Management of Abnormal Gait Patterns & Balance Deficits in Neurological Disorders

What is one of the early and most characteristic symptoms of neurologic disorders

What is critical to independence?

Gait and Balance Difficulty in Neurologic Disorders stats

How a pathology impacts gait depends on?

Impairments affect gait & balance - msk vs nm

MSK changes may occur due to neuro pathologies - like?

Soft-tissue contractures, decreased ROM, changes in alignment, weakness

MSK changes may occur due to neuro pathologies

• How does it affect movement? workload?

MSK changes may occur due to neuro pathologies

• creates what difficulties throughout the gait cycle?

How much DF needed for heel strike?

Common degrees of PF contracture?

Hip flexion contracture affects?

Knee flexion contracture affects?

PF weakness causes?

Quad weakness

• Causes difficulty…

Quad weakness

• compensations:

Quad weakness

• Compensation: hyperextending knee - results in?

Quad weakness

• Compensation: leaning forward (anterior trunk lean) - to control? results in?

Hip flexor weakness

• Need what grade MMT for normal gait?

• Primarily effects what phase?

Hip flexor weakness

• what might also be lost? resulting in? might see what as a result?

Hip flexor weakness

• Compensations

Hip extensor weakness

• Hip extension is critical for

Hip extensor weakness

• Weakness may cause? which threatens?

Hip extensor weakness

• Compensation?

  • this compensation requires?

Hip Abductor weakness

• Results in ___ gait: drop of pelvis on __ side during WB

• Compensates with __ weight shift: over which side? while leaning to which side?

  • moves GRF in same or opp direction?

• Also may affect?

Effects of Weakness/Paresis on Gait

What parts of the motor neurons are impacted?

Effects of Weakness/Paresis on Gait

Insufficient ___ recruitment of motor neurons in specific leg muscles during parts of gait

Effects of Weakness/Paresis on Gait

Non-neural changes in muscle fibers from?

Effects of Weakness/Paresis on Gait
Affects force to move body ___ and ___ of moving segments

Weakness/Paresis Affects Gait Speed

Loss of peak power at what muscles/joints can reduce joint speed?

What has the greatest impact on gait speed?

Also found in geriatric population w/ msk disuse atrophy of __ but no neuro pathology

Effect of Spasticity on Gait

Results in ____

Alters ____

Effect of Spasticity on Gait

Results in inappropriate activation of muscles at the point in the gait cycle when they are?

• eccentric or concentric?

Effect of Spasticity on Gait

Alters mechanical properties of muscles, producing what?

• Which negatively impacts?

Spasticity most commonly seen in which muscles?

PF Spasticity

• Common in which disorders?

PF Spasticity

• Triceps surae (TS) most __ active during __ phase

PF Spasticity

• Spasticity causes TS to fire too soon or too late? resulting in?

  • compensate with?

PF Spasticity

• Early TS shortening limits ___ needed for __

  • Results in increased workload on __ to __ during __ what phase?

  • May see?

PF spasticity occurs with Inversion & Eversion

• With post tib

  • excessive inversion or eversion?

  • Equionovarus or valgus foot?

  • Foot contacts occurs on medial or lateral aspect?

PF spasticity occurs with Inversion & Eversion

• With fibulares/peroneal muscles

  • excessive inversion or eversion?

  • Equionovarus or valgus foot?

  • Foot contacts occurs on medial or lateral aspect?

Spasticity in Quadriceps

• Results in __ during __

  • this is in response to ___ that normally occurs to ___

Spasticity in Quadriceps

• No impact on gait velocity but…

• long term spasticity results in?

Hamstring Spasticity

• Manifests as what gait pattern? seen in?

Hamstring Spasticity

• Affects what in terminal swing?

Hamstring Spasticity

• Excessive knee flexion persists throughout stance phase and increase work of __ to prevent __

• What else does it result in?

Adductor Spasticity

• Produces ___ during __ because femur is drawn __

Adductor Spasticity

• Results in what gait?

Adductor Spasticity

• Results in what during early stance phase?

Adductor Spasticity

• May impede?

Synergistic movement patters = loss of ____

Coordination Problems – Abnormal Synergies

Total flexion pattern during what phase?

or

Total extension pattern during what phase?

Coordination Problems – Abnormal Synergies

Total flexion or extension patterns

• most common after?

• Results in?

Coordination Problems – Abnormal Synergies

• Which synergy may cause inability to accept weight during loading response

Poor inter-segmental coordination

Dyssynergia

Coordination Problems – Coactivation of Agonists & Antagonists

Normal gait involves a high degree of __ muscle recruitment

Co-contraction - loss of selective recruitment of physiologically __ muscles

Common problem in?

Somatosensory deficits result in? due to loss of?

Visual deficits

• impact ___ control of equilibrium

• Results in ___ -> greater risk for ___ and difficulty with ___

Vestibular deficits

• Affects ___ or __ during gait

• Results in 3 things?

Perceptual deficits

• Body image/scheme disorders can result in?

Perceptual deficits

• Unilateral spatial neglect may cause?

Perceptual deficits

• Spatial neglect may prevent?

Balance Impairments in Neurologic Disorders

Cognitive Impairments Also Effect Gait & Balance

Pain often results in alteration in movement

• Gait velocity

• Shortened stance phase on which side?

• Stiff limb during?

• Reduction in?

Compensations for pain includes?

When do you document antalgic gait

Stair climbing

Climbing stairs requires generation of reciprocal motions at what joints?

Along with increased force production at what joints?

Stability demands are the greatest during?

Stair Climbing

Decreased concentric control affects ___

Decreased eccentric control affects ___

People with CNS pathology tend to?

Speed in order to cross street safely in normal time allotted by stop light?

Curbs are how tall?

Examination of gait should include

• Standard gait velocity?

• Energy efficiency =

  • slower means?

A slower walking speed means?

Functional Mobility Tests

Long term goals for gait should be writing in functional terms with cleared state levels of?

Short term goals can be written about?

Interventions for Balance and Gait Deficits

what intensities?

utilize what principles?
Emphasis on promoting?

Locomotor CPG

• For what pathologies?

• What type of approach?

• Includes what variables?

• Does it address impairments?
  Emphasizes?

Traditional Gait Training

• For?

• Focuses on?

Impairment Level

• May work to increase?

• Must have interventions aimed at?

Gait Training Strategies

• Aimed at impairment level

Postural Support and Stability

• Control of HAT segment- work on __ alignment

• Give manual cues at __ and __ - progress to verbal cuing

• Facilitate extension of trunk with?

• May try use of?

Extensor Support Moment

• Weakness of hip & knee extensors = difficulty with?

Extensor Support Moment

• Closed or open chain?

• May brace knee to facilitate WB, but lose?

• May try?

Foot Placement at Initial Contact

• May try?

• Need how much DF?

• Strengthen what muscle?

  • try?

• Use what cues?

Balance in Single and Double Limb Support

• Includes?

• What can be a great tool here?

Progression

• Energy generation from push off (__) and pull off (__)

  • Practice what?

• Advancement of swing limb:

• Faster gait =

Whole vs. Part Training

• What is best to achieve max function?

Harness Systems and Treadmills

What should be your first choice for gait training?