Gait Basics
History and Physical Exam
Clinical Tests/ Classification Scale
Labs Tests/Interventions
Act it Out: Gait
100
What percentage of adults over the age of 65 require ambulation assistance w. a walking device?
20 %
100
How often should a physician ask a patient 65 and older about falls? How often should a physician examine a patient's gait/ balance?
Annually Once
100
What scale is used to assess ambulation?
Functional Ambulation Classification Scale https://www.aafp.org/afp/2010/0701/hi-res/afp20100701p61-t4.gif
100
What lab tests would be useful in assessing fall risk?
CBC TSH RPR BMP Vit B12 Urine
100
Cerebellar Ataxia
What is a staggering, wide gait. Associated Signs:Dysarthria; dysdiadochokinesia; dysmetria; impaired check; intention tremor; nystagmus; postural instability; rebound; Romberg sign present; titubation Cause:Cerebellar degeneration; drug or alcohol intoxication; multiple sclerosis; stroke; thiamine deficiency and vitamin B12 deficiency
200
Studies comparing healthy persons in their 70s with healthy persons in their 20s demonstrate ____ reduction in gait velocity and stride length in the older population.
10 - 20 %
200
What information should be included in an HPI regarding falls?
1. Acute and chronic medical problems that could contribute 2. Falls history (previous falls, injuries from falls, circumstances of fall, and associated symptoms) 3. Nature of difficulty with walking (e.g., pain, imbalance) and associated symptoms 4. Usual activity, mobility status, and level of function 5. Medication review, New medications or dosing changes 6. Environmental Hazards: Clutter Electrical cords Lack of grab bars near bathtub and toilet Low chairs Poor lighting Slippery surfaces Steep or insecure stairways Throw rugs
200
Name four tests used to assess gait.
1. Timed Up and Go test 2. Berg Balance Scale 3. Performance-Oriented Mobility Assessment (POMA) 4. Functional Reach Test
200
What specialist would be helpful with gait concerns/ disorders?
PT Neuro Optho Audiology
200
Choreic
Dance-like; irregular; slow; spontaneous knee flexion and leg rising; wide-based. Associated Signs: Choreoathetotic movements of upper extremities Cause:Huntington disease; levodopa-induced dyskinesia
300
What percent of older adults maintain normal gait patterns into very old age, reinforcing that aging is not inevitably accompanied by disordered gait?
20
300
Physical Exam should include...
1. Vitals, including orthostatic 2. Vision, hearing exam 3. Full physical exam, including gait 4. Cognitive status/ depression screening
300
Which test is most useful in a primary care setting?
Timed Up and Go Test Timed Up and Go test is a sensitive (87 percent) and specific (87 percent) measure for identifying older persons who are prone to falls.
300
What components of physical activity should exercise target?
Strength, balance, flexibility, endurance
300
Vestibular Ataxia AND Name one cause.
Unsteady; falling to one side; postural instability. Associated Signs: Nausea; normal sensation, reflexes, and strength; nystagmus; vertigo Causes: Acute labyrinthitis; Meniere disease
400
Name 3 characteristics of gait that commonly change with aging?
1. Increased stance width 2. Increased time spent in the double support phase (i.e., with both feet on the ground) 3. Bent posture 4. Less vigorous force development at the moment of push off
400
What aspects of gait should be evaluated. List 4.
1. Stance 2. Posture 3. Difficulties with initiation 4. Velocity 5. Step length 6. Symmetry 7. Cadence/ fluidity of movements 8. Instability/ need of assistance.
400
What is the functional reach test and how is it performed?
1. PT stands w. feet shoulder width apart 2. PT asked to raise one arm 90 degrees to the front of body 3. W/O moving feet, PT patient should reach as far forward as possible while still maintaining stability 4. The maximum distance the patient can reach forward beyond arm's length should be measured using a ruler fixed at shoulder height. 5. < 7 inches is highly predictive
400
True or False: Evidence supporting the use of home environment assessment and intervention alone as a strategy to reduce falls in the general older population is strong.
FALSE Although evidence supporting the use of home environment assessment and intervention alone as a strategy to reduce falls in the general older population is mixed, evidence strongly supports home environment assessment and intervention as part of a multifactorial fall prevention program In particular, home safety programs provided by a trained health care professional appear to be effective for persons at high risk of falls, such as those with a history of falls or other fall risk factors.
400
Frontal Gait Disorder
https://www.youtube.com/watch?v=hziyFfJTrQo Magnetic; start and turn hesitation; freezing Associated Signs: Dementia; frontal lobe signs; incontinence Causes:Frontal lobe degeneration; multi-infarct state; normal-pressure hydrocephalus
500
For patients 65 and older... Each year more than __ are treated in the ED for falls. __ % of hip fractures are associated w. falls. More than __ billion is required to cover the cost of falls.
2.8 million 95 31 billion
500
Name as many medical conditions and risk factors associated with gait and balance disorders if the following categories. Cards Infective/ Metabolic Psych MSK Neuro
Affective disorders and psychiatric conditions Depression Fear of falling Sleep disorders Substance abuse Cardiovascular diseases Arrhythmias Congestive heart failure Coronary artery disease Orthostatic hypotension Peripheral arterial disease Thromboembolic disease Infectious and metabolic diseases Diabetes mellitus Hepatic encephalopathy Human immunodeficiency virus–associated neuropathy Hyper- and hypothyroidism Obesity Tertiary syphilis Uremia Vitamin B12 deficiency Musculoskeletal disorders Cervical spondylosis Gout Lumbar spinal stenosis Muscle weakness or atrophy Osteoarthritis Osteoporosis Podiatric conditions Neurologic disorders Cerebellar dysfunction or degeneration Delirium Dementia Multiple sclerosis Myelopathy Normal-pressure hydrocephalus Parkinson disease Stroke Vertebrobasilar insufficiency Vestibular disorders Sensory abnormalities Hearing impairment Peripheral neuropathy Visual impairment Other Recent hospitalization Recent surgery Use of certain medications (i.e., antiarrhythmics, diuretics, digoxin, narcotics, anticonvulsants, psychotropics, and antidepressants), especially four or more
500
Demonstrate the Timed Up and Go test? What is considered normal?
1. PT is asked to sit in a chair, rise w/o using arms 2. PT is instructed to walk 3 meters, turn, return to the chair and sit back down. 3. They may use their own walking aide. 4. < 10 sec normal, 14 + abnormal w. increased fall risk 5. > 20 sec severe gait impairment, likely requiring PT eval.
500
Write an appropriate exercise prescription for a 66 yo M w. HTN and DM.
150 minutes of moderate intensity aerobic activity, plus muscle strengthening activities for at least 2/7 days OR 75 minutes of vigorous intensity aerobic activity, plus muscle strengthening activities for at least 2/7 days Balance training for three or more days per week for a total of two hours If an individual is using insulin dose before, during, and after exercise, and/or ingest carbs if blood sugar < 100 pre workout Aerobic Exercise: Frequency: 3 days Activity/ Intensity: walk briskly Duration: 20 min Flexibility Training Frequency: 3 days Activity/ Muscle Group: stretch calves, thighs after walking Duration: 5 min Resistance Training Frequency: 2 days Activity/ Muscle Group: 5 lbs dumbbells arm raises straight/side Duration: 2 Sets of 5 repetitions
500
Parkinsonian Name three associated signs.
Short-stepped; shuffling; hips, knees, and spine flexed; festination; en bloc turns Associated Signs: Bradykinesia; muscular rigidity; postural instability; reduced arm swing; rest tremor
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