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Flashcards in I. Introduction Deck (67):
1

Pronation in gait

Eversion

Lateral movement of calcaneus, pronation subtalar joint

2

Supination in gait

Inversion

Medial movement calcaneus, supination subtalar joint

3

Name the phases (and percentages) of gait

Stance phase - 60%

  1. heel strike - 27%
  2. midstance - 40%
  3. propulsive period - 33%

Swing phase - 40%

  1. acceleration phase
  2. midswing
  3. deceleration

4

Stance phase is the _____ phase while swing phase is the ______.

weight bearing; toe-off to heel strike

5

What happens in heel strike phase?

Toe-off opposite foot
Knee extended
Foot dorsiflexed
Leg decelerating
Subtalar joint pronating throughout (foot itself is supinated)

6

Function of heel strike phase

Q image thumb

Transfer weight and shock absorption

7

Key points of midstance phase:

Q image thumb

  • Weight-bearing period between foot flat and heel lift
  • Toe-off completed for opposite foot
  • Foot in full contact with floor
  • Subtalar joint supinated (though food is moving to pronation)

8

Major functions of midstance

  • Bearing weight
  • Convert foot from adaptive shock absorber to rigid lever for propulsion

9

Propulsive period key points:

Q image thumb

  • Period between heel life and toe-off
  • Subtalar supination continued and completed (foot is pronated

10

Functions of propulsive period

Transfer weight from lateral to medial side of foot and to ball and toes for even propulsion

Shifting weight of body to other foot

11

Swing phase includes:

Toe-off to heel strike

12

Acceleration phase key points

Q image thumb

Toe-off to midswing

Hip flexes to propel leg forward

13

Functional significance of acceleration phase

Transfer foot forward for next step

14

Midswing key points

Q image thumb

Transition period between acceleration and deceleration

Halfway point of swing phase

15

Deceleration key points

Q image thumb

Midswing to heel strike

16

Major function of deceleration

Decelerates limb to prep for contact and weight transfer

17

Six classical gait determinants

  • Pelvic rotation
  • Pelvic tilt
  • Pelvis shift
  • Knee flexion
  • Knee-ankle relationship
  • Hip flexion

18

Efficient gait has minimal [vertical/horizontal] oscillations

Vertical

19

What are determinants?

Biomechanical properties which decrease vertical oscillations and allow for more efficient motion

20

What is normal oscillation pattern?

High point is midstance

Low point is double weight bearing (10% of gait)

21

What is pelvic rotation

Rotation of entire pelvic away from the side of the forward leg

22

What is the degree of pelvic rotation is walking gait?

4˚ to each side

23

In pelvic rotation, vertical displacement decreased by

3/8”

24

What is the result of pelvic rotation?

Decreased angle between leg and floor, and between hip and leg

25

What happens in pelvic tilt?

Pelvis dips inferiority on swing side (4-6˚)

Opposite hip adducts (weight bearing hip)

26

What muscle prevents excessive adduction of weight bearing hip in pelvic tilt?

Gluteus medius

27

Pelvic tilt decreases vertical displacement

1/8”

28

What happens in pelvis shift?

Pelvis shifts toward stance side about 1”

Hip adduction on stance side

29

What does pelvis shift do?

Smoothies pelvic motion, helps maintain balance

30

What happens in knee flexion?

Stance knee goes from full extension at heel strike to 15˚ flexion

31

What is an important shock absorber?

Knee flexion

32

Knee flexion decreases vertical displacement by

1/8”

33

Knee-ankle relationship is saying:

Ankle is 90˚ at heel strike, then plantar flexion, then dorsiflexion

As heel raises during toe-off = vertical lift

34

Hip flexion is the

Acceleration stage of swing phase

35

What is happening in hip flexion?

Moves foot forward with minimal vertical undulation

36

What are the prime movers of the muscles of gait

Hip flexors/extensor

37

What are the stabilizers of the muscles of gait

Hip abductors/adductors

38

What are the decelerates of the muscles of gait

Hamstrings and Gluteus Maximus to slow down swing

39

7 Majors muscles of gait

Q image thumb

Gluteus Maximus and medius Hamstrings Gastrocnemius and soleus Tibialis anterior Quadriceps Iliopsoas TFL

40

Muscle activity in stance phase: heel strike

  • Hamstring activity decreases
  • Quads extend knee
  • Gluteus medius stabilizes pelvis, controls hip adduction with eccentric contraction
  • Paraspinal muscles keep pelvis from dipping excessively
  • Tibialis anterior dorsiflexes foot, eccentric contraction as foot makes contact

41

Muscle activity in stance phase: mid stance

  • Body weight being pulled over foot by the body’s momentum
  • Gastrocnemius, soleus, and TFL braking and controlling

42

Muscle activity in stance phase: toe off

Gastrocnemius and soleus contraction

43

Muscle activity in swing phase: acceleration

Hip flexors (iliopsoas and quad and rectus femoris) flex hip and accelerate forward

Tibialis anterior contracts so toes clear floor

44

Muscle activity in swing phase: deceleration

  • Gluteus Maximus contracts
  • Hamstrings decelerates and prepares limb for heel strike

45

Concentric contraction

Muscle shortens - force generated is sufficient to overcome resistance

46

Eccentric contraction

Muscle lengthens - force generated is insufficient to overcome resistance

47

What does a physical exam show?

  • Integrity of the neuromuscular system
  • Nervous system integrity
  • Coordination and integration of movements
  • Muscle strength and health
  • Biomechanical integrity and stability of involved joints

48

What is happening in gluteus medius lurch?

  • Weak or paralyzed gluteus medius (hip abductor)
  • Lean toward weak side to center gravity over stance leg

49

What is Trendelenburg gait?

  • Weak gluteus medius
  • Lets opposite side hip sag excessively during swing phase

50

What kind(s) of gait abnormality do you get with a weak/paralyzed Gluteus Medius?

  • Gluteus medius lurch or
  • Trendelenburg Gait

51

What is the gluteus Maximus lurch?

  • Weak gluteus maximus
  • Shift pelvis anterior and thorax posterior to maintain hip extension

52

What kind(s) of gait abnormality do you get with a weak/paralyzed Gluteus Maximus?

Gluteus maximus lurch

53

What is the waddling gait?

  • Proximal lower extremity (hip, etc.) muscle atrophy, dystrophy
  • Feet wide apart; walk resembles a duck

54

What kind(s) of gait abnormality do you get with weak quads?

Knees buckle into flexion

55

Ataxic gait

Unsteadiness, staggering

56

A gait that looks unsteady may be broadly categorized as:

Ataxic gait

57

What is propulsive gait (festination)

  • Walk on toes as though being pushed, small steps
  • Starts slowly, then gets faster; may need to grab something to stop

58

Festination is a typical gait abnormality of:

Parkinson’s disease

59

Cerebellar gait

Reeling gait, may wander off to one side or the other

60

Meniscus and crucial ligament tears lead to instability, called:

Joint injury gait

61

Pain can cause gait abnormality from:

  • Trauma
  • Joint disease
  • Limping

62

Antalgic gait results from pain, what is it?

Protective gait; pain anywhere in the body

63

What kind(s) of gait abnormality do you get with a weak dorsiflexor?

  • Foot drop
  • Steppage

64

What phase of gait does weak dorsiflexor fit into?

Swing phase

65

Foot drop could be a sign of:

L4 nerve lesion

66

What kind(s) of gait abnormality do you get with a hypomobile joint (ie hip or knee)?

Swing leg out to the side (circumsduction gait)

Swing hip higher (hip hike gait)

67

What is spastic paraplegia or scissors gait:

Legs cross midline

Bilateral contractural changes (adductors)

Partial paralysis