What is the term for a gait cycle where someone is hunched over?

Kyphosis: The Term for a Hunched Over Posture During Gait Cycle

Kyphosis is the medical term for a hunched over posture during the gait cycle, characterized by excessive forward bending of the thoracic spine.

Understanding Kyphosis in Gait

Kyphosis refers to an abnormal forward curvature of the spine that creates a hunched appearance. When present during walking, it significantly affects the gait pattern and can lead to several complications:

• Kyphosis during gait is often associated with balance disorders and increased risk of falls due to altered center of mass displacement 1
• The hunched posture shifts the body's weight distribution anteriorly, affecting normal biomechanics of walking 2
• This postural abnormality can be a prominent feature in various neurological and musculoskeletal conditions 2

Clinical Significance and Identification

Identifying kyphosis during gait is important for several reasons:

• It may be the cardinal sign of certain conditions like normal pressure hydrocephalus (NPH), where the patient's feet appear "glued to the floor" with a magnetic or shuffling quality 3
• Kyphosis during gait can point to disorders with co-occurring cognitive, behavioral, and motor impairments, such as Parkinson's disease, dementia with Lewy bodies, or progressive supranuclear palsy 2
• The presence of kyphosis during walking significantly increases fall risk due to reduced muscle strength and altered body mechanics 1

Biomechanical Impact

The biomechanical consequences of kyphosis during gait include:

• Decreased anteroposterior displacement and velocity with increased mediolateral displacement and velocity, creating instability 1
• Reduced back extensor strength and lower extremity muscle weakness, further compromising stability 1
• Altered stride-to-stride fluctuations that may contain important information about locomotor control system integrity 4

Associated Conditions

Kyphosis during gait can be associated with various conditions:

• Osteoporosis with vertebral compression fractures 1
• Neurological disorders including Parkinson's disease and related disorders 2
• Normal pressure hydrocephalus, where the gait disorder is often the cardinal sign 3
• Cerebral palsy (though more commonly associated with crouch gait, which involves excessive knee and hip flexion) 5

Clinical Assessment

When evaluating a patient with kyphotic posture during gait:

• Assess for sensory or motor function alterations, particularly in vision, hearing, and balance 2
• Evaluate fall risk, which may be substantially increased when sensorimotor problems co-occur with cognitive impairments 2, 1
• Consider that gait disorders have predictive utility for future dementia risk 2
• Look for signs of distal polysensory neuropathy, particularly in the feet/legs, which can contribute to fall risk 2

Management Considerations

Management should focus on addressing both the underlying cause and the functional consequences:

• Physical therapy assessment and treatment of gait and balance may improve function and reduce safety risks 2
• Home occupational therapy and safety assessment can help mitigate fall risks 2
• Assistive devices, night lights, shower grab bars, and elimination of trip hazards may be necessary interventions 2
• For osteoporosis-related kyphosis, strengthening of back extensors and lower extremity muscles may be beneficial 1

Pitfalls and Caveats

Important considerations when evaluating kyphosis during gait:

• Don't assume all hunched postures during gait have the same etiology; multiple conditions can present similarly 2, 3
• Recognize that kyphosis may be progressive in nature, potentially compromising walking ability over time 5
• Consider that some sensorimotor impairments in persons with kyphotic gait are amenable to early intervention and sustained treatments 2
• Be aware that fall risk assessment is crucial, as kyphosis significantly alters balance dynamics 1