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79 Cards in this Set

  • Front
  • Back
3 functional tasks of gait
- weight acceptance
- single limb support
- swing limb advancement
Define forefoot contact
initial contact with the ground made by the forefoot
Define foot-flat contact
initial contact with the ground made by entire foot
Define foot slap
uncontrolled plantar flexion at the ankle after heel contact
Define abnormal heel off
heel not in contact with the ground dring LR or midstance
Define drag
contact of the toes, forefood or heel with the ground during swing limb advancement
Define contralateral vaulting
rising on the forefoot of the opposite stance limb during limb advacement of the reference leg
List the 10 major things to look for at the ankle/foot for pathological gait
- forefood contact
- foot-flat contact
- foot slap
- excess plantar flexion
- excess dorsiflexion
- excess inversion/eversion
- heel off
- No heel off
- drage
- contralateral vaulting
Define no heel off
absence of heel rise during terminal stance or preswing
List the 3 major things to look for at the toes for pathological gait
- toes up
- inadequate extension
- clawed/hammered
List the 7 major things to look for at the knee for pathological gait
- limited flexion
- excess flexion
- wobbles
- hyperextends
- extension thrust
- varus/valgus
- excess contralteral flexion
List the 7 major things to look for at the hip for pathological gait
- limited flexion
- internal rotation
- inadequate extension
- external rotation
- past retract
- adduction
- abduction
List the 9 major things to look for at the pelvis for pathological gait
- hikes
- posterior tilt
- anterior tilt
- lacks forward rotation
- lacks backward rotation
- excess forward rotation
- excess backward rotation
- ipsilateral drop
- contralateral drop
List the 4 major things to look for at the trunk for pathological gait
- backward lean
- forward lean
- lateral lean
- rotates back/forward
4 most likely causes of forefoot or foot-flat contact in gait
- excess knee flexion in terminal swing
- compensate for weak quads
- excess plantar flexion in terminal swing
- heel pain
Significance (3) of forefoot or foot-flat contact
- poor position for heel rocker
- decreases forward momentum of tibia
- decreases shock absorption by limiting knee flexion (forefoot)
Cause of foot slap
weak pre-tibials
Significance (2) of foot slap
- decreases forward momentum of the tibia
- decrease shock absorption by limiting knee flexion
Cause of excess plantar flexion in weight acceptance
- plantar flexion contracture
4 most likely causes of excess plantar flexion in single limb support
- plantar flexor hypertonicity
- weak quads
- impaired proprioception
- ankle pain
4 most likely causes of excess plantar flexion in swing limb advancement
- weak pretibials
- plantar flexion contracture
- plantar felxor hypertonicity
- Lack of selective dorsiflexion control in terminal swing
Significance of excess plantar flexion in weight acceptance
- poor position of heel rocker
- decreases shock absoprtion by limiting knee flexion
Significance of excess plantar flexion in single limb support
- decreases forward progress of the tibia over the ankle
Significance of excess plantar flexion in swing limb advancement
- interferes with foot clearance
- interefere with foot position for initial contact
Most likely cause of excess dorsiflexion in weight acceptance
- excess hip or kneee flexion
Significance of excess dorsiflexion in weight acceptance
- increases demand on hip and knee extensors
- decreases limb stability
4 most likely causes of excess dorsflexion in single limb support
- weak calf
- excess hip and knee flexion
- to lower opposite limb for contact
- excess midfoot dorsiflexion secondary to limited ankle mobility
Significance of excess dorsiflexion in single limb support
- increases the demand on the hip and knee extensors
- intereferes with heel rise and decreases step length of the opposite limb
Stage in gait cycle when dorsiflexion weakness most evident
Loading response (see foot slap)
General problems seen with dorsiflexor weakness
- strike with flat foot
- problems clearing toe
- steppage gait or circumduction
Stage in gait cycle when plantarflexion weakness most evident
Terminal stance
General problems seen with plantarflexion weakness
- lack heel rise
- shortened step on contralateral side (loss of toes rocker)
- may be unstable if unable to slow down shank
Stage in gait cycle when quads weakness most evident
- loading response (knee collapses)
General problems seen with quads weakness
- collapse during loading response
- keep knee in extension to compensate
- shorten steps
- strike with metatarsal heads
Hip abductor weakness gives you
- loss of control af ADDuction
- increased pelvic drop contralaterally
- lean over affected side because ground reaction force is medial to the hip
Stage in gait cycle when hip extensor weakness most evident
loading response
General problems seen with hip extensor weakness
- extend knee to compensate
- shorter step
- keep trunk back to keep ground reaction force behind hip (results in pelvic rotation)
Stage in gait cycle when hip flexion contracture most evident
terminal stance
General problems seen with hip flexion contracture
- contralateral shortened step
- excess knee flexion
- increased lumbar loridosis
Stage in gait cycle when knee flexion contracture most evident
throughout stance
General problems seen with knee flexion contracture
- often no changes seen but increased quad demand
- shorter step
- possible toe strike
Stage in gait cycle when ankle plantarflexion contracture most evident
- mid and terminal stance
General problems seen with ankle plantarflexion contracture
- bounce/heel up during mid and terminal stance
- early heel rise
- externally rotated, so just roll over inside of foot
- increased force to the medial longitudinal arch
Classic features of antalgic gait from knee pain
- contralateral short step to unload ASAP
- step away from the pain
- classic limp
Classic features of antalgic gait from arch pain
- walk on outside of foot
- sometimes toe-in
Prevalance of gait disorders by age in 3 key older groups
- 65-74: 15%
- 75-84: 30%
- 85+: 50%
3 essential requirements of locomotion
- progression
- adaptation
- postural control
2 most general elements of postural control
- stability
- orientation
List 4 general systems we look for regarding impairments for gait
- musculoskeletal
- neuromuscularr
- sensory
- cognitive
Describe reactive stability in gait when trip early in swing
- flex swimg limb to clear obstace
- extend stance limb to extend stance
Describe reactive stability in gait when trip late in swing phase
- extend swing limb to lower leg
- flex opposite leg to clear anticipated obstacle
Describe the role of visual sampling as age increases
Become more dependent on visual sampling
Normal pattern of turning during gait
- proceed from head, trunk, pelvis, feet
- turn in 1-2 steps regardless of distance
Major way of increasing stability during turning in gait
Increasing number of steps
General features of initiation of gait
- move COP back and toward swing leg
- then COP towards stance leg
- then COP moves forward to start step
Functional distance to be a physiologic walker
< 50 feet
Functional distance to do in-house only ambulation
75 feet
Functional distance to be a walker around larger home
50 meters
Functional distance to for full community ambulation
250-300 meters
Speed required for physiologic walking
6 meters per min
Speed of in house ambulators
14-16 meters/min
Speed of in and around home ambulators
24-35 meters/min
Speed of community ambulators
48+ meters/min
Speed of normal communityr amublation
80 meters/min
Typical speed of hemiplegic gait
30 meters/min
Typical speed of Parkinsonian gait
34 meters/min
minimum requirements to safely cross the street
Must walk 30-80 meters/min for 10-25 meters
From the view of peripheral input, the stance to swing transition in gait is triggered by
- hip extension
- unloading of ankle plantarflexors
Function of mesencephalic locomotor region
- gait initiation and speed of locomotion
- (vetriculspinal tract)
Function of pontine locomotor region
- postural tone
Functionof subthalamic locomotor region
- obstacle avoidance
Role of cerebellum in gait (general)
- coordinates movement
- onling error correction
- motor learning and adaptation
Role of basal ganglia in giat
- likely involved in posture through projections to brainstem
- context specific selection of muscle activity
Compare O2 costs for paraplegia ambulation vs. WC use
- KAFO swing gait: 0.64
- WC: 0.16 (and over twice as fast)
3 general elements in the framework for studying pathological gait
- impairment framework
- diagnostic framework
- combination
2 (very general) causes of gait abnormality
- pathology
- compensatory strategies
3 common neuromusculal impairment groups that influence gait
- tone
- coordination
- recuitment
3 common strategies for clearing the leg
- hip hike
- circumduction
- lateral lean
Control of posture and giat is most affected with to the
vermis of the cerebellum