Gait Flashcards
(48 cards)
1
Q
IC-Ankle
A
Ankle at Neutral- Isometric Anterior Tibialis
2
Q
LR- Ankle
A
10* PF- Eccentric Ant Tib. Calcaneal Eversion Unlocks the Foot during LR
3
Q
MSt- Ankle
A
Ankle at neutral- Eccentric gastroc
4
Q
TSt- Ankle
A
Eccentric gastroc-10* DF. During TSt and PSw, calcaneal inversion occurs to lock up foot for rigid push off
5
Q
PSw- Ankle
A
15* PF-Concentric Gastroc-Soleus, During TSt and PSw, calcaneal inversion occurs to lock up foot for rigid push off
6
Q
ISw-Ankle
A
0-5* PF- Concentric Ant Tib
7
Q
MSw- Ankle
A
Neutral DF- Isometric Ant Tib
8
Q
TSw-Ankle
A
Isometric Anterior Tib-Ankle at neutral
9
Q
IC-Knee
A
Neutral- Isometric Quads
10
Q
LR-Knee
A
20* Flexion, Eccentric Quads
11
Q
MSt-Knee
A
Neutral- Concentric Quadriceps
12
Q
TSt-Knee
A
5* Flexion-Quads/HS silent
13
Q
PSw-Knee
A
40*Flexion- Concentric Popliteus/Gracilis/Sartorius
14
Q
ISw-Knee
A
60* Flexion-Concentric HS
15
Q
MSw-Knee
A
25* Flexion-Concentric Quads, Eccentric HS
16
Q
TSw-Knee
A
Neutral Knee with Concentric quads and eccentric HS
17
Q
IC-Hip
A
20* Flexion- Cocontraction Glute max
18
Q
LR-Hip
A
17* Flexion- Concentric glute max with HS
19
Q
MS-Hip
A
Neutral- relatively silent glute max and hips
20
Q
TSt
A
20* Extension with Eccentric Iliopsoas
21
Q
PSw
A
10* Extension with Concentric Hip Flexors
22
Q
ISw
A
20* Flexion, Concentric Hip Flexors
23
Q
MSw
A
25* Flexion with concentric gracilis and adductor longus
24
Q
TSw
A
20* Flexion, Eccentric Gracilis
25
Pelvis- IC
5\* Forward Rotation
26
Pelvis- LR
4\* Pelvic Drop on NWB side. WB leg has eccentric glute med
27
Pelvis-MSt
Neutral- WB leg concentric glute med
28
Pelvis-TSt
5\* Backward Rotation
29
What happens to the trunk?
1. Trunk moves from neutral to slight
extension throughout gait
2. Arm swing and Leg swing are opposite
of each other
3. Trunk rotation chases initial contact
\*Lumbar spine rotation opposite to hip rotation
30
Pathology-Foot Slap
an audible ”slap” on the ground immediately following
a heel strike
* What should occur at initial contact?
* Neutral ankle positioning with slow lowering to ankle
plantarflexion immediately afterwards
* What is the impairment?
* Poor dorsiflexion strength/Poor eccentric control
anterior tibialis
• No proper eccentric lowering of the foot to the
ground
31
Pathology-Vaulting
Excessive ankle plantarflexion on the stance
limb in order to help clear the swing limb.
• What should occur at loading response to
midstance?
• Ankle moves from 10-15 degrees of
plantarflexion to neural ankle positioning
* What is the impairment?
* One limb is longer than the other, so in order to
clear the longer limb the patient must excessive
plantarflexion on the stance side.
• The longer limb is on the swing side
32
Pathology-Early Heel Off
Early rise of the heel prior to completion of midstance
• Where is the ankle at midstance and what should
occur at midstance to terminal stance?
• Ankle is in neutral during midstance and transitions to
10-15 degrees dorsiflexion
* What is the impairment?
* There is a limitation in dorsiflexion mobility and therefore
the heel quickly moves into heel off
• Tightness/Spasticity of the plantarflexors, diminished
posterior glide of the talus
33
Pathology-Delayed Heel Off
Delayed rise of the heel at the end of terminal
stance and beginning of pre-swing
* What should occur at terminal stance?
* Ankle moves to 10-15 degrees dorsiflexion
* What is the impairment?
* There is a excessive dorsiflexion mobility or the
plantarflexors lack strength required for propulsion
• Diminished plantarflexion strength, excessive
dorsiflexion mobility
34
Pathology-Knee Extensor Thrust
A rapid and abrupt locking of knee into extension
* What should occur at loading response?
* Knee moves into 15-20 degrees of flexion
* What is the impairment?
* No proper eccentric lowering of the knee into flexion
* Weak quadriceps, quad spasticity, PF spasticity
35
Pathology- High Steppage
A quick and excessive increase in hip flexion
during initial swing in order to clear a long limb
• What should occur at pre-swing to initial
swing?
• Hip moves from 10 degrees of extension to 20
degrees of flexion
* What is the impairment?
* Compensatory swing strategy to clear a long limb
* Decreased ankle dorsiflexion, diminished knee
flexion
36
Pathology-Circumduction
A patient who performs abduction and a semi-circular
movement of the affected hip secondary to the inability
to achieve adequate clearance of the foot.
* What should occur at pre-swing to initial swing?
* Hip moves from 10 degrees of extension to 20 degrees
of flexion
* What is the impairment?
* The patient lacks hip mobility, knee, and ankle mobility
in order to clear the longer limb
• Diminished LE mobility in sagittal plane, diminished hip
strength
37
Pathology- Trendelenberg
An abnormal lateral trunk lean towards the
stance limb during midstance.
* What should occur during midstance?
* Pelvis moves from 4 degrees to 0 degrees on
the swing side through concentric hip abductors
on the stance side.
* What is the impairment?
* Diminished hip abductor strength causes the body
to compensate by shifting the COM over the stance
limb
• Weak gluteus medius, minimus on the stance limb
38
Pathology- Steppage Gait
Due to inability to DF ankles. Could be from herniation at L4-5
39
Pathology- Diminished Forward Rotation
A diminished amount of forward rotation of
the pelvis which limits ipsilateral step
length.
• What should occur during midswing to
terminal swing?
• Pelvis moves from 0 degrees to 4 degrees on
the swing side.
* What is the impairment?
* Diminished hip/pelvis mobility or lack of
pelvic coordination
40
Pathology- Diminished Backward Rotation
A diminished amount of backward rotation
of the pelvis which limits contralateral step
length.
• What should occur between midstance to
terminal stance?
• Pelvis should rotate backward from neutral to
5 degrees on the stance side.
* What is the impairment?
* Diminished hip/pelvis mobility or lack of
pelvic coordination
41
Pathology- Backwards Trunk Lean
Excessive extension of the trunk during the early to
mid stance phases secondary to hip extensor
weakness.
• What should occur during heel strike through
midstance?
• The trunk moves maintain pretty close alignment with
the pelvis, slight extension throughout
* What is the impairment?
* Diminished hip extensor strength causes the body to
compensate by shifting the COM behind the pelvis
• Weak gluteus maximus on the stance limb
42
Pathology- Forward Trunk Lean
Excessive forward trunk lean early to mid stance
phases secondary to lower extremity weakness
or diminished hip mobility.
• What should occur during loading response
through midstance?
• The trunk moves maintain pretty close alignment
with the pelvis, slight extension throughout
* What is the impairment?
* Diminished quad strength causes the body to
compensate by shifting the COM anterior to the
knee.
• Weak quadriceps or hip flexor contracture
43
What is a cushioned heel?
What is a cushioned heel?
• The heel cushion controls the
lowering of the forefoot to the
ground during initial contact and
weight acceptance.
* Too Soft Cushion Heels
* Similar to a weak anterior
tibialis
* Allows for a foot drop/slap
* Absent Knee flexion @ heel
strike
• Think PF = Knee
extension
* Hard or Stiff Cushion Heels
* AKA ”dorsiflexed foot”
* Think DF = Knee flexion
* Excessive Knee flexion @ heel
strike to midstance
• Causes buckling @ knee and
patient will attempt to force
knee extension
44
45
What is an Extension Aide?
• Can be an elastic strap,
spring, or webbing that
assists the prosthesis in
achieve extension.
• Think of the EA “as kinda
like” pseudoquadriceps
Terminal Swing Impact
• Forcible impact as knee
goes into extension at end
of terminal swing phase,
just before heel strike
• Extension aid is set to high
\*NPTE will say too little knee friction
46
What is a socket wall?
High Medial Wall
• Patient wants to
reduce pressure on
pubic ramus
* Abducted gait
* Circumduction
* Lateral Trunk
Bending
Unsupportive Lateral
Wall
• Patient wants to reach a
position of optimal
support on the prosthetic
side
* Abducted gait
* Lateral Trunk Bending
Socket Too
Loose/Inadequate
Suspension
•Socket is sliding off of
the leg during swing
phase
* Pistoning
* Circumducted
47
Socket Positioning...
SOCKET FLEXION
* Normal is 5-8 degrees
* If excessive, creates knee
instability “buckling”
* Gait Deviation
* Excessive knee flexion
* INSUFFICIENT SOCKET FLEXION
* Abnormal!!!
* If present, creates knee extension
and associated ankle
plantarflexion (prosthesis
plantarflexion)
* Gait Deviation
* Excessive knee extension
48
Foot Placement...
* Anteriorly Set Foot
* Center of gravity line passes
anterior to the knee but posterior
to the foot during initial contact to
loading response creating an
extensor moment or knee
extension
* Gait deviation
* Excessive knee extension
* Posteriorly Set Foot
* Center of gravity line passes
posteriorly to the knee during
initial contact to loading response
creating an flexor moment or
knee flexion
* Gait deviation
* Knee buckling; excessive knee
flexion
