Question: An initial evaluation notes the patient has weakness in the hip and knee flexors. Which is not a gait pattern that can be expected?

-Insufficient hip and knee flexion

-Equinovarus

-Hip hiking

-Circumduction

Answer: Equinovarus

Equinovarus is the result of spasticity of the posterior tibias and/or gastrocnemius-soleus. It can also be a developmental abnormality.

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Question: What is equinovarus?

Answer: Abnormal gait pattern due to spasticity of the posterior tibias and/or gastrocnemius-soleus. It can be a developmental abnormality.

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Question: What weak muscles result in the gait abnormalities of circumduction, hip hiking, and insufficient hip/knee flexion

Answer: Weakness in hip and knee flexors

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Question: What gait pattern is appropriate for a non-weight bearing lower extremity?

Answer: 3-point gait

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Question: Which gait pattern is best indicated for an individual who is non-weight bearing in his right lower extremity due to an orthopedic injury?

-Two-point gait

-Four-point gait

-Swing-through gait

-Three-point gait

Answer: Three-point gait

The therapist should instruct the described patient in a three-point gait pattern in order to maintain non-weight bearing status. Both assistive devices and the uninjured legs advance together and weight is taken through the uninjured limb. Then he injured legs is advanced forward. This requires the use of two assistive deices such as axillary crutches or a walker.

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Question: Which gait pattern is typically indicated for a patient with paraplegia or spina bifida?

-Two-point gait with a cane

-Modified three-point gait with canes

-Swing-to pattern with Loftstrand crutches

-Three-point gait with axillary crutches

Answer: Swing-to pattern with Loftstrand crutches

A swing-to pattern is used when both lower extremities are involved. Both crutches are advanced forward together, weight is shifted on the hands for support, and both legs are swung or dragged forward to meet the crutches. This type of gait is indicated for patients with paraplegia, spina bifida and when the trunk is unstable.

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Question: What is a two-point gait pattern used for and how does it work?

Answer: With a two-point gait, one assistive and opposite extremity move together. A two-point gait allows for natural arm and leg gait motion.

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Question: What is a three-point gait pattern used for and how does it work?

Answer: A three-point pattern is indicated for weight bearing restrictions for one lower extremity. Both assistive devices and involved leg are advanced together and then the uninvolved leg advances to or past the assistive devices.

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Question: What’s the benefit of a modified three-point gait?

Answer: Allows for some weight bearing through involved lower extremity.

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Question: What is the expected intervention for a patient after total hip replacement with partial weight bearing (pain is well controlled) post-surgery day two?

-Short distance ambulation with a rolling walker

-Ambulation without an assistive device

-Stair navigation over 10 stairs

-Bed mobility only

Answer: Short distance ambulation with a rolling walker

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Question: When instruction a patient to ascend stairs with a step to pattern after a right total knee replacement, which is the correct sequencing?

-Step up with the right leg by the cane and then meet the left leg on the same step

-Step up with the right leg followed by the cane and then step the left leg onto the higher stair

-Step up with the left leg followed by the cane and then stop the right leg onto the higher stair

-Step up with the left leg followed by the cane and then meet the right leg on the same step

Answer: Step up with the left leg followed by the cane and then meet the right leg on the same step

When teaching stairs, it is important to teach proper sequencing. For ascending, the stronger (uninvolved) leg steps up first followed by the assistive device and then the involved leg.

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Question: A patient with right-side hemiplegia is gait training with a hemi-walker. The patient is having difficulty advancing her right lower extremity forward. The best initial feedback that the physical therapist assistant should give is:

-Verbally cue to shift weight to the right

-Verbally cue the patient to shift weight posteriorly

-Physically lift the right lower extremity and place it forward

-Verbally cue to shift weight to the left

Answer: Verbally cue to shift weight to the left

The patient must shift weight toward the left in order to unweight the right lower extremity and allow for advancement of the right lower extremity. The most appropriate feedback is to cue the patient to weight shift to the left.

Cueing the patient to shift weight to the right or posteriorly would hinder her ability to take a step forward. Physically lifting the right lower extremity forward would be indicated if the patient is not able to complete the task with a verbal cue.

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Question: What is the most appropriate position for a physical therapist assistant, guarding a patient ascending stairs for the first time using crutches and is partial weight bearing on the left side?

-Behind and slightly to the left side

-In front and slightly to the right side

-Behind and slightly to the right side

-In front and slightly to the left side

Answer: Behind and slightly to the left side

The correct guarding position is always behind (lower step) and slightly to the involved side, which is the left side in this case. During descending, the therapist should be in front (lower step) and slightly to the involved side.

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Question: Your patient has left leg weakness due to neurologic injury. As a PTA, how would you instruct your patient to descend stairs with a step to pattern?

-The assistive device and then the left leg steps down first followed by the right leg on the step below, never sharing the same step

-The assistive device and then the right leg steps down first followed by the left leg on the same step

-The assistive device and then the right leg steps down first followed by the left leg on the step below, never sharing the same step

-The assistive device and then the left leg steps down first followed by the right leg on the same step

Answer: The assistive device and then the left leg steps down first followed by the right leg on the same step

Step-to pattern sequencing means the individual meets both feet on the same stair. A reciprocal pattern takes stairs step over step

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Question: What is a Step-to pattern?

Answer: When the patient meets both feet on the same stair

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Question: What is a reciprocal pattern for stairs?

Answer: When the patient takes stairs step over step.

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Question: A patient suffered a peripheral nerve injury that results in foot drop of the left lower extremity during gait. The physical therapist has included function electrical stimulation for orthotic substitution. Which phase of gait should the PTA set up the electrical stimulation to contract the appropriate muscles?

-This is not an appropriate intervention

-Heel-off

-Midswing

-Foot flat

Answer: Midswing

Stimulation of the dorsiflexor muscle group during the swing phase (during midswing) will prevent the toes from dragging on the ground and allow for appropriate foot clearance.

Heel-off and foot flat are incorrect because the gastrocsoleus complex is activated during these times (not the dorsiflexor group). Functional electrical stimulation is an appropriate intervention for foot flat as long as there are no other contraindications.

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Question: Which is not an appropriate point of control for gait training when guarding?

-The gait belt

-The forearm

-The shoulder

-The pelvis

Answer: The forearm

The therapist should not grasp the patient’s clothing or the patient’s extremities for guarding. Key points of control for guarding in gait training include the shoulder, bilateral or unilateral pelvis, and gait belt.

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Question: When utilizing locomotor training with body weight support (BWS) and a motorized treadmill, which percentage of body weight support is contraindicated?

-40 percent

-Less than 10 percent

-Less than 20 percent

-Greater than 55 percent

Answer: Greater than 55 percent

An overhead hardness is used to support the patient’s body weight while stepping is facilitated over a motorized treadmill. Initially, support is high (40 percent of body weight) and then the support decreases progressively (30 percent, 20 percent, 10 percent to no body weight support). Body weight support great than 55 percent is contraindicated because it negatively interferes with the gait cycle, as the patient is unable to achieve flat foot during stepping.

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Question: The physical therapist assistant is teaching a patient to ascend a curb using a large base quad cane. The patient has weakness noted in the right quadriceps, which limits walking stability. Which is the appropriate sequencing for ascending the curb?

-Hold cane in right side, lead with left lower extremity

-Hold cane in left side, lead with left lower extremity

-Hold cane in left side, lead with right lower extremity

-Hold cane in right side, lead with right lower extremity

Answer: Hold cane in left side, lead with left lower extremity

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Question: When initially instructing a patient in ambulation, what is the best gait pattern to use for a patient using a prosthesis for the first time after undergoing a transtibial amputation?

-4-point gait

-2-point gait

-Swing-through gait

-3-point gait

Answer: 4-point gait

When first instructing a patient to walk with a new prosthesis, the 4-point gait will be the most stable gait patter as there is always three points of contact with the ground and it has a slower cadence.

The other three options will not be as stable as a 4-point gait.

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Question: A patient presents with impaired flexion range of motion and weakness in the plantar flexor muscle group. Which task will be most difficult?

-Walking over even surface

-Waking down a ramp

-Ascending stairs

-Descending stairs

Answer: Walking down a ramp

With limited plantar flexion range of motion and weakness in the gastrocnemius/soleus, walking down a decline will be difficult. When walking down a ramp, plantar flexion range is needed for the person to achieve foot flat position. Additionally, the plantar flexor muscle group is activated to hold back the tibia.

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Question: When walking down a steep decline, what muscles need to be sufficiently strong to achieve flat foot position and to hold back the tibia?

Answer: Gastrocnemius/soleus

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Question: When walking up a ramp, what muscles need to be strong enough and what motion needs sufficient range of motion?

Answer: Anterior tibialis for dorsiflexion

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Question: A patient presents with impaired dorsiflexion and weakness in the anterior tibialsis muscle. Which task will be most difficult?

-Walking over even ground

-Walking up a ramp

-Walking down a ramp

-Descending ramps

Answer: Walking up a ramp

With weak dorsiflexion range, walking up an incline will be most difficult.

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Question: The physical therapist assistant is teaching a patient to descend stairs using a cane and one handrail. The patient has poor eccentric control of the left quadriceps. Which is the proper position for the physical therapist assistant for guarding?

-In front and slightly to the patient’s right side

-Behind and slightly to the patient’s right side

-Behind and slightly to the patient’s left side

-In front and slightly to the patient’s left side

Answer: In front and slightly to the patient’s left side

During descending, the therapist should be in front (lower step) and slightly to the involved side.

When ascending, the correct guarding position is always behind (lower step) and slightly on the involved side

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Question: Which gait pattern provides the maximum stability of three points of support, indicated for patients with poor balance?

-Two-point gait

-Swing-to gait

-Four-point gait

-Three-point gait

Answer: Four-point gait

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