Gait Assessment + Intervention in Neurological Disorders

what are 6 TEMPORAL DESCRIPTORS of GAIT

1. stance time (60% gait cycle)

2. single support time (time on one leg)

3. double support time (time on both legs)

4. swing time (40% gait cycle)

5. cadence (steps/min)

6. speed (m/s)

what PERCENTAGE of the gait cycle is the foot in the STANCE PHASE

60%

what PERCENTAGE of the gait cycle is the foot in the SWING PHASE

40%

what does SINGLE SUPPORT TIME refer to

time on one leg

what does DOUBLE SUPPORT TIME refer to

time on both legs

what is the CADENCE for MEN + WOMEN

Men: 110 steps/min

Women: 116 steps/min

regarding the GAIT CYCLE, what is the SPEED for MEN

1.37 m/s

regarding the GAIT CYCLE, what is the SPEED for WOMEN

1.24 m/s

what are 5 SPATIAL DESCRIPTIONS of GAIT

1. stride length

2. step length

3. width of BOS

4. angle of toe out

5. endurance

what is STRIDE LENGTH

distance covered from initial contact of one foot to the initial contact by the same foot

- initial contact to initial contact of one leg

what is the STRIDE LENGTH for MEN + WOMEN

Men: 4.8 ft

Women: 4.2 ft

what is STEP LENGTH

distance between heel strike of one foot + heel strike of the other foot

- initial contact of one leg to initial contact of other leg

what is the STEP LENGTH for MEN + WOMEN

Men: 2.4 ft

Women: 2.1 ft

regarding SPATIAL DESCRIPTORS of GAIT, what is the NORMAL WIDTH of BOS

2-4 inches

regarding SPATIAL DESCRIPTORS of GAIT, what is the NORMAL ANGLE of TOE OUT

7 degrees

what are 3 ESSENTIAL REQUIREMENTS of GAIT

1. upright postural control

2. progression

3. adaptation

what are 4 CHARACTERISTICS of what PROGRESSION should look like with GAIT

1. rhythmic

2. reciprocal

3. smooth

4. maintaining momentum

what are 3 CONTROL MECHANISMS of GAIT

1. pattern generators

2. descending influences

3. sensory feedback

what 2 STRUCTURES are classified as PATTERN GENERATORS for GAIT

1. brainstem

2. spinal cord

what 4 STRUCTURES are classified as DESCENDING INFLUENCES for GAIT

1. cerebrum

2. basal ganglia

3. cerebellum

4. brainstem

what are 4 COMPONENTS classified as SENSORY FEEDBACK for GAIT

1. somatosensation

2. proprioception

3. vision

4. vestibular

what is the RESULT if any of the CONTROL MECHANISMS of GAIT are DAMAGED

degradation of gait

what does COGNITIVE DEMANDS of GAIT + POSTURE increase with

increasing complexity of:

- environment

- speed of movement

- difficulty of task

what causes COGNITIVE DEMANDS of GAIT + POSTURE to increase

dual-task conditions/training

what are 3 MAJOR TASKS ASSOCIATED with GAIT CYCLE

1. weight acceptance

2. single limb support

3. swing limb advancement

weight acceptance

2 Phases Involved:

1. initial contact

2. loading response

What Occurs:

1. shock absorbed

2. momentum preserved

3. foot flat position achieved

Peak Demand On: quads, glutes + anterior tibialis

what 2 PHASES of the GAIT CYCLE make up WEIGHT ACCEPTANCE

1. initial contact (heel strike)

2. loading response (foot flat)

what does INITIAL CONTACT (heel strike) refer to

moment when heel contacts/strikes the ground

what does LOADING RESPONSE (foot flat) refer to

entire foot contacts the ground

what occurs during the LOADING RESPONSE (4)

1. knee flexes to accept weight

2. anterior tibialis eccentrically lowers foot as it contacts the ground; prevents foot drop/slap

3. glutes maximums helps stabilize hip + control forward motion

4. quads eccentrically contract to help control knee flexion

what is ABSORBED during WEIGHT ACCEPTANCE of the gait cycle

shock absorbed

what is PRESERVED during WEIGHT ACCEPTANCE of the gait cycle

momentum preserved

what is ACHIEVED during WEIGHT ACCEPTANCE of the gait cycle

foot flat position

what is there PEAK DEMAND ON during WEIGHT ACCEPTANCE (initial contact + loading response) of the gait cycle (3)

1. quads

2. glutes

3. anterior tibialis

single limb support

2 Phases Involved:

1. mid stance (early + late)

2. terminal stance

Controlled: tibial advancement

Peak Demand On:

1. hip abductors (early/late mid stance)

2. gastrocnemius (terminal stance)

what 2 PHASES of the GAIT CYCLE make up SINGLE LIMB SUPPORT

1. mid stance (early + late)

2. terminal stance

what does MID-STANCE refer to

entire body progresses directly over the stance limb (single stable limb)

what occurs during MID-STANCE (4)

1. in early mid-stance: opposite knee bends + crosses stance leg

2. in late mid-stance: tibia moves forward

3. gluteus medius turns on when on single stable limb

4. gastroc working eccentrically

what does TERMINAL STANCE refer to

heel of stance limb rises off the ground + heel of other foot makes contact with the ground

is there UNCONTROLLED/CONTROLLED TIBIAL ADVANCEMENT during single limb support

controlled tibial advancement

regarding SINGLE LIMB SUPPORT, what is there PEAK DEMAND ON during EARLY/LATE MID-STANCE

hip abductors

regarding SINGLE LIMB SUPPORT, what is there PEAK DEMAND ON during TERMINAL STANCE

gastrocnemius

swing limb advancement

Phase Involved: initial swing

What Occurs:

1. rapid hip/knee flexion

2. toe clearance

Peak Demand Of: hip flexors

what PHASE of the GAIT CYCLE make up SWING LIMB ADVANCEMENT

initial swing

what PHASE is the INITIAL SWING PHASE classified under

swing phase

what does INITIAL SWING refer to

leg is lifted off the ground + moves forward

- hip + knee flexing

- ankle dorsiflexing to clear foot

what occurs during SWING LIMB ADVANCEMENT (2)

1. rapid hip/knee flexion

2. toe clearance

what is there PEAK DEMAND OF during SWING LIMB ADVANCEMENT (initial swing) of the gait cycle

hip flexors

what are 7 GAIT TEST + MEASURES

1. gait speed

2. 2/6/12 MWT

3. TUG (Timed Up + Go)

4. gait portion of Tinetti

5. dynamic gait index

6. functional ambulation category (FAC)

7. step/stride length test (w/ dry erase marker)

what are 4 GUIDELINES for GAIT SPEED

1. 15-30ft (5-10 meter) walkway

2. allow several feet/meters for acceleration/deceleration

3. one practice trial + two timed trials

4. test self-selected pace + fastest pace

what are 2 GUIDELINES for the 2/6/12 MWT

1. measure distance covered

2. measure HR + BP before + after test

what is a 0 on the FUNCTIONAL AMBULATION CATEGORY (FAC) classified as

nonfunctional (unable)

what does NON-FUNCTIONAL (UNABLE) indicate on the FAC

person can't walk/require help of 2 or more people

what is a 1 on the FUNCTIONAL AMBULATION CATEGORY (FAC) classified as

dependent, level 2

what does DEPENDENT, LEVEL 2 indicate on the FAC

person requires firm, continuous support from 1 person to help with carrying weight + balance

what is a 2 on the FUNCTIONAL AMBULATION CATEGORY (FAC) classified as

dependent, level 1

what does DEPENDENT, LEVEL 1 indicate on the FAC

person needs continuous/intermittent support from 1 person to help with balance or coordination

what is the DICHOTOMY for SCORES 0-2 on the FAC

physical dependent gait

what is a 3 on the FUNCTIONAL AMBULATION CATEGORY (FAC) classified as

dependent on supervision

what does DEPENDENT on SUPERVISION indicate on the FAC

person requires verbal supervision/stand-by help from 1 person without physical contact

what is a 4 on the FUNCTIONAL AMBULATION CATEGORY (FAC) classified as

independent on level ground

what does INDEPENDENT on LEVEL GROUND indicate on the FAC

person can walk independently on level ground but requires help on stairs, slopes or uneven surfaces

what is a 5 on the FUNCTIONAL AMBULATION CATEGORY (FAC) classified as

independent

what does INDEPENDENT indicate on the FAC

person can walk independently anywhere

what is the DICHOTOMY for SCORES 3-5 on the FAC

physical independent gait

what are 3 NEUROLOGICAL GAIT PROBLEMS that occurs during WEIGHT ACCEPTANCE

1. excessive knee flexion/buckling

2. excessive knee extension

3. forefoot contact/foot slap

what are 5 CAUSES of EXCESSIVE KNEE FLEXION/BUCKLING during weight acceptance

1. quad weakness

2. glute weakness

3. knee flexion contracture

4. hamstring spasticity

5. flexion syngery

what are 2 INTERVENTIONS for treating EXCESSIVE KNEE FLEXION/BUCKLING

1. quad + glute strength emphasize eccentric loading

2. knee stretching

what TYPE of LOADING should be emphasized for QUAD + GLUTE STRENGTH when treating EXCESSIVE KNEE FLEXION/BUCKLING

eccentric loading

what are 3 CAUSES of EXCESSIVE KNEE EXTENSION during weight acceptance

1. severe quad weakness

2. extension synergy

3. plantarflexor spasticity/contracture

what are 3 INTERVENTIONS for treating EXCESSIVE KNEE EXTENSION

1. quad + glute strengthening, emphasize eccentric loading

2. ankle ROM

3. bracing

what are 3 CAUSES of FOREFOOT CONTACT/FOOT SLAP during weight acceptance

1. plantar flexor contracture

2. dorsiflexor weakness

3. spasticity

what are 4 INTERVENTIONS for treating FOREFOOT CONTACT/FOOT SLAP

1. ankle ROM

2. dorsiflexor strengthening

3. bracing

4. functional e-stim

what are 4 NEUROLOGICAL GAIT PROBLEMS that occurs during SINGLE LIMB SUPPORT

1. excessive knee flexion

2. excessive knee extension

3. trendelenburg sign

4. poor terminal stance/trailing limb position

what are 3 CAUSES of EXCESSIVE KNEE FLEXION during single limb support

1. knee flexion contracture

2. flexion synergy

3. poor knee control

what are 3 INTERVENTIONS for treating EXCESSIVE KNEE FLEXION that occurs during single limb support

1. quad strength

2. knee ROM

3. inner knee control work

what are 2 CAUSES of EXCESSIVE KNEE EXTENSION during single limb support

1. quad weakness

2. plantar flexor contracture/spasticity

what are 3 INTERVENTIONS for treating EXCESSIVE KNEE EXTENSION that occurs during single limb support

1. quad strength

2. ankle ROM

3. bracing

what are 2 CAUSES of the TRENDELENBURG SIGN during single limb support

1. weak hip abductors

or

2. weak hip extensors

what are 2 MAJOR CHARACTERISTICS of the TRENDELENBURG SIGN

1. contralateral hip drop

2. hip moves backwards

what are 2 INTERVENTIONS for treating TRENDELENBURG SIGN

1. dynamic hip strengthening

2. BWS (body weight support)

what are 3 CAUSES for POOR TERMINAL STANCE/TRAILING LIMB POSITION during single limb support

1. weak, spastic + contracted plantar flexors

2. hip flexor contracture

3. poor gait speed

what is POOR TERMINAL STANCE described as

heel pulled off the ground too early

what are 3 INTERVENTIONS for treating POOR TERMINAL STANCE/TRAILING LIMB POSITION

1. plantar flexor strengthening

2. hip ROM

3. increase gait speed

what are 2 NEUROLOGICAL GAIT PROBLEMS that occurs during SWING LIMB ADVANCEMENT

1. poor hip/knee flexion, circumduction

2. poor toe clearance/toe drag

what are 4 CAUSES of POOR HIP/KNEE FLEXION + CIRCUMDUCTION during swing limb advancement

1. hip/knee flexor weakness

2. extension synergy

3. failure to achieve trailing limb posture

4. slow gait speed

what are 2 MAJOR CHARACTERISTICS of CIRCUMDUCTION

1. lateral trunk lean

2. hip hike

what are 3 INTERVENTIONS for treating POOR HIP/KNEE FEXION + CIRCUMDUCTION

1. hip/knee flexor strengthening

2. manual assistance

3. increase gait speed

what are 6 CAUSES for POOR TOE CLEARANCE/TOE DRAG during swing limb advancement

1. hip/knee flexor weakness

2. extension synergy

3. failure to achieve trailing limb posture

4. slow gait speed

5. dorsiflexor weakness

6. plantar flexor contracture/spasticity

what are 5 INTERVENTIONS for treating POOR TOE CLEARANCE/TOE DRAG

1. hip/knee flexor strengthening

2. manual assistance

3. increase gait speed

4. dorsiflexor strengthening

5. functional e-stim

what are 8 GENERAL GAIT PROBLEMS

1. decreased gait speed

2. poor trunk/postural control

3. decreased rhythmicity

4. decreased step/stride length

5. increased double support time

6. poor gait initiation + stopping

7. poor turning, object negotiation

8. difficulty with dual-task situations

what are 6 KEY POINTS for GAIT TRAINING

1. if want to get better at walking have to walk; specificity of training

2. work on speed (intervals)

3. use tools/devices (treadmill, BWS, knee/ankle braces) as needed to increase practice opportunities + intensity

4. use FES, auditory + manual cues as needed

5. work on walking in multiple directions

6. do obstacle courses + obstacles

what is PROPULSIVE/SENILE GAIT

a stooped, rigid posture with head + neck bent forward

what 2 CONDITIONS is PROPULSIVE/SENILE GAIT common with

1. Alzheimer's

2. senile dementia

what is PARKINSON'S GAIT

stopped, rigid posture with head + neck bent forward accompanied with less arm swing + more shuffling/festinating steps

what is PARKINSON'S GAIT common with

parkinson's disease + other disorders that affect basal ganglia

what is SCISSORS GAIT

legs flexed slightly at hips + knees, giving appearance of crouching with knees + thighs hitting/crossing in a scissors-like movement

what is SCISSORS GAIT common with

cerebral palsy

what is SCISSORS GAIT some times a component of

spastic gait

what is SPASTIC/HEMIPARETIC GAIT

a stiff (extension synergy), foot-dragging walk