Gait

Question 1

ROM Requirements for Normal Gait: Hip Flexion

Answer 1

0-30 degrees

Question 2

ROM Requirements for Normal Gait: Hip Extension

Answer 2

0-10 degrees

Question 3

ROM Requirements for Normal Gait: Knee Flexion

Answer 3

0-60 degreea

Question 4

ROM Requirements for Normal Gait: Knee Extension

Answer 4

0 degrees

Question 5

ROM Requirements for Normal Gait: Ankle Dorsiflexion

Answer 5

0-10 degrees

Question 6

ROM Requirements for Normal Gait: Ankle Plantarflexion

Answer 6

0-20 degrees

Question 7

While performing a gait analysis, a PTA observes excessive pronation during foot flat and a lack of supination as a lever for “push- off” in late stance. Weakness in which of the following muscle should the therapist MOST expect to be the cause of the observed gait deviations?

1) Gastrocnemius
2) Tibialis Posterior
3) Fibularis Longus
4) Quadratus Plantae

Answer 7

2

Question 8

A PTA observes a patient lean backwards during the early stance phase of gait. Weakness in which of the following muscles is MOST likely causing this gait deviation?

1) Gluteus Maximus
2) Gluteus Medius
3) quadriceps
4) iliopspas

Answer 8

1

Question 9

Which of the following gait deviations would MOST likely be used by a person wearing a knee immobilizer on the right lower extremity?

1) vaulting gait on the right leg
2) stoppage gait of the right leg
3) circumduction of the right hip
4) uncompensated Trendelenburg gait on the left.

Answer 9

3

Question 10

A PTA examines the gait pattern who sustained an i jury to the deep perineal nerve. Which of the following gait deviations would the therapist MOST likely expect from o observe between heel strike (initial contact) and foot flat (loading response)?

1) Hyperextension of the knee
2) posterior lean of the trunk
3) excessive probation of the foot
4) foot slapping to the ground

Answer 10

4

Question 11

Which of the following muscles are MOST responsible for keeping the right side of the pelvis from dropping during the stance phase of gait on the left leg?

1) left hip abductors
2) right hip abductors
3) left hip adductors
4) right hip adductors

Answer 11

1

Question 12

A patient presents with significant weakness of the quadriceps with a muscle grade of poor plus (2+/5). During examination of gait, which of the following deviations would the therapist MOST likely expect to observe?

1) posterior trunk lean in early stance
2) anterior trunk lean in early stance
3) circumduction during swing phase
4) vaulting on the contralateral limb

Answer 12

2

Question 13

What is the ANKLE doing during heel strike (initial contact) to foot flat (loading response)? What muscle activation would allow this when gravity is helping?

Answer 13

Moving from neutral to PF

ECCENTRIC DF (decelerating ankle into PF)

Question 14

During heel strike (initial contact) the ankle is at

Answer 14

0 degrees Ankle Neutral

Question 15

During foot flat (loading response) the ankle is at

Answer 15

15 degrees of PF

Question 16

What is the ankle doing from foot flat (loading response) to Midstance? What muscle activation would allow this when momentum is helping?

Answer 16

Moving from PF to 10 degrees DF
- ECCENTRIC PF (controlling DF as body moves over the stance leg)

Question 17

What is the ankle doing during midstance to heel off (terminal stance) and toe off (preswing)? What muscle activation would allow this when working against gravity?

Answer 17

Moving back into PF (against gravity to 20 degrees)
- CONCENTRIC PF (heel off and toe off are often referred together as “push- off” for a reason= propulsion!)

Question 18

What happens to the ankle during toe off (preswing) to Acceleration (initial swing)? What muscle activation would allow this against gravity?

Answer 18

Moving from PF back into DF to clear the foot
- CONCENTRIC DF to clear the foot from the ground during swing

Question 19

What is the ankle doing during mid swing to deceleration (terminal swing)? What muscle activation would maintain this?

Answer 19

Maintaining DF to neutral
- CONCENTRIC then ISOMETRIC DF to maintain DF during swing

Question 20

What is the common gait deviation in stance phase when DF are weak?

Answer 20

Foot Slap

Question 21

What are the possible gait deviation in the swing phase when DF are weak?

Answer 21

Hip circumduction
- substitute with hip abductors o swing limb

Hip hiking
- substitute with Quadratus Lumborum on swing limb

Steppage gait= Excessive hip/ knee flexion
- substitute with hip/ knee flexors on swing limb

Vaulting on stance limb
- substitute with concentric PF on stance limb, often combined with hip hiking on swing leg

Question 22

What if the PF are weak during stance and swing phase?

Answer 22

Stance- lack of propulsion or “push off” during late (terminal) stance phase.

PF not active in swing phase,

Question 23

What is the knee doing during heel strike (initial contact) to foot flat (loading response)? What muscle activation would allow for the control of this?

Answer 23

Moving from full Extension to 15-20 degrees flexion as the limb accepts the weight of the body (loading response)
- eccentric quads to control the amount of knee flexion during loading

Question 24

During heel strike (initial contact) the knee is in

Answer 24

Full extension 0 degrees

Question 25

During foot flat (loading response), the knee is at

Answer 25

15- 20 degrees of knee flexion

Question 26

What is the knee doing during foot flat (loading response) to Midstance? What muscle activation would allow this?

Answer 26

Extending back to neutral - concentric quads until neutral knee extension (then activity in the knee musculature is minimal during midstance)

Question 27

What is the knee doing during midstance to heel off (terminal swing) and toe off (preswing)?

Answer 27

Knee muscle activity remains limited in late stance until the hamstrings begin to produce knee flexion at toe off (preswing) in preparation for the swing phase (momentum of body, also aids in this motion)

Question 28

What is the knee doing during Acceleration (initial swing) to Midswing? What muscle activation would allow this to shorten the swing leg?

Answer 28

Moving into about 60 degrees of knee flexion. - concentric hamstrings to bend the knee for foot clearance in early swing

Question 29

What is the knee doing during midswing to deceleration (terminal swing)? what muscle activation would control this?

Answer 29

Momentum of swing is moving the knee back into full extension - eccentric hamstrings to slow the rate of knee extension during terminal swing

Question 30

If the quadriceps are weak, what is the common gait deviation seen during stance phase?

Answer 30

Anterior trunk lean in early stance - compensates for quadriceps weakness by moving the ground reaction force anterior to the knee to “lock” the knee in extension

Question 31

If the hamstrings are weak, what are the common gait deviation in swing phase?

Answer 31

Poor deceleration in terminal swing - hamstrings eccentrically slow hip flexion and knee extension (deceleration) during terminal swing (before heel strike) - hamstrings mainly function during stance phase as a stabilizer for the knee (quadriceps more active in stance phase and hamstrings more active in swing)

Question 32

What is the hip doing during heel strike (initial contact) to foot flat (loading response)? What muscle activation would allow for this?

Answer 32

Hip is in about 30 degrees flexion and stabilizing (in preparation more movement into extension) - Isometric hip extensors (gluteus Maximus) and hip abductors (gluteus medius and minimus)

Question 33

What is the hip doing during foot flat (loading response) to midstance? What muscle activation would allow this?

Answer 33

Moving from 30 degrees flexion into extension (neutral) - concentric hip extensors (gluteus Maximus) to become more erect with hip abductors still stabilizing hip and pelvis.

Question 34

What is the hip doing during midstance to Heel off (terminal stance) and toe off (preswing)? What muscle activation would allow this?

Answer 34

Moving from a neutral hip to 10 degrees extension (beyond neutral) - Eccentric hip flexors (iliopsoas) to control or slow the rate of hip extension

Question 35

What is the hip doing during acceleration (initial swing) to midswing? What muscle activation would allow this?

Answer 35

Moving from extension into 20-30 degrees of flexion - concentric hip flexors (iliopsoas) to advance the swing limb forward.

Question 36

what is the hip doing from midswing to deceleration (terminal swing)? What muscle activation would allow this?

Answer 36

Moving (deceleration) into 30 degrees of flexion - eccentric hips extensors to slow the rate of hip flexion and prepare the limb for heel strike (initial contact)

Question 37

If the gluteus Maximus is weak, what is the common gait deviation in stance phase?

Answer 37

Posterior trunk lean - during early stance compensated for hip extensor weakness by moving the line of gravity of the trunk behind the hip joint to “lock” the hip in extension

Question 38

If the gluteus medius is weak, what is the common gait deviation seen in stance phase?

Answer 38

Lateral Trunk Lean - lean toward the stance leg of the weak hip abductors to prevent contralateral drop of the pelvis on the side of the swing leg

Question 39

Hip Abductors are not active during the

Answer 39

Swing phase in normal gait

Question 40

Trendelenburg Sign

Answer 40

Contralateral (opposite side) pelvic drop

Question 41

Trendelenburg gait

Answer 41

The lateral trunk lean toward weak stance limb

Question 42

If the hip flexors are weak, what is the common gait deviation in swing phase?

Answer 42

Posterior trunk lean - during early swing phase helps pull the femur forward (anteriorly) to advance the swing limb as a compensation for hip flexor weakness Other: - hip circumduction - insufficient hip flexion at terming swing= shorter step length

Question 43

If the hip flexors are weak, what gait deviation will be seen in stance phase:

Answer 43

Poor eccentric control of the rate of hip extension during late stance phase

Question 44

Gait Deviation of Ankle and Foot: Foot Slap

Answer 44

Weak DF DF paralysis

Question 45

Gait Deviation Ankle and Foot: Toe Down instead of heel strike

Answer 45

PF spasticity PF contracture Weak DF DF paralysis Leg Length discrepancy Hindfoot pain

Question 46

Gait Deviation of Ankle and Foot: Clawing of toes

Answer 46

Toe Flexor Spasticity Positive Support Reflex

Question 47

Gait Deviation of Ankle and Foot: Heel lift during Midstance

Answer 47

Insufficient DF range PF spasticity

Question 48

Gait Deviation of Ankle and Foot: No Toe Off

Answer 48

Forefoot/ toe pain Weak PF Weak toe flexors Insufficient PF range of motion

Question 49

Gait Deviation of Knee: Exaggerated Knee Flexion at Contact

Answer 49

Weak Quads Quads paralysis Hamstrings spasticity Insufficient extension ROM

Question 50

Gait Deviation of Knee: Hyperextension in Stance

Answer 50

Compensation for weak quads PF contracture

Question 51

Gait Deviation of Knee: Exaggerated knee flexion at Terminal Stance

Answer 51

Knee Flexion contracture Hip Flexion contracture

Question 52

Gait Deviation of Knee: Insufficient flexion with SWING

Answer 52

Knee effusion Quads Extension Spasticity PF spasticity Insufficient flexion ROM

Question 53

Gait Deviation of Knee: Excessive flexion with Swing

Answer 53

Flexor withdrawal reflex Lower Extremity flexor synergy

Question 54

Gait Deviation of Hip: Insufficient Hip flexion at initial contact

Answer 54

Weak hip flexors Hip flexor paralysis Hip extensor spasticity Insufficient hip flexion ROM

Question 55

Gait Deviation of Hip: Insufficient Hip Extension at Stance

Answer 55

Insufficient hip extension ROM Hip flexion contracture Lower extremity flexor synergy

Question 56

Gait Deviation of Hip: Circumduction during Swing

Answer 56

Compensation for weak hip flexors Compensation for weak DF Compensation for weak Hamstrings

Question 57

Gait Deviation of Hip: Hip hiking during SWING

Answer 57

Compensation for weak DF Compensation for weak knee flexors Compensation for extensor synergy pattern

Question 58

Gait Deviation of Hip: Exaggerated hip flexion during Swing

Answer 58

Lower extremity flexor synergy Compensation for insufficient ankle DF