Gait and locomotion applications

- how far

- how much assistance

- use of assistive device

- document general pattern of walking including secondary gait adaptations

- document deviations related to joint/segment or movement deviations in relationship to gait cycle divisions

what should be included in the documentation of ambulation and gait

- stance

- swing

what are the 2 periods of the gait cycle

- initial contact

- loading response

- mid stance

- terminal stance

- pre swing

- initial swing

- mid swing

- terminal swing

what are the phases of the gait cycle

- weight acceptance

- single limb support

- swing limb advancement

what are the different tasks that occur during the gait cycle

- initial contact

- loading response

- mid stance

- terminal stance

- pre swing

the stance period of the gait cycle is comprised of what 5 phases of the gait cycle

- initial swing

- mid swing

- terminal swing

the stance swing of the gait cycle is comprised of what 3 phases of the gait cycle

- initial contact

- loading response

what 2 phases of the gait cycle involve the task of weight acceptance

- mid stance

- terminal stance

what 2 phases of the gait cycle involve the task of single limb support

- pre swing

- initial swing

- mid swing

- terminal swing

what 4 phases of the gait cycle involve the task of swing limb advancement

initial contact

loading response

weight acceptance occurs during ______ and _______ of gait

mid stance

terminal stance

single limb support occurs during ______ and ______ of gait

cause the gait deviation directly

What are primary impairments of gait abnormalities?

the result of a primary impairment, and now affect gait indirectly

what are secondary impairments of gait abnormalities?

compensations

- may be the result of another impairment

- your body will try and solve the movement problem on its own

gait compensations

Changes to the movement patterns itself to accomplish the task which can lead to additional impairments

- weakens

- spasticity

what are the 2 categories of neurologic causes of gait dysfunction

patients to reach a 4/5 on MMT for safe ambulation

how strong should someone be to safely engage in ambulation and gait training

spasticity

________ can affect gait because an inappropriate reflex activity may occur during the gait cycle as a muscle is lengthened….which alters the mechanical properties of a muscle…..which increases muscle stiffness and may limit motion/compensate for weakness

weight bearing

impact loads

compressive forces

Effects of pain on gait

- reduces _______ on the painful limb

- avoids ______

- reduces joint excursions

- decreases joint ________ by minimizing muscle activity that crosses the joint

proprioception

eyes

Effects of somatosensory impairments on gait

- decreased ______

- use of _____ for compensation

- joint motion may be excessive or decreased

walking

step

assistive device

Effects of cardiovascular impairments on gait

- decreased _____ velocity

- decreased ____ length

- decreased cadence

- decreased joint excursion

- lean on ____ for breathing support

blind

velocity; step length

flat foot

outward

Effects of visual impairments on gait

- ____ gait

- decreased ____ and ______

- ______ shuffling pattern

- feet swing _____

- wide BOS

balance

velocity

double

Effects of vestibular impairments on gait

- _____ deficits

- decreased ______

- increased _____ support time

spatial

avoidance; falls

Effects of cognitive impairments on gait

- _____ neglect

- dementia

- obstacle _____ and ____

painful

step length

velocity

push off

Antalgic Gait

- decreased stance on _____ side

- decreased opposite ________

- decreased _____

- decreased joint motion

- reduced ______

contralateral

weaker

Trendelenburg gait

- excessive downward drop of the ______ pelvis during stance

- may compensate by leaning towards the ____ side to change the COM

step length

flexion

arm swing

Ataxic gait

- wide BOS

- inconsistent _______

- increased hip _____ and ground clearance

- decreased ______

Inconsistency

what is the primary characteristic to classifying ataxic gait

shuffling

arm swing

trunk rotation

stopping

Parkinsonian gait

- small ____ steps

- slow velocity

- decreased _______

- decreased or no ______

- freezing

- festinating gait (trouble _____)

problems with starting and stopping gait - often a result of poor lateral weight shifting

what is freezing seen in parkinsonian gait

trouble stopping

what is festinating seen in parkinsonian gait

stooped

step over

Apraxic gait

- shuffling steps

- ____ posture

- halting steps

- inability to ______ objects

- WIDE BOS

Magnetic gait (feet are glued to the floor)

what is another name for Apraxic gait and why

flexion

clearing

rectus femoris

Stiff knee gait

- knee _____ is decreased throughout swing

- may lead to problems with _____ the limb

- may be due to excessive _______ activity

flexion; ABD; forward

foot clearance

hip flexors

Circumduction during gait

- hip _____ with _____ and _____ rotation of the pelvis

- assists with foot _____ during swing

- Can be seen in patients with weak ______

ipsilateral

Hip hiking during gait

- elevation of the ______ pelvis during swing

- assists with foot clearance during swing

plantarflex; uninvolved

foot clearance

heal off

Vaulting during gait

- ______ the foot during mid stance on the ______ limb

- assists with ______ during swing

- Early _______ during mid stance phase when we wouldn't expect it to help with foot clearance

adduction

adductors

flexors

Hip scissoring during gait

- excessive _____ during swing

- may be due to spasticity of the hip _____

- may be a compensation for weak hip ______

COM; loading response

extensors

assistive device

Hip forward lean during gait

- brings ___ anterior to the knee joint during ____ of gait

- locks the knee if there is weakness of the knee ______

- may be caused by an _________

COM

extension

glut max

extensor

Hip backward lean during gait

- bring ___ behind the hip joint during loading response

- locks the hip into _____

- ______ lurch

- compensation for hip ____ weakness

flexion

lock out

quad; eccentric

plantar flexors

Knee buckling during gait

- during stance knee _____ is uncontrolled, and knee will collapse

- knee wobbles between flexion and extension

- To compensate, people tend to ______ their knees

- Due to ____ weakness, unable to provide _____ control

- Due weak ______ in mid stance it controls during stance

hyperextension

extensor

locking

Genu recurvatum during gait

- knee _____ during stance

- extensor thrust

- usually due to _____ weakness

- can lead to joint instability over time

- Can be caused by chronic _____ the knees out

plantarflexed

dorsiflexors

Foot drop during gait

- ankle remains ______ during swing

- may drag the toes

- Weak ______/ no control of them

- Results in steppage gate as compensation

plantarflexion; initial contact

dorsiflexors

Foot slap during gait

- rapid _______ after _____ of gait

- due to weak _______

plantarflexion

bilateral

Toe walking

- _______ occurs throughout stance

- term usually only for people with _____ involvement

- may result in/caused by plantarflexor contractures

dual task

the ability to divide attention between two or more tasks is an important aspect of locomotion during many activities of daily living

Attention

- ability to sustain focus on something without being distracted

- types: selective, sustained, divided and alternating

learning dependent attention

attention necessary for a task varies with how well learned it is

task dependent attention

- mobility tasks (especially those involving object manipulation) require more attention than stability tasks

- attention required varies with the predictability of the task circumstances

performance

Gait and Attention

- when the sum of attention required for multiple tasks is more than the available resources for that type of task, _______ on one or all of the tasks will suffer.

- this mismatch may occur because of high attention demands of the task, or because of a decrease in available attention resources

- cognitive immaturity

- gait is not as well learned so more attention is needed

what are 2 factors that may reduce available attention in childhood

sensory

plasticity

Factors that may reduce available attention with advancing age

- decreasing accuracy of _____ feedback; therefore more attention needed for an accurate perception

- changes in _____ and loss of neural function

- TBI/CVA/Concussion

- Parkinson's disease

- Alzheimer's disease

- Dementia

what are factors that may reduce available attention due to pathological changes

key points of dual tasking

- attention is finite at some level

- when attention demands of two tasks that exceed the resources, performance of one or both tasks may suffer

- dual tasking can help us learn about how the brain prioritizes and categorizes tasks

- dual tasking is a crucial skill for ADLs

- reaction time

- discrimination or decision making

- mental tracking or memory tasks

- verbal fluency/speech

what are commonly utilized cognitive dual tasks in PT

- shifting visual focus between tasks in different locations

- tracking an object with visual flow in periphery

- adaptation of freshly updated somatosensory information

what are commonly utilized motor dual tasks in PT