Assessments 2 SIMPLY GAIT Understanding movement Evaluations of factors that help therapist form professional judgments Include health, palpatory, range of motion, postural, and gait assessments Assessments tell the therapist if something is present, when something occurred, what the client can do, and how well he or she can do it Before assessments begin, explain what you are planning to do, why you are doing it, how long it will take, what position will be required, and what equipment you will use Observing Posture and Posture and 3 4 Cultivate your observational and critical thinking skills by going to public places Your assessments may reveal compensatory patterns Compensatory patterns: Methods individuals use to correct imbalances and reduce discomfort Current studies suggest that posture and gait do not predict the presence or absence of pain A significant segment of the population never achieves ideal posture Examples: Elderly individuals with osteoporosis and kyphosis, people with congenital defects Small deviations are probably insignificant and should not be overemphasized Keep assessments brief and done in a relaxed manner Postural Assessment Postural Assessment 5 6 Posture: The position of the body over a base of support Most common postures are sitting, standing, or lying down When the body assumes these postures, the body must overcome forces of gravity The efficiency of attaining a posture depends on factors such as muscle tone and strength, muscle length, health of ligaments and tendons, and habitual use of certain postures Phasic muscles provide movement and influence posture When stressed, postural muscles tend to shorten and strengthen, whereas phasic muscles lengthen and weaken These responses may produce dysfunctional patterns Unrelenting gravitational forces make musculoskeletal overload inevitable over time 1
Observing Posture Anterior Landmarks 7 8 When observing posture: Spine has four normal curves Pelvis is in a neutral position Bones of lower extremities are in alignment for bearing weight Chest and upper back should favor optimal respiratory function Head is erect in a position to minimize stress on neck muscles Horizontal symmetry should (ideally) be observed between the: Acromioclavicular joints Anterior superior iliac spines (ASIS) Greater trochanters Tips of the fingers Patellae Fibular heads Medial malleoli Height of the medial arches of the feet Posterior Landmarks Lateral Landmarks (Cont.) 9 Horizontal symmetry should be observed between the: Mastoid processes Base of the occiput Scapulae Posterior superior iliac spines Tops of the greater trochanters Calcanei (singular, calcaneus) 10 Along with the previous landmarks, be sure to note bilateral symmetry (or lack of it) in major muscle groups and between anterior and posterior musculature Anterior pelvic tilt Knees locked back Slumped shoulders rolled and inward Forward head posture Abnormal spinal curvatures Collapsed arches Posture Assessment 11 12 : A series of complex, coordinated, and highly efficient movements against the forces of gravity is the manner in which a person moves on foot (Acture is the term for assessment during movement) Walking, running, skipping, galloping, jogging, and hopping Massage therapists can be trained to perform basic gait assessment 2
Assessment The Cycle 13 14 involves distinct movements of the upper and lower extremities, or limbs, and of the torso and pelvis Functional units of gait: Passenger unit (or HAT, for head, arms, and torso, including pelvis), which is being carried Locomotor unit (pelvis and lower extremities), which provides weight bearing and propulsion Modified from Neumann DA: Kinesiology of the musculoskeletal system: foundations for rehabilitation. St. Louis, 2010, Mosby. = the manner of walking cycle begins when one heel strikes the ground and ends when the same heel strikes the ground again Stance phase - foot on ground 60% Swing phase- foot off ground 40% Stride = two steps (1 right and 1 left) Double stance=both feet on ground, occurs frequently when walking, seldom when running Muscle involvement during gait 3 concepts Concentric contraction to move us (acceleration) Eccentric contraction to slow us down (deceleration) Isometric contraction for stabilization of joints To continue Early/mid stance phase Most muscles in eccentric contraction Foot muscles/joints relaxed to conform to surface and absorb shock Mid/late stance phase Switch to concentric to move Foot muscles/joints stiffen to push 3
Foot positions Stance Heel Strike 19 Heel comes in contact with ground Ankle is in neutral Knee begins flexion-shock absorption Hip slight flexion Hip extensors-eccentric to decelerate Trunk rotates toward stance leg Stance Foot Flat Foot lands to take body weight Dorsiflexors eccentric contract to avoid foot slap Knee - slight flexion Hip moves to extension to allow body to catch up Stance Mid Stance Body weight shifts entirely to this leg Center of gravity is at its highest Dorsiflexion due to momentum Plantar flexion begins as body crosses ankle Knee and hip in extension Trunk and arm in neutral Stance Heel Off Heel begins to lift Plantar flexors concentric to push body Knee and hip neutral Stance - Toe Off End of stance phase Ankle plantar flexes slightly Knee and hip begin flexion Pelvis rotates to opposite side Ipsolateral arm swings 4
Swing - Acceleration Leg and foot are behind body s center of gravity Ankle is in dorsiflexion Hip begins flexion Swing Mid Swing Ankle in neutral Knee and hip flex more to avoid toe drag Hip flexion continues as well as momentum to move the leg Swing -Deceleration Observing 28 Slowing down of leg to begin stance phase Knee is extended hamstrings eccentric to slow down leg movement Hip will not flex more Monitor: Weight transferring from initial contact to push-off Length and symmetry of stride Signs of limping, waddling, or listing to one side Foot orientation, such as toeing-in or toeing-out or excessive supination or pronation Motions of the pelvis, lumbar and thoracic regions, and shoulders Arm swing that is bilaterally equal or unequal Assessment Questions 29 Is there ease of movement or lack of ease? Does the client appear stiff or relaxed? Does one part of the body move more fluidly or more rigidly than another? Does the client seem hesitant, unstable, afraid, or guarded during certain movements? What is the overall picture you get while watching the client move? 5