S3 - Clinical Practice 2 > Week 10- Gait Deviations > Flashcards

Week 10- Gait Deviations Flashcards

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1
Q

What are the parts of stance phase?

A
  • IC
  • LR
  • MSt
  • TSt
  • PSw
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2
Q

What are the parts of swing phase?

A
  • ISw
  • MSw
  • TSw
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3
Q

Progression of gait over the supporting foot requires __ rockers. What are they?

A

3

  • First Rocker (Heel)-Motion of the foot from a DF to PF position during LR to achieve foot flat.
  • Second Rocker (Ankle)-Closed chain advancement of the tibia into a DF position over a fixed foot during MSt.
  • Third Rocker (Forefoot)-Begins when COP is over the mets and heel lift occurs in TSt/PSw.
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4
Q

First Rocker is motion of the foot from a ___ to ___ position during ____ to achieve ________.

A
  • DF to PF
  • LR
  • foot flat
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5
Q

Second Rocker is the closed chain advancement of the tibia into ____ position over a fixed foot during _____.

A
  • DF

- MSt

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6
Q

Third Rocket begins when ____ is over the mets and heel lift occurs in ___/___.

A
  • COP

- TSt/PSw

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7
Q

Stance Phase: IC

  • The instant the foot hits the ground.
  • Critical event = ___________
  • Opposite limb = ____/_____
A
  • heel first contact

- TSt/PSw

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8
Q 
Stance Phase: IC
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 20° flexion
-Major muscles = extensors
Knee
-Position = 0-5° flexion
-Major muscles = quadriceps
Ankle
-Position = 0°
-Major muscles = pretibials
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9
Q

Stance Phase: LR

  • Shock is absorbed as forward momentum is preserved. Foot flat position is achieved.
  • Critical events = __________
  • Opposite limb = ______
A
  • hip stability, controlled knee flexion, ankle PF

- PSw

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10
Q 
Stance Phase: LR
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 20° flexion
-Major muscles = extensors, abductors
Knee
-Position = 15° flexion
-Major muscles = quadriceps
Ankle
-Position = 5° PF
-Major muscles = pretibials
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11
Q

Stance Phase: MSt

  • The body progresses over the foot in a controlled manner. First instance of single limb support.
  • Critical events = __________
  • Opposite limb = ______
A
  • controlled tibial advancement

- ISw/MSw

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12
Q 
Stance Phase: MSt
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 0° 
-Major muscles = abductors
Knee
-Position = 5° flexion
-Major muscles = quadriceps ->quiet
Ankle
-Position = 5° DF
-Major muscles = gastroc/soleus
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13
Q

Stance Phase: TSt

  • Progression over the stance limb continues past the forefoot. Body is ahead of stance limb.
  • Critical events = __________
  • Opposite limb = ______
A
  • controlled ankle DF with heel rise

- TSw

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14
Q 
Stance Phase: TSt
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 20° extension
-Major muscles = none
Knee
-Position = 5° flexion
-Major muscles = none
Ankle
-Position = 10° DF
-Major muscles = gastroc/soleus
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15
Q

Stance Phase: PSw

  • Rapid unloading of the limb with weight transfer to opposite limb, starting the second period of double limb support.
  • Critical events = __________
  • Opposite limb = ______
A
  • passive knee flexion to 40°, ankle PF, 60° MTP ext

- IC/LR

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16
Q 
Stance Phase: PSw
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 10° extension
-Major muscles = adductors
Knee
-Position = 40° flexion
-Major muscles = none
Ankle
-Position = 15° PF
-Major muscles = none -> tib ant
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17
Q

Swing Phase: ISw

  • The thigh begins to advance as the foot leaves.
  • Critical events = __________
  • Opposite limb = ______
A
  • hip flexion, knee flexion

- LR/MSt

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18
Q 
Swing Phase: ISw
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 15° flexion
-Major muscles = flexors
Knee
-Position = 60° flexion
-Major muscles = flexors
Ankle
-Position = 5° PF
-Major muscles = pretibials
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19
Q

Swing Phase: MSw

  • The thigh begins to advance as the foot leaves.
  • Critical events = __________
  • Opposite limb = ______
A
  • continued hip flexion, foot clearance

- MSt

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20
Q 
Swing Phase: MSw
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 25° flexion
-Major muscles = flexors
Knee
-Position = 25° flexion
-Major muscles = flexors
Ankle
-Position = 0° DF
-Major muscles = pretibials
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21
Q

Swing Phase: TSw

  • The leg reaches out to achieve step length.
  • Critical events = __________
  • Opposite limb = ______
A
  • knee extension

- TSt

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22
Q 
Swing Phase: TSw
Hip
-Position?
-Major muscles?
Knee
-Position?
-Major muscles?
Ankle
-Position?
-Major muscles?
A 
Hip
-Position = 20° flexion
-Major muscles = extensors
Knee
-Position = 5° flexion
-Major muscles = quadriceps
Ankle
-Position = 0° DF
-Major muscles = pretibials
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23
Q

Why do we analyze gait?

A
  • Identify deviations in gait in order to address with intervention.
  • Determine functional ambulation capability across variety of environments.
  • Assess balance, safety, endurance, energy expenditure as it relates to walking.
  • Determine need for assistive devices/orthotics.
  • Evaluate the effectiveness of your interventions; describe how your interventions impacted gait.
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24
Q

The goal of analyzing gait is to identify _________ and design appropriate __________ to treat impairments (function/participation limitations.

A
  • deviations

- interventions

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25
What are some abnormalities that can cause gait deviations?
- Pain - Joint and/or muscle ROM limitation - Muscular weakness/paralysis - Impaired motor control - Neurological involvement (UMN or LMN) - Impaired balance - Leg length discrepancy
26
- A single impairment may result in a number of ___________. - A single deviation may be caused by multiple __________. - Deviations are often ____________ to make gait more effecient.
- deviations - impairments - compensations
27
Ways to make analyzing gait easier?
- Analyze from bottom-up/top-down - Work in segments - Identify reference limb - Select a plane to start in (look at all) - Work in phases
28
Can deviations in one joint be due to impairments/deviations in other joints above/below it?
Yes | -not just weak tib anterior could cause toe drag
29
What is an Antalgic Gait?
Compensatory gait adopted to remove or decrease the discomfort caused by pain in the lower leg, pelvis, lumbar spine.
30
What are the characteristic features of an Antalgic Gait?
- Decreased stance phase duration on affected limb. - Lack of weight shift laterally over stance limb to keep weight off the involved limb. - Decrease in stance phase in affected side will result in decrease in swing phase of uninvolved limb and thus shortened step length on uninvolved side.
31
What are some hip deviations we can see with gait?
- Forward Trunk Lean - Decreased Hip Extension - Gluteus Maximus Gait/ backward trunk lean - Hip Drop
32
With gait deviations, what 3 things do you ask yourself?
- What could be tight? - What could be weak? - What could be hypomobile joint wise?
33
What are some causes of Forward Trunk Lean?
- Result of weak quadriceps (decreases flexor movement of knee) - Tight hip flexors - Weak lumbar/hip extensors - Hypomobile joint capsule
34
What are some causes of Decreased Hip Extension?
- Tight hip flexors - Decreased joint mobility - Weak glutes
35
Gluteus Maximus Gait: - What is glute max role during IC of gait? - If glute max is weak, how will my body compensate?
- Contracts at initial contact, slowing forward motion of trunk by resisting flexion of the hip and initiating extension. - Trunk will quickly shift posteriorly during initial contact to try and offset forward momentum, this requires less muscle strength to maintain the hip in extension during stance phase.
36
Hip Drop (Trendelenberg Gait): - What might you see with weak gluteus medius? - How would we compensate?
- Hip drop on contralateral side | - Trunk lean, hip hike
37
What are some hip deviations we can see with gait?
- Knee Hyperextension (genu recurvatum) - Decreased Knee Extension - Excessive Genu Valgum (knock knee) - Excessive Genu Varum (bow leg)
38
What are some causes of Knee Hyperextension?
- Quadriceps weakness (thrust to create bony lock) - Hamstring weakness - Increased tone of quadriceps - Compensation for plantarflexion contracture or spasticity
39
What are some causes of Decreased Knee Extension?
- Quadriceps weakness (unable to straighten knee) - Knee joint hypomobility - Hamstring contracture or stiffness - Strategy to avoid heel rocker
40
Patients with Decreased Knee Extension will see difficulty with what?
Going down stairs because we need to straighten knee to reach for the next step.
41
What are some causes of Excessive Genu Valgum?
- Bony deformity (arthritis) - Pain - Excessive foot pronation - Glute med weakness - Excessive femoral adduction - Ipsilateral trunk lean
42
Does Excessive Genu Valgum result in increasing or decreasing BOS?
Increasing
43
What are some causes of Excessive Genu Varum?
- Degenerative changes - Pain - Bony deformity
44
Does Excessive Genu Varum result in increasing or decreasing BOS?
Decreasing
45
What are some foot/ankle deviations we can see with gait?
- Excessive PF (equinus gait) - Increased DF (calcaneal gait) - Equinovarus gait (club foot) - Foot Drop (foot slap) - Foot Flat - Excessive Supination - Excessive Pronation - Inadequate Push-off
46
What are some causes of Excessive PF?
- Tib ant weakness - Plantarflexion contracture - Hypomobility of talocrural joint - Compensation for short leg/short stride length - Painful heel/avoiding heel rocker
47
With Excessive PF gait, what point of the body will land at IC?
toes
48
What might Excessive PF gait make difficult?
Walk/run without tripping
49
What are some causes of Increased DF?
- Contracture tib anterior - Weakness gastroc - Hypomobility talocrural joint
50
What deviations would we expect with someone with Increased DF?
Walking on heel (heel walking)
51
Equinovarus Gait (club foot) presents as ankle _________ and subtalar __________.
- PF | - inversion
52
How will patients with Equinovarus Gait (club foot) be walking?
On outside of the foot
53
What are some causes of Foot Drop?
-DF weakness caused by paralysis of common peroneal nerve
54
What will a Foot Drop Gait look like?
foot slaps ground due to weakness
55
What muscles would you MMT with Foot Drop?
Tib ant
56
What muscles do you worry about becoming too tight with Foot Drop?
PF
57
How might someone compensate for Foot Drop Gait?
- Steppage gait - Circumduction - Vaulting
58
What are some causes of Foot Flat Gait?
- Weak dorsiflexor - Limited ROM - Hypomobility - Normal immature gait pattern (neonatal)
59
What are some causes of Excessive Supination?
- Hypomobility of subtalar and/or midtarsal joints - Spastic invertors or intrinsic foot muscles - Weak evertors - Genu varum
60
What part of the foot will someone with Excessive Supination likely land on?
Excessive lateral contact of foot during stance with varus position of foot.
61
What are some causes of Excessive Pronation?
- Foot intrinsic muscle weakness - Posterior tibialis weakness - Hip abductor weakness - Hypomobility of subtalar and/or midtarsal joints
62
What part of the foot will someone with Excessive Pronation likely land on?
Excessive medial contact of foot during stance with valgus positon of foot.
63
What are some causes of Inadequate Push-off?
- Result of weak plantar flexors - Tight/spastic dorsiflexors - Hypomobile talocrural joint - Pain in forefoot
64
What are some pelvis deviations we can see with gait?
- Excessive Anterior Pelvic Tilt | - Excessive Posterior Pelvic Tilt
65
What are some causes of Excessive Anterior Pelvic Tilt?
- Weak hip extensors - Hip flexion contracture - Abdominal muscle weakness - Limited hip extension ROM
66
What is a normal Anterior Pelvic Tilt?
10-30°
67
Excessive Anterior Pelvic Tilt can lead to lumbar ________ and ____ back pain.
- lordosis | - low
68
What are some causes of Excessive Posterior Pelvic Tilt?
- Most commonly caused by tight hamstrings - Hip flexor weakness (post tilt acts as substitution) - Low back pain - Limited lumbar extension ROM
69
What are the 2 types of Leg Length Discrepancies?
Anatomical LLD -Legs are ACTUALLY different lengths as confirmed with x ray or tape measure. Functional LLD -Functional LLD means on x-ray the leg lengths are equal, but for some reason they appear longer. Could be due to tightness, weakness, compensation, etc.
70
What are some compensations for LLD?
- Circumduction - Hip Hiking - Steppage Gait - Vaulting
71
What are some other abnormal gaits we can see?
- Trunk Lean (waddling gait) - Abnormal BOS - Hemiplegic Gait - Sensory Ataxic Gait - Festinating Gait
72
What are some causes of Trunk Lean (waddling gait)?
- Tight IT band - Contralateral hip abductor weakness - Limited hip or knee flexion- leans to contralateral side to compensate to clear foot - Commonly seen with pain in hip related to arthritis
73
Clinical Correlations of a Widened BOS: - Results in more _________ movements of the trunk (= less efficient gait) - May indicate ____________ or fear of falling - Observed with decreased ____________, cerebellar ataxia, etc.
- lateral - imbalance - proprioception
74
How does Hemiplegic Gait present?
-Hip into extension, adduction, and medial rotation -Knee in extension -Ankle in drop foot with plantar flexion and inversion, present during both stance and swing phases -Spastic muscles won’t allow hip and knee to flex to clear the floor -Patient often performs circumduction -Usually with no reciprocal arm swing -Step length tends to be lengthened on involved side and shortened on uninvolved side
75
- Sensory Ataxic Gait is often seen in individuals with _______ disorders. - It is defined as presence of abnormal and ___________ movements.
- cerebellar | - uncoordinated
76
What is Festinating Gait most often seen in?
Parkinson's Disease, but can be seen in other basal ganglia diseases.
77
Festinating Gait: - Because of rigidity all the joints will want to flex ________ - Displaces COG ________ - In order to keep the COG within the BOS, patient will _______ their steps - In an attempt to avoid losing their balance due to their anterior COG they walk ______ as if chasing the COG
- forward - anteriorly - shuffle - faster
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