Mobility & Gait PDF

Mobility & Gait Jennifer Krysa, OT Reg (AB), OTR Terminology ► Functional Mobility ► Ambulation ► Gait Terminology Cont’d ► Cadence = frequency ► Step length = distance traveled by 1 foot ► Stride length = 2 x step length ► Step width = distance between heels Functional Mobility ► Bed...

Mobility & Gait Jennifer Krysa, OT Reg (AB), OTR Terminology ► Functional Mobility ► Ambulation ► Gait Terminology Cont’d ► Cadence = frequency ► Step length = distance traveled by 1 foot ► Stride length = 2 x step length ► Step width = distance between heels Functional Mobility ► Bed mobility ► Transfers ► Wheelchair mobility ► Ambulation Ambulation ► Is ambulation an occupation? Ambulation - Purpose ► To get somewhere ► Part of ADLs ► Exercise ► Leisure ► Productivity ► Social expectation of independence Base of Support (BOS) ► Baseof Support: Parts of body +/- mobility device in contact with the ground or another surface Centre of Gravity (COG) ► Centre of Gravity: the point at which weight is distributed equally in all directions Gait Cycle ► Repeatingpattern of lower extremity movements that propel the body forward ►1 gait cycle = time between two occurrences of same event (e.g. heel strike) ► Each gait cycle has two phases ► Stance 60% ► Swing 40% Stance Phase ► Heel strike ► Foot flat ► Midstance ► Heel off ► Toe off Swing Phase Ground Reaction Force (GRF) ► The force exerted on a limb by the ground during contact ► Vectors create direction of moment (external) ► Muscles act to create an internal moment 🡪 equilibrium ► GRF rises & falls below body weight between heel strike & toe off Pelvis during ambulation ► AP: Anterior during swing ► Sup/Inf:elevates with weight shift loading; depresses with swing ► Lateral: towards stance leg in midstance ► Results in a sine wave Models ► Inverted pendulum 🡪 walking ► Spring mass 🡪 Running ► Walking is more dynamic More to the Story ► Neural command & sensory feedback ► Muscle-tendon dynamics ► Musculoskeletal geometry ► Skeletal dynamics ► Accelerations, velocities, angles Developmental Developmental Functional Mobility ► Rolling (4-5 mo) ► Creeping ► Crawling (6-8 mo) ► Sitting without support (6-8 mo) ► Stepping ► Pulling into stand (9-10 mo) ► Cruising ► Walking (11-15 mo) Early Toddler Gait ► Wide—based ► High cadence ► Short stride length ► Hips in ER Development of Gait ► 2 yo: heel strike & reciprocal arm swing present ► Short single leg stance phase ► Ankle response limited ► 3 yo: mature gait pattern ► 7-8 yo: independent control of each anatomical segment Pathological Gait Pathological Gait - Causes ► Medications ► Pain ► Weakness ► Altered tone ► Impaired balance ► Fatigue ► Joint stiffness ► Overall health ► Specific medical conditions Pathological Gait - Effects ► Trunk sway ► Change in weight-bearing ► Altered leg or arm swing ► Circumduction ► Knee dysfunction ► Toe drag ► Decreased heel strike ► Gravitational insecurity ► Postural effects Antalgic Gait ► Decreased stance phase on affected leg; swing phase unaffected ► Decreased swing phase of unaffected leg ► Cause: Pelvis, hip, knee, ankle or foot Ataxic Gait ► Wide-based; uncoordinated ► Lurching & staggering ► Exaggerated movements ► Cause: usually cerebellar dysfunction ► Stroke ► Tumor ► MS ► Neurodegenerative diseases ► EtOH misuse Choreiform ► Hyperkinetic ► Excessive movements ► Balance unaffected Diplegic Gait ► Bilat L/Es more than bilat U/Es ► Flexion at hips & knees in IR ► Tight adductors & walking on toes ► Swinging gait on both sides ► No arm swing; arms in guard position Hemiplegic Gait ► L/E circumduction ► Arm carried across trunk ► Cause: Paralysis or profound weakness on one side ► CVA ► Cerebral palsy ► TBI Myopathic Gait ► Waddling: sway from side-to-side and hip drops each step ► Causes: weakness of hip girdle muscle ► Congenital hip dysplasia ► Muscular dystrophies ► Spinal muscular atrophy Neuropathic ► Foot drop with high stepping (equine) ► Foot slaps the ground ► Cause: inability to dorsiflex ankle ► CVA ► TBI ► Trauma Parkinsonian Gait ► Hypokinetic ► Neck, trunk & knees are flexed ► Short shuffling steps ► Decreased heel strike ► Decreased arm swing ► Festinating Scissor Gait (Neurogenic Gait) ► Narrow or crossed L/Es due to tight adductors ► Causes: spastic paralysis of adductors Trendelenburg Gait ► Weakness in hip abductors ► Gluteus medius (and minimus) ► Unable to stabilize during stance phase and trunk shifts over affected hip ► Pelvis on swing leg side drops Outcome Measures Timed Up & Go (TUG) ► A measure of mobility ► Quick, easy, well-tolerated ► Good test-retest reliability and sensitive to change ► From sitting, walk 3 m then turn & walk back and sit 6 Minute Walk Test ► Developed to test endurance/exercise tolerance (submax exertion) ► Distance covered in 6 minutes 10 Metre Walk test ► A measure of gait speed ► Statistically significant correlations between gait speed and falls, frailty and functional independence 3 Metre backward Walk test (3MBWT) ► Walking backwards requires protective reflexes, proprioception, balance and neuromuscular control ► Vital for self-care occupations Dynamic Gait Index ► Client must maintain walking balance during tasks ► Walking on level ► Head turns ► Stairs ► Step over ► Step around GAITRite ► Electronic walkways ► Cameras & laptop GAITRite Sample Data Considerations Cosiderations ► Footwear ► Test environment ► Gait Aides ► Level of Assist ► Weight-bearing status Level of Assist ► Independent ► Standby Assist ► Contact Guard Assist ► 1 Person Assist ► 2 Person Assist Weight-bearing Status ► Non WB (NWB) ► Feather WB (FWB) ► Partial WB (PWB) ► WB as tolerated (WBAT) ► Full Using the OT Lens ► Assess context in which ambulation is to occur ► Physical: e.g. flooring, transitions ► Need to carry objects ► Home modifications ► Explore relationship between occupations and ability to mobilize and set collaborative goals ► Shovelsnow, walk backwards to toilet, walk sideways to go to movies OT Lens - 2 ► Fabricate/consult on footwear & L/E orthoses ► Leg length discrepancy ► Off load wounds ► Footdrop AFO or toe strap ► Accommodate traumatic injury ► Splinting to preserve nerve function and/or tendon length OT Lens - 3 ► Education ► Energy conservation ► Pain management ► Falls prevention ► Risk mitigation OT Lens - 4 ► Apply psychosocial training to address: ► Cognition ► Perceptual disturbance ► Anxiety ► Hallucinations, illusions OT Lens - 5 ► Hand & U/E rehab to enable manipulation of gait aid handle ► Adapt gait aid interfaces to suit needs of individual (grip, sensory, etc)