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
