with limb advancement (decreased knee extension, pelvic retraction) Swing phase - leg comes up and out
27
Glut Max Gait (Lurching)
Backward lurch of trunk just after initial contact Hyperextension of hip with forward ‘protrusion' Vector behind hips and pushes them forward – glut max
28
Gluteus Medius/Trendelenberg Gait
Uncompensated - contralateral pelvic drop at initial contact of affected side Compensated - lateral trunk flex/lean, steppage gait
29
Antalgic Gait - Hip
Avoidance of WB on affected side Stance - decreased stance phase, trunk lurch toward painful hip, heel strike avoided to prevent jarring and excess loading Swing - flexed, ER, abd (relaxed jt capsule)
30
Antalgic Gait - Knee
Maintained in slight flexion throughout Avoidance of heel strike Toe walking on affected side
31
Antalgic Gait - Foot and Ankle
Stride length shortened Normal heel-to-toe lost - Forefoot avoid toe off - Ankle or hindfoot avoid heel strike
32
Gait Deviation: Swing - Excessive Hip Flexion
Foot drop Flexor synergy (control problem)
33
Gait Deviation: Swing - Limited Hip Flexion
Decreased step length Decreases knee flexion Weak hip flexors (grade 2+ is sufficient) Extensor spasticity Pain
34
Gait Deviations: Swing - Circumduction
BOS is normal Weak hip, knee, and/or ankle flexors Only occurs during swing
35
Gait Deviations: Swing - Hip Hiking (Pelvic Mvt)
Lack of knee flexion and/or ankle DF Compensation for extensor spasticity of swing leg Leg length discrepancy
36
Gait Deviations: Swing - Limited Knee Flexion
Pain (avoid shearing and compressive forces) Decreased range Weak knee flexor/lack of pressing flexion Extensor spasticity Proprioceptive deficit
37
Gait Deviations: Swing - Lacks Knee Ext in Terminal Swing
Flexor synergy Weak quads Knee flex contracture Decreased gait velocity Proprioceptive deficits
38
Gait Deviations: Swing - Excessive Knee Flexion
Flexor synergy
39
Gait Deviations: Swing - Limited Ankle DF
Weak DF - result in decreased ROM Decreased range Spasticity Proprioceptive deficits
40
Gait Deviations: Swing - Toe Drag
Weakness of DF and toe extensors Spasticity of PFs Inadequate hip/knee flex Stay in PF position
41
Gait Deviations: Initial Contact - Limited Hip Flex
Weak hip flexors or glut max Decreased range
42
Gait Deviations: Initial Contact - Excessive Hip Flex
Hip and/or knee flexion contracture Spasticity in hip flexors Weakness in soleus/gastroc (allows tibia to travel forward - see inc. hip and knee flex)
43
Gait Deviations: Initial Contact - Excessive Knee Flex
Knee flex contracture (mvt is same through gait cycle) Hamstring spasticity (muscle turns on and off, changes through gait sped) Weakness in quads (collapse) Impaired proprioception Leg length discrepancy (to shorten contralateral longer leg) Pain
44
Gait Deviations: Initial Contact - Excessive Ankle PF
Dependent on severity - foot slap, low heel strike, flat foot contact, forefoot contact Weak DFs Extensor spasticity PF contracture Leg length (to lengthen short ipsilateral leg) Painful heel (toes first) Fixed DF (fixed ankle orthosis) Glut med/max problems - usually ankle PF Little weakness in tib ant - less heel strike Flat foot - don't use tib ant Toe-heel gait - don't DF - touch w/ toe, then heel, hyperext at knee
45
Gait Deviations: Loading - Excessive Hip Flex w/ APT
May lean trunk backwards to compensate Weak hip extensors
46
Gait Deviations: Loading - Knee Hyperextension
Weak quads Impaired proprioception Spastic quads/PFs Compensation for PF contracture
47
Gait Deviations: Loading - Excessive Knee Flexion
Knee flex contracture Spastic hamstrings Impaired proprioception
48
Gait Deviations: Stance - Lateral Trunk Lean
Lateral trunk lean toward stance leg, contralateral pelvic drop May look like hip hike in stance (hip hike only occurs in swing) Painful hip Weak glut med of stance
49
Gait Deviations: Stance - Backward Trunk Lean, APT
Weak glut max on stance leg
50
Gait Deviations: Stance - Forward Trunk Lean
Compensation for quad weakness Hip and/or knee flex contracture
51
Gait Deviations: Stance - Limited Hip Extension
Hip flexion contracture/arthrodesis Spasticity in hip flexors
52
Gait Deviations: Stance - Hip Abduction
Contracture of glut med
53
Gait Deviations: Stance - Hip Adduction
Spasticity in hip adductors (also in flexors)
54
Gait Deviations: Stance - Excessive Knee Flex
Knee flex contracture Flexor synergy Flexor withdrawal reflex Weak PFs
55
Gait Deviations: Stance - Excessive DF, no heel off
Weak PFs (eccentric) Hip and/or knee flex contractures
56
Gait Deviations: Push-Off - Limited Knee Flex
Spasticity in quads and/or PFs
57
Gait Deviations: Push-Off - Early Heel Rise
Spasticity of PFs Decreased DF range
58
Gait Deviations: Push-Off - Lack of Roll Off
PF weakness Forefoot pain Limited forefoot motion
59
Excessive PF
Limb is longer - toe drags/catches Stance - loss of progression - shortened stride length and reduced gait velocity Swing - obstructs limb advancement - substitutions as result of increased limb length and body effort, shortened step length Initial contact - low heel contact (decreased rocker), forefoot > 20 places forefoot lower than heel Loading - decreased heel rocker, decreased knee flex (hyperext knee) Midstance - inhibits tibial advances - compensations: premature heel-off (faster gait speed), knee hyperext, forward trunk lean (slower gait speeds) Midswing - toe drag - compensations: increased hip flex w/ knee flex, circumlocution, lateral trunk lean (hip hike), contralateral vaulting
60
Excessive DF
Slower walking speed, excessive knee flex, crouched position Stance - shortened step length, increased quad demand Loading (throws body forward - need to have good quads) - increased flex moment, contact w/ foot flat and eliminating normal PF Midstance - instability at onset of single limb support, increased quad demand Preswing - prolonged heel contact
61
Soleus Weakness
Cause excessive DF Soleus holds tibia back during gait - stabilizes tibia to have controlled loading Weak soleus - tibia goes forward way too fast
62
Excessive Inversion (Varus)
Lateral forefoot loading Premature heel-off in mid stance Causes - overactivity of soleus, PF contracture, tib ant/toe extensor, flexor hallicus/flexor digitorum activity (toe clawing), weakness of perennials (muscle imbalance)
63
Excessive Eversion (Valgus)
Shortened heel on at IC Excessive DF secondary to unlocking of mid tarsal jts Center of pressure moved medially in terminal stance and preswing Causes - weakness in invertors Pronation, unstable foot Foot loses arch and goes in other direction - rocker bottom foot Some so locked - resting on navicular
64
Inadequate Knee Flex
Loading - limits shock absorption, absent knee flex is usually substitutive for quad weakness (hyperext) Pre-Swing - makes toe-off harder, lift LE by increasing hip flexion (increased DF and heel contact prolonged) Initial swing - toe drag (circumduction, hip hiking, vaulting on opp side)
65
Excessive Ext (Recurvatum)
Extensor thrust - snapping action Dynamic retraction to substitue for weak quads (grade 3+ to 4) - by soleus to retract tibia, by glut max to retract femur, used to maintain speed and endurance
66
Quad Weakness
Terminal swing - fast retraction of hip (glut max) will extend knee Loading - knee flex avoided, tibial advancement by soles and/or glut max Stance - hyperext used to increase heel contact, may see forward trunk flex to increase anterior vector Pre-swing - knee ext maintained until other foot is fully loaded (double support increased to feel safer)
67
Inadequate Extension
Shortened step length Increased quad demand Inappropriate actions of hamstrings - spasticity, substitution for glut max (see mild loss of knee flex due to action of tibia) Soleus weakness - tibia advances too fast (also see ankle DF and sustained heel contact) Hamstrings give resistance - knee comes back into flex after it's kicked out (at very high speed, usually from mid swing to terminal swing)
68
Genu Valgum
Lateral tilt of distal tibia w/ lateral displacement of foot (knock knees) Distance b/w feet is greater than at knees False impression of valgus - hip IR, add and knee flex Seen in RA
69
Genu Varus
Medial tilt of distal tibia w/ medial displacement of feet (bowleg) Distance b/w knees greater than at feet False impression of varus caused by hip ER, abd and knee flexion Seen in OA
70
Inadequate Hip Extension
Mid-stance - modifies alignment of hip.thigh, compensations - lumbar lordosis (adults < 15, children 30 hip flex), knee flex (reduces body progression/increased demand on quads) Increased demand of hip extensors Terminal stance - body advancement and step length shortened, thigh unable to trail Hip flex tightness - cause lots of problems 30 degrees - crouched gait Lordosis - if there is 15 degrees, get hip flex contracture (occurs first, anterior pelvic occurs)
71
Inadequate Hip Flexion
Decreased step length and speed Substituions - posterior pelvic tilt (uses abs if hip flexors are weak), circumlocution, hip hiking, voluntary excessive knee flex, contralateral vaulting and lateral lean of trunk to opp side
72
Excessive Adduction
Scissoring gait - part of extensor synergy (assoc w/ hip flex and IR), narrow BOS, blocks progression of swing leg Adductor contracture - does not correct thru gait cycle Abductor weakness < 3 - corrects in preswing s weight is transferred to opposite limb Adductor use as hip flexor - medial displacement of tight in swing
73
Excessive Abduction
Wide BOS Increased stance stability (balance impairments) - requires greater effort to shift weight from one limb to another During swing, action increases floor clearance - circumduction substitutes for decreased hip flex Other causes - abduction contracture, short leg (along w/ ipsilateral pelvic drop to lengthen leg) Waddle gait
74
Excessive Rotation - External
ER or IR - limited PF length (avoid stretch) Weak IR Backward pelvic rotation Overactive glut med Compensate for quad weakness Use adductors as hip flexor Using peroneals/fibulari as PFs
75
Excessive Rotation - Internal
ER or IR - limited PF length (avoid stretch) Weak ER Forward pelvic rotation Medial hamstring over activity Adductor over activity (w/ hip flex, hip adductors cause IR) Anterior abductor activity (TFL, ant GM) Quad weakness (IT band and lateral knee ligaments resist flex of knee)
76
Pelvic Tilt
Anterior - weak hip extensors, hip flex contracture Posterior - substitute action for limited hip flex
77
Pelvic Hike and Drop
Hike - assist foot clearance, substitute for weak hip Contralateral drop - weak hip abductors, hip adductor contracture or spasticity (at mid stance - pelvis is drawn as femur assumes vertical) Ipsilateral drop - contralateral abductor weakness, short limb, calf muscle weakness (decreases heel rise - short limb), scoliosis Uncompensated - drop Compensated - ipsilateral lean to weak side
78
Excessive Pelvic Rotation
Forward - advance limb when hip flexors are weak, also IR but doesn't cross neutral line Backward - in terminal stance, calf muscle weakness results in lack of heel rise (shortened limb) - not good push off, pelvis retracts more Lack of rotation - rigid spine w/ stiff gait
79
Backward Lean
Hip extensor weakness - begins at loading and continues through stance, bilateral (during entire stride) Inadequate hip flex - assist limb advancement when lumbar spine is immobile or abs are weak (use pelvis to kick forward)
80
Forward Trunk Lean
Ankle PF - anterior vector moves forward over area of foot support Quad weakness - anterior vector moves forward to force knee ext Glut max weakness - pelvis falls forward and trunk follows (first APT, then trunk leans forward)
81
Ipsilateral Trunk Lean
Toward stance limb - compensate for weak hip abduction (begins w/ loading and ends at terminal stance), hip adductor contracture - to correct, trunk leans to stance limb (if ITB tightness, will see trunk flex also), short limb, scoliosis Toward swing limb - impaired body image (incompatible w/ stability), assist during swing to clear limb
82
Excessive Trunk Rotation
Increased energy cost Causes - synergy (no counterbalance forward rotation of ipsilateral trunk), walking aid synergy (trunk follows cane), arm swing (excessive arm swing used to assist balance)

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