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Falls
Published in Henry J. Woodford, Essential Geriatrics, 2022
Medication review is not always about deprescribing. Some medications can reduce the risk of falling. Examples include medications to control Parkinson's disease or arthritis. An antalgic gait is unlikely to be a safe one.
The locomotor system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Gait Observe the patient from the front and sides while they are standing in their underwear (Figs 5.2 and 5.3), looking for any kind of asymmetry and deformity such as one leg being shorter or longer (Fig. 5.4) than the other, or abnormality of the spinal curvature (kyphosis, scoliosis or a loss of lumbar lordosis). Observe the patient walking to make sure that the gait is normal, that they are swinging the arms and moving the legs symmetrically. Look out for an antalgic gait, and make sure that both the person’s knees are straight. An antalgic gait is an abnormality of gait rhythm in which the patient avoids bearing weight on the painful leg and spends most of the gait cycle on the unaffected limb. This may suggest a problem of the hip, knee, hindfoot, midfoot or forefoot.
Impairment of functions of the nervous system
Published in Ramar Sabapathi Vinayagam, Integrated Evaluation of Disability, 2019
Gait pattern movement relates to translation of a body from one point to another. It is connected with walking and running, and so on (37). In hemiplegia, the person presents with circumduction gait with adduction at the shoulder, flexion of elbow, wrist and fingers and extension of hip, knee, and ankle. Table 6.34 describes impairment classes for gait pattern functions. Persons with paraplegia walk with scissoring gait with stiff lower extremities. Persons with apraxia walks with short shuffling gait with stooped posture with the delay in the initiation and often interrupted by freezing. Persons with parkinsonism walk with shuffling gait with short steps decreased arm swing and stooped posture or festinating gait with faster steps and often associated with propulsion and retropulsion or tremor or walking interrupted by difficulty in turning or freezing with a tendency to fall or associated with fall. Persons with ataxia walk with wide-based gait with irregular speed and step. The person spreads his or her legs apart to widen the base of support to compensate for the imbalance while walking. In severe cases, the person swings the leg irregularly and tends to reel in several sideward steps. Persons with choreoathetosis walk with a gait with disruption of normal pattern with a pelvic lurch, and flexion and extension of the hip and intermittent irregular choreoathetoid movement. In waddling gait, the person walks with bilateral pelvic lift and rotation. In high stepping gait, the person walks with foot drop and high stepping. In antalgic gait, the person walks with painful limp while walking.
AL amyloidosis presenting as inflammatory polyarthritis: a case report
Published in Modern Rheumatology Case Reports, 2021
Muhammad Shoaib Momen Majumder, Shamim Ahmed, Md. Nahiduzzamane Shazzad, Mohammad Mamun Khan, Syed Atiqul Haq, Mohammed Kamal, Md. Sohrab Alam, Johannes J. Rasker
On physical examination, the patient was found moderately pale looking, all vital signs were normal. His pulse rate was 80/min, regular with normal volume, blood pressure 120/70 mm of Hg, respiratory rate 18/min, there was no lower limb edoema or lymphadenopathy. There were papules and plaques over the periocular, perinasal, and perioral area, macroglossia with indentation of the tongue, pinch purpura in the oral cavity (Figures 1 and 2). Nail dystrophy was present in some of his fingers. There was no organomegaly, apex beat was situated in the 5th intercostal space along the midclavicular line. Musculoskeletal examination revealed localised, mildly tender, soft tissue swelling of variable size and shape (largest one was 5Х3 cm, Figure 3 over the wrist) over flexor and extensor aspects of wrists and back of knees. Both shoulders were swollen (shoulder pad sign positive, Figure 4), tenderness was present over MCPs, wrists, elbows, and shoulders. He had an antalgic gait. Active and passive movements of wrists and shoulders were painful and restricted. Flexion contracture (30 degrees) was present in the left elbow.
Implementation of the comprehensive care for joint replacement model: A post-acute physical therapy case report
Published in Physiotherapy Theory and Practice, 2020
Will Bolt, Deborah M. Wendland
Measurements for ROM were taken on the involved lower extremity with a goniometer (Reese and Bandy, 2010). Passive ROM was measured from 15° to 75° of knee flexion with observable signs of discomfort. Active ROM was not measured during the initial examination due to pain severity resulting in muscular inhibition and an inability to adequately perform an active contraction. Gross muscle testing was performed on both the involved and uninvolved limb and scored according to the Modified Medical Research Council scale for strength testing (Yahyaei-Rad, 2012). The patient demonstrated generalized weakness in the involved limb with strength ranging from 2/5 to 4+/5. The patient was able to ambulate approximately 20 feet with a rolling walker requiring minimal assistance. Gait deviations included decreased stance time and decreased foot clearance for the right lower extremity during the swing phase, and an overall antalgic gait pattern (Malanga and DeLisa, 1998). The patient’s gait speed was not objectively measured during the initial evaluation, but she demonstrated a slow cadence and non-functional speed based on observation. The patient required minimal assistance and verbal cuing to safely complete sit to stand and bed to wheelchair transfers. The patient’s stated goal was to be independent in all ADLs and be able to ambulate with the least restrictive assistive device.
Tibiofemoral joint mobilizations following total knee arthroplasty and manipulation under anesthesia
Published in Physiotherapy Theory and Practice, 2020
Kathryn Dailey, Michael McMorris, Michael T. Gross
Observation revealed a well-healed incision, free of sutures and steri-strips. The patient ambulated with an antalgic gait pattern, with decreased stride length, decreased toe-off, and decreased stance time on the left lower extremity. She was able to achieve terminal knee extension during ambulation, but she demonstrated noticeable limitations of knee flexion. The left ischial tuberosity was lifted from the plinth in the seated position, due to self-selected extension of the left knee and abduction of the left hip. Her attempts to sit normally resulted in pain in the left knee, as increased knee flexion was required. Moving from sitting to standing was painful, with decreased weight bearing through the left lower extremity.