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Pathological Gait PowerPoint PPT Presentation


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Pathological Gait. Excessive Plantarflexion. Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak quadriceps. Loading Response Deviations. FF contact sustained. FF contact  foot flat (rigid ankle)  knee hyperextension.

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Pathological Gait

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Pathological Gait


Excessive Plantarflexion

Causes

  • Triceps surae contracture

  • Triceps surae spasticity

  • Pre-tibial weakness

  • Voluntary/compensatory 20 weak quadriceps


Loading Response Deviations

FF contact sustained

FF contact  foot flat (rigid ankle)  knee hyperextension

FF contact  rapid foot

flat (flexible ankle)

FF = fore foot


Midstance Deviations

Foot flat w/ restrained

tibia

Fwd. trunk lean, short contralateral step

Premature

heel rise


Terminal Stance Deviations

Pelvic obliquity  high on side of deviation

Excessive heel rise


Mid Swing Deviations

Compensatory  hip and/or knee flexion

Toe Drag


Excessive Dorsiflexion

  • Weak triceps surae

  • Ankle joint fusion at neutral

  • Excessive knee flexion


Loading Response Deviations

Higher heel rocker

 knee    quad demand


Loading Response Deviations 20 Rigid AFO

Rigid AFO  knee and hip flexion


Terminal Stance Deviations

Prolonged heel contact

 knee  w/ heel rise

OR


Pre Swing Deviations

Sustained heel contact   plantarflexion


Inadequate Knee Flexion / Excessive Extension

  • Quadriceps weakness

  • Pain

  • Quadriceps spasticity

  • Excessive ankle plantarflexion


Pre Swing and Initial Swing

 ankle dorsiflexion w/

prolonged heel contact

Toe Drag


Midstance

Retraction of tibia (soleus)

and femur (gluteus max)

when knee lacks

hyperextension range


Inadequate knee flexion 20 excessive plantarflexion

Overall disruption of normal coordination

between the knee and ankle


Inadequate Knee Extension / Excessive Knee Flexion

Causes

  • Hamstring spasticity

  • Knee flexion contracture

  • Soleus weakness

  • Excessive ankle plantarflexion


Excessive Knee Flexion - Loading Response

Resulting in  ankle dorsiflexion


Excessive Knee Flexion - Midswing

As a compensation for

 ankle plantarflexion


Inadequate Knee Extension – Midstance and Terminal Stance

Accompanied w/  ankle dorsiflexion   limb

and body advancement


Inadequate Knee Extension – Terminal Swing

Loss of terminal reach


Inadequate Hip Extension – Excessive Hip Flexion

  • Hip flexion contracture

  • Iliotibial band contracture

  • Hip flexor spasticity

  • Pain

  • Voluntary/Compensatory


Inadequate Hip Extension – TSt

Contracture

 step length and

body advancement


Excessive Hip Flexion - MSw

Compensation for 

ankle plantarflexion


Inadequate Hip Flexion

  • Hip flexor weakness

  • Hip joint arthrodesis


Inadequate Hip Flexion - TSw

Rapid hip /

Rapid hip 

Compensation for weak quadriceps that

cannot extend the knee (flaccid knee)


Compensations for Inadequate Hip Flexion – PSw/ISw

Compensatory posterior

pelvic tilt


Compensations for Inadequate Hip Flexion – PSw/ISw

Voluntary excessive (magnitude &

velocity) knee flexion


Excessive Hip Adduction

Causes:

  • Ipsilateral abductor weakness

  • Adduction contracture or spasticity

  • Using adductors as hip flexors

  • Contralateral hip abduction contracture


Deviations

Swing  “Scissor Gait”

Combined hip  & IR


Deviations

20 adductor contracture

or spasticity

20 adductors used as hip flexors

20 glute med weakness


Excessive Hip Abduction

Causes

  • Ipsilateral abduction contracture

  • Contralateral adduction contracture

  • Scoliosis w/ pelvic obliquity


Deviations

Compensation for

inadequate knee flexion

20 contralateral

abduction or ipsilateral

adduction contracture


Excessive Hip External Rotation

Causes

  • Gluteus maximus overactivity

  • Excessive ankle plantarflexion


Excessive Hip Internal Rotation

Causes

  • Medial hamstring overactivity

  • Adductor overactivity

  • Anterior abductor overactivity

  • Quadriceps weakness


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