Gait Test 2

Question 1

Causes of impaired feedback (4)

Answer 1

• Proprioceptive (joint position)
• Vestibular, balance
• Foot sensory
• Visual

Question 2

Mass flexor and extensor patterns

Answer 2

Lack of selective muscle control, loss of finely coordinated pattern
- Flexors or extensors all fire together, often post stroke

Question 3

Spasticity, application to gait

Answer 3

Muscle overreacts to passive stretch (clonus, beating pattern twitching if stretched too quickly)
- Rapid knee flexion in pre swing stretches Rec Fem, overactivity can block knee flexion

Question 4

Muscle weakness affects which phases?

- Dorsiflexors, Plantarflexors, Inverters

Answer 4

• DF- loading response, swing phases
• PF- mid and terminal stance, pre swing
• Invertors - stance phases

Question 5

15º plantar flexion contracture means??

Answer 5

• most common ankle contracture, comfort position w lowest intraarticular pressure
• can’t DF, can PF beyond 15º

Question 6

Arthrogenic weakness

Answer 6

• Swelling/pain increases intraarticular pressure in joint, reflex inhibition so can’t activate muscle
• cause of quads weakness

Question 7

Penalty of knee flexion contracture

Answer 7

Increased quads demand, fatigue, PFJ pain?

- 15º contracture, significantly increases demand!

Question 8

hip flexion contracture - postural compensations

Answer 8

• resting position 30-60º FL
• 15º contracture not noticeable- increased lumbar lordosis and anterior pelvic tilt
• Trunk flexion, lordosis, or mass flexion posture

Question 9

Two highest muscle demands in gait

Answer 9

• Isometric Hip extensors in loading response keep trunk upright
• Eccentric Plantarflexors in terminal stance

Question 10

Global observations of gait instability (3)

Answer 10

• trunk movement
• variable step length
• variable foot placement

Question 11

Global Compensations for Gait Instability (6)

Answer 11

• Wide BOS, slow velocity, increased DLS time, reliance on vision, increased frontal plane motion, heavy reliance on assistive device

Question 12

Consequences of weak calf (gastroc, soleus)

Answer 12

• Excessive DF in MS, TS, PSw –> quads overuse, excessive lowering of COM
• Inadequate knee extension in MS, TS –> quads overuse, decreased stance progression and stride length

Question 13

Potential consequences of weak quads

Answer 13

• Excessive PF in MS/TS- compensatory, push off –> decreases stance progression
• Inadequate knee flexion in LR –> decreases shock absorption
• Excessive knee extension in stance –> stresses post. knee
• Inadequate knee extension in mid/terminal swing –> decreased limb adv, stride length, preparation for stance
• Inadequate hip flexion in LR –> decreases shock abs, heel rocker
• Excessive hip flexion in pre/mid swing- past retract maneuver –> hip FL overuse

Question 14

General Causes of Abnormal Gait (5)

Answer 14

• Decreased joint mvt (joint stiffness, elastic or rigid contracture)
• Weakness (excessive motion or avoidance)
• Pain (avoidance) / - Impaired feedback / - Impaired motor control

Question 15

Excessive PF in IC - causes and penalty

Answer 15

Causes: DF weakness / contracture / excessive PF activity / reduce heel rocker 2º weakness or balance / heel pain
Penalty: reduce stance progression (lose heel rocker)

Question 16

Excessive PF in midstance and terminal stance

Causes, penalty, compensations

Answer 16

• Cause: short steps / contracture / excessive PF activity- pushing off to compensate for extensor weakness
• Penalty: decreased stance progression (compensates w/ knee HE OR early heel rise OR midfoot pronation)

Question 17

Excessive PF in swing phases - causes, penalty, comp

Answer 17

• Cause: DF weakness / contracture / excessive PF activity

- Penalty: decreased foot clearance –> will increase hip or knee FL

Question 18

Excessive DF in initial contact/loading response

Cause and penalties

Answer 18

• Cause: AFO or prosthetic foot usu. set 5-8º DF

- Penalty: quads overuse/increased knee FL / increased heel rocker launches forward

Question 19

Excessive DF in mid/terminal stance and pre swing - cause, penalties

Answer 19

• Cause: weak calf

- Penalty: quads overuse / excessive COM lowering

Question 20

Excessive pronation causes (5)

Answer 20

• compensatory for limited DF or hypomobile subtalar
• hypermobile rearfoot/midfoot
• inverter weakness / - dynamic knee valgus / - structural rearfoot/forefoot varus

Question 21

Causes of limited pronation (4)

Answer 21

1. hypomobile rearfoot 2. medial point of contact 3. dynamic splinting, holding self there 4. structural cavus foot

Question 22

Penalties of excessive pronation vs. limited pronation

Answer 22

• Excessive: stress on inverters / plantar fascia / intertarsal ligs / hallux valgus / increased tibia rotation and stress on knee
• Limited: poor shock absorption

Question 23

Inadequate knee flexion in loading response - causes and penalty

Answer 23

• Causes: weak quad OR hip ext / pain avoidance / excessive quad activity / decreased heel rocker
• Penalty: decreased shock absorption

Question 24

Inadequate knee flexion in pre and initial swing

Answer 24

• Causes: weak hip flexors / pain avoidance / excessive quad activity
• Penalty: decreased foot clearance

Question 25

Excessive extension in mid/terminal stance - causes and penalty

Answer 25

- Causes of HE: weak quads / pain avoidance / excessive quad activity / compensation for excessive PF - Penalty: stresses posterior knee

Question 26

Excessive knee flexion in pre/initial swing - causes and penalty

Answer 26

- Cause: compensation for excessive PF / abnormal motor control, flexor pattern - Penalty: overuse of hip flexors, BF short head

Question 27

Inadequate knee extension in mid/terminal stance - causes and penalties

Answer 27

- Causes: contracture of knee OR hip / excessive DF 2º weak calf / excessive hamstring activity - Penalties: quads overuse / decreased stance progression, stride length

Question 28

Inadequate knee extension in mid/terminal swing - causes and penalties

Answer 28

- Cause: contracture of knee / weak quad / excessive hamstring activity / purposefully reduce heel rocker 2º weak/balance/heel pain - Penalty: decreased preparation for stance / limb advancement / stride length

Question 29

Dynamic valgus in stance - cause/penalty

Answer 29

- Cause: weak hip ABD or ER | - Stresses knee - PFJ, MCL, pes anserine, IT Band

Question 30

Dynamic varus in stance - cause/penalty

Answer 30

- Cause: pelvic drop 2º weak hip ABD | - Stresses knee - LCL, IT band, medial compression

Question 31

Excessive knee rotation in stance - cause/penalty

Answer 31

- Cause: excessive pronation OR weak hip ER making whole leg internally rotate - Stresses knee - PFJ, MCL, pes anserine, IT band

Question 32

Inadequate hip flexion in loading response - cause/penalty

Answer 32

- Cause: weak quads or hip ext / decreased heel rocker | - Penalty: decreased shock absorption

Question 33

Inadequate hip flexion in pre to terminal swing - cause/penalties

Answer 33

- Cause: weak hip flexors / pain avoidance - Penalties: decreased limb advancement / stride length / foot clearance - may compensate with excessive knee flexion or circumduction

Question 34

Excessive hip flexion in pre to mid swing - cause/penalty

Answer 34

- Cause: past-retract maneuver (weak quad/amputee) / compensate for excessive PF or inadequate knee FL to clear foot - Penalty: hip flexor overuse

Question 35

Inadequate hip extension in mid/terminal stance - cause/penalty/compensation

Answer 35

- Cause: contracture of knee or hip, tight hip flexors - Penalty: decreases stride length - Compensate- excessive ant pelvic tilt and backward rotation, circumduction

Question 36

3 possible effects of weak hip ABDuctors in stance

Answer 36

1. Excessive hip Add, knee valgus --> stresses ITB, medial knee, lateral hip 2. Pelvic drop --> knee varus stress, spine stress (facet compression, paraspinal/QL overuse) 3. Trunk lean over weak side --> facet compression on concave weak side, ecc muscle overuse on convex side

Question 37

Average Comfortable Gait Speed from 20's to 70's

Answer 37

About 80 m/min

Question 38

Why does slow gait speed require more muscular effort? (5 reasons)

Answer 38

- more active swing phase - lose stabilizing influence of arm swing - larger frontal plane COM excursion - more variable foot placement - increased dynamic instability- need postural muscle synergies

Question 39

Minimum gait velocity for household ambulation, limited community ambulation, full community

Answer 39

- household 48 m/min