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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.