Categorization of Functional Impairments in Human Locomotion
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Pes Anserine Bursitis
BRIGHAM AND WOMEN’S HOSPITAL Department of Rehabilitation Services Physical Therapy Standard of Care: Pes Anserine Bursitis ICD 9 Codes: 726.61 Case Type / Diagnosis: The pes anserine bursa lies behind the medial hamstring, which is composed of the tendons of the sartorius, gracilis and semitendinosus (SGT) muscles. Because these 3 tendons splay out on the anterior aspect of the tibia and give the appearance of the foot of a goose, pes anserine bursitis is also known as goosefoot bursitis.1 These muscles provide for medial stabilization of the knee by acting as a restraint to excessive valgus opening. They also provide a counter-rotary torque function to the knee joint. The pes anserine has an eccentric role during the screw-home mechanism that dampens the effect of excessively forceful lateral rotation that may accompany terminal knee extension.2 Pes anserine bursitis presents as pain, tenderness and swelling over the anteromedial aspect of the knee, 4 to 5 cm below the joint line.3 Pain increases with knee flexion, exercise and/or stair climbing. Inflammation of this bursa is common in overweight, middle-aged women, and may be associated with osteoarthritis of the knee. It also occurs in athletes engaged in activities such as running, basketball, and racquet sports.3 Other risk factors include: 1 • Incorrect training techniques, or changes in terrain and/or distanced run • Lack of flexibility in hamstring muscles • Lack of knee extension • Patellar malalignment Indications for Treatment: • Knee Pain • Knee edema • Decreased active and /or passive ROM of lower extremities • Biomechanical dysfunction lower extremities • Muscle imbalances • Impaired muscle performance (focal weakness or general conditioning) • Impaired function Contraindications: • Patients with active signs/symptoms of infection (fever, chills, prolonged and obvious redness or swelling at hip joint). -
Gait Analysis in Prosthetics by James R
Gait Analysis in Prosthetics by James R. Gage, M.D. Ramona Hicks, R.P.T., M.A. REVIEW lems faced by lower limb amputees. Inman's measurement techniques included motion pic Objective measurement systems which quan tures of coronal and sagittal views, as well as tify locomotion have been in use for the past transverse rotations from below using a glass century. But not until World War II, when walkway. Using interrupted light photography, thousands of men returned home to the United the Biomechanics Laboratory team studied the States with amputations, was technology really motion of body segments during gait. Force applied to the understanding of prosthetic gait. plates measured the subject's ground reaction Inman and colleagues1 founded the Biome forces, and muscle activity was recorded using chanics Laboratory at the University of Cali electromyography (EMG), which measures the fornia to establish fundamental principles of electrical signals associated with contraction of human walking, particularly in relation to prob a muscle. Prior to Inman's fundamental studies, prostheses were customized for the individual Temporal and kinematic data, which were col amputee, without any particular regard to ra lected at slow, free, and fast speeds, showed tional structural design. Inman's goal was to that the hydraulic knees improved the symmetry provide fundamental data essential for the de between the prosthetic limb and the sound limb, sign of prosthetic limbs. By analyzing normal especially at the fast and free speeds. This human walking, he and his colleagues laid the finding was true for both cadence and the groundwork for biomechanical analysis of am amount of knee-flexion at swing phase. -
Common Gait Deviations in the Patient with Hemiplegia
Common gait deviations in the patient with hemiplegia Kim Carter, PT, NCS Things to consider • How did the patient walk before? • Any previous orthopedic conditions? • House set up • Where can they practice walking outside of therapy? • Caregiver’s ability (and/or willingness) to help patient Initial Contact • Problems – Ankle • Contacts with forefoot/flat foot – Is the step too short? – Is the gastroc tight? » Stretch in sitting » Stretch in long sit » Stretch in standing » Stretch in supine Initial Contact • Problems – Ankle • Contacts with the forefoot/flat foot – Are the dorsiflexors weak? » Seated exercises » Standing exercises » Supine exercises » Taping » Bracing Initial Contact Initial Contact • Problems – Knee • Flexed at contact – Look at the ankle first – Tone-inability to extend knee with hip flexion at terminal swing – Are the hamstrings tight? » Supine stretch » Long sit stretch » Sitting stretch » Standing stretch Initial Contact • Problems – Pelvis • Rotation – Inadequate advancing of the leg » Manual cues for orientation of pelvis » Muscular tightness Initial Contact • Problems – Trunk • Flexed – Tight hip flexors – May be due to increased plantarflexion • Rotated – May be rotated forward to advance the leg Loading response • Ankle – Foot slap • Weak dorsiflexors – Closed chain dorsiflexion Loading Response • Knee – Hyperextension • May be due to short step • Muscular weakness – Modified stride squats – Standing knee extension against theraband – Affected leg on step, step up with sound side Midstance • Problems – Ankle -
Health Sciences Library New Book List: July - December 2018 Page 1 of 6
Health Sciences Library New Book List: July - December 2018 Page 1 of 6 Peer support best practice toolkit: a resource for individuals developing and providing peer support programs for families of children with medical complexity and other lifelong disabilities. Contents: 1. Background and models of peer support -- 2. Current HQ759.913 .P43 programs in Ontario: case studies -- 3. Resources to help you get started - - 4. Rapid evidence review: peer support for families of children with disabilities. Holland Bloorview Kids Rehabilitation Hospital. Holland Bloorview Kids Rehabilitation Hospital, [2015]. 1 volume (unpaged). A therapeutic clown emerges: our story of recruitment and training. A full-length documentary film which traces the recruitment and training of the newest therapeutic clown. WB880 .D66 Conceived and written by Helen Donnelly. Directed and edited by Helen Donnelly & Greg Vanden Kroonenberg. Narrated by Diane Savage. Holland Bloorview Kids Rehabilitation Hospital, 2018. 1 videodisc (107 min.) Cognitive rehabilitation for pediatric neurological disorders. Chapter contributed by Holland Bloorview staff: Chapter 6 – Lisa Kakonge WS340 .C63 Locascio, Gianna, editor. Cambridge University Press, [2018]. xi, 263 pages Goal setting and motivation in therapy. Chapter contributed by Holland Bloorview staff: Chapter 5 – Gillian King WS350.2 .G62 Poulsen, Anne A., editor. Jessica Kingsley Publishers, 2015. 269 pages. Qualitative research design: an interactive approach. Maxwell, Joseph Alex, 1941-, SAGE Publications, 2013. xi, 218 -
Section I Introduction
SECTION I INTRODUCTION 1. OVERVIEW The National Center for Medical Rehabilitation Research (NCMRR) was established within the National Institutes of Health (NIH) by legislation (P.L. 101-613) passed in 1990. The Center is a component of the National Institute of Child Health and Human Development (NICHD). The mission of NCMRR is to foster development of scientific knowledge needed to enhance the health, productivity, independence, and quality of life of people with physical disabilities. The primary goal of the Center is to bring the health related problems of people with disabilities to the attention of America’s best scientists in order to capitalize upon the myriad advances occurring in the biological, behavioral, and engineering sciences. This is accomplished in part, by supporting research on enhancing the functioning of people with disabilities in daily life. Periodically the Center also sponsors workshops which allow experts in a field to gather and focus on a topic of interest. This document contains a detailed description of the design, execution, results and interpretation of the workshop “Gait Analysis in Rehabilitation Medicine.” 1.1 Purpose The primary purpose of the workshop, described within this document, was to develop and prioritize a set of recommendations that pertain to the future role of gait analysis in enhancing the function of people with disabilities due to functional limitations of the locomotion system. Although the workshop was entitled "Gait Analysis in Rehabilitation Medicine," the range of topics which gait encompasses is much broader than the classical definition of bi or quadri pedal motion might imply. Gait clinics and laboratories include analysis of many forms of human locomotion which often include the use of assistive devices such as crutches, canes, prosthetics, and wheelchairs. -
Use of Osteopathic Manipulative Treatment to Manage Compensated Trendelenburg Gait Caused by Sacroiliac Somatic Dysfunction
Editor’s Note: Corrections to this article were published in the March 2010 issue of JAOA—The Journal of the CASE REPORT American Osteopathic Association (2010;110[3]:210). The corrections have been incorporated in this online version of the article, which was posted January 2011. An expla - nation of these changes is available at http://www.jaoa .org/cgi/content /full/110/3/210-a. Use of Osteopathic Manipulative Treatment to Manage Compensated Trendelenburg Gait Caused by Sacroiliac Somatic Dysfunction Adam C. Gilliss, DO; Randel L. Swanson, II, OMS III; Deanna Janora, MD; and Venkat Venkataraman, PhD Gait dysfunctions are commonly encountered in the pri - In the present case report, we provide evidence that com - mary care setting. Compensated Trendelenburg gait is a gait pensated Trendelenburg gait may represent a secondary gait dysfunction that was originally described in patients with dysfunction stemming from somatic dysfunction of the weakness of ipsilateral hip abduction. This condition is sacroiliac joints. We also describe evidence of osteopathic thought to result from neuronal injury or myopathy. No manipulative treatment (OMT) resulting in quantitative treatment modalities currently exist for compensated Tren - improvements in the gait cycle. delenburg gait. The authors present a case in which osteo - pathic manipulative treatment may have improved a Tren - Traditional and Osteopathic Gait Theory delenburg gait dysfunction in a man aged 65 years with The gait cycle is divided into two main phases—stance and multiple sclerosis. Evidence of this improvement was swing, each consisting of numerous subphases. 2,3 Traditionally, obtained with the GaitMat II system for measuring the human gait cycle is considered to have six determinants that numerous gait parameters. -
Correlation Between Gait Asymmetry and Leg Length Discrepancy—What Is the Role of Clinical Abnormalities?
applied sciences Article Correlation between Gait Asymmetry and Leg Length Discrepancy—What Is the Role of Clinical Abnormalities? Sam Khamis 1,2,* , Barry Danino 3,4, Dror Ovadia 3,4 and Eli Carmeli 2 1 Gait and Motion Analysis Laboratory, Department of Pediatric Orthopedics, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel 2 Department of Physical Therapy, Faculty of Social Welfare and Health sciences, University of Haifa, Haifa 3498838, Israel; [email protected] 3 Department of Pediatric Orthopedics, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, 6, Weizmann St., Tel Aviv 64239, Israel; [email protected] (B.D.); [email protected] (D.O.) 4 Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel * Correspondence: [email protected]; Tel.: +972-50-5452699 Received: 22 July 2018; Accepted: 16 October 2018; Published: 18 October 2018 Abstract: Reducing the effect of leg length discrepancy (LLD) on gait abnormalities while other abnormal conditions such as spasticity, joint contractures or weak muscle strength are exhibited is challenging. This study aimed to evaluate the impact of mild LLD on lower limb biomechanics, on participants with anatomic LLD with and without other clinical abnormalities. A motion capture system was utilized on 32 participants to measure lower limb kinematics and dynamic leg length (DLL) throughout the gait cycle, calculated as the absolute distance from the hip joint center, either to the heel, ankle joint center, or forefoot. The Pearson correlation coefficient found that LLD was associated with 5 kinematic variables only when LLD appeared with no other clinical abnormalities present (r = 0.574 – 0.846, p < 0.05). -
Primary and Secondary Gait Deviations of Stroke Survivors and Their Association with Gait Performance
J. Phys. Ther. Sci. 28: 2634–2640, 2016 The Journal of Physical Therapy Science Original Article Primary and secondary gait deviations of stroke survivors and their association with gait performance Hyung-Sik Kim, PhD1), Soon-Cheol Chung, PhD1), Mi-Hyun Choi, PhD1), Seon-You ng Gim, BS1), Woo-Ram Kim, BS1), Gye-Rae Tack, PhD1), Dae-Woon Lim, PhD2), Sung-Kuk Chun, MS3), Jin-Wook Kim, PhD3), Kyung-Ryoul Mun, PhD3)* 1) Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea 2) Department of Information and Communication Engineering, Dongguk University, Republic of Korea 3) Imaging Media Research Center, Korea Institute of Science and Technology: Seoul 136791, Republic of Korea Abstract. [Purpose] Stroke survivors exhibit abnormal pelvic motion and significantly deteriorated gait perfor- mance. Although the gait of stroke survivors has been evaluated at the primary level pertaining to ankle, knee, and hip motions, secondary deviations involving the pelvic motions are strongly related to the primary level. Therefore, the aim of this study was to identify the kinematic differences of the primary and secondary joints and to identify mechanism differences that alter the gait performance of stroke survivors. [Subjects and Methods] Five healthy subjects and five stroke survivors were recruited. All the subjects were instructed to walk at a self-selected speed. The joint kinematics and gait parameters were calculated. [Results] For the stroke survivors, the range of motion of the primary-joint motions were significantly reduced, and the secondary-joint motions were significantly increased. Additionally, for the healthy subjects, the primary joint kinematics were the main factors ensuring gait perfor- mance, whereas for the stoke survivors, the secondary-joint motions were the main factors. -
Neurological History and Physical Examination
emedicine.medscape.com eMedicine Specialties > Clinical Procedures > none Neurological History and Physical Examination Kalarickal J Oommen, MD, FAAN, Professor and Crofoot Chair of Epilepsy, Department of Neurology, Chief, Section of Epilepsy, Texas Tech University Health Sciences Center; Medical Director, Texas Tech University Health Sciences Center (TTUHSC) Covenant Comprehensive Epilepsy Center Updated: Nov 25, 2009 Neurological History "From the brain and the brain only arise our pleasures, joys, laughter and jests, as well as our sorrows, pains, griefs, and tears.... These things we suffer all come from the brain, when it is not healthy, but becomes abnormally hot, cold, moist or dry." —Hippocrates The Sacred Disease, Section XVII Taking the patient's history is traditionally the first step in virtually every clinical encounter. A thorough neurologic history allows the clinician to define the patient's problem and, along with the result of physical examination, assists in formulating an etiologic and/or pathologic diagnosis in most cases.[1 ] Solid knowledge of the basic principles of the various disease processes is essential for obtaining a good history. As Goethe stated, "The eyes see what the mind knows." To this end, the reader is referred to the literature about the natural history of diseases. The purpose of this article is to highlight the process of the examination rather than to provide details about the clinical and pathologic features of specific diseases. The history of the presenting illness or chief complaint should -
Equinus Deformity in the Pediatric Patient: Causes, Evaluation, and Management
Equinus Deformity in the Pediatric Patient: Causes, Evaluation, and Management a,b,c Monique C. Gourdine-Shaw, DPM, LCDR, MSC, USN , c, c Bradley M. Lamm, DPM *, John E. Herzenberg, MD, FRCSC , d,e Anil Bhave, PT KEYWORDS Equinus Pediatric External fixation Achilles tendon lengthening Gastrocnemius recession Tendo-Achillis lengthening Different body and limb segments grow at different rates, inducing varying muscle tensions during growth.1 In addition, boys and girls grow at different rates.1 The rate of growth for girls spikes at ages 5, 7, 10, and 13 years.1 The estrogen-induced pubertal growth spurt in girls is one of the earliest manifestations of puberty. Growth of the legs and feet accelerates first, so that many girls have longer legs in proportion to their torso during the first year of puberty. The overall rate of growth tends to reach a peak velocity (as much as 7.5 to 10 cm) midway between thelarche and menarche and declines by the time menarche occurs.1 In the 2 years after menarche, most girls grow approximately 5 cm before growth ceases at maximal adult height.1 The rate of growth for boys spikes at ages 6, 11, and 14 years.1 Compared with girls’ early growth spurt, growth accelerates more slowly in boys and lasts longer, resulting in taller adult stature among men than women (on average, approximately 10 cm).1 The difference is attributed to the much greater potency of estradiol compared with testosterone in Two authors (BML and JEH) host an international teaching conference supported by Smith & Nephew. -
USCP Gait Patterns – Rang Lovell & Winter 2Nd Ed
UNILATERAL SPASTIC CEREBRAL PALSY: GAIT PATTERNS AND SURGICAL MANAGEMENT Jon R. Davids, MD Assistant Chief of Orthopaedic Surgery Director, Motion Analysis Laboratory Shriners Hospital for Children Professor and Ben Ali Chair in Pediatric Orthopaedics Department of Orthopaedic Surgery University of California Davis Medical School Sacramento, CA USA Presenter Disclosure Information JON R. DAVIDS, MD Unilateral Spastic Cerebral Palsy: Gait Patterns and Surgical Management Disclosure Information The following relationships exist: • OrthoPediatrics – Consultant • OrthoPediatrics Foundation for Education and Research – Board Member USCP: Gait Patterns and Surgical Management • Classification of CP – Historical / Critical Overview • Unilateral Spastic CP (USCP) – Definition – Common Deviations – Management Options • Surgical • Orthotic – “A Tale of 2 Unis” Classification of CP • Definitions – Classification: systematic arrangement in groups or categories according to established criteria • https://www.merriam- webster.com/dictionary/classification – Purpose • Incidence/Prevalence • Natural History • Clinical Decision Making • Outcome Assessment Classification of CP • Definitions – Hemiplegia: total or partial paralysis of one side of the body that results from disease of or injury to the motor centers of the brain • https://www.merriam- webster.com/dictionary/hemiplegia – Causes • Normal Brain – Trauma / Infection / Tumor / Vascular • Abnormal Brain Structure – Neuronal Migration Disorders Classification of CP • Definitions – Hemiplegia: total -
The Impact of Increased Femoral Antetorsion on Gait Deviations In
Journal of Biomechanics 86 (2019) 167–174 Contents lists available at ScienceDirect Journal of Biomechanics journal homepage: www.elsevier.com/locate/jbiomech www.JBiomech.com The impact of increased femoral antetorsion on gait deviations in healthy adolescents q ⇑ Nathalie Alexander a,b, , Kathrin Studer c, Harald Lengnick c, Erika Payne c, Harry Klima c, Regina Wegener a,b a Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland b Department of Orthopaedics and Traumatology, Cantonal Hospital St. Gallen, Switzerland c Department of Paediatric Orthopaedics, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland article info abstract Article history: Increased femoral antetorsion leads to several gait deviations, and amongst others, an increased knee Accepted 8 February 2019 flexion was reported in mid and terminal stance. Therefore, the purpose of this retrospective study was to identify gait deviations caused by increased femoral antetorsion and to perform subgroup analy- ses based on sagittal knee kinematics. Patients with isolated, CT confirmed increased femoral antetorsion Keywords: (n = 42) and age-matched typically developing children (TDC, n = 17) were included in this study. Patients Coxa antetorta were referred to gait analysis because of gait abnormalities going along with an increased femoral ante- Gait analysis torsion 30°. Kinematic and kinetic data were recorded during 3D gait analysis and three valid gait cycles Principal component analysis were analyzed. Principal component (PC) analysis was used to achieve data transformation. A linear Linear mixed model Hip internal rotation mixed model was used to estimate the group effect of PC-scores of retained PCs explaining 90% of the Knee flexion cumulative variance.