KnB Normal Gait Flashcards
1
Q
Gait Cycle Mnemonic
A
I Love Many Types of Pussy In My Tesla
- I
- Initial Contact
- Love
- Loading phase
- Many
- Midstance
- Types of
- Terminal stance
- Pussy
- Pre swing
- In
- Initial swing
- My
- Mid swing
- Tesla
- Terminal swing
2
Q
Gait basics:
A
- Cyclical
- coordinated jt motion, sensory INput, motor OUTput
- “controlled forward fall”
- coord
- balance
- strength
- sensory INput
- jt integrity
3
Q
Stance phase is
A
60%
4
Q
Swing phase is
A
40%
5
Q
Gait BEGINS and ENDS w/ what?
A
Consecutive ground contact of SAME FOOT
6
Q
2 Phases of Gait Cycle:
A
- Stance
* Time reference foot is on GROUND
* 60^
- Stance
- Swing
* Time reference foot is NOT TOUCHING GROUND
* 40%
- Swing
7
Q
Limb phases of gait
A
- Double limb support
-
TWO brief pds when BOTH limbs in contact w/ ground
- 20%
-
TWO brief pds when BOTH limbs in contact w/ ground
- Single limb support
-
Rest of cycle
- 80%
-
Rest of cycle
8
Q
Stance Phase
Rancho Los Amigos
60% of Gait
I Love Many Types of Pussy
A
Initial contact
Loading response
Midstance
Terminal swing
Preswing
9
Q
What are the Tasks of Stance Phase?
A
- support/fall prevent
- wt. acceptance
- shock absorb
- force prod. to produce forward progress
10
Q
Normal Gait “Rockers”: 3
Only in STANCE !!!
A
- Heel rocker
- Ankle rocker
- Forefoot rocker
11
Q
Initial Contact
A
moment foot touches floor
- Heel contact
-
Tasks:
- proper pos. of foot to begin stance phase
12
Q
Loading Response
A
IC until opposite foot comes OFF floor
*1st of TWO double limb support pds
-
Tasks:
- wt. acceptance, shock absorption
13
Q
Midstance
*start of Single limb support
A
- Begins when non-reference (opp. foot) lifts off and continues until body is aligned directly over foot on ground
-
Tasks:
- progression from heel-ankle rocker
- momentum transfer
14
Q
Terminal Stance
A
- Concludes single limb support
- Begins when reference limb heel rises and ENDS when opp foot hits ground
-
Tasks:
- progression of body PAST forefoot rocker
15
Q
Preswing
*Reference leg ABOUT TO swing
A
- 2nd of 2 double limb support phases
- BEGINS w/ IC of opp foot and ENDS w/ toes off on reference limb
-
Tasks:
- position limb for swing
16
Q
Swing phase
Rancho Los Amigos
In My Tesla
A
- Initial swing
- Mid swing
- Terminal Swing
17
Q
Tasks of Swing Phase
A
- limb clearance
- Limb placement
- momentum transfer
18
Q
Initial Swing
A
- begins w/ lift off of reference foot ENDS w/ ref foot is just OPP non-ref stance limb
-
Tasks:
- limb advancement, foot clearance
19
Q
Midswing
A
- STARTS when ref limb is OPP non-ref stance limb ENDS when the tibia is VERT to ground (ref leg)
-
Tasks:
- limb advance, foot clearance
20
Q
Terminal Swing
A
- BEGINS when tibia is vertical to ground, ENDS w/ next initial contact
-
Tasks:
- completeslimb advance,preps limb for wt acceptance
21
Q
NO wt. acceptance during________
A
Stance phase!!!
22
Q
Step length===
A
dist b/w ground contact of one foot TO opp foot
23
Q
Stride length ====
A
1 complete gait cycle
dist. b/w consecutive steps
24
Q
Clinical issues related to Foot angle and Gait
A
-
In-Toeing
- pigeon toed
- INCs motion needed @ ankle (talocrural) jt
- narrows BOS
-
Out-Toeing
- DECd motion needed @ ankle BUT INCs subtalar motion
- INCs BOS
25
Time-Distance Parameters
## Footnote
**Stride (cycle) time**
****1.0-1.2 m/sec********
26
Time-Distance Parameters
## Footnote
**Stride Length**
1.2-1.9m
27
Time-Distance Parameters
## Footnote
**Step Length**
.56-1.1 m
28
Time-Dist parameters
## Footnote
**Step Width**
7.7-9.6cm
29
Time-Dist parameters
## Footnote
**Cadence**
90-140 step/min
30
Time-Dist parameters
## Footnote
**Velocity**
.9-1.8 m/sec
31
Tips for Gait Analysis
* **Dynamic process**
* think about **direction** things are moving, NOT STATIC POS.
* Be clear w/ **eccentric vs. concentric**
* **gait is mostly eccentric \*\*\*\***
* Recognize that in **stance** we are talking **Closed Chain** and in **swing** we are talking **Open Chain**
32
Ankle in terms of Gait
Talocrural joint
33
Subtalar joint
aka
**Talocalcaneal**
just **inferior to Talocrural**
## Footnote
**talus+calcaneus**
34
These 2 joints are **crucial** in transmitting **rotational forces** b/w **foot** (horizontal) and **leg** (vertical)
Talocrural
+
Subtalar (talocalcaneal)
35
Initial Contact
**Sagittal plane**
**Goal:** proper pos. to **begin stance w/ heel rocker**
* **MTP==** up to 25o EXT (DF)
* **Ankle==** neutral
* **Knee==** neutral
* **Hip==** 20o flex
* **Pelvis==** 5o ant. rot.
* **Trunk==** neutral
## Footnote
**Forward facilitation ==\> Heel Rocker**
36
IC--\> Loading Response
**Sagittal Plane**
* **Goal:**
* ****shock absorb
* stable wt accept
* preserve progression via heel rocker
* **MTP==** 25ext---\> neutral
* **Ankle==** 0 --\> 10 PF (eccentric DF)
* **Knee==** 0--\> 20 flex
* **Hip==** 20 flex
* **Trunk==** neutral
37
LR---\> Midstance
* **Goal:**
* ****progression from **heel to ankle rocker**
* **keeps COM over BOS**
* forward progress. of HAT
* **via hip and knee EXT**
* **MTP==** neutral
* **Ankle==** 10 PF--\> 5 DF
* closed chain
* tibia moving forward
* **Knee==** 20 flex--\> neutral
* **Hip==** 20 flex--\> neutral
* **Pelvis==** moves to neutral
* **Trunk==** neutral
38
MST--\> Terminal Stance
* **Goal:**
* ****progress of body past the **forefoot rocker**
* **contralat. limb catches forward fall**
* **MTP==** neutral--\> 20 ext
* **Ankle==** 5--\> 10 DF
* **Knee==** neutral
* **Hip==** 0--\> 20 EXT
* **Trunk==** neutral
39
TST--\> Pre Swing
* **Goal:**
* ****pos. limb for **swing (limb advance)**
NOTE: **despite "swing" preswing is STILL A STANCE SUBPHASE**
* **MTP==** 20--\> 55 EXT
* closed-chain
* **Ankle==** 10 DF--\> 20 PF
* **Knee==** 0--\> 40 flex
* **Hip==** 20 ext--\> neutral
* **Trunk==** neutral
40
Initial Swing:
* **Goals:**
* ****limb advance
* **Foot clearance**
* **MTP==** neutral
* **Ankle==** 20--\> 5 PF
* leg shortening
* **Knee==** 40--\> 60 flex
* leg shortening
* **Hip==** 0--\> 10 flex
* leg shortening
* **Trunk==** neutral
41
ISW--\> Mid Swing
* **Goals:**
* ****limb advance
* foot clearance
* **MTP==** neutral
* **Ankle==** 5 PF--\> neutral
* **Knee==** 60--\> 30 flex
* make leg long again
* **Hip==** 10--\> 20 flex
* make leg long again
* **Trunk==** neutral
42
MSW--\> Terminal Swing
* **Goals:**
* ****fulfills limb advance needs for **forward progress**
* preps limb for **wt accept.**
* **MTP==** neutral--\> 25 ext
* **Ankle==** neutral
* **Knee==** 30--\> 0 flex (neutral)
* **Hip==** maints 20 flex
* **Trunk==** neutral
43
Sagittal plane drives \_\_\_\_\_\_\_
Motion!!!
44
Initial Contact
## Footnote
**Frontal plane**
Subtalar=== inverted
Foot=== supinated
Knee=== neutral
Hip/pelvis=== neutral
Trunk=== neutral
45
LR--\> Midstance
## Footnote
**Frontal Plane**
Subtalar=== everted
Foot=== pronated
Knee=== neutral
Hip=== neutral--\> 5 adduction
Pelvis=== elevated
Trunk=== neutral
46
Terminal Stance
**Frontal plane**
Subtalar== neutral
Foot== neutral
Knee== neutral
Hip/Pelvis== neutral--\> 5 Adduction
Trunk== neutral
47
NOTE: Subtalar joint
## Footnote
**Motion in Stance**
* motion in **Stance** allows foot to adapt to **varied surfs.**
* Transfers **tibial rotation to the foot** in the form of **inversion/eversion**
48
Subtalar joint
## Footnote
**Eversion (Closed Chain)**
* JUST LIKE **PRONATION**
* tibia medially rotates
* talus add's
* calcaneus everts
* **usually causes knee flex**
49
Subtalar Joint
## Footnote
**Inversion (Closed Chain)**
* Just like **SUPINATION**
* ****tibia laterally rotates
* talus ABD's
* calcaneus inverts
* **Usually causes Knee Extension**
* **rigid foot**
50
Subtalar Joint
## Footnote
**Eversion**
mostly passive
**unlocks midtarsal jt to allow flexible forefoot to adapt to contact surf.**
**after IC and peaks early Midstance**
51
Subtalar Joint
## Footnote
**Inversion (forefoot rigid and locked)**
* begins TSw
* Peaks first in IC
* peaks again PSw
* **neutral in MSw**
52
Midtarsal or "arches"
* Arch **flattens**
* ****Midstance w/ **pronation**
* Arch **restored**
* ****as heel rises/PSw w/ **supination**
53
LR--\> Midstance
## Footnote
**transverse plane**
Femur== IR 5-7
tibia== IR 5-7
54
Midstance--\> Term stance
## Footnote
**transverse plane**
femur== ER to neutral
tibia== ER to neutral
55
In stance, ______________ are acting to COUNTER the \_\_\_\_\_\_\_\_\_\_
Muscles Forces (**internal moments)** acting to COUNTER the GRF's (**external moments)**
56
IC--\> Loading Response
## Footnote
**Sag. plane mm control**
Hip
Knee
Ankle
57
LR--\> Early Midstance
**Sag. plane mm control**
Hip
Knee
Ankle
58
Early Midstance--\> Late Midstance
Hip and Knee **negligible**
* Ankle
* ext moment== DF
* Int moment (mm)== PFs
* mm activity == Eccentric
**\*\*mostly momentum here\*\***
59
Terminal Stance
60
Pre Swing
61
Key Points for **Swing Phase Muscular Control**
* NO EXT moments bc **Open Chain**
* Primary role of mm's of LE
* **control momentum of swinging limb**
* **mostly eccentric**
* **maintain clearance of foot**
* Magnitude of mm contract depends on **gait speed**
* Secondary role of LE mm's is to **control limb in all planes and pos. properly for NEXT IC and WBing**
62
Initial Swing
63
MidSwing
64
Terminal Swing
65
DF's
Tib ant
EDL + peroneus
EHL
66
Dorsiflexors
**Biphasic**
* begins IC to LR
* **eccentric control of foot slapping down**
* peaks again PSw to MSw
* **concentric to clear foot**
67
DF's
## Footnote
**EHL**
**\*mechanical advantage bc easier to contract FIRST**
* Initiates DF act. in PSw
68
DF's
## Footnote
**Tib Ant**
* produces **greatest amt of torque**
69
PF's and **control of Talocrural joint**
* Soleus + Gastroc == 93% PF torque
* **soleus first THEN gastroc @ end of LR**
* **eccentric**
* ****rises thru Midstance
* **declines in PSw bc DFs want to pull UP foot so PFs relax**
70
Other PF's
FHL, FDL, FL, FB, TP
\***FHL prod's most torque of these 5**
71
LR--\> Midstance
## Footnote
**Frontal Plane**
* Subtalar/foot
* ext mom== PRO (subtalar eversion)
* mm's== TP, TA, FHL, FDL
* Eccentric
* Knee
* ext mom== varus
* mm's== IT band
* passive tension
* Hip
* ext mom== ADD.
* mm's==
* eccentric
72
Midstance--\> Term Stance
* Subtalar/Foot
* ext mom== pro--\> sup
* mm's== inverters
* concentric
* Knee
* ext mom== varus
* mm's== IT band
* passive tension
* Hip
* ext mom== add.
* iso/eccentric
73
Pronation w/ IR of Knee
74
Supination w/ ER of Knee
75
LR--\> Term Stance
* Tibia
* mom== IR-ER
* lat. HS, ACL controls IR
* eccentric
* Femur
* mom==IR
* Glute max, piriformis, hip ERs
* eccentric
76
Path of Center of Mass during Gait
* Biphasic
* **IC--\> LR**
* low and centered
* **MidStance**
* ****moves SUP and IPSILAT (stance foot)
* **CONTRALAT IC**
* ****drops
* **CONTRALAT MidStance**
* ****rises
77
DECd gait speed=====
DECd arm swing
78
