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CSB523- Gait > wk 8 - pathological gait > Flashcards

wk 8 - pathological gait Flashcards

1
Q

understand classifications and cause of gait pathology

A
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2
Q

discuss some examples of neurological disorders causing gait disturbance

A
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3
Q

4 things that must occur for a person to walk and what is the difference between normal and abnormal gait with these 4 things

A
  • Each leg must be able to support body weight
  • Balance must be maintained during single limb support
  • Swinging leg must be able to advance
  • Sufficient power must be generated

In normal gait, these are achieved efficiently and symmetrically

In abnormal gait, these may be achieved through abnormal movements,
increasing energy consumption and potentially requiring walking aids

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4
Q

when describing gait patterns how should you explain it?

A

descriptive anatomical terminology with refernce to gait cycle events/periods

not described by cause (eg hemiplegic gait) as that can look different in different people

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5
Q

overall observations for gait (8)

A
  • Speed
  • Cadence
  • Head tilt
  • Shoulder tilt
  • Base of gait
  • Asymmetry
  • Irregularity/lack of coordination
  • Tremor/involuntary movements
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6
Q

observing abnormal gait can be looked at during 3 gait periods

A

weight acceptance- includes initial contact and loading response

single limb support- midstance and terminal stance

swing lim advancement -

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7
Q

weight acceptance (IC) what to look out for with abnormal gait and in what plane?

A

initial contact (sagittal view): striking with the heel is normal, anything else (midfoot, flat foot, forefoot) strike is abnormal

IC (frontal view): excessive calcaneal inversion/eversion (is it just at initial contact or just it correct through midstance?- may be normal if corrects)

IC (transverse): adducted or abducted foot placement (more than 10 degrees)
Could be abnormal hip rotation, abnormal bony torsion at the femur or tibia or deformity of the foot.

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8
Q

weight acceptance (LR) - 3 abnormal things that can occur in sagittal plane

A

sagittal plane:

foot slap- rapid/uncontrolled plantarflexion after heel strike, often audible (weakness of ankle dorsiflexors

abnormal knee flexion/extension
1. inadequate extension (crouch gait)
-due to knee/hip contracture/spasticity
2. inadequate flexion or hyper extension (stiff knee gait)
-due to knee hyperextension (genu recurvatum)

trunk/hip abnormailities
1. anterior trunk bending - weak knee extensors
2. posterior trunk bending - weak hip extensors
3. abnormal hip flexion -inadequate (shortened stride on one side)

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9
Q

single limb support - ankle, rearfoot and toes in sagittal and frontal plane

A

sagittal plane:
1. early heel lift or no heel lift (apropulsive gait)
2. peak dorsiflex angle at ankle and first metatarsophalangeal joint - should be 20 degree in ankle and 15-20 in MTPJ
3. excessive clawing of toes / overactivity of long extensor muscles

frontal plane:
1. calcaneus (inversion/eversion) and foot pronation/ supination

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10
Q

single limb support- knee and thigh

A

knee:
should be full extended
1. indequate extension
2. hyperextension
3. varus/valgus (frontal plane)

thigh:
1. internal/external rotation looking at patella (frontal)
2. femoral anteversion (squinting patalla)

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11
Q

single limb support - pelvis and trunk

A
  1. contralateral pelvic drop (trendelenburg sign)-hip abductor weakness, pain, abnormal hip joint, wide base of gait
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12
Q

swing phase - ankle

A
  1. failure to dorsiflex the ankle to neutral during swing can impact ground clearance (compensation strategies will occur: steppage, hip hiking, circumduction)
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13
Q

swing phase - 4 compensation strategies for limb length difference

A
  1. Circumduction – weak hip
    flexors
  2. Hip hiking – pelvis lifted via
    contraction of spinal
    muscles
  3. Steppage – exaggerated
    knee and hip flexion
  4. Vaulting – going up on the
    toes of the stance phase leg
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14
Q

what is step length asymmetry due to (3)

A

weak hip flexors,
limited hip extension on one side, or hyperactive/spastic hamstring muscles

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15
Q

what do walking aids do and what types of are there

A

Operate by supporting part of the body weight through the arm rather than the
leg

  • Cane – increases the base of support, Suitable for minor stability problems
  • Crutches – by definition 2 points of attachment/loading. Armpit/hand or forearm/hand
  • Walking frames- Most stable walking aid, Usually move frame forwards first, then take a short step with each foot. Rolling walker
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16
Q

classifications of gait pathology based on what? (7)

A

-body systems approach
-planes of motion
-structure and function
-key components of gait control
-level of pathology
-gait classification scores
-global pathology

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17
Q

classifying gait dysfunction (3)

A

-High level (e.g. cautious gait, frontal or subcortical dysequilibrium)
* Mid-level (cerebellar ataxic, Parkinsonian, hemiplegic gait)
* Low-level (arthritic or antalgic gait)

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18
Q

sensory disorders (sensory ataxia, vestibular ataxia, visual ataxia) - what are their gait characteristics?

A

SA- steppage gait

VA- weaving from side to side, may fall to one side

Visual A- tentative, cautious

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19
Q

peripheral motor disorders (arthritic, myopathic/neurpathic) - what are their gait characteristics

A

A- shortened stance phase on affected side, trendelenburg sign

M- exagerated lumbar lordosis, trendelenburg sign, foot slapping, foot drop, steppage gait

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20
Q

neuromotor disorders (hemiplegia/paresis, paraplegia, parkinsonism, cerebellar ataxia)

A

H- leg circumduction, loss of arm swing, foot dragging

P- bilateral leg circumduction, scissor gait

Park- small shuffling, absent arm swing, freezing

C- wide base of gait, increased trunk sway, staggering

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21
Q

high level/ cognitive (cautious, frontal related gait disorders) - what characteristics

A

CG- wide base of gait, shortened stride, decreased velocity

FRGD- same as above + freezing and difficulty initiating gait

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22
Q

upper motor neurone lesions are what

A

due to damage occurirng anywhere between the cortex and L1 in the spinal cord

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23
Q

what are typical features of UMNL

A

gait:
circumduction,
foot plantar flexed and inverted,
knee and hip fail to flex,
scissor gait if paraplegia

increased reflexes, muscle tone, muscle spasticity

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24
Q

what is Lower Motor Neurone Lesion

A

damage of LMN axon (nerve cell bodies within the central horn of spinal cord- they innervate peripheral musculature), L2 and lower is LMN only.

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25
Q

damage to what areas can be UMN or LMN

A

C1- L1

26
Q

cerebral palsy what is it

A

Singe or multiple lesions to the motor centres of the cerebellum before, during or shortly after birth

Brain damage is non-progressive, but clinical
manifestations develop and change as the child grows

Similar patterns seen in other UMN disorders
(stroke, traumatic brain injury, etc)

27
Q

hemiplegia means what

A

one side of body is affected, upper and lower limb

28
Q

diaplegia

A

both legs affected

29
Q

monoplegia

A

one limb affected

30
Q

how is cerebral palsy classified ?

A

according to site
quadriplegia
diplegia
hemiplegia

31
Q

problems with cerebral palsy include

A

-motor control
-balance
-muscle spasm - overactivity of the stretch reflex is normally inhibited by Upper motor neurones. partial reduction in inhibition leads to exaggerated reflexes. major reduction in UMN inihibition leads to muscle spasm

32
Q

gait abnormalities in cerebral palsy

A

-Increased hip adduction and knee flexion secondary to spasticity
or contracture
– Knee: jump gait, crouch gait, stiff knee gait, recurvatum knee
– Foot and ankle: equinus, calcaneus, varus (common with spastic
hemiplegia), valgus (more common in diplegia)

33
Q

what is the most common neurological deficit and leading cause of gait impairment?

A

stroke

34
Q

what is the major effect of having a stroke?

A

hemiparesis- weakness on one side of the body (lower/upper limb and face)

it occurs contralateral to the side of the stroke lesion and is sometimes accompanied by
1. unilateral sensory loss
2. loss of vision

35
Q

Spina Bifida what is it?

A
  • Caused by incomplete closure of the neural arches
    of the spinal cord
    *Motor and sensory deficits, varying in severity with
    different forms
    *Depends on level of spinal cord affected
  • need to know dermatomal and myotomal anatomy!
  • e.g. low lumbar (L4 and L5) and sacral (S1) level
  • Gait deviations will be consistent with patterns ofmuscle weakness
36
Q

friedriech’s ataxia

A

Recessive genetic disorder, usually presents between 5-15 years of age
* Degenerative disease which effects Cerebullum and spine
* Causes unco-ordinated movements of trunk, arms, legs
* First symptom is usually gait disturbances

37
Q

what gait abnormailities occur with friedriech’s ataxia

A
  • Wide base of support
  • Poor control of limbs in open chain movements
  • Scissoring gait
  • Athetoid Movements – slow writhing involuntarty movments
  • Poor trunk stability
38
Q

parkinsonian gait is what ?

A

Degenerative disease of the dopamine-
producing cells of the basal ganglia
* May be idiopathic or drug-induced
* Strength is relatively preserved
* Rigidity, bradykinesia (slow movement) and
tremor

39
Q

parkinsonian gait - gait abnormalities

A

-Postural instability
* Short steps of rapid cadence
* Difficulty with gait initiation (freezing

40
Q

multiple sclerosis what is it?

A

Autoimmune attack on oligodendrocytes in
the CNS causing progressive demyelination
and repair
* Over time causes scars or plaques on
nerves
* Commonly affects the cerebellum causing
ataxia, and spinal cord causing spastic
paralysis

41
Q

duschenne muscular dystrophy, what is it

A

Only affects boys
* Dx between ages of 1-5 yrs
* By age 12 usually progressed to wheelchair
* Death usually early adulthood due
pulmonary and cardiac complications

42
Q

duschenne muscular dystrophy - gait characteristics

A
  • Trendelenburg
  • Toe walking
  • Lumbar lordosis
  • Knee instability and recurvatum
  • Balance problems
43
Q

drop foot - what is it

A

Inability to dorsiflex foot during swing phase
of gait
* Can be caused by:
- Nerve injury (Spinal nerve root or Peroneal
nerve)
- Muscle or nerve disorders (MS, polio, CMT)
- Brain or spinal cord disorders
- Muscle weakness

44
Q

drop foot gait abnormalities

A

high steppage gait with foot slap

45
Q

poliomyelitis what is it?

A

Virus attacks and destroys anterior
horn cells of the spinal cord, causing
paralysis, flaccidity and atrophy

46
Q

polio abnormal gait characteristics

A

-Genu recurvatum
* Foot drop
* Contractures due to imbalance between
agonist/antagonist muscle groups
* Fatigue
* Orthoses and walking aids are often required

47
Q

Charcot Marie-Tooth (CMT) what is it

A

-genetic disorder - hereditary
-onset is delayed until second/third decade of life
-distal weakness (stork leg) appearance caused by muscle atrophy
-often pes cavus deformity with clawing of the toes

48
Q

CMT - abnormal gait characteristics

A
  • increased peak pressures under lateral/mid foot and forefoot
    -increased pressure time integrals under the lateral heel and lateral forefoot.
49
Q

ataxic means what

A

signs: staggering, unsteady, wide based
cause: cerebellar lesion/ proprioceptive deficit

50
Q

abductory twist means what

A

signs: forefoot abduction and heel adduction following heel lift
cause: compensation for prolonged pronation/ hallux limitus

51
Q

antalgic means what

A

signs: shortened stance phase, unequal arm swing + other pain avoiding compensations
causes: pain avoidance during weight bearing

52
Q

anteversion means what

A

signs: excessive medial rotation of the femoral neck (normal is 20 degrees)
cause: in toeing often compensated by ipsilateral internal pelvic rotation and external hip rotation

53
Q

apropulsive means what

A

signs: ineffective leverage during push off
cause: inadequate supination, hallus limitus, elderly

54
Q

equinus means what

A

signs: plantarflexed foot, causing tip toe gait with forefoot contact rather than a heel strike
cause: plantarflexor spasticity with or without tendoachillies contracture, congential talipes equinovarus (clubfoot)

55
Q

drop foot means what

A

signs: plantarflexion of foot during swing with reduced clearance

cause: dorsiflexor weakness due to peroneal neuropathy, plantarflexor spasisicty or stroke

56
Q

delayed heel rise means what

A

signs: delay in transferring weight to forefoot, normal heel rise occurs around 44% of gait cycle

cause: plantar flexor weakness

57
Q

circumduction means what

A

signs; trunk and pelvic rotation

cause: compensation for restricted hip/knee flexion

58
Q

foot slap means what

A

signs: sudden plantarflexion of foot during loading response

cause: weak dorsiflexors

59
Q

forefoot abduction means what

A

signs; forefoot deviation laterally

cause: may compensation for in toeing cause by femoral anteversion

60
Q

genu recurvatum

A

signs: knee hyperextension during stance

cause: weak quads, plantarflexion contracture

61
Q

genu valgum

A

signs: abduction defomrity of the knee

cause: arthristis, hereditary

62
Q

genu varum

A

adduction deformity of the knee (bow legged)

cause: arthritis, hereditary

CSB523- Gait (12 decks)

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