Week 1 Gait Flashcards
1
Q
Orthosis
A
an external appliance worn to restrict or assist motion or to transfer load from one area to another
2
Q
Synonym for orthosis
A
brace
3
Q
Plural for orthosis
A
orthoses
4
Q
Prothesis
A
a replacement of all or part of the leg or arm
5
Q
Plural of prothesis
A
protheses
6
Q
Certified orthotist/prothetis
A
bachelor degree in O&P
or
post grad O&P
and
clinical residency
7
Q
CPO responsibilities
A
Patient assessment, formulation of treatment plan, patient follow- up
Select appropriate device and materials
Design, fabricate, and fit orthoses
Design, fabricate and fit prostheses
Demonstrate how to use device to patient
8
Q
O&P Assistant
A
Practice under guidance of CPO, assist with O&P procedures and tasks related to patient mgmt.
Fabricates, repairs, and maintenance of devices
American Board for Certification in O&P:
High school degree (or higher) AND 3 semester hours in human anatomy, general/fundament physics, and medical terminology AND 1-1.5 yrs of clinical experience under CPO
9
Q
O&P Technicians
A
Fabricates, repairs, and maintains orthoses and/or prostheses. Must be proficient in current fabricating techniques, familiar with material properties and skilled in use of necessary equipment
American Board for Certification in O&P:
Completion of accredited program OR high school degree (or higher) and 2 yrs experience under CPO or assistant
10
Q
PTs Role in O&P
A
Assessment for identified purposes
Preparation for use
Evaluation of fit
Education in fit and training in use (donning/doffing)
Gait Training, Transfer Training, High-Level Training
Assessment and quantification of functional benefits and uses
11
Q
Level I code
A
current procedural terminology
12
Q
Level II code
A
Codes that identify services, products and supplies not included in CPT codes, such as prosthetic and orthotics. “L- Codes”
13
Q
heel strike
A
initial contact
14
Q
foot flat
A
loading response
15
Q
midstance
A
midstance
16
Q
heel off
A
terminal stance
17
Q
toe off
A
pre-swing
18
Q
Acceleration
A
initial swing
19
Q
midswing
A
midswing
20
Q
deceleration
A
terminal stance
21
Q
percentage of gait cycle
A
100
22
Q
stance phase percentage
A
60
23
Q
swing phase percentage
A
40
24
Q
initial contact percentage
A
0
25
loading response percentage
0-10
26
mid stance percentage
10-30
27
terminal stance percentage
30-50
28
pre swing percentage
50-60
29
initial swing percentage
60-73
30
mid swing percentage
73-87
31
terminal swing percentage
87-100
32
What are the phases of stance phase
initial contact
loading response
mid stance
terminal stance
pre swing
33
What are the phase of swing phase
initial swing
mid stance
terminal swing
34
velocity
rate of linear forward motion of the body (m/sec)
35
Cadence
number of steps taken per unit of time (steps/min)
36
Stride length
heel strike to ipsilateral heel strike
37
step length
heel strike to contralateral heel strike
38
Step width
width of base of support
39
sagittal plane
flx/ext
40
frontal plane
abd/add
41
Transverse plane
rotation
42
What is the sixth vital sign
walking speed
43
1 stride =
1 gait cycle
44
Primary forces that control walking
internal muscle forces
gravity (body weight)
air resistance
GFRs
45
GRFs in gait
forces applied to the body by the ground, opposing forces applied to the ground during a step
46
External forces
produce external torque/movement
GRF
can measure with force plates
47
Internal forces
produces internal torque/movement
response to external torque by GRF
Can control or generate movement
Possible contributions from ligaments, joint capsules, muscles, or bony structures
48
movement = torque
potential for a force, acting a distance from the axis of rotation, to produce rotation of a segment
49
Torque =
force x movement arm
50
Movement arm
perpendicular distance btw axis of rotation and line of action of the force
51
Internal torque =
IF x Ima
52
External Torque =
EF x Ema
53
static equilibrium
INT = EXT
54
Functional task of stance
weight acceptance
single limb support
55
Functional task of Swing
foot clearance
single limb advancement
56
Weight acceptance
initial contact
loading response
57
Initial contact objectives
start of 1st rocker
impact deceleration
58
loading response objects
shock absorption
weight-bearing stability
preservation of progression
59
IC - ankle
held at neutral by pre-tibial muscles
60
IC - knee
full ext
provide stability
61
IC - hip
peak flexion (20 deg)
positioned for optimal fwd progression and stability
62
IC critical event
heel contact
63
Muscle activity for hip stability in IC
hamstrings and gluteals
64
Muscle activity for knee stability in IC
qaudricep
65
What counterbalances PF movement in IC
Pre-tibialis
66
Shock is absorbed while FWD momentum is preserved
Loading respones
67
LR - ankle
pre-tibial muscles eccentrically control PF
subtalar eversion
1st rocker
68
LR - knee
20 deg of flx for shock absorption
quadriceps to control knee flx movement
69
LR - hip
maintained in flex (20 deg)
hip ext active to stability
70
LR critical events
pre-tibial muscles eccentrical control PF
quads active to control knee flexion movement
hip extensors active to stability
71
LR muscles for hip stability
hamstrings and gluteals
72
LR muscles to counterbalance flexion movement
quadriceps
73
LR muscles at ankle
pre-tibialis to counterbalance PF moment. Calf for stance stability
74
Single limb support
midstance
terminal stance
75
Midstance objectives
progression over stationary foot
limb and trunk stability
76
terminal stance objective
progression of body beyond the supporting foot
limb and trunk stability
77
Body progresses over foot in controlled manner. Contralateral limb provides momentum
Midstance
78
Mst - ankle
DF controlled eccentrically by gastrocnemius and soleus
ankle 2nd rocker
79
Mst - knee
extension
80
Mst - hip
neutral
81
Mst critical event
DF controlled eccentrically by gastrocnemius and soleus
82
Mst muscles for stance stability
quadriceps
83
Mst calf muscle
for stance stability and to counterbalance DF movement
84
Tst - ankle
Noted by heel rise
forefoot 3rd rocker
decline in gastro/soleus mm activity
85
Tst - knee
full ext to maximum step length
86
Tst - hip
20 deg of apparent hyperextension for maximum step length
87
Tst critical event
Trailing limb
88
Tst calf
counterbalance DF movement
89
1st rocker
arc of ankle PF right after IC
90
2nd Rocker
Tibial progression FWD during midstance
91
3rd rocker
forefoot DF as heel rises
92
4th rocker
tibia continues to progress fwd as great toe extends
93
Swing limb advancement
preswing
initial swing
midswing
terminal stance
94
Pre swing objective
position of limb for swing
accelerate progression
95
Psw critical event
passive knee flexion 40 deg
96
Psw hip flexors
counterbalance extension movement and initate swing
97
Psw calf
counterbalance DF movement
98
Psw pre-tibialis
foot clearance
99
initial swing objectives
foot clearance
advancement of the limb from the trailing limb position
100
Isw critical events
Peak knee flexion for toe clearance \15 deg of hip flx
101
Msw critical event
ankle neutral to slight DF
102
Tsw Critical event
knee extension to neutral
103
Midswing objectives
limb advancement
foot clearance
104
terminal swing objectives
complete limb advancement
105
Forefoot remains on ground. Knee rapidly while weight is shifted to other limb.
Pre-swing
106
Psw - ankle
2nd arc of PF (15 deg)
toe rocker
no gastroc/soleus mm activity
107
Psw - knee
passive knee flx (40 deg)
Prepares limb for toe clearance
108
Psw - hip
10 deg of apparent hyperextension
109
110
Isw - ankle
nearly neutral for foot clearance
111
Isw - knee
peak flexion (60 deg) for toe clearance
Peak mm activity of biceps femoris short head, sartorius, and gracilis
112
Isw - hip
15 deg of flex
Peak mm activty of gracilis and sartorius
113
Msw - ankle
Neutral to slight DF
114
Msw - knee
passive ext caused by the momentum of hip flx
115
Msw - hip
peak flx (25 deg)
116
Leg reaches out to achieve step length. Preparation for IC.
Terminal swing
117
Tsw - ankle
at neutral to prepare for heel strike
118
Tsw - knee
extensions to neutral (5 deg flex)
extension controlled eccentrically by the hamstrings
Quads turn on in late Tsw to prepare for weight-bearing
119
Tsw - hip
subtle retraction to 20 deg of flx
120
Tsw critical event
Knee extension to neutral
121
What are the key muscles for pelvic control
hip ext and hip abd
122
Pelvic motion during gait in the sagittal plane
neutral pelvis in ~ 10 deg of anterior tilt
Slight increase in anterior pelvic tilt during Tst and Tsw
123
Pelvic motion during gait in frontal plane
During WA, 4 deg of contralateral pelvic drop
During Psw, 4 deg of ipsilateral pelvic drop
124
Pelvic motion during gait transverse plane
Max pelvic protraction (4°) during TSW and IC
Max pelvic retraction (4°) during TST
Neutral rotation at MSW and MST
125
Average vertical displacement
4.2 cm
126
Average lateral displacement
4.5 cm to the R and L
127
Trunk during gait
Multifidus act bilaterally during IC
Low level activity of rectus abdominis and external obliques
128
The arms provide counterforce to oppose
excessive rotation of the body
129
UE
Peak flexion (shoulder = 8°) during contralateral initial contact
Flexion is a passive movement
Peak extension (shoulder = 24°) during ipsilateral initial contact
Extension is controlled by posterior deltoid and teres major
Arm swing range (increased extension) increased with increased walking velocity
130
critical joint angles - ankle
neutral ankle during swing
20 deg of DF in terminal stance
131
critical joint angle - knee
60 deg of flexion in intial swing
20 deg of flexion in loading response
0 in at IC and midstance
132
critical joint angle - hip
25 deg of flx in midswing
20 deg of extension in terminal stance
133
Critical muscle activity - ankle
anter tib during loading response (eccentric)
anter tib during swing (concentric)
Gastrocnemius active during stance to control knee flexion movement
134
Critical muscle activity - knee
No hamstring or quadriceps muscle activity during Msw
Quadriceps active during stance to control knee flexion movement
135
Critical muscle activity - hip
hip flexors during swing (concentric)
hip abductors during single limb support to prevent hip drop
136
Faster walking speeds create
higher peaks and lower valleys
137
Increase knee adduction moments have been associated with
knee OA
138
Goal of gait methods
is the individual achieving a functional, comfortable, biomechanically, efficient, and energy efficient gait
139
Gait methods
Manual assessment of spatial and temporal parameters
Instrumented Walkways
Three-Dimensional Gait Analysis
Video Analysis
Observational Gait Analysis
140
Outcome measures for manual assessment of spatial and temporal parameters
6 MWT
2 MWT
10 meter walk test
141
Physical measurements of manual assessment of spatial and temporal parameters
step length, step width, or cadence
142
Advantages of instrumented walkways
Easy to use
Less expensive
Portable
Requires minimal set up
Requires minimal space
Generally produces reliable data
143
Limitations of instrumented walkways
Generally limited to temporal spatial data acquisition
Limited to number of steps
Artificial environment validity?
144
GAITRite
2 ft wide x 12-24 ft length walkway
Numerous client-specific normal databases can be created and compared against
Can use to track a patient’s progress
145
Which gait analysis is the gold standard
three-dimensional gait analysis
146
Three-dimensional gait analysis
measures temporal spatial parameters, kinematics, and kinetics
147
Advantages of three-dimensional gait analysis
Captures joint kinematics and kinetics in all planes
Accurate
Good for complicated gait patterns
Can sync with EMG data
148
Limitations of three-dimensional gait analysis
Need large room
Costly
Must have knowledge to process data
Accuracy influenced by body composition and precision of marker placement
Skin artifact
149
Capture rate
minimum 60 Hz for walking for faster movements must increase rate
150
detecting gait events
foot strikes on force plates
velocity of foot
foot switches
151
Can a EMG distinguish if muscle contraction is concentric, eccentric, or isometric
there is no way
152
EMG surface
Non-invasive
Good for group and/or surface muscle activity
Should be placed at muscle belly
Good for measuring timing of muscle activity
Signal can be “noisy”
Does not work well with thick layer of subcutaneous fat
153
EMG fine wire
Invasive
Good for deep or specific muscle activity
Needles must be sterilized
In CA, need to be certified to perform
Time intensive
154
Plantar Pressures
Instrumented insoles place in patient’s shoes
Can not use during barefoot walking
Published “normals”
155
Inertial measurement units
Self-contained system that measures linear and angular motion with the use of gyroscopes, magnetometers, and accelerometers
156
Advantages of video gait analysis
Measures joint angles
Inexpensive
Simple to use
157
Limitations of video gait analysis
Accuracy
Patient consent to video
158
Tips for observational gait analysis
Must be familiar with NORMAL gait first!
Start global then get specific
Breakdown into stance and swing and then further into phases
Can list in order of significance or superior inferior
159
what are the 3 main functional task of gait
weight acceptance
single limb support
swing limb advancement
160
