Gait Training Flashcards Preview

PT 515 Musculo > Gait Training > Flashcards

Flashcards in Gait Training Deck (59):
1

Rquirements for gait

Trunk control
LE strength

2

Five main functions of Gait

1. Support head, arms, and trunk
2. Maintain upright posture and balance
3. Controls the foot to allow it to clear obstacles; allows gentle heel or toe landing
4. Generates mechanical energy by concentric muscle contraction to initiate and maintain forward velocity
5. Provides shock absorption and stability and decreases forward velocity

3

Gait and age

Irregular and variable until about age 7
Toddlers learn to walk and the elderly typically resemble one another

4

Functional tasks in gait

Forward progression
Balance
Support of the upright body

5

Gait cycle

Time interval or sequence of motion occurring between two consecutive initial contacts of the same foot
-Measured as stride length

6

Traditional gait cycle

1 cycle: Heel strike-->foot flat--> heel off--> toe off-->acceleration-->midswing-->deceleration

2 Phases: Stance 60% and Swing 40%

7

Normal Stride Length

70-82cm

8

Normal Step Length

35-41cm

9

Normal Base Width

5-10cm

10

Normal Foot angle

5-18 degrees
Fick angle

11

Normal Cadence

90-120 steps per minute

12

Normal Gait Speed

Approximate 1.4m/sec

13

Center of Gravity

Typically 5cm or 2 in anterior to the second sacral vertebrae
Wider stance lowers COG

14

Observation of gait

Anterior view- Frontal plane motion
Lateral view- Sagittal plane motion
Posterior view- Frontal plane motion
Footwear wear patterns

15

Objective Functional Tests

Timed up and go test
Performance oriented balance and mobility assessment
Standardized walking obstacle course

16

3 Main reasons for Gait deviations

1. Pathology or injury to specific joint
2. Compensations for injury or pathology in other joints on the same side
3. Compensation for injury or pathology on the opposite limb

17

Specific factors leading to gait deviations

Pain/Discomfort during WB
Muscle weakness/tone abnormalities
Limitation of joint ROM
Incoordination of movement
Changes in bone or soft tissue

18

Ankylosis

Fusing/Stiffening of joint

19

Joint instability

More than hypermobility
Reduces shock absorption ability

20

Antalgic

Painful

21

Arthrogenic

Clumsy, hobbling due to stiffness
Joint origin

22

Hemiplegia

Decreased use of one side, paralysis
EX: vaulting on one side to clear weak side

23

Cerebral Palsy

Congenital Condition
Lower or upper or both extremities affected
Doesnt change over time

24

Parkinson's Disease (basal ganglia)

Tremors, movement not smooth

25

Festinating Gait

Decreased strength, Decreased arm movement, decreased foot pickup, decreased trunk rotation

26

Tabes Dorsalis

Foot Condition
Inversion

27

Ataxia

Decreased control during walking
Huntington's have poorly controlled movement

28

Aging

Downward Gaze
Widened
Decreased arm swing

29

Contracture

ll, mm, jt shortening
Prolonged time in shortened position

30

Equinus Gait

Toe Walking

31

Trendelenburg

Frontal Plane Problem
Problem w/ glute medius
Hip drops

32

Scissor Gait

Crossing midline
Hypertonic adductors

33

Drop Foot

Decreased tib anterior strength
Cant DF foot to move it for walking

34

Hip flexors deficiency

Used in swing phase, shortened limb during swing

35

Hip Abductors deficiency

Pelvic instability during stance

36

Hip extensors

Help w/ sagittal plane motion, propulse body over limb

37

Quadriceps

Hold LE stable during stance phase

38

Hamstrings

During midstance, eccentric control and isometric control

39

Dorsi Flexors weak

Foot drop, decreased clearance during swing

40

Plantar flexors weak

Decreased push off into swing

41

Impairment indicators for assistive device prescription

1. Structural deformity/loss, injury, disease that decrease ability to WB
2. Muscle weakness or paralysis
3. Inadequate balance

42

Assistive devices can..

1. Increase BOS and provide additional support
2. Provide larger area for patient to shift COG without loss of balance
3. Redistribute support within a wider BOS

43

Factors that may hinder patient learning

Pain
Fatigue
Ability to concentrate
Time of day

44

Devices for gait training

Parallel bars
Gait belt
Assistive devices
PTA

45

Landmarks for fitting walker

Ulnar styloid at handles

46

Landmarks for fitting crutches

45 degrees off foot about 6 inches
2-3 finger notch in armpit
Ulnar styloid on lower handle

47

Guard on which side?

Stronger side
Allows you to pull them onto the strong side

48

WBAT

50-100 percent BW
Limited only by patient tolerance

49

Gait pattern

Number of contacts (assistive device and lower extremities that move independently from another)
-4 point
-3 point
-2 point

50

4 point gait pattern

Alternate pattern best simulates typical gait
Standard pattern is also an option

51

3 Point gait pattern

Tripod Drag-to
-Bilateral crutches then good leg then drag bad
-Move weaker first

52

2 Point gait pattern

Standard
-R crutch/R extremity--->L crutch/L extremity

Alternate

Swing to

Swing through

53

Prerequisites for ambulation aides

Ability to stand erect with head and neck upright
Ability to move LE forward with hip flexors
Sufficient strength and load tolerance to bear weight through LE
Strength of UE to push down and lift aide
Sufficient psychological/ mental preparation capacity

54

Sit to stand with crutches

Crutches on side of uninvolved LE
Push off chair with hand on involved side
Adjust crutch under involved side first

55

Sit to stand walker

Push off from stable surface
Get affected leg out of the way

56

Sit to stand cane

Push off from stable surface
Cane in affected hand

57

Turning with total hip replacement

Turn away from the side of the surgery because no IR is allowed

58

Turning normally

Towards strong side normally

59

Guarding for stairs

Infront for descent
Behind for ascent