Pathological Gait Flashcards
(31 cards)
What are the 5 preqrequisites of gait
Stability in stance
Clearance in swing
Appropriate pre positioning of foot for initial contact
Conservation of energy
Adequate step length
Age of normal walking
9-15 months
Mature, synchronous gait pattern
- 5 years
Heel strike
2-3 years
Reciprocal arm swing
2 years but mature at 4 years
Longitudinal arch development
3 years
Adult gait pattern
7-8 years
What are different walking speeds
Will increase with age.
2 years old — 1.5 ft/sec
7 years old — 2.6 ft/sec
>13 years old — 4.95 ft/ sec
How is stability in stance challenged?
- Body is top heavy ! COM is above BOS
- Walking continually alters segmental alignment. COM is constantly moving forward and laterally relative to each support
For stability in stance not only is a stable foot required, but the lower extremity segments must function to…
- Allow advancement of the limb in swing
- Maintain balance
- Provide propulsion
- Ensure appropriate position of the structures above
What does sufficient foot clearance require
- Appropriate position and power at the hip, knee, and ankle on the stance side.
- Enough DF, knee flexion and hip flexion during swing
- Stability of foot in stance
- Adequate body balance
What does appropriate pre positioning of the foot for initial contact require
- Appropriate body balance
- Stability, power, and proper position of stance limb
- Enough DF, balance between foot investors/evertors, and knee position
What does adequate step length require
- Appropriate body balance
- Stability and proper position of the stance lib
- Adequate hip flexion and knee extension
- Neutral ankle and foot position
What does energy conservation require
- Joint stability
- Minimization of the COM excursion
- Muscle forces optimized
What is the relationship between step length and leg length throughout development
Linear relationship — bigger you get, larger step length and larger leg length
Duration of single limb stance ____ as walking pattern matures
Increases
Standing energy expenditure rate ______ with age
Decreases
What is the difference between primary and secondary impairments in gait pathology
Primary impairments — direct result of CNS injury
Secondary impairments — compensations/mechanisms.
abnormal gait patterns typically develop due to bony deformities, loss of ROM, muscle weakness, spasticity, and/or abnormal motor control
Do you treat the primary or secondary impairments?
PRIMARY!!!! You can’t treat secondary impairments because they will just come back
What are some pertinent questions about child’s history
- Medical, birth, specialist history
- General development history — when did they start to walk
- Any family history of walking difficulties
- Were there any interruptions in the child’s ability to walk independently?
- Has the child ever walked?
What are the gait evaluation methods
Observation — Edinburgh Visual Gait Scale
Efficiency and practicality of walking — energy expenditure
Footprint analysis method
Gait assessment tools
Gait analysis motion analysis — 3D analysis of gait
What is the reliability of observational gait analysis
Interrater reliability of video analysis is low to moderate
— more reliable at distal segments and with experienced clinicians
How long should you observe gait?
At least 10 minutes of walking !!
Energy expenditure in gait
- Heat rate has been shown to be an accurate and convenient estimate of EE
- Linear relationship between HR and O2 uptake during walking for normal children and children with CP
- Walking velocity = distance/time
