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From Flashcardlet > -PPOD1: Locomotion handouts > Flashcards

-PPOD1: Locomotion handouts Flashcards

0
Q

What is medial?

A

Closer to the midline

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1
Q

What is the anatomical position?

A 
Standing
Feet together
Arms to the side
Head and eyes facing forwards
Palms of the hands facing forwards
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2
Q

What is lateral?

A

Further from the midline

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3
Q

What is superior?

A

Closer to the head

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4
Q

What is inferior?

A

Closer to the feet

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5
Q

What is proximal?

A

Closer to the origin of a structure

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6
Q

What is distal?

A

Further away from the origin of a structure

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7
Q

What is posterior?

A

Or dorsal

Closer to the posterior surface of the body

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8
Q

What is anterior?

A

Or ventral

Closer to the anterior surface of the body

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9
Q

What is supine?

A

Face or palm up

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10
Q

What is prone?

A

Face or palm down

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11
Q

What is flexion?

A

In non-anatomical language is bending

Flexion usually means the angle between the body segments on either side of the flexion joint is decreased

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12
Q

What is extension?

A

The opposite motion to flexion

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13
Q

For most joints what is the difference between flexion and extension?

A

Flexion rom is usually greater than extension rom

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14
Q

What is abduction?

A

Moving away from the midline of the body or segment

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15
Q

What is adduction?

A

Moving closer to the midline of the body or segment

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16
Q

Internal rotation

A

Rotation towards the midline

The anterior aspect of the segment rolls towards the midline

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17
Q

External rotation

A

The opposite to internal rotation

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18
Q

Supination

A

Rotating the arm and wrist so that the palm faces up

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19
Q

Pronation

A

Rotating the arm and wrist so that the palm faces down

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20
Q

Valgus

A

Turned outward away from midline of the body

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21
Q

Varus

A

Turned inward, towards the midline of the body

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22
Q

Gait cycle

A

Reference framework for the walking process

Defines terms for the different phases and events of gait

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23
Q

Loading

A

Shock absorption
Stabilisation of limb
Preservation of progression

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24
Q

Mid stance

A

Progression of the COM to level with the supporting foot

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25
Q

Terminal stance

A

Progression of the COm to beyond the supporting foot

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26
Q

Pre-swing

A

Preparation pf the lib for swing

Assist with balance as weight is transferred

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27
Q

Initial swing

A

Clearance of the floor

Advancement of the swinging limb to the level with the supporting foot

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28
Q

Mid swing

A

Clearance of the floor

Advancement of the swinging limb to beyond the supporting foot

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29
Q

Terminal swing

A

Preparation of the limb for weight acceptance

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30
Q

Cadence

A

Number of steps (not strides) per minute
Also known as step rate
Speed=(stride length/2) x (cadence/60)

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31
Q

Step width

A

The distance between the centres of the right and left heels measured perpendicular to the direction of progression
Also known as walking base

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32
Q

Toe out angle

A

The angle between the direction of progression and a line drawn from the centre of the heel running between the 2nd and 3rd toes
Also known as foot progression angle

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33
Q

Footprint analysis

A

Stride length
Left and right step lengths
Step width
Left and right toe out angles

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34
Q

Kinematics

A

The study or description of motion, without regard to the forces which produce it

  • the displacements and velocities of the body segments
  • the angular displacements and velocities at the joints
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35
Q

Kinematics

A

Joint angles

  • measured in degrees from the neutral position
  • e.g. The knee is in 25degrees of flexion
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36
Q

Kinetics

A

The study or description of the forces, moments and masses which bring about the motion

  • forces - accelerations
  • moments - angular accelerations
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37
Q

Kinematics

A

The study or description of motion, without regard to the forces which produce it

  • the displacements and velocities of the body segments
  • the angular displacements and velocities at the joints
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38
Q

Ground reaction force

A

Measured with a force platform
Gives the magnitude of the force (Newtons)
The direction of the force
And also the point of origin under the foot

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39
Q

Moment

A

-A turning force
Moment=magnitude of force x shortest distance between line of force and joint centre
-the ground reaction force acts to produce a moment at each of the joints

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40
Q

External moment

A

Arrises outside the body

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41
Q

Concentric muscle action

A

Muscle length decreases as the muscle generates tension i.e. The muscle contracts

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42
Q

Eccentric muscle action

A

Muscle length increases as the muscle generates tension

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43
Q

Concentric muscle action

A

High energy cost i.e. Muscles fatigue quickly

Mainly concerned with propulsion in walking

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44
Q

Eccentric muscle action

A

Much lower energy cost than concentric action

Mainly concerned with control in walking

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45
Q

Concentric muscle action

A

Muscle activity causing motion which opposes the external moment

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46
Q

Eccentric muscle action

A

Muscle activity controlling motion which is the same direction as the external moment

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47
Q

Obervational gait analysis

A

Many studies have shown this to be unreliable with much variation existing between and within observers
Nevertheless it remains the primary method in the clinical environment

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48
Q

Negative factors of observational gait analysis

A
  • in real time the eye is not fast enough to observe some gait events
  • it may not be quantitative and may not even be objective
  • subjects may fatigue if much walking is required

The objections can be in some part addressed by using video recording
-dvd, dv, vhs etc

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49
Q

Important factors for observational gait analysis

A

Try not to have limbs obscured by loose and/or dark clothing
Mark the skin or use stickers to highlight relevant anatomical features
-asis
-patellae
-feet
-joint centers
Collect sagittal and coronal plane views

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50
Q

Features for examination: Feet - sagittal

A
  • initial contact by heel, flat or forefoot
  • does the foot slap down?
  • does the heel contact the floor (if so when does it lift?)
  • are the toes dragging in swing?
  • can you estimate the peak dorsiflexion in stance?
  • can you estimate the plantarflexion in swing?
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51
Q

Features for Examination: Feet-coronal

A
  • are the forefeet pronated?

- is the hindfoot in valgus or varus(in stance and in swing)?

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52
Q

Features for examination: Knees

A

What is the peak knee extension in stance?
-too much or too little?
What is the peak of flexion in swing?
What is the position at initial contact?
Are the knees rotated in the transverse plane?
-relative to the direction of progression
-relative to the pelvis

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53
Q

Features for examination: Hips

A

What is the peak knee extension in stance?
-too much or too little?
What is the peak of flexion in swing?
-too much or too little?

Are these related to the position of the pelvis?

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54
Q

Features for examination: Pelvis-sagittal

A

Is the pelvis more anteriorly or posteriorly tilted than normal?
Is there a marked lordosis?
Does the pelvis tilt through a greater range than normal through the gait cycle?

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55
Q

Features for examination: Pelvis- coronal and transverse

A

Is the pelvis higher/more retracted on one side than the other?
Does the pelvis move through a greater range than normal through the gait cycle?

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56
Q

Features for examination: upper body

A

Is there any forward pr backward lean?
Is there any lateral tilting or flexing?
Is arm swing normal?

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57
Q

Video vector systems

A

Use a force platform in conjunction with video to superimpose an image of the ground reaction force on the picture
Subject to all the pitfalls and constraints of video and
Video image and vector image but be accurately aligned and synchronised

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58
Q

3D computerised systems

A

Markets positioned on anatomical landmarks
Cameras detect the positions of the markers in 3 dimensions
System uses a model to infer joint centres and segment orientations from the positions of the surface markers
Relative and absolute positions of joints and segments can be calculated
In conjunction with a force platform joint moments can also be calculated
In conjunction with electromyography, muscle activity can be related to kinematic and kinetics

59
Q

Muscle activity and EMG

A

When a muscle is active it produces a very low level electrical signal
This signal can be detected on the surface of the skin and is known as the electromyogram or EMG

59
Q

Muscle activity and EMG

A

When a muscle is active it produces a very low level electrical signal
This signal can be detected on the surface of the skin and is known as the electromyogram or EMG

60
Q

Loading Response- ankle

A

In normal gait, initial contact is by the heel
Tibialis anterior is active in loading
It controls the plantarflexor moment and moderates plantarflexion as the foot moves to plantargrade
Also active in swing to lift the foot, ensuring that it clears the ground

60
Q

Loading Response- ankle

A

In normal gait, initial contact is by the heel
Tibialis anterior is active in loading
It controls the plantarflexor moment and moderates plantarflexion as the foot moves to plantargrade
Also active in swing to lift the foot, ensuring that it clears the ground

61
Q

Loading response-knee

A

Quads are active in loading

Controlling the external flexor moment to prevent collapse as the knee flexes to absorb shock

61
Q

Loading response-knee

A

Quads are active in loading

Controlling the external flexor moment to prevent collapse as the knee flexes to absorb shock

62
Q

Loading response- hip

A

Hip extensors are active in loading

Generating power to extend the hip and progress the body centre of mass forward

62
Q

Loading response- hip

A

Hip extensors are active in loading

Generating power to extend the hip and progress the body centre of mass forward

63
Q

Loading response summary

A

Dorsiflexors acting eccentrically to control motion of foot
Quads acting eccentrically to control motion of knee
Hip extensors acting concentrically to assist with forward propulsion of centre of mass

63
Q

Loading response summary

A

Dorsiflexors acting eccentrically to control motion of foot
Quads acting eccentrically to control motion of knee
Hip extensors acting concentrically to assist with forward propulsion of centre of mass

64
Q

Mid stance-ankle

A

The plantarflexors are active throughout mid and terminal stance
They oppose the dorsiflexor moment and control dorsiflexion and tibial progression

64
Q

Mid stance-ankle

A

The plantarflexors are active throughout mid and terminal stance
They oppose the dorsiflexor moment and control dorsiflexion and tibial progression

65
Q

Mid stance- knee

A

The quads are still active in mid stance
-but activity tails off in terminal stance as the moment crosses over to extensor
They oppose the external flexor moment to effect extension of the knee

65
Q

Mid stance- knee

A

The quads are still active in mid stance
-but activity tails off in terminal stance as the moment crosses over to extensor
They oppose the external flexor moment to effect extension of the knee

66
Q

Mid stance- hip

A

The hip extensors are also still active in mid-stance
-and activity also tails off in terminal stance as the moment crosses over to extensor
They oppose the external flexor moment to continue the extension of the hip

66
Q

Mid stance- hip

A

The hip extensors are also still active in mid-stance
-and activity also tails off in terminal stance as the moment crosses over to extensor
They oppose the external flexor moment to continue the extension of the hip

67
Q

Mid stance summary

A

Plantarflexors acing eccentrically to control progression of tibia
Quads acting concentrically to effect extension of knee against flexor moment
Hip extensors still acting concentrically to assist with forward propulsion of centre of mass

67
Q

Mid stance summary

A

Plantarflexors acing eccentrically to control progression of tibia
Quads acting concentrically to effect extension of knee against flexor moment
Hip extensors still acting concentrically to assist with forward propulsion of centre of mass

68
Q

Pre-awing-ankle

A

The plantarflexors are active in the early part of preswing
They generate power which plantarflexes the foot against the dorsiflexor moment, and helps to propel the leg forward to initiate the swing phase

68
Q

Pre-awing-ankle

A

The plantarflexors are active in the early part of preswing
They generate power which plantarflexes the foot against the dorsiflexor moment, and helps to propel the leg forward to initiate the swing phase

69
Q

Preswing-knee

A

The quads are still active in preswing

Even though the knee is starting to flex rapidly, this muscle action is required to moderate the rate of flexion

69
Q

Preswing-knee

A

The quads are still active in preswing

Even though the knee is starting to flex rapidly, this muscle action is required to moderate the rate of flexion

70
Q

Preswing-hip

A

The hip flexors are active in later preswing

They generate power to flex the hip at the beginning of swing

70
Q

Preswing-hip

A

The hip flexors are active in later preswing

They generate power to flex the hip at the beginning of swing

71
Q

Preswing summary

A

Plantarflexors acting concentrically in early preswing to plantarflex the foot
Quads acting eccentrically to control rate of flexion of knee
Hip flexors acting concentrically to flex hip in preparation for swing

71
Q

Preswing summary

A

Plantarflexors acting concentrically in early preswing to plantarflex the foot
Quads acting eccentrically to control rate of flexion of knee
Hip flexors acting concentrically to flex hip in preparation for swing

72
Q

Hip extensors in gait

A

Concentric action- loading and mid stance

72
Q

Hip extensors in gait

A

Concentric action- loading and mid stance

73
Q

Hip flexors during gait

A

Concentrically in preswig

73
Q

Hip flexors during gait

A

Concentrically in preswig

74
Q

Knee extensors during gait

A

Eccentrically in loading

Concentrically in mid stance

74
Q

Knee extensors during gait

A

Eccentrically in loading

Concentrically in mid stance

75
Q

Plantarflexors during gait

A

Eccentrically in mid stance and terminal stance

Concentrically in preswing

75
Q

Plantarflexors during gait

A

Eccentrically in mid stance and terminal stance

Concentrically in preswing

76
Q

Dorsiflexors during gait

A

Eccentrically in loading

76
Q

Dorsiflexors during gait

A

Eccentrically in loading

77
Q

Muscle action summary

A 
Allows opposes the external moment and
Is either concentric i.e.
-the muscle is shortening
-producing motion which opposes the external moment
-generates power for propulsion/support
Or eccentric, i.e.
-the muscle is lengthening
-controlling/moderating the motion brought about by the external moment
77
Q

Muscle action summary

A 
Allows opposes the external moment and
Is either concentric i.e.
-the muscle is shortening
-producing motion which opposes the external moment
-generates power for propulsion/support
Or eccentric, i.e.
-the muscle is lengthening
-controlling/moderating the motion brought about by the external moment
78
Q

Mechanical energy

A

Calculations using kinematic and kinetic data

78
Q

Mechanical energy

A

Calculations using kinematic and kinetic data

79
Q

Metabolic energy

A

Measurements related to metabolic energy expenditure

79
Q

Metabolic energy

A

Measurements related to metabolic energy expenditure

80
Q

Mechanical energy

A

Calculations suggest that energy is transferred between segments during the gait cycle
May give us insight into the mechanisms behind an energy efficient gait
Energy calculations involve motion
-cocontraction?
-isometric contraction?

81
Q

Metabolic energy

A

O2 consumption is an indicator of metabolic energy expenditure
-millilitres of 02 consumed per kilogram body mass per minute (ml/kg/min)

82
Q

Metabolic energy

A

O2 cost=O2 consumption/speed

-millilitres of O2 consumed per kilogram body mass per metre (ml/kg/m)

83
Q

Attributes of normal gait

A 
Stability in stance
Adequate foot clearance in swing
Pre-positioning of foot for initial contact
Adequate step length
Energy conservation
84
Q

Stability in stance

A

Poor balance
Poor trunk and lower body control
Abnormal foot position

85
Q

Adequate foot clearance in swing

A

Loss of dorsiflexion in swing due to
-weakness of the dorsiflexors
-spasticity or shortness in the plantarflexors
Inadequate knee flexion in swing

86
Q

Pre-positioning of foot for initial contact

A

This allows efficient transfer of weight during loading
Compromised by:
-poor control of swinging limb
-possibility because of poor stability in stance on the contralateral side

87
Q

Adequate step length

A

Poor knee extension in stance
Poor stance stability on the contralateral side
Poor propulsive effort to the swinging limb (poor ‘push off’)

88
Q

Energy conservation

A

Increased vertical excursion of the centre of mass
Poor control of momentum
Poor control of energy transfer between the body segments
Energy efficiency summarises the degree of severity of all gait deviations

89
Q

Functional interpretation of the foot

A

Shock absorption
Weight bearing stability
Progression

90
Q

Shock absorption mechanisms in gait

A

Plantarflexion of foot (eccentric action of dorsiflexors)
Flexion of knee (eccentric action of quads)
Adduction of hip (eccentric action of abductions)

-plus…functions within the foot

91
Q

Shock absorption mechanisms of the foot

A

Heel fat pad

Subtalar and midtarsal joint motion

92
Q

Spina Bifida

A

Neural tube defect

  • involves incomplete development of the brain, spinal cord, and/or protective coverings
  • caused by the failure of the foetus’s spine to close properly during the first month of pregnancy
  • infants born with SB may have an open lesion on their spine where significant damage to the nerves and spinal cord has occurred

Although the spinal opening can be surgically repaired shortly after birth, the nerve damage is permanent, resulting in varying degrees of paralysis of the lower limbs

93
Q

What does S2 supply?

A

Knee and foot

  • peroneus brevis
  • peroneus longus
  • flexor digitorum longus
  • flexor hallucis longus
  • gastrocnemius
  • soleus
  • intrinsics

Hip and knee

  • gluteus maximus
  • medial hamstrings
  • lateral hamstrings
  • external rotators
94
Q

What does s3 supply?

A

Knee and foot

  • flexor digitorum longus
  • flexor hallucis longus
  • intrinsics
95
Q

What does l5 supply?

A

Knee and foot

  • peroneus brevis
  • peroneus longus
  • tibialis anterior
  • extensor digitorum longus
  • extensor hallucis longus
  • tibialis posterior

Hip and knee

  • gluteus maximus
  • medial hamstrings
  • lateral hamstrings
  • abductors
  • external rotators
96
Q

What does s1 supply?

A

Knee and foot

  • peroneus brevis
  • peroneus longus
  • tibialis anterior
  • extensor digitorum longus
  • extensor hallucis longus
  • tibialis posterior

Hip and knee

  • gluteus maximus
  • medial hamstrings
  • lateral hamstrings
  • abductors
  • extenal rotators
97
Q

What does s1 supply?

A 
Knee and foot
-peroneus brevis
-peroneus longus
-extensor digitorum longus
-extensor hallucis longus
-flexor digitorum longus
-flexor hallucis longus
-gastrocnemius
-soleus
Hip and knee
-gluteus maximus
-medial hamstrings
-lateral hamstrings
-abductors
-external rotators
98
Q

What does l1 supply?

A

Hip and knee

-hip flexors

99
Q

What does l2 supply?

A

Hip and knee

  • hip flexors
  • adductors
  • internal rotators
  • quads
100
Q

What does l3 supply?

A

Hip and knee

  • hip flexors
  • quads
  • adductors
  • internal rotators
  • external rotators
101
Q

What does l4 supply?

A 
Knee and foot
-tibialis anterior
-tibialis posterior
Hip and knee
-adductors
-external rotators
-quads
102
Q

Spina bifida

A 
Weakness in?
Hip extensors
Hip abductors
Dorsiflexors 
Plantarflexors
103
Q

Weak hip extensors

A

Hip extensors active during terminal swing, loading and midstance
A backwards upper body lean will redirect the ground reaction force further back
Extension of the hip progresses the trunk forward:if not possible what other strategies?
-rotate the pelvis in transverse plane

104
Q

Weak hip abductors

A

Hip abductors active during terminal swing, loading and midstance
In loading and midstance they act to balance the external adductor moment at the hip
A lateral upper body lean to the stance side will redirect the ground reactiob force more laterally
Using a stick on the opposite side will produce an opposing moment to assist the hip abductors: an alternative strategy to lateral lean

105
Q

Weak dorsiflexors

A

The dorsiflexors are active during swing and loading
In swing they lift the foot to ensure that the toes do not drag along the ground
In loading they resist the external plantarflexor moment at the ankle and prevent the forefoot from slapping the ground

106
Q

Weak plantarflexors

A

The plantarflexors are active during mid and terminal stance

107
Q

Spina bifida subject with lesion at l5

A 
Weak in
-hip extensors
-hip abductors
-dorsiflexors
-plantarflexors
Strong in
-hip flexors
-hip adductors
-quadriceps
108
Q

Cerebral palsy

A

A group of chronic conditions affecting body movement and muscle coordination
Caused by damage to one or more specific areas of the brain
-usually occurring during foetal development; before, during or shortly after birth; or during infancy
-not caused by problems in the muscles or nerves
-faulty development or damage to motor areas in the brain disrupt the brains ability to adequately control movement and posture
Not progressive (i.e. Brain damage does not get worse); however, secondary conditions, such as muscle length and spasticity, and bony deformity may change over time

109
Q

Three main types of cp

A

Spastic
Athetoid
Ataxic

110
Q

Spastic cp

A

Muscles become very stiff and weak, especially under effort

Leads to poor control of movement

111
Q

Athetoid cp

A

Some loss of control of their posture

Unwanted movements

112
Q

Ataxic cp

A

Poor coordination and balance

Maybe also shaky hand movements and irregular speech

113
Q

Spasticity

A

‘Spasticity is a motor disorder characterised by a velocity dependent increase in tonic stretch reflexes, with exaggerated tendon jerks resulting from hyperexcitability of the stretch reflex, as one component of the upper motorneurone syndrome’ lance 1980

114
Q

What can happen with muscle spasticity

A 
Muscle shortness
Joint contracture
Bony deformation
-femoral anteversion
-tibial torsion
-foot deformity
115
Q

Spastic cp

A

Poor selective motor control
Abnormal reflex activity
Weakness

116
Q

What muscles are frequently affected in cp?

A 
Gastrocnemius
Soleus
Hamstrings
Rectus femoris
Psoas
117
Q

Gastocnemius

A

2 joint
Knee flexor
Plantarflexor

118
Q

Soleus

A

Single joint

Plantarflexor

119
Q

Hamstrings

A

2 joint
Hip extensor
Knee flexor

120
Q

Rectus femoris

A

2 joint
Hip flexor
Knee extensor

121
Q

Psoas

A

Single joint

Hip flexor

122
Q

Spasticity in psoas

A

Psoas is a single joint muscle which stretches when hip extends
Maximal stretch on psoas therefore occurs at max hip extension i.e. During terminal stance
Shortness and/or spasticity in psoas will cause limited peak hip extension
Also an anteriorly tilted pelvis and lordosis
-but beware, this is not the only cause for these

123
Q

Spasticity in rectus femoris

A

Maximal stretch on rectus femoris occurs when knee is flexed and hip is extended
Max hip extension does not happen at the same time as max knee flexion but they do become close in pre-swing and initial swing
Shortness and/or tone causes decreased and delayed knee flexion in swing

124
Q

Spasticity of hamstrings

A

Maximal stretch on the hamstrings occurs when the hip is maximally flexed and the knee is maximally extended
This happens around initial contact i.e. Terminal swing and loading
Flexed knee in terminal swing and loading
-not always because of short hamstrings-there are several causes for this

125
Q

Increased spasticity in gastrocnemius/soleus

A

Maximal stretch on these muscles occurs during terminal stance

From Flashcardlet (43 decks)

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