abnormal gait

Question 1

2 broad requirements of gait

Answer 1

neuromuscular and musculoskeletal

Question 2

neuromuscular requirement of gait

Answer 2

is essential for afferent sensing of limb position and forces on the body (proprioception), reflexive management of muscle forces, and excitation of motor units

Question 3

musculoskeletal requirement for gait

Answer 3

adequate range of motion and capacity to withstand, produce, and control forces

Question 4

4 steps for evaluating normal gait

Answer 4

what is affected, where/why is that structure important in normal gait, predict the likely deviations from normal gait, and measure/observe and compare to expectations of gait

Question 5

reasons for muscle dysfunction

Answer 5

atrophy, disuse, motor unit recruitment, compromised tissue, and pain

Question 6

why does muscle dysfunction occur?

Answer 6

due to external moments overpowering the ability to produce internal moments, leading to motion tends to occur in the direction of the external moment

Question 7

how is achilles tendon rupture treated surgically?

Answer 7

ends of tendon are sutured together and the ankle is casted in PF position

Question 8

how is achilles tendon rupture treated non-surgically?

Answer 8

casted in PF position, early PT, small ROM exercise, lower limb open chain exercises, and progression to weight bearing

Question 9

how does an achilles tendon rupture affect gait

Answer 9

decreased PF, more knee/hip flexion during swing to compensate for PF, reduced propulsion, reduced DF ROM (if surgically repaired) leading to early toe off (which then leads to reduced stance), limp, and reduced step length

Question 10

antalgic gait meaning

Answer 10

limp

Question 11

what do biomechanical changes of above knee amputation depend on?

Answer 11

type of prosthetic, other complications regarding initial intervention, and tissue preservation

Question 12

above knee amputation kinematic findings for gait

Answer 12

reduced joint ROM, intact limb generally more flexed, and longer stance duration on intact limb

Question 13

kinetic findings of gait for above knee amputation

Answer 13

reduced joint loading in amputated limb, increased propulsion GRF in intact limb to compensate, and more loading in intact limb

Question 14

why is hip extension reduced in gait for above knee amputation?

Answer 14

due to earlier toe off on amputated leg and decreased DF in stance, causing this phase to shorten, and thus less extension

Question 15

what do responses of internal moments as a response of external moments arise from?

Answer 15

afferent sensing (proprioception), descending CNS drive, and muscle reflex and function

Question 16

how can we make larger moments?

Answer 16

more mass, faster speeds, or increasing the moment arm

Question 17

how can we increase internal forces to generate larger internal moments?

Answer 17

increased rate or firing and increased motor recruitment

Question 18

how can we reduce external moments?

Answer 18

decrease body weight, decrease walking speed, or decrease the moment arm

Question 19

how can we alter the GRF to change knee moments?

Answer 19

move the origin/COP, move the end point of the GRF (centre of mass), or move the joint of interest closer to the GRF vector

Question 20

what is the biggest functional impairment in ACL tear?

Answer 20

decreased knee flexion and increased knee extension in stance and this is due to decreasing the force of the quadriceps that produce force when in flexion due to antagonist activity

Question 21

why is knee extended in ACL gait?

Answer 21

keeping the knee extended and shortening the step keeps the GRF in front of the knee and thus limits flexion activity that would activate quads as an antagonist

Question 22

what would quad contraction result in during an ACL tear?

Answer 22

anterior tibial translation

Question 23

ACL gait characteristics

Answer 23

reduced range of the external sagittal moment, less internal moments required, and reduced knee flexion angles in stance

Question 24

what muscles have larger demands during ACL gait?

Answer 24

knee flexors, hip extensors, and ankle plantarflexors

Question 25

what muscles to strengthen in ACL tear?

Answer 25

lower leg muscles, especially knee flexors

Question 26

potential causes for decreased a heel contact

Answer 26

weak ankle DF or limited DF ROM

Question 27

potential causes for foot slap

Answer 27

weak DF

Question 28

potential causes for knee remained flexed throughout gait cycle

Answer 28

knee flexion contracture

Question 29

potential causes for knee hyperextension

Answer 29

weak quadriceps, quadriceps spasticity, or limited ankle DF ROM

Question 30

potential causes for premature elevation of heel in mid stance

Answer 30

limited ankle DF ROM due to muscle shortening or spasticity

Question 31

potential causes for absence of terminal hip extension

Answer 31

weak hip extensors, tight hip flexors, reduced weight bearing, poor knee control, limited ankle DF ROM, or poor balance

Question 32

potential causes for lack of toe off

Answer 32

weak ankle PFs, limited ankle PF ROM, knee hyperextension, or poor balance

Question 33

gait vaulting meaning

Answer 33

is when an individual rises up onto the foot of their unaffected leg to swing to affected or prosthetic leg forward to increase toe clearence

Question 34

potential causes for vaulting

Answer 34

reduced toe clearance ability on the contralateral side

Question 35

potential causes for trunk leaning towards the ipsilateral side

Answer 35

ipsilateral hip or knee pain and weak ipsilateral hip abductors

Question 36

potential causes for trunk leaned towards the contralateral side

Answer 36

ipsilateral knee or foot pain

Question 37

potential causes for excessive pelvic drop contralaterally

Answer 37

weak ipsilateral hip abductors

Question 38

potential causes for decreased stance duration with small step contralaterally

Answer 38

ipsilateral leg pain or weakness and reduced weight bearing ability

Question 39

potential causes for excessive hip flexion and knee flexion

Answer 39

weak ankle DF

Question 40

potential causes for hip hiking or circumduction

Answer 40

weak flexor muscle groups

Question 41

potential causes for foot drop or toe drag

Answer 41

paralysis or weakness of ankle DF and limited ankle DF ROM

Question 42

potential causes for hip external rotation at early swing

Answer 42

weak hip flexors

Question 43

potential causes for scissor gait

Answer 43

spasticity in hip adductors

Question 44

potential causes for wide BOS

Answer 44

poor balance

Question 45

potential causes for toe out

Answer 45

poor balance, retroversion of neck of femur, or tight hip external rotators

Question 46

potential causes for toe in

Answer 46

anteversion of neck of femur or tight hip adductors or internal rotators