570: Exam 3: Gait Dysfunctions

Front 1

Normal gait is often sacrificed for _____ at the cost of ______

Back 1

ambulation at the cost of increase energy expenditure and abnormal stress applied to the body

Front 2

what are the 5 necessities for normal gait

Back 2

1) stability in stance
2) foot clearance in swing
3) pre positioning of foot for initial contact
4) step length
5) energy conservation

Front 3

what are the causes of gait dysfunction

Back 3

1) pain
2) CNS disorders
3) musculoskeletal system impairments

Front 4

Antalgic gait has what characteristics

Back 4

1) weight avoidance
2) step length: shorter B
3) stance time: shorter (affected side)
4) swing time: shorter (good side)
5) trunk lean either towards or away from painful side

Front 5

with antalgic gait the trunk would lean TOWARDS the painful side if _________ whereras it would lean AWAY from the painful side if

Back 5

leans towards painful side if pain due to compressive hip forces

leans away from painful side if pain not due to compressive hip forces

Front 6

what are the characteristics of CVA or CP gait patterns

Back 6

1) increased extensor tone
2) stiff legged
3) circumduction of hip
4) scissoring gait

Front 7

what would you notice in a patient who is circumducting their hip

Back 7

scuffing their feet along

Front 8

what causes the scissoring gait in a patient with a CVA or CP

Back 8

hyperactive hip adductors

Front 9

what are the characteristics of Parkinsons gait patterns

Back 9

Festinating (hurried small step gait pattern)

Front 10

what types of musculoskeletal impairments can affect gait

Back 10

- weakness
- lack of motion
- excessive motion
(often present with 1 degree and 2 degree impairments)

Front 11

What are the descriptors of abnormal gait

Back 11

1) gait speed
2) spatial parameters (stride length, which side gives the short step? step width, foot angle, etc.)
3) temporal parameters (cadence, step time)

Front 12

what are the two approaches to gait deviations

Back 12

1) specific gait deviation and determine the impairment
2) look at a specific impairment and establish the gait deviation it may produce

Front 13

gait deviations at the joint itself are caused by _____; deviations at other joints are caused by ______

Back 13

deviations at the joint itself are caused by the impairment; deviations at other joints are a compensation for the impairment

Front 14

Heel makes contact with the floor followed by rapid plantar flexion at the ankle

Deviation? Likely Impairment?

Back 14

Deviation: Foot Slap
Impairment: weak dorsiflexors (yet still strong enough to actively dorsiflex the ankle during swing)

Front 15

how would you confirm ankle dorsiflexion weakness in a patient with foot slap

Back 15

have patient attempt to walk on heels or with manual muscle testing

Front 16

why would the patient be able to DF during swing, yet be too weak to be able to do it at heel strike

Back 16

high torque demands at heel strinke cause a very high GRF causing significant extension PF torque--- more force eccentrically needed to DF

Front 17

No heel strike, the entire plantar aspect of the foot makes contact with the ground

Deviation? Likely Impairment?

Back 17

Deviation: Foot flat at initial contact
Likely Impairment: weak DF (lack of DF)

Front 18

what other issues would you notice with a patient presenting with foot flat

Back 18

- possibly difficulty clearing toes during swing (if extreme lack of DF)
- limited DF in stance (weak)
- shorter step length to bring foot to the floor

Front 19

Contact with the ground is made with the forefoot

Deviation? Impairment?

Back 19

Deviation: Plantar Flexed Foot at Initial Contact (mobile ankle)

Impairment: severe weakness of Dorsiflexors

Front 20

what other issues would you notice with a paitent presenting with Plantar flexed foot at initial contact

Back 20

- difficulty clearing toes during swing
- shorter step length
- normal dorsiflexion during stance (the ROM is there, but the strength is not)

Front 21

what is an example of an injury that could cause plantar flexed foot at initial contact (mobile ankle)

Back 21

peroneal nerve injury

Front 22

Patient has difficulty clearing toes during swing + shorter step length how would you differentiate ROM or weakness problem with DF

Back 22

Normal DF during stance= weakness = plantar flexed foot at initial contact (mobile ankle)

Limited DF during stance= ROM problem = Foot Flat at Initial contact

Front 23

Contact with the ground is made with the forefoot, but the ankle does not DF the heel does not come into contact with the ground during stance

Deviation? Likely impairment?

Back 23

Deviation: Plantar flexed foot at initial contact (fixed ankle)

Likely Impairment: fixed plantar flexed position of the ankle

Front 24

what are the consequences of a plantar flexed foot (fixed ankle) at initial contact on the hip and knee

Back 24

"crouched gait" causes hip and knee flexion

Front 25

what happens to step length in a plantar flexed foot (fixed ankle) at initial contact and why

Back 25

reduced step length because leg cant react with calcaneus and needs to place the foot close to the CoM to keep it in front of the CoR of the knee

Front 26

Contact with the ground is made with the forefoot, the ankle does not DF, but the heel is brought to the floor during stance with a backward displacement of the tibia during loading response

Deviation? Likely impairment?

Back 26

Deviation: Plantar flexed foot at initial contact (fixed ankle) II

Likely Impairment: Fixed PF position of the ankles

Front 27

what deviation would cause excessive hyperextension at the knee

Back 27

plnatar flexed foot (fixed ankle) at initial contact II (especially as stance phase takes place).... causes stretching out of post. capsule

Front 28

what are the consequences of the plantar flexed foot (fixed ankle) at initial contact II on the trunk

Back 28

the tibia can't move forward so the trunk leans forward to move the CoM over the foot in mid and terminal stance

Front 29

The heel comes off the ground early (before the tibia is vertical)

Deviation? Impairment?

Back 29

Deviation: Early heel rise at midstance

Impairment: lack of ankle DF

Front 30

what are some of the consequences of early heel rise at midstance

Back 30

- knee hyperextension is possible
- shorter step length becasue there is excessive vertical CoM displacement (instead of forward)

Front 31

what's a method of treatment for a person with early heel rise at midstance

Back 31

fil the patient and let them watch themselves on video

Front 32

the heel does not come off the ground before the toes so the entire foot is "picked up" at once

Deviation? Impairment?

Back 32

Deviation: Absence of heel rise in terminal stance

Impairment: weakness of PF (the tibia continues to translate forward without the PFs activating)

Front 33

what are the other consequences/deviations that can be noticed in absence of heel rise in terminal stance

Back 33

- excessive knee flexion in mid and terminal stance due to uncontrolled and excessive forward tibial displacement

- absence of push off and shorter step (CL leg)

Front 34

why would you have a shorter step on the CL leg with an absecne of heel rise in terminal stance

Back 34

becasue you don't have the plantar flexion "PUSH"

Front 35

Absence of ankle dorsiflexion during swing

Deviation? Impairment?

Back 35

Deviation: foot drop during swing

Impairment: weakness of DF (or lack of DF ROM)

Front 36

what are the secondary deviations caused by absence of ankle dorsiflexion during swing

Back 36

need to artificially "shorten" the swing leg for toe clearance by...
1) hip hiking
2) hip circumduction
3) excessive knee and hip flexion
4) lengthen other leg (vaulting)

Front 37

what does a vaulting gait look like

Back 37

go up on the toe to lengthen that leg

Front 38

what does a steppage gait look like

Back 38

increased hip and knee flexion to shorten that limb

Front 39

how do you differentiate vaulting from an early heel rise

Back 39

ankle will have normal DF and MMT with vaulting gait

Front 40

Excessive ankle plantar flexion during midstance

Deviation? Impairment?

Back 40

Deviation: Vaulting at midstance (compensation)

Impairment: none at the ankle used to elevate the body and facilitate toe clearance during swing of CL toe

Front 41

Vaulting at midstance is a compensation for ______ due to ___, ____, or _____

Back 41

compensation for CL "long" leg due to:
1) leg length difference
2) lack of DF
3) lack of knee flexion or of hip flexion during swing

Front 42

Excessive External rotation of the foot

Deviation? Impairment?

Back 42

Deviation: Toeing out during stance

Impairment: Tight hip ER or Hip retroversion

Front 43

how would you determine that out toeing during stance was a compensation for hip retroversion

Back 43

the hip would go into ER in order to work in its neutral most congruent position so we would measure hip rotation for evidence of hip retroversion

Front 44

Clown foot is which deviation

Back 44

out-toeing during stance

Front 45

pigeon toe is which deviation

Back 45

in-toeing during stance

Front 46

Excessive IR of the foot/LE

Deviation? Impairment?

Back 46

Deviation: in-toeing during stance

Impairment: thight hip IR's/adductors, excessive anteversion

Front 47

how would you clinically measure for hip anteversion

Back 47

measure hip rotation for excessive IR and limited ER

Front 48

what are the "compensations" at the ankle

Back 48

1) vaulting at mid stance
2) out-toeing during stance
3) in toeing during stance

Front 49

Rapid extension of the knee after heel contact

Deviation? Impairment?

Back 49

Deviation: Knee Extensor Thrust at Initial Contact

Impairment: spasticity of knee extensors

Front 50

what happens to the trunk every time the knee hyperextends in knee extensor thrust at initial contact

Back 50

trunk flaps forward

Front 51

what is the consequence of complete knee extension at heel contact (as with knee extensor thrust at initial contact)

Back 51

moves the line of gravity anterior to the knee and further promoted hyperextension

Front 52

Knee remains extended after initial contact

Deviation? Impairment?

Back 52

Deviation: lack of knee flexion during loading phase

Impairment: weak quads, knee pain

Front 53

why would someone with knee pain present with "lack of knee flexion during loading phase"

Back 53

to eliminate the compressive forces associated with strong muscular action

Front 54

what happens to the rest of the body with a lack of knee flexion during the loading phase

Back 54

anterior trunk lean moves the line of gravity of the trunk in front of the knee (along with GRF) --> knee extension

Front 55

Someone with lack of knee flexion during the loading phase is likely to land with _____ and have a _____ step length

Back 55

likely to land with foot flat position and have a shorter step length

Front 56

Knee goes into hyperextension during stance

Deviation? Impairment?

Back 56

Deviation: genu Recurvatum during stance

Impairment: weak quads

Front 57

what is the difference between hyperextension during stance and extensor thrust/lack of knee flexion during loading response

Back 57

the posterior structures are overstretched and the knee goes into hyperextension

Front 58

rapid varus deviation of teh knee in stance

Deviation? Impairment?

Back 58

Deviation: varust thrust during stance

Impairment: weak quads and poor dynamic stabilization of femur

Front 59

why is the knee pushed into the varus position during varus thrust during stance

Back 59

posterolateral structures are stretched causing the normal line of gravity of CoM to be medial to the knee