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Rancho Observational Gait Analysis:Maximizing Gait Outcomes through Targeted
Interventions for Individuals with Neurologic Impairments
Kelley Kubota, PT, MS, NCS, CBIS
Walt Weiss, MPT, NCS, KEMG
Rancho Los Amigos National Rehabilitation Center
American Physical Therapy AssociationCombined Sections Meeting
Anaheim, CaliforniaFebruary 16 - 17, 2016
Rancho Pathologic
Gait
Ankle / Knee
Causes
• Motor control
• ROM
• Sensation
• Pain
Rancho Observational Gait Analysis: Pathologic Ankle / Knee
February 16 - 17, 2016
This material is the property of K. Kubota and W. Weiss and the Physical Therapy Department of Rancho Los Amigos National Rehabilitation Center and should not be copied or otherwise used without express written permission of the authors.
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Ankle
Excess Plantar Flexion with Knee Extension
Deviation: Excess Plantar FlexionWeight Acceptance Single Limb Support Swing Limb Advancement
Shock absorption
Fwd progression
Stability
Forward progression
Stability
Foot clearance
Limb advancement
IC LR MSt TSt PSw ISw MSw TSw
When Significant
Causes:
Motor Control
ROM
Pain
Sensation
Excess Dorsiflexion with Knee Flexion
Rancho Observational Gait Analysis: Pathologic Ankle / Knee
February 16 - 17, 2016
This material is the property of K. Kubota and W. Weiss and the Physical Therapy Department of Rancho Los Amigos National Rehabilitation Center and should not be copied or otherwise used without express written permission of the authors.
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Deviation: Excess DorsiflexionWeight Acceptance
Single Limb Support
Swing Limb Advancement
Shock absorption
Fwd progression
Stability
Forward progression
Stability
Foot clearance
Limb advancement
IC LR MSt TSt PSw ISw MSw TSw
When Significant
Causes:
Motor Control
ROM
Pain
Sensation
Pathologic Ankle
Video
Musculoskeletal Evaluation: L Stroke
DIAGNOSIS: L Frontoparietal AVM Rupture, Hematoma with midline shift
HISTORY: Unremarkable
TRUNK: Strength = 4 ROM = WNL
LEFT LOWER
EXTREMITY:STRENGTH SELECTIVITY ROM
HIP: Flexion
Extension
Abduction
3+ 0 - 120
3 Selective with P overlay
3 0 – 35
KNEE: Extension 3+
ANKLE: Dorsiflexion
Plantar Flexion
2 0 - 0
2 (std) 0 - 45
Spasticity: None
Sensation:
Tactile: Impaired light touch; intact pinprick
Proprioception: Impaired: at hip, knee, ankle, and great toe
Rancho Observational Gait Analysis: Pathologic Ankle / Knee
February 16 - 17, 2016
This material is the property of K. Kubota and W. Weiss and the Physical Therapy Department of Rancho Los Amigos National Rehabilitation Center and should not be copied or otherwise used without express written permission of the authors.
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Knee
Hyperextension Excess Contralateral Knee Flexion
Rancho Observational Gait Analysis: Pathologic Ankle / Knee
February 16 - 17, 2016
This material is the property of K. Kubota and W. Weiss and the Physical Therapy Department of Rancho Los Amigos National Rehabilitation Center and should not be copied or otherwise used without express written permission of the authors.
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Causes for Excess Knee Flexion
Pathologic Knee
Video (insert Paul)
Musculoskeletal Evaluation: Brain Injury
DIAGNOSIS: Traumatic brain injury (20 years post), with new CSF leak
LEFT LOWER
EXTREMITY
STRENGTH/
MOTOR CONTROL
ROM SPASTICITY
HIP: Flexion
Extension
Abduction
4 0-135 0
2+ 0
2 0 - 40 0
KNEE: Extension 3+ Fast ROM (15-20°)
ANKLE: Dorsiflexion
Plantar Flexion
0 0 0
0 0 - 45 Fast ROM (20°)
Toes: ROM: WNL
Spasticity (L) quads, plantar flexors
Proprioception: Normal at hip, knee, ankle, and great toe
Balance Reactions: Impaired bilaterally
Velocity: 52% normal (42.2 m/min)
Questions?
Rancho Observational Gait Analysis: Pathologic Ankle / Knee
February 16 - 17, 2016
This material is the property of K. Kubota and W. Weiss and the Physical Therapy Department of Rancho Los Amigos National Rehabilitation Center and should not be copied or otherwise used without express written permission of the authors.
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