L13 - Gait

Question 1

What are some physiological variables that can disturb the gait cycle?

Answer 1

• Obscured vision
• Abnormal balance (e.g. alcohol consumption)
• Muscle fatigue
• Pain in joint
• Stress

Question 2

List some diseases that can cause abnormal gait.

Answer 2

• Stroke
• Cerebral palsy
• Parkinson disease
• Spinal cord injury
• Motor neuron disease
• Spinal muscular atrophy
• Peripheral neuropathy
• Fracture

Question 3

What are the 5 prerequisites of normal gait?

Answer 3

1) Stability in stance (need to stand stably)
2) Sufficient foot clearance during swing (e.g. not drag on ground)
3) Appropriate swing phase pre-positioning of foot (put foot in correct position)
4) Adequate step length/ stride (e.g. cervical neuropathy, Parkinson’s = inefficient)
5) Energy conservation (action and reaction)

Question 4

What are the 2 phases of gait?

Answer 4

Stance phase - 60%

Swing phase - 40%

Question 5

What are the 7 stages of the gait cycle?

Answer 5

Stance phase:

1) Heel strike (initial contact) - Double support
2) Loading response (foot flat) - Single support
3) Midstance - Single support
4) Terminal stance (heel off) - Single support

All of swing phase is single support*

5) Preswing (toe off) - Double support
6) Initial and Mid-swing
7) Terminal swing

Question 6

What muscles contract during Heel strike phase?

Answer 6

• Tibialis anterior (dorsiflexes ankle), extensor digitorum longus, extensor hallucis longus
• Gluteus maximus (extends hip), tensor fasciae latae, gluteus medius

Question 7

What muscles contract during the Loading response phase?

Answer 7

Foot flat:

Quadriceps femoris, sartorius

Question 8

What muscles contract during the Mid stance phase and Terminal stance (heel off) phase?

Answer 8

• Triceps surae (gastrocnemius + soleus)
• Tibialis posterior (supports foot arches)
• Peroneus longus (supports foot arches)
• Erector spinae

Question 9

What muscles contract during the Pre-swing (toe off) phase?

Answer 9

• Deep plantarflexors
• Flexors of toes (flexor digitorum longus, flexor hallucis longus)
• Intrinsic foot muscles (flexor digitorum brevis, flexor hallucis brevis, extensor digitorum brevis)
• Rectus femoris (quadriceps femoris) (flexes hip)

Question 10

What are the phases included in Swing phase of gait cycle?

Answer 10

Initial and mid-swing

Terminal Swing

Question 11

What muscles contract during initial & mid-swing?

Answer 11

• Iliopsoas (psoas major + iliacus) (flexes hip)
• Rectus femoris, vasti
• Contralateral abductors of hip

Question 12

What muscles contract during Terminal swing?

Answer 12

• Quadriceps femoris, sartorius
• Hamstrings (flexes knee, extends hip)
• Tibialis anterior, extensor digitorum longus, extensor hallucis longus

Question 13

What are the phases in Running gait?

Answer 13

Stance (40- 50%) - Power absorption, Propulsion, Tow off

Double float - initial swing

Swing (50-60%) - terminal swing

Double float - terminal swing

Question 14

What is the 3 prong approach when evaluating gait by history taking?

Answer 14

Approach from 3 angles:
1) CNS - i.e. stroke, cerebral palsy, degenerative disease (e.g. Parkinson disease), spinal cord injury (signal cannot travel down), motor neuron disease, spinal muscular atrophy

2) PNS - i.e. peripheral neuropathy, injury
3) MSS - i.e. - Fracture, muscle weakness, joint contracture, bone deformity

Question 15

What are some signs of abnormal gait seen in physical examination?

Answer 15

observe from front, back, side

• Dipping shoulder, swinging trunk, unstable pelvis, waltzing
• Tiptoeing / intoeing (may be caused by excessive anteversion of femur) / out-toeing

Question 16

What is the difference between Kinematics and Kinetics in regard to Gait?

Answer 16

• Kinematic: describes motion without regard to its causes

- Kinetic: the effect of forces and torques on the motion of bodies

Question 17

Is Range of Motion a Kinematic or Kinetic parameter?

Answer 17

Kinematic

Question 18

List the things that Kinematics encompass regarding gait?

Answer 18

1) Range of motion:
a) Stride length – distance between 2 successive placements of the same foot
b) Step length – distance by which one foot moves forward in front of the other one
c) Stride/step width – side-to-side distance between the 2 feet
d) Joint rotation (flexion / extension)

2) Velocity: cadence – number of steps in a given time

Question 19

List the things that Kinetics encompass regarding gait?

Answer 19

1) Ground reaction force
2) Joint moment (extensor / flexor)
3) Joint power (generation / absorption)

Question 20

Describe the kinematics and kinetics of intoeing gait seen in children?

Answer 20

Intoeing gait with excessive inward foot progression

kinetics&raquo_space; excess inward foot rotation increases force on femoral head anteversion

kinematics&raquo_space; Increase internal rotation angle of tibia

Question 21

What are the 3 common abnormal gait patterns?

Answer 21

1) Antalgic gait
2) Trendelenburg gait
3) Short limb gait

Question 22

Describe the observation of Antalgic gait?

Answer 22

Gait is modified to reduce weight-bearing on the painful limb

Uninvolved limb is rapidly advanced to shorten stance phase (different stance time between 2 sides)

Initial contact is avoided to decrease jarring

Gait is often slow, steps are short to limit the weight-bearing period

Question 23

What causes Trendelenburg gait?

Answer 23

Caused by weakness in hip abductors (e.g. gluteus medius), hip pain in osteoarthritis

Question 24

Name one disease that can cause Trendelenburg gait?

Answer 24

Perthes disease: necrosis of femoral head changes position of femur = misalignment means gluteus medius not in tension and cannot offset dropping of pelvis

Question 25

Describe the observation of Trendelenburg gait?

Answer 25

• Upper trunk swing with dropping of pelvis
• Pelvic instability

Bend toward the affected side to:

• Keep the center of gravity directly above the hip joint
• Eliminate the need for hip abductors, lower forces across hip joint

Question 26

Describe the observation of Short Limb gait?

Answer 26

• Upper trunk swing with shoulder drop on shorter limb side
• Tiptoe on shorter limb
• Knee bending and Circumduction on longer limb

Question 27

Define Cerebral Palsy?

Answer 27

Cerebral palsy (CP) is caused by abnormal development of the brain or damage to the developing brain that affects a child’s ability to control his or her muscles

Question 28

What causes Cerebral Palsy?

Answer 28

Congenital CP : Low birthweight, Premature birth, Infection during pregnancy, Jaundice, Birth complication leading to hypoxia …etc

Acquired CP: Infection, trauma, stroke, sickle cell anemia …etc

Question 29

What are some Common Gait Abnormalities in Cerebral Palsy?

Answer 29

1) Spasticity of calf muscle results in tiptoeing
2) Soft tissue contracture (too tight) results in crouching: Knees were held in flexion and the ankles in dorsiflexion throughout the stance phase
3) Stiff knee gait due to abnormal Rectus femoris contraction

Question 30

What are some treatment options for cerebral palsy gait?

Answer 30

soft tissue release, selective dorsal rhiztomy to change muscle spasticity, foot stabilization

Question 31

List some advances in management of abnormal gait?

Answer 31

• Improved technology in gait analysis
• Better understanding of the abnormalities
• Technological advancement e.g.: Robotic assisted gait training/ Exoskeleton for paraplegic patients