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79 Cards in this Set
- Front
- Back
3 functional tasks of gait
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- weight acceptance
- single limb support - swing limb advancement |
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Define forefoot contact
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initial contact with the ground made by the forefoot
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Define foot-flat contact
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initial contact with the ground made by entire foot
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Define foot slap
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uncontrolled plantar flexion at the ankle after heel contact
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Define abnormal heel off
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heel not in contact with the ground dring LR or midstance
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Define drag
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contact of the toes, forefood or heel with the ground during swing limb advancement
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Define contralateral vaulting
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rising on the forefoot of the opposite stance limb during limb advacement of the reference leg
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List the 10 major things to look for at the ankle/foot for pathological gait
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- forefood contact
- foot-flat contact - foot slap - excess plantar flexion - excess dorsiflexion - excess inversion/eversion - heel off - No heel off - drage - contralateral vaulting |
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Define no heel off
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absence of heel rise during terminal stance or preswing
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List the 3 major things to look for at the toes for pathological gait
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- toes up
- inadequate extension - clawed/hammered |
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List the 7 major things to look for at the knee for pathological gait
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- limited flexion
- excess flexion - wobbles - hyperextends - extension thrust - varus/valgus - excess contralteral flexion |
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List the 7 major things to look for at the hip for pathological gait
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- limited flexion
- internal rotation - inadequate extension - external rotation - past retract - adduction - abduction |
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List the 9 major things to look for at the pelvis for pathological gait
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- hikes
- posterior tilt - anterior tilt - lacks forward rotation - lacks backward rotation - excess forward rotation - excess backward rotation - ipsilateral drop - contralateral drop |
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List the 4 major things to look for at the trunk for pathological gait
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- backward lean
- forward lean - lateral lean - rotates back/forward |
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4 most likely causes of forefoot or foot-flat contact in gait
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- excess knee flexion in terminal swing
- compensate for weak quads - excess plantar flexion in terminal swing - heel pain |
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Significance (3) of forefoot or foot-flat contact
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- poor position for heel rocker
- decreases forward momentum of tibia - decreases shock absorption by limiting knee flexion (forefoot) |
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Cause of foot slap
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weak pre-tibials
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Significance (2) of foot slap
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- decreases forward momentum of the tibia
- decrease shock absorption by limiting knee flexion |
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Cause of excess plantar flexion in weight acceptance
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- plantar flexion contracture
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4 most likely causes of excess plantar flexion in single limb support
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- plantar flexor hypertonicity
- weak quads - impaired proprioception - ankle pain |
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4 most likely causes of excess plantar flexion in swing limb advancement
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- weak pretibials
- plantar flexion contracture - plantar felxor hypertonicity - Lack of selective dorsiflexion control in terminal swing |
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Significance of excess plantar flexion in weight acceptance
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- poor position of heel rocker
- decreases shock absoprtion by limiting knee flexion |
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Significance of excess plantar flexion in single limb support
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- decreases forward progress of the tibia over the ankle
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Significance of excess plantar flexion in swing limb advancement
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- interferes with foot clearance
- interefere with foot position for initial contact |
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Most likely cause of excess dorsiflexion in weight acceptance
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- excess hip or kneee flexion
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Significance of excess dorsiflexion in weight acceptance
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- increases demand on hip and knee extensors
- decreases limb stability |
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4 most likely causes of excess dorsflexion in single limb support
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- weak calf
- excess hip and knee flexion - to lower opposite limb for contact - excess midfoot dorsiflexion secondary to limited ankle mobility |
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Significance of excess dorsiflexion in single limb support
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- increases the demand on the hip and knee extensors
- intereferes with heel rise and decreases step length of the opposite limb |
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Stage in gait cycle when dorsiflexion weakness most evident
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Loading response (see foot slap)
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General problems seen with dorsiflexor weakness
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- strike with flat foot
- problems clearing toe - steppage gait or circumduction |
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Stage in gait cycle when plantarflexion weakness most evident
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Terminal stance
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General problems seen with plantarflexion weakness
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- lack heel rise
- shortened step on contralateral side (loss of toes rocker) - may be unstable if unable to slow down shank |
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Stage in gait cycle when quads weakness most evident
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- loading response (knee collapses)
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General problems seen with quads weakness
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- collapse during loading response
- keep knee in extension to compensate - shorten steps - strike with metatarsal heads |
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Hip abductor weakness gives you
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- loss of control af ADDuction
- increased pelvic drop contralaterally - lean over affected side because ground reaction force is medial to the hip |
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Stage in gait cycle when hip extensor weakness most evident
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loading response
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General problems seen with hip extensor weakness
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- extend knee to compensate
- shorter step - keep trunk back to keep ground reaction force behind hip (results in pelvic rotation) |
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Stage in gait cycle when hip flexion contracture most evident
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terminal stance
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General problems seen with hip flexion contracture
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- contralateral shortened step
- excess knee flexion - increased lumbar loridosis |
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Stage in gait cycle when knee flexion contracture most evident
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throughout stance
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General problems seen with knee flexion contracture
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- often no changes seen but increased quad demand
- shorter step - possible toe strike |
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Stage in gait cycle when ankle plantarflexion contracture most evident
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- mid and terminal stance
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General problems seen with ankle plantarflexion contracture
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- bounce/heel up during mid and terminal stance
- early heel rise - externally rotated, so just roll over inside of foot - increased force to the medial longitudinal arch |
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Classic features of antalgic gait from knee pain
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- contralateral short step to unload ASAP
- step away from the pain - classic limp |
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Classic features of antalgic gait from arch pain
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- walk on outside of foot
- sometimes toe-in |
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Prevalance of gait disorders by age in 3 key older groups
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- 65-74: 15%
- 75-84: 30% - 85+: 50% |
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3 essential requirements of locomotion
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- progression
- adaptation - postural control |
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2 most general elements of postural control
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- stability
- orientation |
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List 4 general systems we look for regarding impairments for gait
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- musculoskeletal
- neuromuscularr - sensory - cognitive |
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Describe reactive stability in gait when trip early in swing
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- flex swimg limb to clear obstace
- extend stance limb to extend stance |
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Describe reactive stability in gait when trip late in swing phase
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- extend swing limb to lower leg
- flex opposite leg to clear anticipated obstacle |
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Describe the role of visual sampling as age increases
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Become more dependent on visual sampling
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Normal pattern of turning during gait
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- proceed from head, trunk, pelvis, feet
- turn in 1-2 steps regardless of distance |
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Major way of increasing stability during turning in gait
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Increasing number of steps
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General features of initiation of gait
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- move COP back and toward swing leg
- then COP towards stance leg - then COP moves forward to start step |
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Functional distance to be a physiologic walker
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< 50 feet
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Functional distance to do in-house only ambulation
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75 feet
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Functional distance to be a walker around larger home
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50 meters
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Functional distance to for full community ambulation
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250-300 meters
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Speed required for physiologic walking
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6 meters per min
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Speed of in house ambulators
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14-16 meters/min
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Speed of in and around home ambulators
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24-35 meters/min
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Speed of community ambulators
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48+ meters/min
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Speed of normal communityr amublation
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80 meters/min
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Typical speed of hemiplegic gait
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30 meters/min
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Typical speed of Parkinsonian gait
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34 meters/min
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minimum requirements to safely cross the street
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Must walk 30-80 meters/min for 10-25 meters
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From the view of peripheral input, the stance to swing transition in gait is triggered by
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- hip extension
- unloading of ankle plantarflexors |
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Function of mesencephalic locomotor region
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- gait initiation and speed of locomotion
- (vetriculspinal tract) |
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Function of pontine locomotor region
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- postural tone
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Functionof subthalamic locomotor region
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- obstacle avoidance
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Role of cerebellum in gait (general)
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- coordinates movement
- onling error correction - motor learning and adaptation |
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Role of basal ganglia in giat
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- likely involved in posture through projections to brainstem
- context specific selection of muscle activity |
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Compare O2 costs for paraplegia ambulation vs. WC use
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- KAFO swing gait: 0.64
- WC: 0.16 (and over twice as fast) |
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3 general elements in the framework for studying pathological gait
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- impairment framework
- diagnostic framework - combination |
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2 (very general) causes of gait abnormality
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- pathology
- compensatory strategies |
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3 common neuromusculal impairment groups that influence gait
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- tone
- coordination - recuitment |
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3 common strategies for clearing the leg
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- hip hike
- circumduction - lateral lean |
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Control of posture and giat is most affected with to the
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vermis of the cerebellum
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