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NDT Ch 10 Gait Exam

NDT Test 2 Gait Exam

Gait problems affect what percentages in the elderly 15% >60 yrs old 25% >80 yrs old 50% nursing home residents
4 Common Reasons for Gait Disturbances Pain Immobile Joint Muscle Weakness Abnormal neurological control
If gait disturbance is symmetrical, what does this suggest? Faulty neurological control
If gait disturbance is asymmetrical, what does this suggest? Pain, fixed joint, muscle weakness
General Exam Acute- vascular disease Chronic- pt. may be unaware; slower onset= alcoholism/other drugs Presence mm wkness, stiff lmbs, b/b dysfxn Difficulty start/stop- Parkinson's Vertigo/light-headed? Pn, numb, tingling limbs? Problems in dark- diabetic, ssy
Look from front, back, side at any/all how patient: Gets up from chair Initiates walking Walks at different speeds Turns in both directions Walks on toes, heels, straight line, EO/EC Stands with EO/EC Copes with postural challenges
Most gaits share non-specific characteristics such as? Widened base in standing (men normally wider than women) Short steps while walking Greater proportion of gait cycle in double-limb support
Which gaits have unique features? Cerebellar Ataxia Hip arthritis Parkinson's Disease
May be able to divide problems you observe into what 3 basic areas? Joint & skeletal abnormalities Motor abnormalities Impaired balance (cerebellar & sensory ataxias)
What causes a limp? Hyperesthesia? Limp from discomfort of WB Hyperes.- from a neuro disease, too much sensation, causing pain with walking
By age 75, what percent of the population has OA changes in large joints? 85%
What will antalgic gait look like? Very short stance on affected leg, which may be placed gingerly on the floor & lifted almost immediately, with weight rapidly redistributed to normal leg
Gait Disturbances Due to Immoble Joints Loss of mobility from arthritis Ex. PF contraction due to long time wearing a cast
Gait Disturbance Due to weak hip abductors Trendelenburg gait, reduced arm swing; Bilaterally weak, lurching/waddling may be seen; pt may also compensate by stepping very high on unsupported side, allowing swing leg to clear ground
Gait disturbance due to weak anterior tibialis & toe extensors causes what? Steppage Gait- knees raised unusually high to allow dropped foot to clear; toe still point downward, so falls are common Foot slap- after heel touches, forefoot brought down suddenly with a slap; double loud sound (heel, then forefoot)
Looking at what can help you infer a lot about a patient's gait? Their shoes
Most common abnormal neurological control issues causing gait disturbances? Myelopathy, ataxia, apraxia, Parkinson's Disease
Myelopathy 2ndary to cervial spondylosis; Osteophytes common without neck discomfort/radicular pn, chronic cord compression caused. Spastic hyperreflexia, urinary urgency, dorsal column s/sx
Gait with myelopathy patients Early gait- stiff legged, with circumduction & reduced toe clearance Later gait- wide-based, unsteady, shuffling, spastic Suspect lumbar problems if patient c/o sever leg pains resolving upon sitting
Spastic Diplegia Gait crouched, toe-walking, most common with spastic CP individuals
Apraxic Gait (Frontal Lobe involvement) Hesitant to start, short shuffling steps that rarely leave floor; can't maintain upright posture (fwd flexed upper trunk, arms, knees); lack reflexes vs. sudden perturbations; maintain arm swing; gait not b/c of mm wkness, paralysis, motor/ssy problems
More apraxic gait Pt. can't carry out familiar purposeful mvmts +/- memory or other cognitive impairments
Malingering Gait No objective s/sx neurological deficit & all kinda of arm/leg mvmts that follow no physiologic pattern Usually capable of maintaining their balance & never allow themselves to fall
Start/Stop in Normal Gait Gait begins when heel of reference extremity hits supporting surface & ends when heel of same extremity hits ground again Abnormal pts, heel may not be 1st part of foot to hit ground, gait may begin when another part of reference extremity touches ground
Stance & Swing Phases Stride = 2 steps Step = 1 foot in contact with the floor Step length, stride length, stride & step time
Stance phase of gait contains what? 60% of gait cycle Reference extremity in contact with floor
Swing phase of gait contains what? 40% of gait cycle Reference extremity doesn't contact floor
There are 2 period of double support time when? Within the stance & swing phases
Kinematic Gait Analysis Describe mvmt patterns w/o regard for forces involved Description of mvmt of body as a whole &/or body segments in relation to each other during gait Qualitative or Quantitative
Kinetic Gait Analysis Determines forces involved in gait
Observational Gait Analysis (OGA) Eval of ankle, foot, knee, hip, pelvis, trunk at each point of cycle PT determines presence & occurrence of deviations Reliability is important No instrumentation needed Use videos
What would you examine before you do a gait eval? MMT, ROM, ask how often patient walks & if they have trouble with falls
what kind of data that you gathered before the gait eval would lead you to watch for certain deviations? Sensory info, weakness, etc.
When might you do a gait eval early in the exam? If you think fatigue might be an issue
Why use an ambulation profile/scale? Normative data, harder to forget to do b/c it's all listed for you
Functional Ambulation Profile (FAP) & modifications Examines gait skills from standing balance in parallel bars to I amb Timed to measure how long pt can maintain a position or perform a task Modified with such items as stairs, carpet, obstacle course
Iowa Level of Assistance Scale 4 fxnal tasks- get out of bed, stand from bed, ambulating, asc/desc steps Made for people in inpatient rehab for ortho purposes, not neuro
Functional Independence Measure (FIM) Designed to examine progress
Functional Assessment Measure (FAM) Similar to FIM with communication, psychosocial adjustment & cognitive functions added Mainly for CVA & TBI patients
WeeFIM For kids 3-8 yrs old Consists of 18 items
Gait Abnormality Rating Scale & Modifications ID patents in nursing homes that were at risk for falls Need to tape the observation Modified version supposed to be a better predictor of falls
Fast Eval of Mobility Balance & Fear ID's risk factors, functional performance & factors that hinder mobility
Preliminary ?'s for Patient with Neuro Damage (maybe even ortho) Influence of abnormal tone on position/mvmt Head position WB influence Abnormal (obligatory) synergistic activity on position/mvmt Influence of wkness Coordination deficits Impaired balance rxns
What is energy cost influenced by? Generally, conditions that affect either motor control of gait & posture or conditions that affect joint & muscle structure & fxn will increase the energy cost of gait Could also be influenced by footwear, ADs, gait speed
Physiological Energy Cost Measures Measure heat (energy) produced by subject at rest & during gait Measure O2 uptake with open loop spirometry method
Heart Rate Data Relative energy consumption is highly correlated with HR Absolute level of energy consumption is highly correlated with HR & max walking speed
Kinematic Quantitative Gait Analysis Used to obtain info on spatial & temporal gait variables as well as motion patterns Data obtained through these analyses are quantifiable & therefore provide the PT w/ baseline data that can be used to plan treatment programs
How would a patient's demographics effect spatial & temporal variables? Pt may need to attain a certain gait speed to cross the street in a certain amount of time, or may need to walk a certain distance to the supermarket
Created by: 1190550002



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