NPTEFF Normal Gait Exam Questions with Correct Answers.docx

NPTEFF Normal Gait Exam Questions with Correct A A PT observes the gait of a 34 y/o male. PT suspects a leg length discrepancy. Which deviation is MOST likely seen by the PT? A.Increased DF of short limb during swing and increased PF of the long limb during stance B.Decreased knee flexion and increased DF of the long limb during stance and increased DF of the short limb during swing C.Increased DF with early heel rise of the long limb at heel off and increased PF of the short limb during stance D.Increased PF of the long limb at heel strike and decreased knee flexion of the short limb during heel off - Answer-C. Increased DF with early heel rise of the long limb at heel off and increased PF of the short limb during stance -Answer-Gait cycle is the time from heel strike to the next heel strike Stride - Answer-One complete gait cycle Step - Answer-Beginning of an event of one limb until the beginning of the same event on the other leg. Cadence - Answer-# of steps per minute Average cadence of gait is - Answer-113 steps/min *knowing cadence is reduced in diagnoses such as Parkinson's* A patient present to the clinic with history of burns on the left hip and thigh causing tight hip flexors. What gait abnormality is MOST likely to be demonstrated? A.Shorter L LE step length B.Short R LE step length C.Backward trunk lean during stance on L LE D.Lateral lean during swing phase on R LE - Answer-B. Short R LE step length -The answer would be A if it was tight hip EXTENSORS. Tight Flexors = opposite side Tight Extensors = same side Simplification: chain muscles are active during initial portion of gait cycle (heel contact to midstance) - Answer-Anterior Simplification: chain muscles are active during latter portion of gait cycle (midstance to toe off) - Answer-Posterior What are the 3 rockers of gait? - Answer-Heel -- ankle -- forefoot Following right hip surgery, a patient ambulates with trendelenburg gait (L hip drop during R stance). As part of intervention PT includes FES to improve gait. Stimulation should be initiated for: A.R hip abductors during R swing phase B.R hip abductors during R stance phase C.L hip abductors during L stance phase D.L hip abductors during L swing phase - Answer-B. R hip abductors during R stance phase During intervention for a patient with a weak tibialis anterior muscle, the PT decides to use FES to improve ambulation. Stimulation should initiated for the weak muscle during which phase of gait? A.Mid stance to terminal stance B.Initial contact to mid stance C.Loading response to mid stance D.Initial swing to mid swing - Answer-D. Initial swing to mid swing *D is the most necessary for functional purposes* B and C are not ideal, but not as problematic as D for functional ambulation. Most knee flexion during gait cycle? - Answer-Initial swing (60 degrees) Most ankle DF during gait cycle? - Answer-Midstance (10 degrees) Most ankle PF during gait cycle? - Answer-Pre-swing (20 degrees) Normal Gait ROM: Hip flexion - Answer-30 degrees (20-30) Normal Gait ROM: Hip extension - Answer-10 degrees Normal Gait ROM: Knee Flexion - Answer-60 degrees Normal Gait ROM: Knee extension - Answer-0 degrees (full extension) Normal Gait ROM: Ankle DF - Answer-10 degrees Normal Gait ROM: Ankle PF - Answer-20 degrees While evaluating gait of a 68 y/o male, PT observes R pelvic hike during swing phase of R gait cycle. What is LEAST likely to cause this problem? A.Reduced R hip flexion B.Inadequate R knee flexion C.Lack of R ankle DF D.R ankle PF weakness - Answer-D. R ankle PF weakness -Swing phase issues are due to restriction in ROM -Stance phase issues are due to muscle weakness ROM at hip for normal gait: stance + swing - Answer-Stance: 0-30 degrees flexion + 0 to 10-20 degrees extension Swing: 20-30 degrees flexion ROM at knee for normal gait: stance + swing - Answer-Stance: 0-40 degrees flexion Swing: 0-60 degrees flexion ROM at ankle for normal gait: stance + swing - Answer-Stance: 0-10 degrees DF, 0-20 degrees PF Swing: 0-10 degrees PF Patient with a sustained hip fracture has difficulty gaining hip flexion ROM. What is the minimum ROM the PT should try to obtain to allow the patient to ambulate with normal gait pattern? A.15 B.25 C.35 D.45 - Answer-B. 25 degrees Range is 20-30 degrees ROM flexion during swing Normal degree of out-toeing - Answer-7 degrees (7-10) What is the landmark to measure out-toeing - Answer-through the 2nd met/toe A 54 y/o patient is seen by a PT for gait training. Patient perfoms excessive hip flexion while ascending the ramp. What should the PT mobilize first? A.Anterior glide on hip B.Posterior glide on hip C.Anterior glide on ankle D.Posterior glide on ankle - Answer-D. Posterior glide on ankle -Excessive hip flexion is a compensation for lack of DF during swing -Want to avoid mobilizing a joint with too much ROM What are the pretibial muscles? - Answer-Anterior tibialis, EDL, EHL When are the pretibial muscles active? - Answer-- Prior to and during heel strike (eccentric) -Prior to and during swing (concentric) What are the calf muscles active in gait? - Answer-Gastroc, soleus, FDL, FHL, Posterior Tibialis When are the calf muscles active in gait active? - Answer-- Midstance (eccentric control of DF) -Heel off (concentric push off) A patient demonstrates a positive thomas test (inability of the hip to contact the mat with the knee flexed). What phase of gait cycle will MOST likely show limitation in hip ROM? A.Loading response B.Initial contact C.Midstance D.Terminal stance - Answer-D. Terminal stance Tight hip flexors will create a problem when the hip is in extension When are the quadriceps active during gait cycle? - Answer-- Before heel strike (concentric to slow HS) -Initial contact and loading response When are the HS active during gait cycle? - Answer-- Heel strike (eccentric prevent hyperextension) -Swing phase (concentric) Early heel off is associated with what impairment? A.Shortening of HS B.Shortening of gastrocnemius C.Weakness of tibialis anterior D.Weakness of iliopsoas - Answer-B. Shortening of gastrocnemius Lack of adequate DF ROM Hip abductors are active during what part of the gait cycle? - Answer-- Stance phase (eccentric) Hip adductors are active during what part of the gait cycle? - Answer-- Early and late stance (concentric) What would be a potential cause of R pelvic drop? A.Weak R hip abductors B.Hip abductor contracture on R side C.Weak hip adductors on L side D.Hip abductor contract on L side - Answer-B. Hip abductor contracture on R side All causes: -B -Weak glute med on L side -Weak hip adductors on R side; Tight hip adductors on L side -Trunk lean to L side (to the weak side) -L glute med weak, when one muscle is weak the antagonist is usually tight (L adductors are tight) so R glut med should be strong and R adductors would be weak