Higher Level Gait disorder

Question 1

describe the upper body movement during the gait cycle

Answer 1

Trunk twists around a vertical axis
Pelvis rotates (12)
Upper trunk in opposite direction
Arms out of phase with legs

Question 2

gait parameters

Answer 2

stance phase
swing phase
stance time
swing time
cadence
step length
stride length
step time
gait cycle
stride time
average gait velocity

Question 3

function of Mesencephalic locomotor region

Answer 3

receives afferents from basal ganglia, limbic system, sensorimotor cortex, and connects spinal circuitry via reticulospinal tract.

Question 4

function of Pontine locomotor regions

Answer 4

postural tone

Question 5

function of subthalamic region

Answer 5

modulation of locomotor patterns

Question 6

function reticular formation

Answer 6

temporal and spatial co-ordination of movement

Question 7

purpose of basal ganglia

Answer 7

Initiation and termination of movement

Question 8

purpose of cerebral cortex

Answer 8

Motor planning

Visuomotor
co-ordination

Cognitive aspects of motor control

Question 9

gait pattern is the integration of what cognitive abilities

Answer 9

Attention, planning and memory
Integration of motor, perceptual and cognitive processes

Question 10

what afferent feedback is received during gait

Answer 10

Somatosensory
Visual
Vestibular

Question 11

what is reduced regarding age related changes in gait

Answer 11

Velocity (norm 1.5m/s)
Step/stride length
Arm swing
Pelvic rotation
Heel-strike
Reaction time

Question 12

what is increased regarding age related changes in gait

Answer 12

Double support time (norm 60% gait cycle)
Cadence (norm 110 steps/min)
Time needed to travel

Question 13

what is the anatomical correlation of higher level gait disorder

Answer 13

higher - cortex different patterns cautious, parkinsonian, ataxic,
higher -subcortical - spastic, magnetic, gait ignition failure, disequilibrium

Question 14

characteristics of higher level gait disorder

Answer 14

Difficulties with initiation
Shuffling gait
Bradykinesia
Freezing
Demonstrate wide BOS +/-
Deteriorating postural responses/ balance
Tendency to retropulsion

Question 14

higher level gait disorder descriptors

Answer 14

Gait apraxia
Frontal ataxia
Frontal disequilibrium
Frontal gait disorder
Subcortical disequilibrium
‘Marche a petit pas’
Vascular pseudoparkinsonism
Senile Gait
Lower body Parkinsonism
Ateriosclerotic Parkinsonism
Cautious gait
Isolated gait ignition failure

Question 15

pathophysiology of higher level gait disorder

Answer 15

Vascular/Ischaemic processes
Disruption of the neural pathways
Frontal lesions
Diffuse cerebral disease
Multiple lacunar infarcts
Basal ganglia infarcts

Question 16

middle level gait disorder causes

Answer 16

Cerebellar disorders
Spasticity with corticospinal dysfunction
Bradykinetic, dystonic, and choreic gaits with basal ganglia disorders

Question 17

what gait patterns are middle level gait disorder

Answer 17

Paraplegic Gait
Hemiplegic Gait
Cerebellar ataxic Gait
Parkinsonian Gait
Choreic Gait
Dystonic Gait

Question 18

gait and balance assessment for gait disorder

Answer 18

Head, Trunk, UL, LL (hip, knee, ankle, foot).
Swing and stance phase (observe different components)
Turning: Balance / stability
Alignment / symmetry
Weight transfer
BOS
Cadence
Associated reactions
describe gait pattern
t/f
safety awareness

Question 19

what abnormalities may be detected in a gait analysis

Answer 19

Slowness of walking
Decreased stride length
En-bloc turning
Retropulsion
Shuffling gait
Inadequate heel strike
Inadequate foot clearance
Loss of arm swing

Question 20

implications for physio with gait disorder

Answer 20

strategies for gait initiation and turning difficulties
improve postural alignment and balance training - enhance balance reaction, core stability, postural alignment
gait traing - T/F, stepping practice

Question 21

dual task theory

Answer 21

People often have trouble performing two relatively simple tasks concurrently

Evidence from studies of healthy volunteers has suggested that there may be an identifiable cognitive function responsible for dual

Question 22

decerebrate model

Answer 22

Weight support

Active propulsion

Improved co-ordination of stepping patterns

Note- only when ES is applied to an important area in the brainstem- mesencephalic locomotor region

Cerebellum - vital for correction of central pattern generator activity

Question 23

decorticate model

Answer 23

External stimulus not required to produce locomotion

Reasonably goal directed

Cortex important in skills such as walking over uneven terrain/navigation- use of vision recognition pathways in the cortex