NR548/ NR 548 Final Exam Questions and Answers Latest 2024/2025 | 100% Correct | Graded A+

Describe the compensated trendelenburg gait that occurs with hip pain - ANS -Compensated trendelenburg gait shifts GRFV *through* the painful hip joint to *stabilize* the joint and *decrease* torque -Without compensation, aBductor muscles have to contract against aDuction moment, which causes *compression* at hip joint ___% of people with Parkinson's disease have difficulty walking within 3 years of diagnosis - ANS *85%* of people with Parkinson's disease have difficulty walking within 3 years of diagnosis ___% of people with MS experience mobility problems - ANS *75%* of people with MS experience mobility problems ___% of people who have strokes regain community mobility - ANS *50%* of people who have strokes regain community mobility Define *gait* versus *walking* versus *mobility* - ANS -*Gait*: pattern of movement of the limbs during locomotion -*Walking*: one form of locomotion -*Mobility*: ability to safely and independently move from one point to another List 3 dimensions of the neural control of walking - ANS 1. *Sensory*: afferent input 2. *Spinal cord*: central pattern generators 3. *Supraspinal*: cortical systems for complex navigation (obsticles, etc.) to adapt gait pattern Define and describe the function of *central pattern generators (CPG)* - ANS -*CPG* = network of neurons and inter-neurons in spinal cord -Generate coordinated movements autonomously -Modified by ascending and descending signals from cortex and the periphery Name two *ascending sensory inputs* that influence the stance-to-swing transition - ANS -Hip NR548 Final Exam Questions and Answers Latest 2024/2025 | 100% Correct | Graded A+ extension -Unloading of ankle PFs The same ascending sensory input can modify gait responses to stimuli in (the same/different) ways - ANS The same ascending sensory input can modify gait responses to stimuli in *different* ways Describe the *reactive control* to an obstacle encountered EARLY during swing phase - ANS -"Elevating strategy" -Flexion of swing limb to clear obstacle -Extension of stance leg to prolong stance Describe the *reactive control* to an obstacle encountered LATE during swing phase - ANS -"Extension strategy" -Extension of swing limb to lower leg -Flexion during opposite leg's swing phase to clear obstacle What are the two greatest requirements during gait in terms of body function? - ANS - PROGRESSION: Moving forward -STABILITY: Staying upright Describe the two major domains of the proactive control during walking - ANS *Sensory* -Vision: avoidance & accommodation *Cognitive* -Piloting/navigating -Anticipation -Attention Name the three brainstem locomotor regions and their functions during gait - ANS - *Mesencephalic*: gait initiation, speed of locomotion -*Pontine*: control of postural tone -*Subthalamic*: obstacle avoidance Name the two major subcortical regions and their function during gait - ANS *Cerebellum* -Coordination of gait pattern -Online error correction -Motor learning and adaptation *Basal Ganglia* -Projections to brainstem -Automaticity of walking Describe the 4 components of observational movement analysis - ANS 1. *Description*: what does efficient gait look like 2. *Observation*: describe performance 3. *Evaluate*: compare observed movement to ideal movement 4. *Treat*: provide interventions to correct or improve movement Define the *impairment framework* versus the *diagnostic framework* of pathologic gait - ANS -*Impairment framework*: identifies impairments in the gait pattern -*Diagnostic framework*: identifies changes in the gait pattern that are common to a particular diagnosis Define *spasticity*. Which populations experience spasticity? When is spasticity apparent in gait pattern? - ANS -Velocity-dependent increase in resistance to passive stretch; results in excessive activation of muscles when they are quickly lengthened -Common in: CP, CVA, TBI, MS -Gait pattern impairments apparent when spastic muscle is being lengthened rapidly In which phases of gait is PF spasticity most provoked? What effects does this have? - ANS *LR -- Terminal Stance* -Inability to dorsiflex -- early heel rise -Shank moves back -- hyperextension of knee *Initial Swing -- Mid Swing* -Inability to clear toes/DF -- circumduction, lateral lean, rotation In which phases of gait is quadriceps spasticity most provoked? What effects does this have? - ANS *LR* -Contributes to knee extension/hyperextension *Terminal stance -- initial swing* -Decreased knee flexion -Decreased foot clearance in swing Generally: increased risk for tripping/falling In which phases of gait is hamstring spasticity most provoked? What effects does this have? - ANS *Mid Stance -- Terminal Stance* -Decreased extension/increased flexion of knee during stance *Mid Swing -- Terminal Swing* -Decreased extension/increased flexion of knee during swing Generally: hamstring spasticity common in CP and can contribute to "crouched" gait pattern In which phases of gait is adductor spasticity most provoked? What effects does this have? - ANS *Swing* -Increased hip adduction during swing leads to foot placement that crosses midline *Stance* -Contralateral hip drop (e.g. L hip drops during R stance due to R hip adduction) Generally: "scissoring" gait pattern seen in SCI, MS, & CP -Narrow BOS = instability -Moving into swing phase, can catch foot on opposite leg = risk for tripping/falling Define *rigidity*. Which populations experience rigidity? When is rigidity apparent in gait pattern? - ANS -Increased resistance to passive stretch that is independent of velocity -Common in: PD and Parkinson-plus syndromes -Tends to affect the entire limb versus certain muscle groups; effect on gait depends upon degree of rigidity Define *paresis*. Which populations experience paresis? - ANS -Inability to contract a muscle due to insufficient supraspinal recruitment of motor neurons -Common in: CVA, TBI, SCI, MS In which phases of gait is PF paresis most evident? What effects does this have? - ANS Reduced PF force from *mid stance -- terminal stance* reduces advancement of limb during *swing phase*; can result in compensatory strategies at hip & trunk to advance limb: -Posterior trunk lean -LE external rotation to use hip adductors -Circumduction In which phases of gait is DF paresis most evident? What effects does this have? - ANS *Pre Swing-- Initial Contact* -Reduced DF leads to reduced foot clearance during swing phase; can result in compensatory strategies at knee, hip, or trunk -Hip circumduction -Elevation of ipsilateral hip to clear foot In which phases of gait is hip flexor paresis most evident? What effects does this have? - ANS *Pre Swing -- Terminal Swing* -Reduced hip flexor activation limits limb advancement during swing; can result in compensatory strategies to advance limb -LE external rotation to use hip adductors -Posterior trunk lean Define *ataxia*. Which populations experience ataxia? How does ataxia affect gait? - ANS - Abnormal patterns of muscle activation that affect the timing or scaling of muscle activity -Common in: cerebellar dysfunction (CVA, MS, TBI, degenerative disease), proprioceptive loss -Highly variable effect on gait (generally may see a "high steppage gait"; more hip & knee flexion) Loss of sensory inputs can be __________ or __________ - ANS Loss of sensory inputs can be *central* or *peripheral* -Central = visual, vestibular, perceptual (e.g. hemispatial inattention) -Peripheral = peripheral neuropathy How might *cognitive/behavioral* impairments affect gait? - ANS -Impulsivity -Impaired judgment -Attention & memory deficits impacting route finding/navigation -After ~___ years, half of the population has a gait impairment -20-30% of individuals above ___ years fall every year (and 10-30% of falls result in injury) - ANS -After ~*85* years, half of the population has a gait impairment -20-30% of individuals above *65* years fall every year (and 10-30% of falls result in injury) According to the Functional Independence Measure (FIM) you must be able to walk ___m/___ft to be designated an "independent ambulator" - ANS According to the Functional Independence Measure (FIM) you must be able to walk *46*m/*150*ft to be designated an "independent ambulator" Community ambulation requires: -Crosswalks: ___m -Curb height: ___cm -Post office: ___m -Club warehouse (e.g. Costco): ___m - ANS Community ambulation requires: -Crosswalks: *10-20*m -Curb height: *17-18.5*cm -Post office: *64*m -Club warehouse (e.g. Costco): *677*m What is the "normal" speed of walking? - ANS 1.33m/s Which populations typically display a *hemiparetic gait*? How does a hemiparetic gait affect gait? - ANS -Common in: CVA, TBI -Stance phase shortened on hemiparetic side due to lack of stability and swing phase lengthened Name 4 variable contributing impairments that can occur with *hemiparetic gait* - ANS - *Musculoskeletal*: ROM, weakness -*Neuromuscular*: spasticity, paresis, coordination -*Sensory/perceptual*: hemianopsia, somatosensory deficits, hemispatial inattention -*Cognitive/behavioral*: confusion/impulsiveness What are some common spatiotemporal characteristics of *hemiparetic gait*? Think in general terms as well as in the involved and uninvolved LE. - ANS General: According to the Functional Independence Measure (FIM) you must be able to walk ___m/___ft to be designated an "independent ambulator" - ANS According to the Functional Independence Measure (FIM) you must be able to walk *46*m/*150*ft to be designated an "independent ambulator" Community ambulation requires: -Crosswalks: ___m -Curb height: ___cm -Post office: ___m -Club warehouse (e.g. Costco): ___m - ANS Community ambulation requires: -Crosswalks: *10-20*m -Curb height: *17-18.5*cm -Post office: *64*m -Club warehouse (e.g. Costco): *677*m What is the "normal" speed of walking? - ANS 1.33m/s Which populations typically display a *hemiparetic gait*? How does a hemiparetic gait affect gait? - ANS -Common in: CVA, TBI -Stance phase shortened on hemiparetic side due to lack of stability and swing phase lengthened Name 4 variable contributing impairments that can occur with *hemiparetic gait* - ANS - *Musculoskeletal*: ROM, weakness -*Neuromuscular*: spasticity, paresis, coordination -*Sensory/perceptual*: hemianopsia, somatosensory deficits, hemispatial inattention -*Cognitive/behavioral*: confusion/impulsiveness What are some common spatiotemporal characteristics of *hemiparetic gait*? Think in general terms as well as in the involved and uninvolved LE. - ANS General: EMAIL ME: For help with report, Assignment, Essay and thesis writing -Decreased velocity -Decreased cadence -Increased double limb support time Involved LE: -Decreased stance time -Increased swing time -Decreased toe clearance Uninvolved LE: -Increased stance time -Decreased swing time -Decreased step length What are some common kinematic characteristics at the ankle, knee, and hip during the STANCE phase of *hemiparetic gait*? - ANS *Ankle* -Plantarflexed -Flat foot or forefoot IC *Knee* -Hyperextension in mid stance *Hip* -Limited extension in terminal stance What are some common kinematic characteristics at the ankle, knee, and hip during the SWING phase of *hemiparetic gait*? - ANS *Ankle* -Insufficient DF -Variable foot placement at IC *Knee & Hip* -Insufficient flexion to functionally shorten limb What are some common spatiotemporal characteristics of *ataxic gait*? - ANS -Decreased velocity -Decreased step length -Increased or variable step width -"High steppage" pattern to clear feet What are some common kinematic characteristics of *ataxic gait*? - ANS -Increased trunk movement -Poorly coordinated limb movement -Increased step-to-step variability Name 3 variable contributing impairments that can occur with *parkinsonian gait* - ANS - *Musculoskeletal*: ROM, weakness -*Neuromuscular*: rigidity, bradykinesia -*Cognitive/behavioral*: normal -- mild cognitive impairment -- dementia What are some common spatiotemporal characteristics of *parkinsonian gait*? - ANS - Decreased velocity -Decreased step length -Decreased toe clearance -Decreased stance and swing time -"Shuffling"/"festinating" gait pattern