Exam 4: Gait Flashcards Preview

Bringman class fall 2015 > Exam 4: Gait > Flashcards

Flashcards in Exam 4: Gait Deck (60):
1

True/False: orthotics make the biggest difference in the swing phase of gait.

False

Orthotic can make the biggest difference in Stance Phase

(think of the most basic orthotic, a shoe insert)

2

During normal gait, where does most of the forward energy come from?

momentum

3

Understanding ________ is of utmost importance to understand gait and orthotics.

Ground Reaction Forces!

  • We need to understand GRF, where they are and how they change during the gait cycle.

4

True/False: GRF cannot occur during swing phase

True:

if the limb isn’t touching the ground, a GRF cannot occur

5

What is a Ground Reaction Force?

  • From Book (pg 105): Ground reaction force (GRF) vector is the mean load bearing line, which takes into account the forces acting in all three planes. It has magnitude as well as directional qualities.
  • From Wikipedia: In physics, and in particular in biomechanics, the ground reaction force (GRF) is the force exerted by the ground on a body in contact with it. Sara's addition: It is basically the same magnitude as the force the body exerts on the ground but in the opposite direction of the force the body is exerting on the ground.

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6

Why is it important to know the relationship of the GRF to a joint?

 

The relationship of the GRF to the joint (usually anterior or posterior) will determine if the GRF is pushing the joint to flex or extend.

7

T/F: GRF is always parallel with gravity

False

While GRF can be parallel to gravity, it usually is pushing at an angle. GRF is the equal and opposite force matching the sum of all forces produced by the body on the ground.

(sorry I can't figure out how to explain it better)

Maybe this will help: GRF is always parallel to the sum of the forces of the body on the ground.

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8

Initial Contact: Ankle

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Initial Contact: Ankle

  • Movement/ROM
    • Neutral 0*

  • Muscle(s)
    • Tibialis Anterior
  • Type of Action
    • Muscles fire to keep joint stable (Tim said Isometric)
  • Direction of movement
    • Moving Into PF

  • GRF relationship to joint
    • Posterior to ankle (allow/promotes PF)

      • the fulcrum is actually the tip of the calcaneus

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9

Initial Contact: Knee

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Initial Contact: Knee

  • Movement/ROM
    • Neutral 0*

  • Muscle(s)
    • Quads (book also says hamstrings)

  • Type of Action
    • Muscle fire to keep joint stable (Tim's isometric)

  • Direction of movement
    • stay in extension

  • GRF to joint
    • Anterior (keeps extension)

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10

Initial Contact: Hip

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Initial Contact: Hip

  • Movement/ROM
    • Flexed 30*

  • Muscle(s)
    • Hip extensors

  • Type of Action
    • Eccentric

  • Direction of movement
    • Stay in flexion

  • GRF to joint
    • anterior (acts on hip to produce flexion)

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11

Loading Response: Ankle

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Loading Response: Ankle

  • Movement/ROM
    • PF 10*
  • Muscle(s)
    • Tibialis Anterior
  • Type of Action
    • Ecc (decelerating foot)
  • Direction of movement
    • Going into PF
  • GRF to joint
    • slightly posterior (allows foot to remain in PF)

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12

Loading Response: Knee

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Loading Response: Knee

  • Movement/ROM
    • Flex 10-15*

  • Muscle(s)
    • Quads

  • Type of Action
    • Ecc to control flexion

  • Direction of movement
    • into more flexion

  • GRF to joint
    • Posterior (pushing into flexion)

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13

Loading Response: Hip

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Loading Response: Hip

  • Movement/ROM
    • Flex 20-25*
  • Muscle(s)
    • Hip Extensors
  • Type of Action
    • Ecc
  • Direction of movement
    • Decreasing flexion
  • GRF to joint
    • Slightly anterior

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14

Midstance: Ankle

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Midstance: Ankle

  • Movement/ROM
    • Slight PF (5* PF to neutral to 5* DF)
  • Muscle(s)
    • Gastroc
  • Type of Action
    • Eccentric
  • Direction of movement
    • moving from PF to DF
  • GRF to joint
    • Anterior (pushes toward DF)

 

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15

Midstance: Knee

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Midstance: Knee

  • Movement/ROM
    • 0-5*
  • Muscle(s)
    • Quads
  • Type of Action
    • Concentric
  • Direction of movement
    • move to extension
  • GRF to joint
    • neutral/slightly anterior

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16

Midstance: Hip

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Midstance: Hip

  • Movement/ROM
    • 0-5*
  • Muscle(s)
    • Abductors
  • Type of Action
    • Isometric (stabilize)
  • Direction of movement
    • Moving towards extension (probably from momentum)
  • GRF to joint
    • Almost neutral

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17

Terminal Stance: Ankle

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Terminal Stance: Ankle

  • Movement/ROM
    • 10*+   DF
  • Muscle(s)
    • Gastrocs
  • Type of Action
    • Eccentric
  • Direction of movement
    • towards DF
  • GRF to joint
    • Anterior (encourages DF)

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18

Terminal Stance: Knee

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Terminal Stance: Knee

  • Movement/ROM
    • Neutral 0-5*
  • Muscle(s)
    • none (momentum)
  • Type of Action
    • momentum
  • Direction of movement
    • Neutral
  • GRF to joint
    • Slightly Anterior

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19

Terminal Stance: Hip

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Terminal Stance: Hip

  • Movement/ROM
    • 10-15* extension
  • Muscle(s)
    • none (momentum)
  • Type of Action
    • momentum
  • Direction of movement
    • Extension
  • GRF to joint
    • Posterior (pushes towards extension)

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20

Preswing: Ankle

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Preswing: Ankle

  • Movement/ROM
    • 5-10* PF
  • Muscle(s)
    • Tibialis Anterior
  • Type of Action
    • Eccentric
  • Direction of movement
    • Fighting Gravity moving into DF (as foot lifts off ground, gravity would be pushing foot into PF so tib anterior is going to pull up the toe into DF - OKC)
  • GRF to joint
    • Anterior

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21

Preswing: Knee

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Preswing: Knee

  • Movement/ROM
    • 50-60* flexion
  • Muscle(s)
    • Hamstrings
  • Type of Action
    • concentric
  • Direction of movement
    • Moving towards flexion against gravity
  • GRF to joint 
    • technically posterior (but not enough force to matter)

 

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22

Preswing: Hip

  • Movement/ROM
  • Muscle(s)
  • Type of Action
  • Direction of movement
  • GRF to joint

Preswing: Hip

  • Movement/ROM
    • Neutral on its way to 20* flexion
  • Muscle(s)
    • hip flexors
  • Type of Action
    • concentric
  • Direction of movement
    • moving towards flexion
  • GRF to joint
    • none of significance at hip

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23

Alternate name for pre-swing

toe off

24

alternate name for terminal stance

heel off

25

What are the two main divisions portions of the gait cycle?

  1. Stance phase
  2. Swing phase

26

In normal gait, what percentage of a gait cycle is spent in

  • stance phase?
  • swing phase?

stance phase: 60%

swing phase: 40%

27

Define Stride length

The distance from floor contact on one side to the next floor contact on that same side

  • for example, the distance from right heel contact to the next right heel contact

28

Define Step length

the distance from the floor-contact point of one (ipsilateral, originating) foot in early stance to the floor contact point of the contralateral foot.

  • For example, the distance from right heel contact to left heel contact.

29

Double limb support:

  • Definition
  • When it occurs
  • Changes in fast gait
  • Changes in slow gait

Double limb support is the period of time when both feet are in contact with the ground.

  • It occurs twice during the gait cycle, at the beginning and the end of each stance phase.
  • As velocity increases, double limb support time decreases. When running, the individual has rapid forward movement with little or not period of double limb support.
  • Individuals with slow walking speeds spend more of the gait cycle in double support.

30

What are two sub-categories of stance phase?

  1. Weight acceptance
  2. Single limb support

31

What is the sub category of swing phase?

limb advancement

32

What are the two subcatagories of Weight Acceptance?

  1. Initial Contact (IC)
  2. Loading response (LR)

33

What are the three subcatagories of Single Leg Support?

  1. Midstance
  2. Terminal Stance
  3. Preswing

34

What are the three subcategories of limb advancement?

  1. Initial swing
  2. mid swing
  3. terminal swing

35

What do Initial contact, loading response, midstance, terminal stance, and pre swing have in common?

All are part of the stance phase

36

What do Initial swing, mid swing, and terminal swing have in common?

all are part of the swing phase (and limb advancement)

37

What is the best single index of walking ability?

velocity

38

Four Gait Deviations that occur in the Stance Phase

  1. Foot Slap
  2. Trendelenburg Gait
  3. Vaulting Gait
  4. Antalgic Gait

39

What are some causes of Foot Slap (6)

  1. Charcot Marie Tooth
  2. MS
  3. Diabetic Neuropathy
  4. CVA
  5. Brain Injury
  6. Saturday Night Palsy
    • could be UE or LE (sail boat wires),
      • bed rest, etc, could cause

40

What is foot slap?

Rapid plantar flexion movement at heal contact. Tibialis Anterior is not strong enough to control plantar flexion into loading phase

41

What is Trendelenurg gait?

Lean toward side of weakness during stance phase to compensate for hip abductor weakness while the contralateral leg is is in swing phase. The contralateral hip may drop (more than the normal 5 degrees).

 

Trendelenburg gait occurs in the stance phase, when the trunk leans to the same side as the hip pathology (ipsilateral lean). This is a compensatory strategy used when the gluteus minimus and tensor facia lata)  cannot adequately stabilize the spelvis during stance. Normally contralateral pelvis is limited to 5 degrees by eccentric control of the strong hop abductor muscles.

 

 

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42

What are four pathologies that can cause trendelenburg gait?

  1. non weight bearing status
  2. hip fracture
  3. stroke
  4. Generalized weakness

 

*THA should not cause trendelenburg unless something went wrong in surgery

43

What is a vaulting gait?

(When does it occur? - optional)

Vaulting is exaggerated heel elevation of the stance foot, occasionally occuring with simultaneous stance limb hip and knee extension, with the goal of raising the pelvis to clear the contralateral swing limb.

It occurs wihen the functional length of the swing limb is relatively longer than that of the stance limb. It also occurs when the swing limb advancedment is impaired or delayed by inadequate motor control of hip or knee flexion, or both, or in the presence of a plantar flexion contracture of the swing leg. It may compensate for pelvic obliquity or leg lenght discrepency.

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44

What are three things that can cause Vaulting gait?

  1. Foot drop in contralateral leg
  2. Leg length discrepancy
  3. knee or hip doesn’t bend on contralateral side

**One calf will be massive (you may pick this up from observation)

45

What is an antalgic gait?

pt has pain in stance phase (can also have pain in swing phase, but it almost always occurs stance phase)

A very broad term

always elaborate on the term Antalgic if you note it in chart

  • describe how it looks and where it might be coming from.

46

Four things you may notice when observing an Antalgic Gait

  1. Decreased contralateral step length
  2. Decreased ipsilateral stance time
  3. Decreased momentum (increased energy expenditure)
  4. Create abnormal alignment in upper body etc.
    1. pelvic obliquity
    2. crouching

47

What should you always do if you not antalgic gait in the chart?

always elaborate on the term Antalgic if you note it in chart

  • describe how it looks and where it might be coming from.

48

What are three common gait deviations that occur in swing phase?

  1. Circumduction
  2. Hip Hike
  3. Steppage Gait

49

What is circumduction gait?

A swing phase deviation in which hip abduction is combined with a wide arc of pelvic rotation, most often occuring as a compensatory pattern when there is a relatively longer swing limb compared with the stance limb.

Circumduction can be observed as a lateral arc of the foot in the transverse plane that begins at the end of PSs and ends at IC on the same limb.

*PSw = pre swing

*IC = Initial Contact

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50

What are 7 things that could cause Circumduction Gait or Hip Hike?

  1. foot drop
  2. decreased knee/hip/ankle flexion
  3. leg length discrepancy
  4. weak hip flexors
  5. Contracture
    • ankle PF ipsilateral?
    • knee/hip contralateral?
  6. Scoliosis
  7. Cerebral Palsy (circumduct both legs - sissor gait)
    • usually a birth issue

51

What is Hip Hike?

Occurs for the same reasons as cirumduction gait

Lift the hip to clear the swinging limb when it's functional length is longer than the stance limb.

 

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52

What his steppage gate?

A compensation for foot drop

Must use exaggerated hip and knee flexion in the swing leg in order to clear the floor

 

 

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53

is hip hike or steppage gate more likely to be used as a compensation for foot drop?

steppage gate

(hip hike more likely when there is also a hip or knee issue)

54

What is Scissor Gait?

What is it caused by?

What is a common population who suffers from it?

Gait pattern like bilateral circumduction gait

caused by lots of Adductor spacticity

Common in CP

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55

Two things we can do in rehab for scissor gait found in a patient with a stroke

Rehab (at least for stroke)

  • we will place foot in proper place to prevent scissoring
  • or give pt target that is exaggerated to prevent crossing midline

56

What are 3 Gait deviations with abnormal tone?

  1. Scissor Gait
  2. Croutched Gait
  3. Ataxic Gait

57

What Is crouch gait?

What population is this gait pattern common in?

What is a problem it causes?

In Crouch gait exaggerated knee and hip flexion occurs throughout the gait cycle.

Common population: pts with Parkinson’s

Problem: Causes lack of swing

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58

What is ataxic gait?

Basically, lack of coordination during gait

 

In ataxic gait there is a failure of coordination or irregularity of muscular action of the limb segments commonly cuased by cerebellar dysfunciton. Ataxia often becomes accentuated whtn the eyes are closed or vision is impaired or distracted.

59

What should you always do if you note ataxic gait in a chart?

always elaborate on Ataxic if you note it in chart

Because it is a broad term

60

What might you do to help rehab someone with ataxic gait?

add weight to get more proprioceptive input

  • downside, makes wrong muscles stronger
    • solution: make sure you use other means of helping to reorganize coordination, (and use weighting temporarily?)