TRANSTIBIAL GAIT DEVIATIONS

1) Excessive knee flexion from IC - midstance

• lack of HS
• frwd trunk flexion
• lateral trunk flexion
• lower cog

2) Absent/ dec knee flexion from IC - midstance

• prolonged foot flat
• hip abd on P Side
• vaulting on sound side

3) Sudden early knee flexion at the end of midstance

• prolong heel off
• prolonged stance phase on sound side
• arrhythmic gait pattern

4) Delayed knee flexion at end of stance

• forward trunk lean
• delayed toe-off on P Side
• dec swing phase on sound side
• sound leg leads
• vaulting on s side

5) Excessive knee flexion prior to toe-off

• pelvic drop, shoulder drop on P side
• prolong stance on s side
• arrhythmic gait pattern

6) Insufficient wt bearing during prosthetic midstance

• prolonged stance on s side
• shortened stance on p side
• prosthesis abducted, cane braced, abducted against s side

TRANSFEMORAL DEVIATIONS

1) Abducted gait

• lateral placement of prosthesis during GC
• inc in width of BOS
• uneven timing
• hip-hiking
• prolonged stance on s side
• vaulting
• moderate lateral lean on p side

2) Circumducted gait

• walking base is normal on double support
• dec knee flexion on p side
• hip hiking on p side
• lateral pelvic drop
• lateral trunk bending toward p side during stance
• unequal timing

3) Uneven heel rise – caused by knee flexion following toe-off

• swing phase is prolonged
• moderate trunk bending towards s side

4) foot-slap following heel contact

• unequal rhythm
• trunk frwd flexion on heel contact
• prolonged stance on s leg

5) Trunk frwd flexion

• trunk leans frwd
• reduced step-length
• hip-hiking
• prosthetic knee flex reduced
• uneven timing

Coxalgia

• characteristic limp, antalgic gait of reflex defence
• period of weight bearing on affected side is shorter
• gluteus medius atrophy, cannot maintain the pelvis horizontally – follows painful stretching of the external part of the capsule – tendency to closure the angle between pelvis axis and axis of weight bearing limb
• tendency to descent of pelvis contra-laterally
• inclination of trunk toward weight bearing member
• arm on wGait in RA

RA a systemic inflammatory disease process, characterized by B/L symmetrical pattern of joint involvement and chronic inflammation of the synovium

*According to a study in J Biomechanics in 1988, “Gait in RA” following results were concluded on a study of 17 female RA patients.

• Stride length & duration of g art cycle were decreased .
• Mobility (ROM) of ankle joint was significantly less in both rotation & adduction among RA patients.

AT HIP JOINT

• Rotation of the hip joint increased.
• Adduction at hip joint decreased

AT KNEE JOINT

• No ssd were ascertained in ROM of knee joint.

AT ANKLE JOINT

• Maximum angular execution of ankle at toe off.

• Pattern of ankle flexion- different in RA patients.

• Smaller PF at toe off than normals.

• In advanced stages of disease, tendency to valgus deformity.

• Inflammation of ankle joint prevented the normal mechanism of adduction in subtlar joint at the end of stance, for an energetic push off (by rigid lever)

*According to a study by D Laroche et al in J Biomechanics, 2005 on “Effect of loss of MTP joint mobility on gait in RA”, it was concluded.

• Walking velocity & stride length were decreased +vely related to MTP DF ROM
• Decreased MTP ROM –esp in DF rom
• Pain during walking was exp by 5/9 patients and DF tended to be decreased in these patients
• Negative relationship b/w MTP DF rom & maximal hip and knee flexion during walking.

OA marked by two localized , pathological features

Progressive destruction of articular & formation of bone at the margins of joint.

Confines itself to affected joint.

Mechanical factors play a significant role in the ethology of the disease by giving rise to instating

joint damage.

High loading rates-increases risk if OA.

*According to study by H.S. Gill of Biomechanics, 2003 on”Heel strike & pathomechanics of OA” it was concluded that;

The test population was divided into two gps

Displayed markedly different loading during H S phrase of gait- attributed to differences in the vertical velocity of the ankle at HS.

Differences in loading -more apparent in saggital plane.

Subtle differences in the trajectories appeared to produce large difference on ankle velocity at HS .

The Non -loader gp lifted their ankle higher (ssd) than loader gp during early swing phase.

Antalgic Gait

It reflects the body’s efforts to compensate for pain or instability in the stance- phase limb by minimizing the duration and magnitude of loading. It is a gait pattern characterized by diminished single limb stance time.

• Habitual limp
• Distinguished by awkward displacement of shoulder &
• Characteristic rhythm

*According to a study in JBJS, 1939

Probable cause

1. Shortening – a sufficiently large number of coxalgic patient are cured with affected limb, the same length as the other

• i.e. there is no shortening but patients continue to limp
• patients with shortening following fracture of the thigh do not commence to limp (unless 3-4 cm)

2. Ankylosis – Bony ankylosis of hip, consequent to a true osseous fusion of femur to pelvis causes only a very slight limp

- the less complete the ankylosis the more attentuated limp

3) Deformity – (flexion, abduction, adduction, irotation)

• deformities when very marked – render walking almost impossible

• compensatory attitude – ascent of pelvis, accentuated lorsosis – too render walking possible but with awkward and painful limp

• with correction of deformity antalgic gait reappears

Trendelenburg Limp – mechanical phenomenon

• insufficiency of the gluteus medius
• causes pivoting of the pelvis around femoral head
• descent of iliac spine on the contra-lateral side, as a result
• lack of opposition of this descent
• may be associated with CDH

• eight bearing side is carried outward in order to aid in the lateral displacement of the weight of the upper segment
• ankle of the contra-lateral side rests upon knee of the stance side, permits transposition of weight of non weight bearing limb to a point outside the affected hip
• cog is no longer in the middle, displaced towards affected side – almost above femoral head

Thus limp seen in coxalgia – a limp of defence be antalgic reflex

• not associated exclusively with coxalgia
• seen in all conditions causing instability of hip
• frequent in CDH – particularly in subluxation where arthritis predominates
• bi-lateral CDH
• it is an indication of degree of irritability of neo-capsule
• arthritis deformans
• antalgic movement makes avoidance of pain possible

Hemiplegic Gait

The word hemiplegia means the neuromuscular disorder that involves one-half of the body i.e. paralysis of the body in the frontal plane while the other half is normal/near normal.

Hemiplegia may occur in adults as a result of CVA, traumatic brain injury & in children due to cp apart from trauma.

Deviations in hemiplegic gait

*Acc. To a study by Sandra J Olney et al in 1994 on various variables related to gait speed in hemiplegic pts. Following results were concluded.

• -ve correlations b/w gait speed & variables-stance double support
• max. extension of the affected hip bore the strongest relationship to speed the greater the angle the greater the speed.
• A very strong association b/w speed & max. hip flexion moment was observed,
• Speed of walking chosen by the pts. Is related to the strength of affected limb
• Knee power relates +vely to speed –unless knee flexion occurs a functional push-off at ankle & pull-off at hip cannot be achieved
• High correlation b/w max hip power & +ve work of the hip with speed is noted. Max hip power occurs durin late stance, early swing.
• Therapeutic programs (biofeedback) that are directed towards changing specific variables have potential only if within subject variation relates to predictably to speed otherwise it will be useless to train in them.
• Certain variables are notable for not relating to speed e.g. knee flexion in stance phase is poorly related to speed so no point training in knee control to gain speed .

Commonly Used Abbreviations for Pediatric PhysicalTherapist

PEDIATRIC THERAPIES TEST ABBREVIATIONS

Physical therapist and students here given below is the list of abbreviations to which you must be familiar before entering in the pediatric ward or neonatal ICU

ABBREVIATION             TITLE

ACE 6-11                      Assessment of Comprehension and Expression 6-11

BPVS                            British Picture Vocabulary Scale

CELF                             Clinical Evaluation of Language Fundamentals

CELF                             Pre Clinical Evaluation of Language Fundamentals - Pre-School

CLEAR                          Clear phonology screening assessment

DEAP                            Diagnostic Evaluation of Articulation and Phonology

DLS                              Derbyshire Language Scheme

PLS                              Pre-school Language Scales

PSA                              Phonology Screening Assessment

RAPT                            Renfrew Action Picture Test

RDLS                            Reynell Developmental Language Scales

RWFT                           Renfrew Word Finding Test

STAP                            South Tyneside Assessment of Phonology

CANT & THAN               Canterbury & Thanet Verbal Reasoning Scales

MVPT-R                        Motor-Free Visual Perception Test - Revised

DTV-P2                        Developmental Test of Visual Perception 2

Peabody                       Peabody Developmental Motor Scales

TVPS                            Test of Visual- Perceptual Skills (Non Motor)

Beery                           VMI Developmental Test of Visual Motor integration

BOTOMP-2                    Bruininks- Oseretsky Test of Motor Proficiency 2

MAP                             Miller Assessment for Preschoolers

MABC-2                        Movement Assessment Battery for Children - 2

Bayleys                        Bayley Scales of Infant Development (II)

Clin Obs                       Observational/Criterion Referenced Assessments

Durrell                          Durrell Test of Handwriting Speed

DASH                           Detailed assessment of Speed of Handwriting

SFA                              School Function Assessment

Sensory Profile             Sensory Profile Questionnaire (Winnie Dunn)

PEDI                            Peadiatric Evaluation of Disability Inventory

AIMS                           Alberta Infant Motor Scale

Chailey level                Chailey Levels of Ability

GMFCS                         Gross Motor Function Classification System

GMFM                          Gross Motor Function Measure

GAS                            Goal Attainment scaling

AHA                            Assisting Hand Assessment