Gait Assessment of Gait Assessment of Neurologically Challenged g - - PowerPoint PPT Presentation

Gait Assessment of Gait Assessment of Neurologically Challenged g y g Patients

Cathelyn Timple, PT, DPT, NCS, ATP

Casa Colina Centers for Rehabilitation

Objectives Objectives

Understand normal gait mechanics and terminology Understand normal gait mechanics and terminology Recognize pathological gait patterns commonly associated with visual and vestibular deficits in neurologically challenged g y g patients. Administer the Functional Gait Assessment and the 10-Meter W lk T t Walk Test

Normal Gait Normal Gait

“repetitious sequence of limb motion to move the body forward while simultaneously maintaining stance stability stability

Observational Gait Analysis Gait Analysis

• Qualitative visual description
• Qualitative visual description
• f an individual’s upper and

lower extremities, pelvis and k d trunk motions during ambulation.

Normal Human Gait Normal Human Gait

Stride Stride Stance Stance Weight Acceptance Weight Acceptance Single Limb Support Single Limb Support Swing Swing AdvancementLimb AdvancementLimb Initial Contact Initial Contact Loading Response Loading Response Support Support Mid Stance Mid Stance Terminal Stance Terminal Stance PreSwing PreSwing Initial Swing Initial Swing Mid Swing Mid Swing Terminal Swing Terminal Swing

Normal Human Gait Normal Human Gait

STANCE: 62% SWING 38% IC LR MSt TSt PSw ISw MSw TSw Weight Single Limb Swing Limb Advancement Acceptance Support

Stance Phase Stance Phase

Initial Contact (IC) The moment when the foot Initial Contact (IC): The moment when the foot contacts the ground

Stance Phase Stance Phase

Loading Response (LR) Weight is rapidly transferred Loading Response (LR): Weight is rapidly transferred

• nto the outstretched limb, the first period of double-

limb support

Stance Phase Stance Phase

Mid Stance (MSt): The body progresses over a single Mid-Stance (MSt): The body progresses over a single, stable limb.

Stance Phase Stance Phase

Terminal Stance (TSt): Progression over the stance Terminal Stance (TSt): Progression over the stance limb continues. The body moves ahead of the limb and weight is transferred onto the forefoot.

Stance Phase Stance Phase

Pre Swing (PSw): A rapid unloading of the limb Pre-Swing (PSw): A rapid unloading of the limb

• ccurs as weight is transferred to the contralateral limb.

Swing Phase Swing Phase

Initial Swing (ISw): The thigh begins to advance as Initial Swing (ISw): The thigh begins to advance as the foot comes up off the floor.

Swing Phase Swing Phase

Mid Swing (MSw): The thigh continues to advance as Mid-Swing (MSw): The thigh continues to advance as the foot comes up off the floor.

Swing Phase Swing Phase

Terminal Swing (TSw): The knee extends the limb Terminal Swing (TSw): The knee extends; the limb prepares to contact the ground for Initial Contact.

Pathological Gait Analysis Analysis

Common Descriptive Terms for p Abnormal Gait

Antalgic Hiking Antalgic Ataxic Hiking Trendelenberg Athetoid Festinating Toe Drag Vaulting Scissoring Shuffling Unstable Extensor syngery Shuffling Steppage Extensor syngery Flexor syngery

Qualitative Gait Analysis Form

Quantitative Gait Analysis

Functional Gait Assessment Functional Gait Assessment

Standardized test for assessing postural instability Standardized test for assessing postural instability during various walking tasks 10 item gait assessment based on the Dynamic Gait 10- item gait assessment based on the Dynamic Gait Index Equipment Stop atch marked alking area shoe bo Equipment: Stopwatch, marked walking area, shoe box for obstacle, set of steps S i g 0 f i i t t 3 f l Scoring: 0 for severe impairment to 3 for normal performance; maximum score possible is 30.

Functional Gait Assessment Functional Gait Assessment

Step over Obstacle Gait Level Surface Step over Obstacle Gait with Narrow Base of Support Gait Level Surface Change in Gait Speed pp Gait with Eyes Closed A b l B k d Gait with Horizontal Head Turns G h V l H d Ambulation Backwards Steps Gait with Vertical Head Turns G it d Pi t T Gait and Pivot Turn

Functional Gait Assessment

Reference Group Data

Age N Min Max Mean SD CI Age N Min Score Max Score Mean SD CI 40-49 27 24 30 28.9 1.5 28.2-29.5 50 59 33 25 30 28 4 1 6 27 9 29 0 50-59 33 25 30 28.4 1.6 27.9-29.0 60-69 63 20 30 27.1 2.3 26.5-27.7 70-79 44 16 30 24.9 3.6 23.9-26.0 80-89 33 10 28 20.8 4.7 19.2-22.6 TOTAL 20 10 30 26.1 4.0 25.5-26.6

10-Meter Walk Test 10-Meter Walk Test

Examines gait speed Examines gait speed To administer test:

M 10 d k d i h Measure a 10 meter course and mark ends with tape Position subject 3 feet behind tape Instruct the subject to walk at a comfortable rate until Instruct the subject to walk at a comfortable rate until he is 3 feet past the time line Repeat up to 3 times and average the times h b lk b b f Instruct the subject to walk as above , but as fast as possible Repeat up to 3 times and average the times p p g

10-Meter Walk Test 10-Meter Walk Test

Comfortable (m/min) Maximum (m/min) Gender/Deca d Men Women Men Women de 20s 83.6 84.4 151.9 148.0 30s 87.5 84.9 147.4 140.5 40s 88.1 83.5 147.7 127.4 50s 83.6 83.7 124.1 120.6 60s 81.5 77.8 115.9 106.4 60s 81.5 77.8 115.9 106.4 70s 79.5 76.3 124.7 104.9

CASE STUDY CASE STUDY

QUESTIONS???? QUESTIONS????

REFERENCES

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Perry J. Gait Analysis: Normal and Pathological Function. Thorofare, New Jersey, SLACK Incorporated, 1992. Schulmann DL, Godfrey B, Fisher AG. Effect of Eye Movements on Dynamic Equilibrium. Physical Therapy 1987:1054-1057. Von Schroeder HP, Coutts RD, Lyden PD, Billings Jr. E, Nickel VL. Gait parameters following stroke: A practical assessment. Journal of Rehabilitation Research and Development. February 1995; 32(1): 25-31. Wade MG, Jones G. The Role of Vision and Spatial Orientation in the Maintenance of Posture. Phys Ther. 1997;77:619-628. Zampieri C, Di Fabio RP. Balance and Eye Movement Training to Improve Gait in People With Progressive Supranuclear Palsy: Quasi- Randomized Clinical Trial. Physical Therapy. 2008;88:1460-1473. The Pathokinesiology Department and The Physical Therapy Department Rancho Los Amigos. Observational Gait Analysis Handbook. Los Amigos Research and Education Institute, Inc; 1996.