Gait Exam 3

Common gait deviations for transfemoral and transtibial amputees

Asymmetric gait pattern and slower walking

Post-stroke gait is characterized by what?

Asymmetric step lengths, slow walking speed, hip hiking, and increased hip circumduction

Stages of PD

1 - unilateral involvement only 1.5 - unilateral and axial involvement 2 - bilatereal involvement without impaired balance 2.5 - mild bilateral disease with recovery on pull test 3 - mild to moderate bilateral dx, some postural instability; physically independent 4 - severe disability, still able to walk or stand unassisted 5 - wheelchair bound and bedridden unless aided

Risk of falls for those with arthritis increases ______ times of individuals without

2.5 times

Knee contact forces while walking

200-300% BW walking 400% BW stair climbing

Muscles crossing the joint pull the bones in the joint and generate force at _____ as much body weight through the joint

3-4x

What is the vGRF of running?

3-7 times body weight

Hip contact forces while walking

300-400% BW walking 350% BW descending stairs (with handrail)

Gait cycle for running

35% stance, 65% swing walking is 60% stance, 40% swing

Does the use of an AD predispose a fall?

A person with an AD is no more at risk -- the presence of ADs isn't causally related to falls, but the AD didn't reduce the risk of falls either

Which of the following gait modifications are common deviations by neurological and musculoskeletal populations? A. Decreased walking speed B. Increased swing time in swing C. Decreased knee extension moment D. Increased double float phase

A. Decreased walking speed

What is the motion of the ankle during running?

At IC, there is a rapid PF, follow by peak DF, and peak PF

Compared to walking, muscle activity of the lower extremity (i.e., hip, knee, ankle) while running can be described as: A. Similar pattern as walking proximally, but not distally, reflecting difference in joint action B. Same pattern as walking just larger amplitude to account for greater forces C. Different pattern from walking reflecting difference in joint action D. Similar pattern as walking distally, but not proximally, reflecting difference in joint action

A. Similar pattern as walking proximally, but not distally, reflecting difference in joint action

Functional leg length discrepancy while walking can lead to which of the following gait deviations? A. Steppage gait pattern B. Lateral trunk bending C. Anterior trunk bending at initial contact D. Increased lumbar lordosis

A. Steppage gait pattern

Which of the following is NOT true about use of assistive devices? A. They prevent individuals from falling B. They act to increase the BOS of the individual while locomoting C. They can increase the energetic cost of walking D. They can make performing a compensatory step more difficult

A. They prevent individuals from falling

PD and abnormal APA

APA = anticipatory postural adjustments APAs are affected by PD

When is the transition point from walking to running?

About 2 m/s, a little over 4 mph

Running kinetics: absorption, generation, absorption

Absorption - IC to stance phase reversal Generation - stance phase reversal to swing phase reversal Absorption - swing phase reversal to stance phase reversal

What tells us to switch from walking to running?

An energetic trigger -- a person switches from walking to running at the point where walking becomes more energy expensive than running

______ can reduce your ability to recover from postural disturbances

Assistive devices

An individual wants to begin running for health. They come to you for advice to help them initiate training in a smart, effective way. They describe their stretching regimen and show you their minimalist running shoes they just purchased. Based on the scientific evidence, what sound advice can you give them regarding initiating a training regimen? A. They are off to a great start. Stretching and shoes, along with slowly incrementing the distance they are training, will help get them into shape B. You advise that warming up is extremely important, but need not consist of stretching and that slowly incrementing distance run over a period of time is important to safely begin a running regimen C. You inspect their running shoes and their foot type and educate them on the strong link between foot type and running injuries D. They are off to a great start and further you let them know no pain, no gain, and that they cannot injure themselves if they warm up properly

B. You advise that warming up is extremely important, but need not consist of stretching and that slowly incrementing distance run over a period of time is important to safely begin a running regimen

An assistive device increases the ____

BOS

The edge of your COM is within your ____

BOS

When is peak hip flexion when running?

Before initial contact

Common neuromuscular gait patterns/deviations: diplegia

Both LE are affected and LE is impacted more than UE flexion at the hips and knees, ankles are extended and internally rotated, tight adductors that lead to adduction at the knees, swinging gait of both sides, UEs in mid guard or low guard position

What are the cardinal signs of Parkinson's

Bradykinesia, rigidity, tremor, postural instability

____ forces are generated when holding your cane anterior

Braking

OA: disease manifested primarily

By deterioration of the joint's articular cartilage, loss of joint space, sclerosis of subchondral bone, presence of osteophytes

An underlying cause of excess knee flexion in late stance phase is: A. Tibialis posterior spasticity B. Quadriceps spasticity C. Hamstrings spasticity D. B and C

C. Hamstrings spasticity

Use of assistive devices have been shown to decrease step width variability by patients with peripheral neuropathy. What is most likely the case reason for this? A. Increase stabilization from falls B. Decreased demand to generate lower limb force C. Increase proprioceptive input about the body's location D. Decreased body weight support demand

C. Increase proprioceptive input about the body's location

Which of the following deviations would you most expect to see with tightness or spasticity of the hip adductors? A. Decrease stride length B. Wide-based gait C. Scissoring gait D. Lateral trunk bend on stance side

C. Scissoring gait

In one study, ____ behavior by young adults was significantly altered by the presence of an assistive device

Compensatory step behavior

Reduction in the intensity of _____ activation may result in impaired motor unit recruitment PD

Corticospinal Parkinson's may limit the ability of the nervous system to recruit larger, high frequency motor units

Increased energetic cost of walking with prosthesis

Cost can be significantly higher depending on the design and type of prosthesis Bionic prosthesis -- less energetic cost than passive elastic, but more expensive than normal walking

Which of the following is NOT an implication for gait deviations by individuals with prosthetic limbs? A. Increased energetic cost of walking B. Decreased dynamic stability and falls C. Increased risk of developing OA in intact limb D. Symmetric presentation of the gait pattern

D. Symmetric presentation of the gait pattern

You are observing your patient walk. You observe that at mid-swing, her R hip is flexed at approximately 75%, knee is flexed approximately 60 degrees and the ankle is plantarflexed 20 degrees. At initial contact you note that contact is with the forefoot. Your hypothesis is: A. Contracture of the hip flexors B. Contracture of the ankle dorsiflexors C. Weakness of the hip extensors D. Weakness of the ankle dorsiflexors

D. Weakness of the ankle dorsiflexors

As you move from a rearfoot to a mid or forefoot strike patttern (during running), you see a ______ in the magnitude of the impact strike

Decrease

Age related changes: peak power

Decrease in peak power even in trained, aged individuals Everyone decreases with age

As PD progresses, you see ____ (increased/decreased) torque and activation of muscles

Decreased

Weakness can be driven by three different factors

Decreased control of motor neurons (post-stroke), inactivity (disuse myopathy), decreased ability to recruit motor neurons (seen commonly in PD)

Common gait deviations: transtibial amputation - knee hyperextension

Delayed heel lift at the end of stance delaying timing of swing causes: foot set too far forward on prosthesis in relation to socket, too much PF on the foot, heel cushion is too soft, keel lever is too long or too firm, laxity of the posterior capsule of the knee or hamstrings tendon

Walking vs. running: the ____ muscles show different patterns of activity

Distal muscles -- gastroc and TA

A/P GRF during a sprint

During a sprint your foot is coming down almost totally under you and there is no braking force, just propulsion

When is peak knee flexion? Running

During middle swing

Walking vs. running: gastroc

During running, the gastroc is on much earlier

Why do we switch from walking to running?

Energetics is one reason - it's more energy efficient to run at certain speeds than to walk

Common gait abnormalities: excessive hip rotation

External - retroversion of the neck of the femur or tight hip external rotators internal - anteversion or spasticity of hip adductors and/or hip internal rotators

As PD progresses, worsening balance and stability leads to increased ____ risk

Fall In older adults, reduced lower limb strength is an important risk factor for falls and may be used to identify falls in PD FOG, FAB, abnormal axial posture, poor coordinated stability, and reduced knee extension strength of the weaker side were independently associated with falls

T/F Stretching is a factor related to running injury

False

T/F Older adults do not respond favorably to resistance training

False -- even older adults can improve strength with some type of resistance training the gains in strength after a resistance training program require higher dose of weekly loading than young to maintain hypertrophy, yet strength gains can be preserved above that of untrained young

What causes variability of movement patterns post-stroke?

Location and severity of stroke

When comparing running and walking, what is different about initial contact?

Flexion at IC is greater during running by about 10 degrees

Which transfemoral prosthetic is the most stable?

Friction

Transfemoral prosthetic: swing control

Friction - cadence control is common purpose. Indicated for children and amputees with good muscle control. Not indicated for persons with weak hip flexors, poor balance, or change cadence often Hydraulic - smoother gait than constant friction. Extreme cold temperature may thicken fluid. May not reliably lock out during weight acceptance Pneumatic - lighter than hydraulic pistons, but creates a little bounce. Less sensitive to hydraulic controls Computerized - provides a more normal rate of terminal knee extension as walking speed is varied. 3-15% energy cost during walking

Transfemoral prosthetic: stance control

Friction - simplest design aligns vertical GRF anterior to prosthetic knee joint for stance stability. Can buckle when knee fails to fully extend, but this can be fixed with a locking mechanism Polycentric - use of 4 bar linkage system to reproduce instantaneous center of rotation, improved stability and appropriate for long and short residual limbs Hydraulic - unit relies on flow of liquid within a system of cylinders and pistons to control knee motion. May not reliably lock out during weight acceptance Computerized - knee angle sensor and force transducers within the prosthetic tibia collected to perform real-time adjustments to hydraulic knee unit

Comparing walking vs. running: anterior-posterior GRF

GRF for running had a similar shape as walking, but the magnitude of braking and propulsion are a lot higher Walking: 25% Running: 40%

What muscles are active during the first part of stance? Running

Hamstrings, hip extensors, rectus femoris, quadriceps, gastrocs, anterior tib

What compensation can a person with a prosthetic use to swing the leg opposite the stance leg?

Hip hiking -- helps increase foot clearance on prosthetic side to avoid tripping, can result in excessive circumduction

Diagnosis of hip OA

Hip pain, <115 degrees of hip flexion, <15 internal rotation atrophy, weakness of hip muscles, morning stiffness, crepitus, inflammation of soft tissue

Which transfemoral prosthetic provides the smoothest gait cycle

Hydraulic

Common neuromuscular gait patterns/deviations: Parkinson's

Hypokinetic gait posture is stooped and leaning forward difficulty initiating gait -- when starting they have small, shuffling steps, and tremor as gait progresses, pick up speed to a festinating gait turn with en bloc movements -- turn like a statue and then have difficulty initiating gait again

OA and prosthetics

Increased risk of developing OA in the intact limb -- higher incidence than the general population risk factor: increased loading of the intact limb as they increased speed -- more work is being done by the intact limb to propel them forward

Common gait deviations with prosthetics

Increasing loading on intact limb, increased motion of the trunk, increased step width, decreased knee flexion during stance

PD and fatigue

Individuals with low PD signs -- see an increase in fatigue High PD signs -- saw an increase in force, less fatigue, more fatigue resistant

What are possible causes for decreased stance on prosthetic?

Insufficient friction of prosthetic knee, hip flexion contracture, pain due to weight bearing on prosthetic side, poorly fitted socket

PD and HIIT study

Key findings: - muscle fiber hypertrophy along with increased mitochondrial activity -- increased strength and power, improved six-minute walk distance, decreased in fatigue severity scale - improved measures of balance -- single leg balance test - improved UPDRS motor section

What is the impact of imbalance of force generation (too much braking, not enough propulsion) in individuals post-stroke?

Limits walking speed, reduces efficiency, and may perdispose stroke survivors to secondary health conditions -- makes their walking gait pattern very expensive

What is theorize to be related to impaired muscle force generation and coordination of body movements in patients post-stroke?

Loss of monosynaptic neurons because of this loss, motor neurons will take a more diffuse path through the brain

What are the four functional tasks of gait?

Maintaining balance in SLS, generation of power to rediret COM, advancing the swing limb, support body weight without collapsing

Age related changes: muscle mass

Mass mass decreases with age, but it's the rate of loss that counts Those with higher functional reserve lose mass at a slower rate The slope of decline depends on the individual and their patterns of behavior

Age related changes: maximum strength

Maximum strength decreases with healthy aging -- as you age, your max torque decreases

When does peak DF happen during running?

Midway through stance

What is the motion of the hip during swing? Running

Rapid flexion to swing the leg forward

What is the evidence on exercise and progressive resistive training? PD

PD pts. are starting off a little weaker, but in terms of improvements, they are improving in a similar way PD pts. can tolerate exercise, benefit from it, and enjoy it Increases in strength measures translate to increased walking speed -- functional improvement However, studies are limited

In individual's post-stroke the _____ (paretic/non-paretic) limb does more negative work and the ____ (paretic/non-paretic) limb does more positive work

Paretic, non-paretic

Common neuromuscular gait patterns/deviations: ataxic (cerebellar)

Patient has difficulty narrowing their BOS - have a wide stance to maintain balance unsteadiness in the trunk -- tremor a/p of trunk tendency to jerk sideways and the patient has to catch themselves have difficulty walking in tandem

Which population uses their assistive device to create propulsive forces?

Patients with hip pain

Age related changes: Peak performance

Peak performance declines with age

Age related changes: summary

Physical function decreases with age The slope of decline depends on the individual and their patterns of behavior However, muscle can be remodeled through exercise, at any age and thus should be part of any exercise regimen You're never too old to include resistance training as part of one's physical activity

Which population uses their assistive device to create braking forces?

Post-stroke

_____ decreases to a greater amount than strength with aging

Power

Are assistive devices related to falls?

Presence of an AD was shown to be prospectively associated with a greater than 200% increase in fall risk in both community and nursing home setting

Specific roles: knee power Running

Primarily at the knee, especially in the first part of stance, we see the primary power absorption happening at the knee

What's the most efficacious way to rehab after stroke?

Principles of neuroplasticity apply; intense and very deliberate training purposeful and functionally driven therapy, specific training, trying to prevent compensatory strategies early on

Three key elements of gait analysis

Problem identification, cause of identification, treatment

_____ forces are generated when holding your cane posterior

Propulsion

Transtibial prosthetic: dynamic keel

Provide a more dynamic response by reducing stiffness and preserving stability In place of a SACH foot, we have a spring -- allows for shock absorption and energy storage Allows for greater efficiency at faster speeds and allows for running

Walking vs. running: the ____ muscles show similar muscle activity

Proximal muscles -- glut med, vastus med

PD and gait initiation

Pts. with PD display abnormal patterns of gait initiation -- not a smooth transition as the individual is stepping forward this affects the initial step length individuals with PD take longer to get to a comfortable walking speed

Age related changes: Rate of force development

Rate of force development significantly decreases with age

What is different about vGRF when comparing running and walking?

Running vGRF has an impact peak, along with an active peak

Walking vs. running: tibialis anterior

See a lot more TA activity and higher TA peak at a different point during the cycle

What is the motion of the hip during the first part of stance? Running

The hip is being held steady in a relatively flexed position and doesn't move a lot

_____ that a person is able to take is a factor in where you successfully recover or not

Size of step

Why prescribe an assistive device?

Stability, energy conservation, weakness

Phases of the running cycle

Stance (35%), early float (15%), middle swing (35%), late float (15%)

Ankle power when running

Stance: power absorption (knee>ankle) Second half of stance: power generation (ankle>knee)

Knee power when running

Stance: power absorption (knee>ankle) Second half of stance: power generation (ankle>knee)

Transfemoral prosthetic types

Swing control and stance control -- within these types you have friction, hydraulic, pneumatic, polycentric and computerized

What can cause adduction torque at the knee?

TFL and ligaments that cross the knee 20% increase in peak varus torque increases the risk of developing OA 6 fold

Foot structure and shoes: pronators

The arch is collapse, suggest motion control shoes have a stiff medial part of the shoe to prevent over pronation

PD and exercise summary

The benefits of exercise cannot be overstated for all individuals recent research suggests that individuals with PD are able to tolerate progressive resistive exercise -- may help to slow the disease progression and in the short run improve motor symptoms Some current research suggests that they can tolerate HIIT -- more work is needed in this area

Which prosthesis gives us the greatest amount of power generation?

The dynamic plyon

What is the motion of the hip during the second part of stance? Running

The hip is quickly going from flexion into extension -- allows you to push off

How would you describe ankle motion walking vs. running?

The pattern is somewhat similar, but when the peak moments occur is different peak PF happens earlier in running

As you move through the gait cycle, how is ankle motion affected by a prosthetic?

The timing of PF during stance happens a lot later and slow with a dynamic response pylon, you see an increase in PF based on the materials that are being used key: more time is spent in DF with a prosthesis and peak PF happens later during swing, there is no DF momen

How would you describe hip and knee motion walking vs. running?

There are similar patterns of motion, but the magnitudes are different

How would you describe knee extension walking vs. running?

There is a greater extension moment when running

When an individual with PD attempts an isometric finger abduction task, what is observed?

There is increased variability Their activation pattern is very different from non-impaired individuals -- in non-impaired you see a smooth EMG and the variability displays a tight distribution

Hip power when running: what's happening with the hip joint during stance?

There isn't much motion during stance phase, so power isn't very large

How does ankle power change when using a prosthesis?

There's a much smaller amount of power generation You see a similar amount of power absorption when comparing normal and proesthesis during stance

When an individual with PD attempts a triphasic muscle activation, what is observed?

They achieve the end goal with starts and spurts -- you see multiple repetitions of the triphasic pattern As movement pattern gets bigger, they aren't scaling the muscle amplitude like you would expect

What is a reason people with prosthetics have an unstable gait?

They have a hard time trusting the prosthetic to hold their weight

What is the TA active during swing? Running

To DF the ankle and clear the foot

Why do you see activity of the RF and TA into stance? Running

To control the motion as COM drops

Why is there a burst of activity from the RF during swing? Running

To start extending the knee

Individuals with ____ (traumatic/disease related) amputations walk faster and have more energy conservation Prosthetics

Traumatic

OA: gait modifications

Trendelenburg gait, slower gait speed, decreased step length, decreased single limb support walking slower reduces the amount of forces and muscular activity needed to counter the forces generated

T/F During running there is no double stance Running

True

T/F the walking gait pattern is not fixed

True - you can use compensatory patterns to generate purposeful gait, but it will be more energetically expensive

Cost of walking for post-stroke can be ____ that of non-impaired individuals

Twice

_____ forces are generated when holding your AD vertical

Unloading

Common neuromuscular gait patterns/deviations: myopathic

Waddling pelvic girdle weakness, pelvic drop on the non-weight bearing leg and trunk lean to the weight bearing leg, hyperlordotic back

Walking vs. Running

Walk: hip highest at mid-stance, leg is straighter, speed increased by both step length and step frequency Run: hip lowest at midstance, leg more bent, presence of flight phase, speed increased by step length

What is considered the sixth vital sign?

Walking speed

Which are more helpful, wheeled walkers or non-wheeled walkers?

Wheeled -- a four-point walker with no wheels is incredibly energy expensive

How does using an assistive device decrease your M/L COP displacement?

When you are walking, you shift your COP from one leg to the other -- with a larger BOS (using AD), the COP stays closer to the AD and we don't have to shift weight as much

Assistive device falls: _____ (sex) injury rates exceeded those for ____

Women's, men

If individuals are given assistive devices, and trained to properly use them, will they be able to walk longer before the onset of pain?

Yes There was no significant difference in the individuals using pole or walking without in terms of GRF; don't know what causes the difference

Is there a relationship between weakness in PD and functional outcomes?

Yes -- decreased strength is related to functional outcomes, like TUG

Can an assistive device be destabilizing?

Yes, if they aren't used properly

PD and progressive resistive exercise study

You see a decrease in their scores -- they look better than at baseline -- they improved their function and their motor signs of PD decreased over two years compared to the modified fitness group Conclusion: individuals with PD tolerate a progressive resistive program, significant improvement in motor complications related to PD was seen as measured by the UPDRS

Power and prosthetics

You see decreased peak PF power generation compared to the intact limb Overall, there were similarities in power, but the magnitudes were different on prosthetics compared to intact and normal -- hip had slightly increased power generation and ankle had significantly decreased power on prosthetic (graph 11-7)

What is the motion of the knee during the second half of stance? Running

Your knee is extending, plateaus briefly, then rapidly starts flexing as you progress through swing phase

Holding an assistive device on the contralateral side results in _____

a decreased adduction moment at the hip -- you are countering the adductor moment with the AD --> AD creates own abduction moment

Criteria for OA of the knee

age greater than 50, morning stiffness lasting less than 30 minutes, crackling or grating sensation (crepitus), bony tenderness of the knee, bony enlargement of the knee, no detectable warmth of the joint to the touch

Holding an assistive device on the affected side results in _____

an increased adduction moment at the hip

Common neuromuscular gait patterns/deviations: choreiform gait (chorea)

associated movements like oral facial dyskinesia or movements in the UEs balance isn't affected, they just have abnormal movements

As you increase speed, how does it change with prosthetics?

at the hip, more positive work, especially at faster speeds -- could be compensation for decreased power at the ankle greater knee work by the intact and control limb greater positive and negative work at the ankle the residual limb is doing less work -- the intact limb compensates (graph 11-7)

Common gait deviations: transfemoral amputation - whip

at toe off, the heel moves laterally or medially causes: prosthetic knee alignment, incorrect donning of the prosthetic, prosthetic too tight

Common gait deviations: transfemoral amputation - lateral trunk bending

bending towards the prosthetic side causes: prosthesis too short, short stump length, weak or contracted hip abductors, fitting of prosthesis causing offset between foot and socket, lack of balance, weak or contracted hip abductors

Common neuromuscular gait patterns/deviations: hemiplegia

circumduction of the paretic side, UE is in the decorticate posture

Holding an assistive device in _____ hand reduces the load in single limb stance

contralateral or unaffected

PD patients have ____ (increased/decreased) moments and powers in late stance

decreased generating decreased PF moment, which causes decreased PF power there's less power generation at the hip while they're walking

What are gross observable gait deviations from a neurologic perspective?

decreased ROM, altered kinetic and kinematic patterns, decreased dynamic stability, slow walking speed

Common characteristics of an antalgic gait pattern

decreased gait speed, stance time (on injured leg), step length, internal moments

Common neuromuscular gait patterns/deviations: sensory

decreased somatosensation/ proprioception

Common gait deviations: transtibial amputation - pistoning

don't get proper suction or contact with the prosthetic amputee drops into the socket as the foot moves into foot flat, tibia moves veritcally during alternately weight bearing and non-weight bearing periods of gait causes: suspension loose or inadequate, too large or faulty socket

Parkinson's results from the loss of ____ producing cells in the ______

dopamine, substantia nigra

PD posture is characterized by:

flexion through the hip, less extension through the knees ankle, knee, hip -- all stay in a more flexed position

During running, vertical COM is highest during ____ and lowest at ______

flight phase, stance

Common gait deviations: transfemoral amputation - foot slap

foot progresses too quickly from heel strike to foot flat creating a slapping noise causes: patient forcing foot contact to gain knee stability, heel cushion too soft, too soft PF bumper

Common gait deviations: transfemoral amputation - anterior trunk bending

helps passively extend the knee -- trunk flexes anterior during prosthetic stance phase

Common gait deviations: transfemoral amputation - vaulting

helps with knee flexion -- individual excessively plantarflexes during stance phase of non-prosthetic limb during swing phase of prosthetic limb causes: prosthesis that is too long, insufficient knee flexion, socket too small, presence of excessive knee flexion of the prosthesis can become habit

Foot structure and shoes: supinators

high, rigid arch, landing on the lateral aspect of your foot Shoes are made to provide extra cushioning to absorb the shock generated when you load the limb

Individuals who use assistive devices have a (higher/lower) risk of falls

higher -- there's a strong correlation in the literature between AD use and falls

Common gait abnormalities: increased lumbar lordosis

hip flexion contracture or pain from arthritis

Common gait deviations: transfemoral amputation - abducted gait

increased BOS during mobility, prosthetic foot placement is lateral to the normal foot placement during the gait cycle causes: excessive pressure on the ramus during walking, socket too small, lateral wall of prosthesis not supporting the femur sufficiently, fear/lack of confidence transferring weight onto prosthesis

Common gait deviations: transtibial amputation - excessive knee flexion

increased knee flexion at heelstrike or midstance (patient feels as though they are walking downhill) Causes: prosthetic foot set in too much DF, stiff heel cushion, flexion contracture of knee, foot too posterior in relation to the socket

Decreased balance and stability and post-stroke

individuals post-stroke demonstrate increased COP postural sway weight bearing asymmetry is also present they are also at increased risk for falls compared to age matched controls

TBI gait/balance

individuals walk more slowly with decreased stride length; reduced ankle power generation at push-off and increased hip power generation (distal to proximal activation) inc. m/l sway during quiet standing

Systematic gait analysis involves what three steps?

information organization, established sequence of organization, format for data interpretation

Common gait deviations: transtibial amputation - valgus/varus moment

knee either collapses in or out -- knee shifts medially or laterally during prosthetic stance causes: foot placement, foot alignment on prosthesis, loose socket

Common gait abnormalities due to functional leg length discrepancy

leg length discrepancies can be caused by prosthetics, polio, older adults gait abnormalities: limb circumduction, hip hiking, steppage gait, vaulting

Knee OA gait modifications

less initial flexion and extension at the knee at weight acceptance --> reduces contact forces once the limb is off-loaded there's normal flexion and extension during loading phase, the knee is kept mostly straight and stiff -- leads to decreased peak knee flexion moment slower walking speed is another way to reduce pain

vGRF and prosthetics

less time is spent on the impaired limb -- individuals are trying to get on and off that limb as fast as possible as you increased gait speed, the vGRF increases in the intact limb, but not the prosthetic limb --> makes the intact limb compensate even more and does a lot more work to generate the gait pattern (can explain why they self-select a slower walking speed)

In older adults, falls tend to be during ____

locomotion

What are two common symptoms observed following a TBI?

loss of coordination and difficulty balancing -- these can alter movement in more severe cases, weakness or numbness in the extremities; spasticity, and contractures can be observed

During walking, vertical COM is highest during ______ and lowest at ________

midstance, double stance

Definition: antalgic gait pattern

pattern that tries to minimize the force going through the injured leg goal: to off-load the affected limb

Stretching the ______ of the foot and ______ tendon increases energy efficiency Running

plantar fascia, Achilles'

Running injuries: risk factors

previous injury, body mass index training errors: volume and intensity

Specific roles: ankle power Running

propulsion or power (generation) --> during stance, relative to the other joints, the ankle is the primary power generation

As you increase in severity of stroke, you see a decrease in the _____ forces that are being generated and an increased in the amount of ____ on the paretic limb

propulsive, braking more force is being produced by the non-paretic limb to compensate for this

Common gait deviations: transtibial amputation - absent knee flexion

reduced or absent knee flexion throughout stance phase -- seen in nearly all persons with a transT amputation, but is greater in people with general muscle weakness caused by the angle of inclination of the tibia to the femur during fitting and anterior translation of the socket relative to the foot

When running, peak flexion of hip, knee, and ankle occur ______

roughly at the same time

Impact peak is a consequence of _____

running on your heel

Common gait deviations: transtibial amputation - drop off

seen in late stance -- heel off occurs too early causing early knee flexion causes: foot too posterior on the prosthesis, excessive DF of the foot on the prosthesis, heel to toe height, keel or toe lever is too soft

Level of ____ of Parkinson's has a large impact on measures of isokinetic muscle strength

severity

Use of an assistive device increases ____ to give the user more information about where they are in space

somatosensory cues

Trade off for prosthetics between _____ and _____

stability and flexibility -- the more flexible the material, the less stable

OA: significant loss of function

stairs, bathing, rising from chairs

As you increase speed, you see a decrease in ______ Running

stance duration and cycle duration

Compared to age matched controls, pts. with PD have decreased _____, but similar _____

step length, step frequency

Common neuromuscular gait patterns/deviations: Neuropathic

steppage gait pattern -- increased hip and knee flexion as they try to bring the foot through the foot will stay in PF, so they need to increase hip and knee flexion to clear the foot of the ground

When running, you primarily increase speed by increasing ________

stride length walking, you have a linear increase in both stride frequency and stride length

Transtibial prosthetic: passive

the foot and ankle are integrated into a single structure difficult to walk at fast speeds SACH foot - rigid piece of wood replaces the ankle --> improved design: SAFE foot Cushion that absorbs shock -- absorbs the vertical GRF

Common gait deviations: transfemoral amputation - circumduction

the limb abducts in early swing creating a lateral curvature causes: high medial brim, incorrect length, extension moment that is too strong, fixed knee, poor suspension causing prosthesis to slip, weak hip flexors, insufficient knee flexion

Common gait deviations: transfemoral amputation - terminal impact

the person swings the limb forward and snaps the knee into extension with excessive force causes: lack of friction of knee flexion, individual deliberately snaps knee into extension by excessive force to ensure extension, inadequate resistance to knee extension

Common gait deviations: transfemoral amputation - prosthetic instability

the prosthetic knee has a tendency to buck on weight bearing causes: knee set too far anterior, weak hip extensors, heel of the shoe too high

Common gait abnormalities: abnormal walking base

tightness or spasticity of hip ab/adductors -- scissoring gait

Why are the hamstrings active during late stance? Running

to decelerate the tibia

Antalgic gait pattern: treatment

treat the source of pain, medical interventions (analgesics, anti-inflamm), use of assistive devices

Transtibial prosthetic: articulated

two segments represent the foot and the tibia -- joined by a mobile joint bumper acts as a shock absorber for individuals when they walk, but limits motion -- limits DF and PF

Specific roles: hip Running

very little happening at the hip -- not much power absorption or generation

Maintaining balance during single leg stance and prostheitcs

walk with a wider stance - increases BOS see a lot more lateral trunk flexion towards the prosthetic side -- trendelenburg gait

Common gait abnormalities: insufficient push-off

weak PF or contracture

Common gait abnormalities: posterior trunk bending

weak glut maximus

Common gait abnormalities: anterior trunk bending

weak quads, pes equinus deformity (mid and terminal stance), hip flexion contracture or hip from hip OA (mid and terminal stance)

Common gait abnormalities: lateral trunk bending

weakness or pain related to arthritis, leg length discrepancy, weak glut med

What is the knee motion during the first part of stance? Running

you see an increase in knee flexion --> loading energy into the spring