NDT Test 2 Gait Exam
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| Gait problems affect what percentages in the elderly | 15% >60 yrs old
25% >80 yrs old
50% nursing home residents
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| 4 Common Reasons for Gait Disturbances | Pain
Immobile Joint
Muscle Weakness
Abnormal neurological control
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| If gait disturbance is symmetrical, what does this suggest? | Faulty neurological control
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| If gait disturbance is asymmetrical, what does this suggest? | Pain, fixed joint, muscle weakness
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| 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
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| 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
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| 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
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| Which gaits have unique features? | Cerebellar Ataxia
Hip arthritis
Parkinson's Disease
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| May be able to divide problems you observe into what 3 basic areas? | Joint & skeletal abnormalities
Motor abnormalities
Impaired balance (cerebellar & sensory ataxias)
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| What causes a limp? Hyperesthesia? | Limp from discomfort of WB
Hyperes.- from a neuro disease, too much sensation, causing pain with walking
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| By age 75, what percent of the population has OA changes in large joints? | 85%
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| 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
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| Gait Disturbances Due to Immoble Joints | Loss of mobility from arthritis
Ex. PF contraction due to long time wearing a cast
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| 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
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| 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)
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| Looking at what can help you infer a lot about a patient's gait? | Their shoes
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| Most common abnormal neurological control issues causing gait disturbances? | Myelopathy, ataxia, apraxia, Parkinson's Disease
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| Myelopathy | 2ndary to cervial spondylosis; Osteophytes common without neck discomfort/radicular pn, chronic cord compression caused. Spastic hyperreflexia, urinary urgency, dorsal column s/sx
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| 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
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| Spastic Diplegia Gait | crouched, toe-walking, most common with spastic CP individuals
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| 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
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| More apraxic gait | Pt. can't carry out familiar purposeful mvmts
+/- memory or other cognitive impairments
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| 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
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| 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
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| Stance & Swing Phases | Stride = 2 steps
Step = 1 foot in contact with the floor
Step length, stride length, stride & step time
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| Stance phase of gait contains what? | 60% of gait cycle
Reference extremity in contact with floor
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| Swing phase of gait contains what? | 40% of gait cycle
Reference extremity doesn't contact floor
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| There are 2 period of double support time when? | Within the stance & swing phases
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| 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
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| Kinetic Gait Analysis | Determines forces involved in gait
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| 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
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| What would you examine before you do a gait eval? | MMT, ROM, ask how often patient walks & if they have trouble with falls
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| what kind of data that you gathered before the gait eval would lead you to watch for certain deviations? | Sensory info, weakness, etc.
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| When might you do a gait eval early in the exam? | If you think fatigue might be an issue
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| Why use an ambulation profile/scale? | Normative data, harder to forget to do b/c it's all listed for you
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| 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
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| 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
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| Functional Independence Measure (FIM) | Designed to examine progress
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| Functional Assessment Measure (FAM) | Similar to FIM with communication, psychosocial adjustment & cognitive functions added
Mainly for CVA & TBI patients
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| WeeFIM | For kids 3-8 yrs old
Consists of 18 items
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| 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
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| Fast Eval of Mobility Balance & Fear | ID's risk factors, functional performance & factors that hinder mobility
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| 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
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| 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
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| Physiological Energy Cost Measures | Measure heat (energy) produced by subject at rest & during gait
Measure O2 uptake with open loop spirometry method
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| Heart Rate Data | Relative energy consumption is highly correlated with HR
Absolute level of energy consumption is highly correlated with HR & max walking speed
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| 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
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| 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
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