1 SEMIOLOGY ORTHOPEDIC FOR PHYSICIAN ASSISTANT AND MEDICAL EXPERT José Heitor Machado Fernandes, MD Visiting professor of occupational medicine course of postgraduate at the Faculty of Medicine, UFRGS. Ex-Visiting professor of occupational medicine course of postgraduate at the Faculty of Medicine, (FFFCMPA since 1997 until 2003) UFCSPA. Professor of medical expertise in postgraduate at Institute of Hospital Administration and Health Sciences, Porto Alegre / RS. International Member of the AAOS since 1978 until 2013. Member Jubilated SBOT since 1974 until 2013. ______________________________________________________________________ You can find the “Illustrated E-book of Semiology Orthopedic” in these addresses: 1) – On the blog of the semiology orthopedic for physician assistant and medical expert. http://www.semiologiaortopedica.com.br/ http://www.semiologiaortopedica.com.br/p/livro-eletronico-ilustrado-de.html Or: 2)- On Slide Share: “Illustrated E-book of Semiology Orthopedic”. http://www.slideshare.net/semiologiaortopedica/livro-eletrnico-de-semiologia- ortopdica-mdulo-10 Or: 3) On the Internet: by typing in Google: http://www.ufrgs.br/semiologiaortopedica/ (Illustrated E-book of Semiology Orthopedic with index) ______________________________________________________________________Module 6 - HUMAN GAITModule 6 issues1-Introduction
22-Normal gait Biomechanics, Kinematics3-Phases of the gait (stance phase; rocking or oscillating phase)4 normal gait cycle5-normal gait reference values6-Gait in children7-walking in elderlyfor pain-March 89-pathological Gait10-abnormal Marches Gait in Parkinsons -block March ebriosa- cerebellar ataxia March talonante- sensory ataxia March "on Star" - vestibular ataxia The small steps- frontal ataxia March escarvante- injury of Peroneal nerve sciatic or L5 root or March ceifante- Pyramidal Syndrome11-common gait Disorders12- videos on the Internet about human gait____________________________________________________________________________Transcript of presentation the topics and the text in the "slides" from module 6 .pdf inE-book Illustrated of Semiology Orthopedic. Introduction(See figures in "slides" module 6.pdf) • From the late 19th century began the documentation of human gait. • In the 20th century, with advances in technology, several centers have developed laboratories to analyze human movement and, consequently, much has been published on this subject. • Advancement in the studies in recent years has been so important that today are considered inadmissible indicate treatment for a disability gear without a careful analysis of locomotion.
3 • Quantification of motion and change detection is not perceived by the naked eye have added many advantages to research and understanding of the gait, allowing, even in cases that established some treatment, compare the before and after periods. • The human gait is characterized by a sequence of multiple fast and complex events, which complicates the clinical observation, identification of changes of phenomena and quantifying their degree of remoteness of normality. • This led scholars to develop resources of subject records and analysis of movement increasingly sensitive and accurate. • The gait analysis (AM) is the measurement, description and systematic evaluation of data that characterize human locomotion. • It has fundamental relevance in the study and treatment of disorders of the locomotor system. • The AM can be clinical (in order to study a specific patient) or scientific (in order to study the repercussions of a pathology on the March).Normal gait Biomechanics(See figures in "slides" module 6.pdf) • Concepts in Kinematics • CadenceIs the number of steps taken in one unit of time, typically expressed as steps per minute. • StepIs the space between the initial contact of one foot and the initial contact of the contralateralfoot on the ground.Can be expressed in time or in length. • PassedIs the space between the initial contact of one foot on the ground and the new initial contactof the same foot.So a passed matches the 2 steps.Can also be expressed in time or length. Operating cycleIs the set of phenomena understood within a week and corresponds to a members functions,which are repeated also after each new contact.
4 • Phases of the gait • Stance phaseAllows you to progress while maintaining stability of body weight support. It is subdivided. • Swing phaseHas features leg lifting from the ground, the advancement of Member in space and thepreparation for the next support.It is subdivided. MARCH(See figures in "slides" module 6.pdf) • Normal gait cycle (right foot). A. Heel tap B. Flattening C. medium Support D. Discharge E. swing phase F. heel Touch • Gait cycle • Reference values of normal gait • In the literature, there is much variation between different authors on "normal" parameters. • There are many explanations for this, since the characteristics of popuylação studied by conditions of data collection. • In General, one can adopt the values cited by j. Perry ( Gait analysis: normal and pathological function-1992) as references for normal adults: • Speed: 82 m/min; • Cadence: 113 steps/min; • Last Length: 1.4 m; • Measurement: o, 75 m; • Swing time: 40% of the cycle;Support period: 60% of the cycle; Gait in children
5 • Between 1 and 3 years of age, the Overdrive is the model of locomotion. • Neurologic immaturity is that the child behaves as if "went behind the Centre of gravity of the body". • As the child grows, the intra and interpersonal tend to decrease. After 3 years, acquired the mature standard, more adult-like. • Sutherland described gait characteristics between 1 and 3 years of age.The simple support time is lower in babies and increases as you improve strength andcoordination.There is a linear increase in speed according to age.Cadence also decreases as the age.The stride length increases as the musculoskeletal growth, having a relationship with thestature.The base of support, in proportion, will comply with the growth.The initial contact in the first few months, is done on tiptoe and spends 18 months until thePlantigrade; After that age, begins to be done also with the heel.The knee is always slightly bent, in the early months of travel, regardless, because the loweringof the Centre of gravity provides greater stability.Gait in Elderly • Of Winter (1991) reported that the main difference between the March of healthy elderly and young adults is that the first presents a general reduction in variability of parameters of kinematics. • The intra-individual and interindividual variability is low.The interpretation for this trend may be that older people have lost a bit of its plasticity(adaptive capacity), being then more consistent with your own standard and forming a morehomogeneous population.Comparing with the young adult, some differences in gait in elderly degenerative originate,and others are adaptations of a safer driving.Mainly occurs, decrease stride length, double support time increase and decrease the powerof push-off (anterior displacement of the body) at the end of support. Pathological Gait
6(See figures in "slides" module 6.pdf) • The normal gait is a form of progression with reciprocation (alternate advancement) of the lower limbs, which features the offset with safety and energy saving. • In pathological gait, loss of at least one of these principles.The origin of the disturbance can be in one of the following components of the volunteermovement:-source of the movement;-hinged levers;-awareness of the desired movement;-movement control;-energy;Pathological Gait • THE SOURCE OF THE MOVEMENT • The source of the movement as responsible structures, the power unit and the muscles.Are examples of disorders that interfere with these structures polio, peripheral Neuropathiesand myopathies. • HINGED LEVERS • Hinged levers have as structures responsible for the bones and joints.The joint contractures and deformities are examples of diseases that can affect thesestructures. • THE DESIRED MOVEMENT AWARENESS • Awareness of the desired movement depends on the sensory system.Are examples of disorders that interfere with that process those with lack of propiocepção(such as Tabes Dorsalis and multiple sclerosis). • THE MOTION CONTROL • Motion control has as responsible structures the pyramidal system (cerebral cortex), extrapyramidal (basal ganglia) and coordination (cerebellum).The pyramidal syndromes (stroke, spinal cord injury, cerebral palsy), extra-pyramidalsyndromes (complete, Parkinsonism) and ataxia are examples of disorders that interfere withthat.
7 • THE POWER SYSTEM • The power system has the cardiopulmonary system as responsible structure.Examples of disorders that interfere with this are the heart, the lung diseases in General(generating an absolute energy failure) and the deformities that impose a high cost (energygenerating energy on failure). ABNORMAL MARCHES(See figures in "slides" module 6.pdf) - The physical examination begins observing the walking that the patient presents when enters the doctors Office. - Gait in Parkinsons -block - March ebriosa- cerebellar ataxia - March talonante- sensory ataxia - March "on Star" - vestibular ataxia - The small steps- frontal ataxia - March escarvante-foot dorsiflexion that compresses deficit- injury of Peroneal nerve sciatic or L5 root or - March ceifante- SD. pyramidalAbnormal marches • ceifante = the hypertonia mm Extenders-spastic (not flexes, "foot"), sickle movements (pyramidal tract lesion)-plays with the quadratus lumborum. Sd. Pyramidal. • parética -trail paretic limb (pyramidal lesion). • escarvante -foot tower without dorsal flexion and eversion (Peroneal n. injury). • ataxic -does not maintain straight line (Cerebellar lesion). • small steps = "petit pass" (s. Parkinson) – injury Nigro-induced. • coreica -(different from atetótica; most proximal) large movements (the most distal, tone float), Messier (Korea) (as). • vestibular -swerves to one side (vestibular).
8 • miopática = March of the frog (myopathies) – – weakness of adductor hyperlordosis- Duchenne-Gauwer signal. • scissor -bilateral hypertonia adductor ceifante – – for both sides. • tabética -loss of sensation-step strong-it is not known where he is stepping. Videos on the Internet about the human gait • Analysis of human gait • Passive Gait and human gait • Operating cycle • Gait Biomechanics • Biodynamic Muscle during the Act of getting up • Pathological Marches ___________________________________________________________________ Videos • Examination of Gait (SBOT)You need Adobe Flash Player to view this video.http://www.youtube.com/watch?v=MF8GexW9xLs Orthopedic Physical Examination-Gait (Video of the AAOS; ACO; McGill University)http://www.youtube.com/watch?v=EHcNQ_qG7Tw