Gait Analysis in Physical Therapy

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Questions and Answers

In a patient exhibiting Trendelenburg gait due to right gluteus medius weakness, what compensatory strategy would MOST likely be observed during the stance phase of the right leg?

  • Contralateral trunk lean towards the left side to reduce the demand on the right hip abductors.
  • Exaggerated hip abduction on the right side to compensate for the weakened gluteus medius.
  • Increased hip adduction on the right side to maintain pelvic stability.
  • Ipsilateral trunk lean towards the right side to reduce the demand on the right hip abductors. (correct)

Which of the following combinations of kinematic and kinetic data derived from instrumented gait analysis would BEST differentiate between a subject with stiff-knee gait and a subject with hamstring spasticity during the swing phase?

  • Reduced knee flexion; decreased hip extensor moment.
  • Increased knee flexion; decreased hip flexor moment.
  • Increased knee flexion; increased knee extensor moment.
  • Reduced knee flexion; increased hip flexion moment. (correct)

A patient presents with a steppage gait secondary to anterior compartment syndrome. What intervention strategy would be MOST effective in addressing the underlying cause of this gait deviation?

  • Ankle-foot orthosis (AFO) to assist with dorsiflexion and prevent foot drop. (correct)
  • Strengthening exercises for the plantarflexors to compensate for dorsiflexion weakness.
  • Gastrocnemius recession surgery to lengthen the calf muscles and improve ankle range of motion.
  • Stretching exercises for plantarflexors to reduce equinus deformity.

A patient with Parkinson's disease exhibits a shuffling gait pattern. Which of the following intervention strategies would be MOST appropriate to address the hypokinesia contributing to this gait pattern?

<p>Implementing high-intensity treadmill training with visual and auditory cues to increase step length and cadence. (B)</p> Signup and view all the answers

Which of the following scenarios BEST exemplifies the application of instrumented gait analysis in a research setting?

<p>Employing motion capture systems and force plates to quantify changes in joint kinematics and kinetics following a total knee arthroplasty. (D)</p> Signup and view all the answers

During gait analysis, a patient demonstrates excessive hip adduction during the swing phase, causing the knees to cross the midline. Which of the following gait deviations is MOST likely present?

<p>Scissoring gait. (C)</p> Signup and view all the answers

A patient exhibits a gait pattern characterized by excessive flexion of the hips, knees, and ankles throughout the gait cycle. Which of the following gait deviations is MOST likely present?

<p>Crouch gait. (D)</p> Signup and view all the answers

A patient displays a gait pattern characterized by shuffling steps, reduced arm swing, forward trunk flexion, and festination. Which of the following gait deviations is MOST likely present?

<p>Parkinsonian gait. (B)</p> Signup and view all the answers

What is the MOST critical consideration when utilizing observational gait analysis in a clinical setting?

<p>Employing a systematic and consistent approach to visually assess gait patterns from multiple perspectives. (D)</p> Signup and view all the answers

Which of the following conditions would be MOST effectively assessed using instrumented gait analysis rather than observational gait analysis alone?

<p>Subtle kinematic abnormalities in a high-level athlete following ACL reconstruction. (D)</p> Signup and view all the answers

A patient presents with an antalgic gait pattern due to pain in the right hip. Which of the following adaptations would you MOST likely observe during gait analysis?

<p>Shortened stance phase on the right leg to reduce weight-bearing time. (A)</p> Signup and view all the answers

What is the MOST important reason for comparing a patient's gait parameters to normative data during gait analysis?

<p>To identify deviations from normal gait patterns and quantify the extent of impairment. (D)</p> Signup and view all the answers

Which of the following BEST describes the primary advantage of using inertial measurement units (IMUs) in gait analysis compared to traditional motion capture systems?

<p>IMUs are less susceptible to environmental interference and can be used in real-world settings. (B)</p> Signup and view all the answers

A physical therapist is analyzing the gait of a patient with right ankle pain. During the loading response phase, the therapist observes excessive pronation. Which of the following intrinsic factors is MOST likely contributing to this gait deviation?

<p>Pes planus (flat foot). (A)</p> Signup and view all the answers

During the terminal stance phase of gait, what muscle group is PRIMARILY responsible for controlling the rate of ankle dorsiflexion and preventing a rapid drop of the forefoot?

<p>Plantarflexors (gastrocnemius and soleus). (C)</p> Signup and view all the answers

A patient with hemiplegia exhibits circumduction during the swing phase of gait. Which of the following impairments is LEAST likely to contribute to this gait deviation?

<p>Knee flexor spasticity. (A)</p> Signup and view all the answers

Which of the following kinetic parameters obtained from force plate analysis would provide the MOST direct information about the loading rate experienced by the lower extremity during gait?

<p>Rate of change of the vertical ground reaction force. (C)</p> Signup and view all the answers

A patient with cerebral palsy presents with a crouch gait pattern. Which of the following muscle groups is MOST likely exhibiting excessive activity throughout the gait cycle, contributing to this deviation?

<p>Knee extensors (quadriceps). (B)</p> Signup and view all the answers

During gait analysis, a patient is observed to have a wide base of support and uncoordinated movements. What neurological condition is MOST likely associated with this type of gait?

<p>Cerebellar dysfunction. (B)</p> Signup and view all the answers

Which of the following outcome measures would be MOST appropriate for quantifying the effectiveness of an intervention aimed at improving gait symmetry and reducing compensatory strategies in a patient with hemiparesis?

<p>Gait Symmetry Ratio. (C)</p> Signup and view all the answers

A patient with a transfemoral amputation is being evaluated for prosthetic gait training. During the mid-stance phase on the prosthetic side, the therapist observes excessive lateral trunk bending towards the prosthetic side. Which of the following factors is LEAST likely to contribute to this gait deviation?

<p>Prosthetic foot is set in excessive inversion. (C)</p> Signup and view all the answers

Which of the following strategies would be MOST effective in differentiating between equinus gait due to gastrocnemius contracture versus equinus gait due to spasticity?

<p>Assess ankle dorsiflexion range of motion with the knee extended and flexed. (C)</p> Signup and view all the answers

A patient with a history of stroke presents with a hemiplegic gait pattern. During the swing phase, the therapist observes that the patient is using hip hiking to clear the affected limb. Which of the following impairments is MOST likely contributing to this compensatory strategy?

<p>Weak ankle dorsiflexors (C)</p> Signup and view all the answers

A researcher is investigating the effects of a new rehabilitation protocol on gait biomechanics in individuals with knee osteoarthritis. Which of the following instrumented gait analysis parameters would be MOST relevant for assessing changes in knee joint loading?

<p>Knee adduction moment during stance phase (A)</p> Signup and view all the answers

A patient recovering from a femoral fracture demonstrates a noticeable circumduction gait. Beyond muscle strength and range of motion, which neuromuscular factor is MOST crucial to address for improving gait efficiency?

<p>Coordination of pelvic rotation with stride length. (C)</p> Signup and view all the answers

During observational gait analysis of a patient with patellofemoral pain syndrome, which specific deviation would MOST strongly indicate a need to assess and address proximal hip muscle weakness?

<p>Medial knee displacement during midstance. (B)</p> Signup and view all the answers

In designing a gait retraining program for a patient post-stroke, what strategy would be MOST effective for improving paretic limb propulsion during the terminal stance phase?

<p>Incorporating resisted plantarflexion exercises with focus on push-off. (A)</p> Signup and view all the answers

A patient with bilateral transtibial amputations demonstrates inconsistent step length and cadence. Which of the following prosthetic modifications would MOST directly address these gait deviations?

<p>Optimizing the alignment of the prosthetic feet in the sagittal plane. (D)</p> Signup and view all the answers

What is the MOST significant advantage of using a split-belt treadmill for gait training in individuals with neurological conditions?

<p>It can independently control the speed of each leg to address asymmetry. (A)</p> Signup and view all the answers

Which electrophysiological measure would provide the MOST specific information about the contribution of spasticity to a patient's equinus gait?

<p>H-reflex of the gastrocnemius muscle. (C)</p> Signup and view all the answers

In a gait analysis study focusing on patients with knee osteoarthritis, which biomechanical factor during stair ascent would MOST likely correlate with increased pain and functional limitations?

<p>Elevated knee joint contact force during weight acceptance. (D)</p> Signup and view all the answers

A patient with a spinal cord injury at the T12 level presents with a gait pattern characterized by hip hiking and circumduction. Which of the following orthotic interventions would be MOST appropriate for improving gait efficiency and reducing energy expenditure?

<p>Reciprocating gait orthosis (RGO). (A)</p> Signup and view all the answers

During a research study on gait adaptations in older adults, which of the following instructions would be MOST effective in eliciting a 'dual-task' gait pattern?

<p>Walk while counting backwards from 100 by sevens. (C)</p> Signup and view all the answers

Which of the following represents the MOST effective strategy for addressing decreased step length on the affected side of a patient post-stroke?

<p>Providing visual cues to step further with each stride. (C)</p> Signup and view all the answers

When examining the gait of a patient with unilateral lower extremity edema, which measurement would be MOST reliable in determining the impact of edema on gait symmetry?

<p>Comparison of stance phase duration between limbs. (D)</p> Signup and view all the answers

In a research study utilizing instrumented gait analysis, what methodological consideration would be MOST critical to ensure the validity and reliability of the collected electromyography (EMG) data?

<p>Normalizing EMG data to a maximal voluntary isometric contraction (MVIC) to account for inter-subject variability. (B)</p> Signup and view all the answers

A patient with a history of poliomyelitis presents with significant weakness in the right quadriceps. During gait analysis, which compensatory strategy would MOST likely be observed during the loading response phase on the affected limb?

<p>Excessive knee hyperextension to provide passive joint stability. (A)</p> Signup and view all the answers

Which of the following represents the MOST significant limitation of relying solely on observational gait analysis in assessing a patient with subtle, early-stage Parkinson's disease?

<p>Difficulty in detecting minor changes in gait parameters like step length and arm swing. (A)</p> Signup and view all the answers

A researcher is investigating the effectiveness of a novel rehabilitation intervention on gait biomechanics in individuals with cerebral palsy. Which combination of gait parameters, assessed using instrumented gait analysis, would provide the MOST comprehensive assessment of changes in gait efficiency and motor control?

<p>Ground reaction forces, joint kinematics, and electromyography (EMG) activity. (A)</p> Signup and view all the answers

In a patient with a transfemoral amputation, what modification to the prosthetic limb would MOST effectively address excessive energy expenditure related to increased vertical displacement of the center of mass during ambulation?

<p>Adding a dynamic elastic response (energy storing) foot. (A)</p> Signup and view all the answers

Flashcards

Gait Analysis

Systematic evaluation of human walking to identify deviations from normal patterns.

Gait Cycle

The time from when one foot touches the ground until it touches the ground again.

Stance Phase

Phase when the foot is in contact with the ground (60% of gait cycle).

Initial Contact

The moment the foot initially touches the ground.

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Loading Response

Weight is transferred onto the limb.

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Midstance

Body weight is aligned over the stance limb.

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Terminal Stance

Heel rises off the ground.

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Preswing

Final phase of stance, just before the foot leaves the ground.

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Swing Phase

Phase when the foot is not in contact with the ground (40% of gait cycle).

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Initial Swing

Foot is lifted off the ground.

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Midswing

Limb passes directly beneath the body.

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Terminal Swing

Limb slows down, preparing for initial contact.

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Cadence

The number of steps taken per minute.

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Step Length

Distance between heel strike of one foot and the other foot.

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Stride Length

Distance between successive heel strikes of the same foot.

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Base of Support

Distance between the two feet during ambulation.

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Normal Gait

Smooth weight transfer and forward progression while walking.

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Observational Gait Analysis

Visual assessment of gait patterns.

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Antalgic Gait

Limping due to pain, shortened stance phase on affected side.

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Gait: Trendelenburg

Excessive trunk flexion towards stance side due to weak hip abductors.

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Steppage Gait

Excessive hip/knee flexion to lift foot, often due to foot drop.

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Hemiplegic Gait

Circumduction, hip hiking, limited arm swing due to muscle weakness.

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Parkinsonian Gait

Shuffling steps, reduced arm swing, forward trunk flexion.

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Ataxic Gait

Wide base of support, unsteady, uncoordinated movements.

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Crouch Gait

Excessive flexion of hips, knees, ankles throughout gait cycle.

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Scissoring Gait

Excessive adduction of legs during swing, knees cross midline.

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Instrumented Gait Analysis

Technology provides objective data about gait (motion capture, force plates).

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Motion Capture Systems

Cameras/markers track joint movements in 3D.

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Force Plates

Measure ground reaction forces during stance.

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Electromyography (EMG)

Records muscle activity patterns.

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Inertial Measurement Units (IMUs)

Sensors measure acceleration and angular velocity.

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Kinematics

Joint angles, velocities, and accelerations during gait.

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Kinetics

Forces and moments acting on the body during gait.

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Temporal-Spatial Parameters

Cadence, step length, stride length, and velocity during gait.

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Muscle Activation Patterns

Timing and intensity of muscle activity during gait.

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Exercise for Gait

Strengthening weak muscles, stretching tight muscles.

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Orthotics for Gait

Support/align foot and ankle, correct deformities improving gait.

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Assistive Devices for Gait

Canes/walkers improve stability, reduce weight-bearing, and increase independence.

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Manual Therapy for Gait

Address joint restrictions and soft tissue limitations.

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Neuromuscular Re-education

Retraining normal movement patterns and improving motor control.

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Functional Training

Practicing gait-related activities in a real-world setting.

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Patient Education

Providing information about gait abnormalities and strategies for improving gait.

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Gait Normative Data

Compare a patient's walking to normal walking data.

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Study Notes

  • Gait analysis in physical therapy systematically evaluates human walking to identify deviations from normal gait patterns, diagnose underlying conditions, assess the impact of impairments, and guide treatment interventions.

Components of Gait

  • Gait cycle: The period from when one foot contacts the ground until that same foot contacts the ground again. The cycle is divided into stance and swing phases.
  • Stance phase: When the foot is in contact with the ground, comprising approximately 60% of the gait cycle and subdivided into:
    • Initial contact (heel strike): The moment the foot initially touches the ground.
    • Loading response (foot flat): Weight is transferred onto the limb.
    • Midstance: Body weight is aligned over the stance limb.
    • Terminal stance (heel off): Heel rises off the ground.
    • Preswing (toe off): The final phase of stance, just before the foot leaves the ground.
  • Swing phase: When the foot is not in contact with the ground, making up approximately 40% of the gait cycle and subdivided into:
    • Initial swing (acceleration): Foot is lifted off the ground.
    • Midswing: Limb passes directly beneath the body.
    • Terminal swing (deceleration): Limb is slowing down, preparing for initial contact.
  • Cadence: The number of steps taken per minute.
  • Step length: The distance between the heel strike of one foot and the heel strike of the other foot.
  • Stride length: The distance between successive heel strikes of the same foot.
  • Base of support: The distance between the two feet during ambulation.

Normal Gait Characteristics

  • Smooth, coordinated movements: Efficient transfer of weight and forward progression.
  • Minimal vertical displacement: The body's center of mass moves in a relatively level plane.
  • Narrow base of support: Feet are positioned close to the midline.
  • Adequate step and stride length: Consistent and appropriate for the individual's height and age.
  • Normal cadence: Typically between 100-120 steps per minute.
  • Reciprocal arm swing: Arm movements coordinated with leg movements for balance and momentum.

Observational Gait Analysis

  • Visual assessment of gait patterns to identify deviations from normal.
  • Requires a trained eye and a systematic approach.
  • Observe the patient from multiple angles (anterior, posterior, lateral).
  • Focus on:
    • Posture: Alignment of the head, trunk, and limbs.
    • Arm swing: Presence, symmetry, and coordination.
    • Trunk movement: Excessive rotation, lateral bending.
    • Pelvic motion: Rotation, tilt, and drop.
    • Hip motion: Flexion, extension, abduction, adduction, and rotation.
    • Knee motion: Flexion, extension, hyperextension, and varus/valgus.
    • Ankle and foot motion: Dorsiflexion, plantarflexion, inversion, eversion, pronation, and supination.
  • Common Gait Deviations:
    • Antalgic gait: Limping due to pain, characterized by a shortened stance phase on the affected side.
    • Trendelenburg gait: Excessive lateral trunk flexion towards the stance side due to weakness of the hip abductors (gluteus medius).
    • Steppage gait: Excessive hip and knee flexion to lift the foot higher off the ground, often due to foot drop (weakness of ankle dorsiflexors).
    • Hemiplegic gait: Circumduction of the affected leg, hip hiking, and limited arm swing due to muscle weakness or spasticity.
    • Parkinsonian gait: Shuffling steps, reduced arm swing, forward trunk flexion, and festination (acceleration of gait).
    • Ataxic gait: Wide base of support, unsteady, and uncoordinated movements due to cerebellar dysfunction.
    • Crouch gait: Excessive flexion of the hips, knees, and ankles throughout the gait cycle, often seen in cerebral palsy.
    • Scissoring gait: Excessive adduction of the legs during swing, causing the knees to cross midline, often seen in cerebral palsy.

Instrumented Gait Analysis

  • Technology is utilized to provide objective and quantitative data about gait.
  • Includes:
    • Motion capture systems: Cameras and reflective markers track joint movements in three dimensions.
    • Force plates: Measure ground reaction forces during stance.
    • Electromyography (EMG): Records muscle activity patterns.
    • Inertial measurement units (IMUs): Sensors that measure acceleration and angular velocity.
  • Provides detailed information about:
    • Kinematics: Joint angles, velocities, and accelerations.
    • Kinetics: Forces and moments acting on the body.
    • Temporal-spatial parameters: Cadence, step length, stride length, and velocity.
    • Muscle activation patterns: Timing and intensity of muscle activity.
  • Advantages:
    • Objective and reliable data.
    • Sensitive to subtle gait deviations.
    • Useful for research and clinical decision-making.
  • Disadvantages:
    • Expensive equipment and specialized training required.
    • Time-consuming data collection and analysis.
    • May not be available in all clinical settings.

Clinical Applications

  • Diagnosis: Identifying the underlying cause of gait abnormalities.
  • Treatment planning: Guiding the selection of appropriate interventions (e.g., exercise, orthotics, assistive devices).
  • Monitoring progress: Tracking changes in gait patterns over time to assess the effectiveness of treatment.
  • Research: Studying the biomechanics of gait and the effects of various interventions.
  • Specific conditions where gait analysis is useful:
    • Stroke
    • Cerebral palsy
    • Parkinson's disease
    • Multiple sclerosis
    • Traumatic brain injury
    • Spinal cord injury
    • Orthopedic conditions (e.g., hip or knee osteoarthritis, ankle sprains)
    • Amputations
    • Foot and ankle disorders

Interpretation of Gait Analysis Data

  • Compare the patient's gait parameters to normative data.
  • Identify deviations from normal gait patterns.
  • Determine the underlying causes of gait deviations (e.g., muscle weakness, joint stiffness, pain).
  • Consider the patient's functional limitations and goals.
  • Integrate gait analysis data with other clinical findings (e.g., physical examination, medical history).

Intervention Strategies

  • Exercise: Strengthening weak muscles, stretching tight muscles, and improving balance and coordination.
  • Orthotics: Providing support and alignment to the foot and ankle, correcting deformities, and improving gait mechanics.
  • Assistive devices: Using canes, walkers, or crutches to improve stability, reduce weight-bearing, and increase independence.
  • Manual therapy: Addressing joint restrictions and soft tissue limitations.
  • Neuromuscular re-education: Retraining normal movement patterns and improving motor control.
  • Functional training: Practicing gait-related activities in a real-world setting.
  • Patient education: Providing information about gait abnormalities and strategies for improving gait.

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