Pathological Gait AOM 2 BA

What does a crouch gait look like? Who is this common in?

- Hip flexed and IR - knee flexion - valgus knees

How might a hip flexion contracture or spasticity affect a persons gait? What phases would be affected most?

- Person would be unable to achieve neutral or extended hip - this would limit propulsion and step length Phases - Midstance and terminal stance

What does an equinus gait look like?

- hips IR - knees extended - feet pointing in

What kinematic variables are primarily affected if someone has a festinating gait?

- short step length - short stride length - faster cadence - lower velocity

Describe a vaulting gait.

A gait technique used to assist in toe clearance. Commonly seen in people who have very limited knee flexion, people with different lengths of legs, and new amputees.

What muscle group is likely tight in a scissoring gait?

Adductors

What pathological gait is commonly caused by pain?

Antalgic gait

What type of pathological gait is characterized as being very irregular placement of their limbs and they might look like they are "drunk" walking?

Ataxic

You are reviewing a patients evaluation that you are going to be working with tomorrow. The patient suffered from a cerebral stroke and you noticed that the PT doing the evaluation noted that some of their coordination tests were not normal. What type of gait pattern might you suspect when working with this patient?

Ataxic

Differentiate between a compensated vs non-compensated trendelenberg.

Compensated - person leans to side of weakness to shift LOG. Non-compensated - persons contralateral hip/pelvis drops due to weakness

What gait patterns are very common in patients who has cerebral palsy?

Crouch gait and equinus gait

What muscle group is weak if a person displays a foot drop/slap?

Dorsiflexors (do not have the eccentric contraction needed in order to control the PF during the IC/LS phase of gait)

T/F: Crouched gait is always bilateral.

False. A crouch gait can be uniliateral

You are observing a persons gait in public. The are taking very short and quick steps however they suddenly stop once they reach a point where they are about to go into the grass from the sidewalk they are on. What type of gait do you suspect?

Festinating

What pathological gait is characterized by someone having poor timing and initiation of their walking?

Festinating gait

What pathological gait is known to make their IC with the forefoot?

Foot drop/slap

What two pathological gaits are most associated with someone having weak dorsiflexors?

Foot drop/slap and steppage gait

While observing someones gait you notice the they constantly snap their knee into extension when they are in their midstance phase of the gait. What pathological gait is this?

Genu recurvarum

You are working at an outpatient clinic and are going to get your new eval from the waiting room. As they are walking back to the table you observe that as they walk it almost looks like they thrust their trunk back in order to continue in their progression. What gait is this?

Gluteus maximus lurch

What muscle is usually weak if someone has a trendelenberg gait?

Gluteus medius (weak eccentrically)

What phases of gait would be affected if someone had a PF contracture/spasticity?

IC/LR - might contact ground with forefoot/ will eliminate heel rocker/ may lead to knee hyperextension Midstance - loss of ankle rocker/premature heel off Terminal stance - step length shortened/ inappropriate forefoot rocker Mid-swing - toes may drag (may compensate with a hip hike/steppage gait/circumduction/vaultng/lateral lean)

What phases of gait would be most affected if someone were to have a knee flexion contracture?

Initial contact/Loading response/ midstance / terminal swing

If someones average gait velocity is 0.82 mph what would they be considered?

Limited community ambulator (think that they can walk into the store but will have to hop on a scooter to go through store)

What has been shown to help someone who has a festinating gait?

Music - helps give them a rhythm

You are about to perform and evaluation and as you observe your new patients gait you notice that they go into genu recurvatum frequently. To help get to the bottom of why they are presenting this way you perform some basic MMT. You find that their hamstring strength is a 3-/5 and that their quad strength is a 4+/5. Are they doing the genu recurvatum purposefully?

No. Weak hamstrings suggest that they are unable to control/prevent knee extension so they snap back into genu recurvatum. If someone has weak quads they will often put themselves into genu recurvatum purposefully so they do not have to rely on their weak quads to maintain the slight knee flexion during stance phases.

What is normal gait velocity and what is the minimum velocity that is acceptable for someone to be a community ambulator?

Normal - 3 mph Minimum - 48 m/min (1.78 mph)

What population is it common to see a festinating gait pattern?

People with parkinsons (advanced)

What muscle is being excessively used if someone is hip hiking?

Quadratus lumborum

If someone has a hip flexion contracture or spasticity what other muscle group must be strong? Why?

Quads Hip flexion will also cause flexion at the knees. Since the contracture will promote knee flexion then the SHM will not be as effective. This means the quads will have to prevent the flexion moment at the knees at all times meaning they must be very strong.

If someone has a positive R trendelenberg what is the problem?

Right gluteus medius is weak

You are working at an inpatient hospital with a patient who has recently suffered an incomplete spinal cord injury. They have been making great progress in walking but still have quite a ways to go. Once you get them up you notice they are able to walk but they always seem to cross their feet across their body when taking steps. What type of gait are they presenting with?

Scissoring

If someone has spastic adductors what type of gait might you suspect?

Scissoring gait

What pathological gait is characterized by an increase in knee or hip flexion to help clear to foot/ankle?

Steppage gait

What pathological gait might you suspect if the patient has a plantar flexion contracture?

Steppage gait

What happens to swing time and stance time if someone has an antalgic gait?

Swing time increases Stance time decrease (want to spend less time on the painful leg)

What leg is the issue for someone who is compensating via circumduction on the left leg?

The left leg is having trouble clearing the ground during the swing phase. So the person must circumduct in order to clear it. *video shows both a circumduction and a hip hike

If someone is vaulting on their right leg which leg is the problem on?

The left leg. The right leg must vault in order to clear the deficit of the left leg (commonly a knee flexion problem)

If someone has very limited knee flexion and is having trouble clearing their foot due to this. What are some types of gait they may refer to in order to compensate?

Vaulting, circumduction, and hip hiking

Differentiate between voluntary and involuntary genu recuratum.

Voluntary - people consciously snap their knees back into full extension because they know their quads will not be able to support them if left flexed at all. (put knees in SHM so quads do not need to work) Involuntary - knee snaps back due to hamstring and gastroc weakness... the hamstring cannot eccentrically control knee extension so the knees snap into full extension