KnB Gait Deviations

Question 1

Causes of Gait deviation

Answer 1

deformity

weakness

sensory changes

pain

impaired motor control

Question 2

Where is pain usually in gait cycle?

Answer 2

Stance

Question 3

Impaired motor control in Gait

Answer 3

• impaired selective control
• impaired eccentric control
  
  • ​spasticity
• primitive motor patterns emerge
• altered timing/grading of mm act.

Question 4

What 2 phases rep. Wt. acceptance?

Answer 4

IC

LR

Question 5

What 2 phases rep. Single Limb Support?

Answer 5

MidStance

Terminal Stance

Question 6

What phases rep. Swing Limb Advance.?

Answer 6

PSw

ISw

MSw

TSw

Question 7

Devs @ the Toes

when will you see these??

Trouble bringing toes UP

Answer 7

TSt and PSw

• Inadequate EXT –> Hallux Rigidus
• Clawed/Hammer Toes

Question 8

1st MTP joint

Explain..

Answer 8

• Up to almost 55deg Toe EXT occurs @ PSw
• compensations:
  
  • ​Hallux limitans
  • Hallux rigidus
  • Hallux valgus

Question 9

Deviations @ Foot and Ankle

Excess PF

Answer 9

• Typically affects:
  
  • ​IC
  • LR
  • MSt
  • TSt
  • ISw
  • MSw
  • TSw

Question 10

Exess PF @ IC

Answer 10

forefoot contact

LOW heel contact

Loss of Heel rocker

Question 11

Excess PF in LR

Answer 11

Loss of heel rocker== limtd knee flexion

MAY drive tibia posteriorly

Question 12

Exess PF @ MSt

Answer 12

inhibits advance. of tibia== loss of ankle rocker

• MAY result:
  
  • premature heel off
  • knee hyperext.
  • forward trunk lean

Question 13

Excess PF @ ISw and MSw

Answer 13

Toe drag

DECd step length due to inhibited advance. of limb

Question 14

Excess DF

Answer 14

• Where?
  
  • IC
  • LR
  • MSt
  • TSt
  • PSw
• functionally more sig. in Stance
• Usually due to:
  
  • LACK of normal PF
  • gastroc/soleus weakness

Question 15

Excess DF in LR and MSt/TSt

Answer 15

• INCd heel rocker== INCd quads demand
• Excess tibial translation==unstable knee==INCd quad demand

Question 16

Deviations @ the knee

Limtd Knee Flex

Answer 16

• where?
  
  • LR
  • PSw
  • ISw

Question 17

Dev’s @ Knee

Excess Knee Flex

Answer 17

• Where?
  
  • LR
  • MSt
  • TSt
  • TSw
• Excess knee flex– Stance
  
  • ​mostly affects LR, MSt, TSt
• Excess knee flex– Swing
  
  • ​aka inadequate EXT
  • Mostly affects TSw

Question 18

Devs @ Knee

Extensor Thrust or

Hyperextension

Answer 18

• Extensor Thrust
  
  • ​usually seen LR–> TSt
    
    • ​possibly TSw
  • active extensor moment created by glute max and early PF
    
    • spastic PFs
• Hyperextension
  
  • ​usually passive (and static) in SLS (LR–> MSt or TSt)
  • PSw also
    
    • ​knee lig insufficiency
• • may be compensatory

Question 19

Deviations @ the Hip

Limtd Hip Flex

Answer 19

• where?
  
  • IC
  • LR
  • ISw
  • MSw
  • TSw
• usually due to weakness or DECd gait speed
• Primarily affects Swing phases of gait

Question 20

Devs @ Hip

Excess Flex or inadequate EXT

MSt

Answer 20

forward trunk lean OR excessive lordosis compensated by knee flex

• Where?
  
  • IC, LR, MSt, TSt

Question 21

Devs @ Hip

Excess Flex or inadequate EXT

TSt

Answer 21

pelvis remains ANT. tilted, loss of extended thigh==> poor advance.

• where?
  
  • IC, LR, MSt, TSt

Question 22

Common Causes of Hip excess flexion or inadequate extension

Answer 22

• hip flex contracture/spasticity
• ITB tightness
• Hip pain
• Jt. inflammation
• HO
  
  • bony growth in mm
  • usually illiacus

Question 23

Devs @ HIP

Excess ADDuction

*Rare

Answer 23

• Scissor Gait—-feet cross ea. other
  
  • ​excess hip ADD. in stance phase resulting in narrow BOS
  • ADD. spasticity
• Trendelenberg Gait
  
  • ​MOST pronounced in SLS
  • CONTRALAT pelvic drop due to weak hip ABD’s
    
    • ​results in Excess ADD.

Question 24

Positive Trendelenberg

*WEAK ABD’s

*Excess ADD.

Answer 24

Question 25

Devs @ HIP **Excess ABDuction**

Answer 25

* **Stance** * **​**==\> wide BOS but **greater effort in transition** * **Swing** * **​**compensatory to INC foot clearance * **more circumduction**

Question 26

Tips for Assessing Gait

Answer 26

* Select **reference limb** * observe **overall appearance** in standing, THEN walking * velocity, step length, UE/trunk motion * THEN **break it down joint by joint** * focus on **one joint thru all phases** * view from all sides * note **major devs** * hypothesize cause of deviations * perform specific assessments to test * ex. **if you sus weak DFs bc bad toe clearance during swing====\> TEST DF STRENGTH!!!**

Question 27

RLA Analysis Sheet

Answer 27

Look @ what is listed for Ea. Joint