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CSB523- Gait > wk 8 - pathological gait > Flashcards

wk 8 - pathological gait Flashcards

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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
damage to what areas can be UMN or LMN
C1- L1
26
cerebral palsy what is it
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
hemiplegia means what
one side of body is affected, upper and lower limb
28
diaplegia
both legs affected
29
monoplegia
one limb affected
30
how is cerebral palsy classified ?
according to site quadriplegia diplegia hemiplegia
31
problems with cerebral palsy include
-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
gait abnormalities in cerebral palsy
-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
what is the most common neurological deficit and leading cause of gait impairment?
stroke
34
what is the major effect of having a stroke?
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
Spina Bifida what is it?
* 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
friedriech's ataxia
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
what gait abnormailities occur with friedriech's ataxia
* Wide base of support * Poor control of limbs in open chain movements * Scissoring gait * Athetoid Movements – slow writhing involuntarty movments * Poor trunk stability
38
parkinsonian gait is what ?
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
parkinsonian gait - gait abnormalities
-Postural instability * Short steps of rapid cadence * Difficulty with gait initiation (freezing
40
multiple sclerosis what is it?
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
duschenne muscular dystrophy, what is it
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
duschenne muscular dystrophy - gait characteristics
- Trendelenburg - Toe walking - Lumbar lordosis - Knee instability and recurvatum - Balance problems
43
drop foot - what is it
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
drop foot gait abnormalities
high steppage gait with foot slap
45
poliomyelitis what is it?
Virus attacks and destroys anterior horn cells of the spinal cord, causing paralysis, flaccidity and atrophy
46
polio abnormal gait characteristics
-Genu recurvatum * Foot drop * Contractures due to imbalance between agonist/antagonist muscle groups * Fatigue * Orthoses and walking aids are often required
47
Charcot Marie-Tooth (CMT) what is it
-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
CMT - abnormal gait characteristics
- increased peak pressures under lateral/mid foot and forefoot -increased pressure time integrals under the lateral heel and lateral forefoot.
49
ataxic means what
signs: staggering, unsteady, wide based cause: cerebellar lesion/ proprioceptive deficit
50
abductory twist means what
signs: forefoot abduction and heel adduction following heel lift cause: compensation for prolonged pronation/ hallux limitus
51
antalgic means what
signs: shortened stance phase, unequal arm swing + other pain avoiding compensations causes: pain avoidance during weight bearing
52
anteversion means what
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
apropulsive means what
signs: ineffective leverage during push off cause: inadequate supination, hallus limitus, elderly
54
equinus means what
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
drop foot means what
signs: plantarflexion of foot during swing with reduced clearance cause: dorsiflexor weakness due to peroneal neuropathy, plantarflexor spasisicty or stroke
56
delayed heel rise means what
signs: delay in transferring weight to forefoot, normal heel rise occurs around 44% of gait cycle cause: plantar flexor weakness
57
circumduction means what
signs; trunk and pelvic rotation cause: compensation for restricted hip/knee flexion
58
foot slap means what
signs: sudden plantarflexion of foot during loading response cause: weak dorsiflexors
59
forefoot abduction means what
signs; forefoot deviation laterally cause: may compensation for in toeing cause by femoral anteversion
60
genu recurvatum
signs: knee hyperextension during stance cause: weak quads, plantarflexion contracture
61
genu valgum
signs: abduction defomrity of the knee cause: arthristis, hereditary
62
genu varum
adduction deformity of the knee (bow legged) cause: arthritis, hereditary

CSB523- Gait (12 decks)

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