L13 - Gait Flashcards
(31 cards)
What are some physiological variables that can disturb the gait cycle?
- Obscured vision
- Abnormal balance (e.g. alcohol consumption)
- Muscle fatigue
- Pain in joint
- Stress
List some diseases that can cause abnormal gait.
- Stroke
- Cerebral palsy
- Parkinson disease
- Spinal cord injury
- Motor neuron disease
- Spinal muscular atrophy
- Peripheral neuropathy
- Fracture
What are the 5 prerequisites of normal gait?
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)
What are the 2 phases of gait?
Stance phase - 60%
Swing phase - 40%
What are the 7 stages of the gait cycle?
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
What muscles contract during Heel strike phase?
- Tibialis anterior (dorsiflexes ankle), extensor digitorum longus, extensor hallucis longus
- Gluteus maximus (extends hip), tensor fasciae latae, gluteus medius
What muscles contract during the Loading response phase?
Foot flat:
Quadriceps femoris, sartorius
What muscles contract during the Mid stance phase and Terminal stance (heel off) phase?
- Triceps surae (gastrocnemius + soleus)
- Tibialis posterior (supports foot arches)
- Peroneus longus (supports foot arches)
- Erector spinae
What muscles contract during the Pre-swing (toe off) phase?
- 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)
What are the phases included in Swing phase of gait cycle?
Initial and mid-swing
Terminal Swing
What muscles contract during initial & mid-swing?
- Iliopsoas (psoas major + iliacus) (flexes hip)
- Rectus femoris, vasti
- Contralateral abductors of hip
What muscles contract during Terminal swing?
- Quadriceps femoris, sartorius
- Hamstrings (flexes knee, extends hip)
- Tibialis anterior, extensor digitorum longus, extensor hallucis longus
What are the phases in Running gait?
Stance (40- 50%) - Power absorption, Propulsion, Tow off
Double float - initial swing
Swing (50-60%) - terminal swing
Double float - terminal swing
What is the 3 prong approach when evaluating gait by history taking?
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
What are some signs of abnormal gait seen in physical examination?
observe from front, back, side
- Dipping shoulder, swinging trunk, unstable pelvis, waltzing
- Tiptoeing / intoeing (may be caused by excessive anteversion of femur) / out-toeing
What is the difference between Kinematics and Kinetics in regard to Gait?
- Kinematic: describes motion without regard to its causes
- Kinetic: the effect of forces and torques on the motion of bodies
Is Range of Motion a Kinematic or Kinetic parameter?
Kinematic
List the things that Kinematics encompass regarding gait?
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
List the things that Kinetics encompass regarding gait?
1) Ground reaction force
2) Joint moment (extensor / flexor)
3) Joint power (generation / absorption)
Describe the kinematics and kinetics of intoeing gait seen in children?
Intoeing gait with excessive inward foot progression
kinetics»_space; excess inward foot rotation increases force on femoral head anteversion
kinematics»_space; Increase internal rotation angle of tibia
What are the 3 common abnormal gait patterns?
1) Antalgic gait
2) Trendelenburg gait
3) Short limb gait
Describe the observation of Antalgic gait?
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
What causes Trendelenburg gait?
Caused by weakness in hip abductors (e.g. gluteus medius), hip pain in osteoarthritis
Name one disease that can cause Trendelenburg gait?
Perthes disease: necrosis of femoral head changes position of femur = misalignment means gluteus medius not in tension and cannot offset dropping of pelvis
