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 of an individual’s upper and lower extremities, pelvis and trunk motions during k d ambulation.

Normal Human Gait Normal Human Gait Stride Stride Stance Stance Swing Swing Weight Acceptance Weight Acceptance Single Limb Single Limb AdvancementLimb AdvancementLimb Support Support Support Support Initial Contact Initial Contact Loading Response Loading Response 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) Initial Contact (IC) : The moment when the foot 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 onto 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 occurs 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 Antalgic Hiking Hiking Ataxic Trendelenberg Athetoid Toe Drag Festinating Vaulting Scissoring Unstable Shuffling Shuffling Extensor syngery Extensor syngery Steppage 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 Scoring: 0 for severe impairment to 3 for normal S i g 0 f i i t t 3 f l performance; maximum score possible is 30.

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

Functional Gait Assessment Reference Group Data Age Age N N Min Min Max Max Mean Mean SD SD CI CI Score Score 40-49 27 24 30 28.9 1.5 28.2-29.5 50-59 50 59 33 33 25 25 30 30 28 4 28.4 1.6 1 6 27 9 29 0 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 Measure a 10 meter course and mark ends with tape 10 d k d i h 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 Instruct the subject to walk as above , but as fast as h b lk b b f 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 Men Women Men Women d 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 60s 81.5 81.5 77.8 77.8 115.9 115.9 106.4 106.4 70s 79.5 76.3 124.7 104.9

CASE STUDY CASE STUDY

QUESTIONS???? QUESTIONS????

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