Week 7: Gait Flashcards by Amber Lindsey

Q

Terminology

Gait cycle

Two phases

A

Period of time from when the heel strikes the ground to when the same heel strikes the ground again

Stance phase
Swing phase

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Q

Terminology

Stance phase

What percentage of the gait cycle does this phase take up?

A

total time foot is in contact with the floor

60%

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Q

Terminology

Swing phase

What percentage of the gait cycle does this phase take up?

A

total time foot is off the floor

40%

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Q

Terminology

Double support

Does double support occur while running?

A

period during stance phase when both feet are on the floor

No, weight is being transferred directly from one foot to the other.

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Q

Terminology

Single support

A

one foot is in contact with the floor

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Q

Terminology

What is the normal width for base of support (BOS)?
What is the normal degree of toe out?

A

2-4 inches
7°

Wider base = more stability

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Q

Terminology

Stride length

A

Distance between heel strike of one foot to heel strike of the same foot

shorter legs = shorter stride

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Q

Terminology

Step length

A

Distance between heel strike of one foot to heel strike of opposite foot

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Q

Terminology

Cadence

What else is it called?

A

Number of steps per minute

walking speed

normal cadence: 70-130 steps per minute

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Q

Terminology

What is the amount of lateral pelvic tilt during normal gait?

When does it occur?

A

<5°

toe off/pre-swing

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Q

Terminology

What is the amount of pelvic rotation during normal gait?

When does this occur?

A

swing leg 4° anteriorly
stance leg 4° posteriorly

swing phase

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Q

Terminology

What is the amount of vertical displacement during normal gait?

When does this occur?

A

2 inches

midstance

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Q

Terminology

What is the amount of horizontal displacement during normal gait?

When does the greatest amount of horizontal displacement occur?

A

2 inches

single support phase at midstance

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Q

What is the Rancho los Amigos term?

heel strike

A

initial contact

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Q

What is the Rancho los Amigos term?

foot flat

A

loading response

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Q

What is the Rancho los Amigos term?

midstance

A

midstance

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Q

What is the Rancho los Amigos term?

heel off

A

terminal stance

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Q

What is the Rancho los Amigos term?

toe off

A

pre-swing

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Q

What is the Rancho los Amigos term?

acceleration

A

initial swing

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Q

What is the Rancho los Amigos term?

midswing

A

midswing

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Q

What is the Rancho los Amigos term?

deceleration

A

terminal swing

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Q

Components of Gait Cycle

What is heel strike?

A

heel makes contact with the ground

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Q

Components of Gait Cycle

What is foot flat?

A

anterior tibialis works eccentrically to lower foot to the ground

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Q

Components of Gait Cycle

What is midstance?

A

entire foot in contact with the floor
body accelerating forward

Rancho los Amigos: foot flat to midstance

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# Components of Gait Cycle What is **initial contact**?

first contact with the ground

# Components of Gait Cycle What is **loading response**?

initial contact until opposite foot is lifted for swing | heel strike to foot flat

# Components of Gait Cycle What is **heel off**?

heel lifts off the floor

# Components of Gait Cycle What is **terminal stance**?

begins with heel rise, continues until other foot strikes ground | midstance to heel off

# Components of Gait Cycle What is **toe off**?

toe lifts off floor

# Components of Gait Cycle What is **pre-swing**?

begins with initial contact of opposite limb, ends with ipsilateral toe | toe off

# Components of Gait Cycle What is **acceleration**?

toe off to midwing when swinging LE is directly under the body

# Components of Gait Cycle What is **initial swing**?

begins with foot lifting from floor, ends with swing foot opposite stance foot | toe off to acceleration

# Components of Gait Cycle What is **midswing**? | Traditional terminology & Rancho los Amigos

Traditional: LE passes directly under the body RLA: acceleration to midswing - begins with swinging limb opposite stance leg and ends with swinging leg forward and tibia vertical

# Components of Gait Cycle What is **deceleration**?

tibia passes beyond perpendicular to the knee extending to prepare for heel strike

# Components of Gait Cycle What is **terminal swing**?

begins with tibia in vertical position and ends with foot striking the floor | midswing to deceleration

# Which muscle groups are used? **Acceleration/initial swing** | Concentric or eccentric? ## Footnote What are the working muscles?

* hip flexors - concentric * knee flexors - concentric * ankle dorsiflexors - concentric ## Footnote hip flexors: iliopsoas, rectus femoris knee flexors: hamstrings DF: anterior tib

# Which muscle groups are used? **Midswing** | Concentric or eccentric? ## Footnote What are the working muscles? (Hint: same as **acceleration**)

* hip flexors - concentric * knee flexors - concentric * ankle dorsiflexors - concentric ## Footnote hip flexors: iliopsoas, rectus femoris knee flexors: hamstrings DF: anterior tib

# Which muscle groups are being used? **deceleration/terminal swing** | Concentric or eccentric? ## Footnote What are the working muscles?

* knee extensors - concentric * knee flexors - eccentric * ankle dorsiflexors - concentric ## Footnote knee extensors: quadriceps knee flexors: hamstrings DF: anterior tib

# Which muscle groups are being used? **heel strike/initial contact** | Concentric or eccentric? ## Footnote What are the working muscles?

* knee extensors - eccentric * ankle dorsiflexors - concentric ## Footnote knee extensors: quadriceps DF: ant tib

# Which muscle groups are being used? **foot flat/loading response** | Concentric or eccentric? ## Footnote What are the working muscles?

* hip extensors - eccentric * knee extensors - eccentric * ankle dorsiflexors - eccentric ## Footnote hip extensors: glute max knee extensors: quadriceps DF : ant tib

# Which muscle groups are being used? **midstance** | Concentric or eccentric? ## Footnote What are the working muscles?

* knee extensors - concentric * ankle plantarflexors - eccentric ## Footnote knee extensors: quadriceps (PF unspecified)

# What muscles groups are being used? **heel off/terminal stance** | Concentric or eccentric? ## Footnote What are the working muscles?

ankle plantarflexors - concentric

# What muscle groups are being used? **toe-off/pre-swing** | Concentric or eccentric?

* hip flexors - concentric * ankle plantarflexors - concentric

# Range of Motion What ROM is required at **heel strike/initial contact**? | (hip, knee, and ankle)

* hip flex: 25° * knee: 0° * ankle: 0°

# Range of Motion What ROM is required at **foot flat/loading response**? | (hip, knee, and ankle)

* hip flex: 15° * knee flex: 15°-20° * ankle PF: 15°

# Range of Motion What ROM is required at **midstance**? | (hip, knee, and ankle)

* hip: 0° * knee flex: 5° * ankle DF: 5°-10º

# Range of Motion What ROM is required at **heel off/terminal stance**? | (hip, knee, and ankle)

* hip: 10º-20º ext * knee: 0º * ankle: 10º-15º DF

# Range of Motion What ROM is required at **toe off/pre-swing**? | (hip, knee, and ankle)

* hip: 10º-20º ext * knee: 30º-40º flex * ankle 15º-20º PF

# Range of Motion What ROM is required at **acceleration/initial swing**? | (hip, knee, and ankle)

* hip: 25º-30º flex * knee: 60º flex * ankle: 10º-20º PF

# Range of Motion What ROM is required for **midswing**? | (hip, knee, and ankle)

* hip: 25º flex * knee: 60º-65º flex * ankle: 0º

# Range of Motion What ROM is required for **deceleration/terminal swing**? | (hip, knee, and ankle)

* hip: 30º flex * knee: 0º * ankle: 0º

# Abnormal Gait What is "limping?" | Description/Cause

Antalgic Gait 1. reduced time spent on affected leg in order to reduce weight on affected leg* 2. cause: pain | * How does this affect step length?

# Abnormal Gait What is circumducted gait? | Description/Cause

1. bringing leg out and around 2. cause: knee immobilizer, knee flexor/DF weakness, limited hip flex/knee flex/DF ROM

# Abnormal Gait What is Glute Max Gait? | Description/Cause ## Footnote What else is this gait pattern called?

1. trunk shifts posteriorly to shift COG back in order to maintain hip ext 2. cause: glute max weakness ## Footnote 1. Extensor Lurch 2. Rocking Horse

# Abnormal Gait What is Glute Med Gait? | Description/Cause ## Footnote What else is it called?

1. trunk SB over stance leg to prevent swing leg hip from dropping 2. cause: glute med weakness ## Footnote 1. ABD lurch

# Abnormal Gait What are the two types of Glute Med Gait?

* Compensated * Uncompensated (a.k.a. Trendelenburg gait)

# Abnormal Gait What is Anterior Trunk Lean? | Description/Cause

1. forward lean & pushing with anterior thigh to hold knee into ext *during stance phase* 2. cause: quad weakness, paralysis* | *especially caused by polio

# Abnormal Gait What is Genu Recurvatum Gait? | Description/Cause

1. hyperext of knee at midstance OR deceleration 2. cause: quads (midstance), hamstrings (deceleration)

# Abnormal Gait What are the four abnormal gait patterns caused by DF weakness?

1. Equinas Gait 2. Steppage Gait 3. Foot Slap 4. Drop Foot

# Abnormal Gait What is Equinas Gait? | Description/cause

1. toes contact ground before heel strike 2. cause: DF weakness, lack DF ROM

# Abnormal Gait What is Steppage? | Description

excessive hip/knee flex during *swing phase* to prevent foot from dragging

# Abnormal Gait What is Foot Slap? | Description/cause

1. foot slapping from *heel strike* to *foot flat* 2. cause: DF weakness (inability to eccentrically lower)

# Abnormal Gait What is Vaulting Gait? | Description/Cause

1. pelvic elevation and PF of stance leg 2. cause: decreased hip/knee ROM of swing leg

# Abnormal Gait What is Drop Foot? | Description/Cause

1. foot drop during *swing phase* when foot is off the ground 2. cause: DF weakness

# Abnormal Gait What is Scissor's Gait? | Description/Cause

1. unsupported leg swings across or against stance leg during *swing phase* 2. cause: spasticity in hip abductors

# Abnormal Gait What is Hemiplegic Gait? | Description/Cause

1. LE ext/UE flex synergy which leads to reduced WB on affected side 2. cause: spasticity in LEs/UEs

# Strength Grade What is the minimal strength grade of the **hip flexors** during the **swing phase**?

2+/5 to 3-/5

# Strength Grade What is the minimal strength grade of the **hip extensors** during the **stance phase**?

4/5

# Strength Grade What is the minimal strength grade of the **knee flexors** during the **swing phase**?

2+/5 to 3-/5

# Strength Grade What is the minimal strength grade of the **knee extensors** during the **stance phase**?

4/5

# Strength Grade What is the minimal strength grade of the **ankle dorsiflexors** during the **swing phase**?

3-/5 to 3/5

# Strength Grade What is the minimal strength grade of the **ankle plantarflexors** during the **stance phase**?

2+/5 to 3-/5

# Strength Grade Which muscle groups require a strength grade of **2+/5 to 3-/5**? | During which phases do they occur?

* hip flexors during swing phase * knee flexors during swing phase * ankle PF during stance phase

# Strength Grade Which muscle group requires a strength grade of **3-/5 to 3/5**? | During which phase does it occur?

ankle DF in swing phase

# Strength Grade Which muscle groups require a strength grade of **4/5**? | During which phases do they occur?

* hip extensors during stance phase * knee extensors during stance phase

# Abnormal Gait Which abnormal gaits are caused by muscular weakness? | (8)

1. Circumducted gait 2. Glute max gait 2. Glute med gait 3. Trendenlengburg gait 4. Anterior trunk lean 5. Genu recurvatum 6. Equinas gait 7. Steppage gait 8. Foot slap 9. Drop foot

# Abnormal Gait Which abnormal gaits are caused by ROM limitations? | (3)

1. Vaulting gait 2. Circumducted gait 3. Equinas gait

# Abnormal Gait Which abnormal gait is caused by pain? | (1)

antalgic gait

# Abnormal Gait What muscle weakness causes circumducted gait?

* hip flexors * knee flexors * dorsiflexors

# Abnormal Gait What muscle weakness causes extensor lurch/posterior trunk lean?

glute max

# Abnormal Gait What muscle weakness causes glute med gait?

glute med

# Abnormal Gait What are the two types of **glute med gait** and what are they called?

1. compensated - abductor lurch 2. uncompensated - Trendelenburg gait

# Abnormal Gait Describe compensated glute med gait.

trunk sidebends over weak leg to compensate for glute med weakness to avoid hip of opposite leg from dropping

# Abnormal Gait Describe uncompensated glute med gait. | What is it called? ## Footnote What amount of hip drop is considered excessive?

weakness of glute med on affected leg causes hip to drop on opposite side | Trendelenburg gait ## Footnote >5º

# Abnormal Gait How is Trendelenburg gait named?

named after the weak side

# Abnormal Gait Which side is weak during R Trendelenburg gait? Which hip drops?

* R side is weak * L hip dropsROM

# Range of Motion What ROM is required of the **hip** during initial contact?

25º of flexion

# Range of Motion What ROM is required of the **hip** during terminal stance?

10º-20º of extension

# Range of Motion What ROM is required of the **hip** during initial swing?

25º-30º of flexion

# Range of Motion What ROM is required at the **knee** during pre-swing?

30º-40º of flexion

# Range of Motion What ROM is required at the **knee** during midswing?

65º of flexion

# Range of Motion What ROM is required at the **ankle** during terminal stance?

10º-15º of DF

# Range of Motion What ROM is required at the **ankle** at heel off?

10º-15º of DF

# Range of Motion What ROM is required at the **ankle** during pre-swing?

15º-20º of PF

# Range of Motion What ROM is required at the **ankle** during initial swing?

10º-20º of PF

# Range of Motion What ROM of **hip flexion** is required for normal gait?

25º-30º

# Range of Motion What ROM of **hip extension** is required for normal gait?

10º-20º

# Range of Motion What ROM of **knee flexion** is required for normal gait?

65º

# Range of Motion What ROM of **knee extension** is required for normal gait?

0º

# Range of Motion What ROM of **ankle DF** is required for normal gait?

10º-15º

# Range of Motion What ROM of **ankle PF** is required for normal gait?

15º-20º

# Components of Gait Cycle What is this stage? During which phase does it occur?

Heel strike/initial contact during stance phase

# Components of Gait Cycle What is this stage? During which phase does it occur?

foot flat/loading response during stance phase

# Components of Gait Cycle What is this stage? During which phase does it occur?

midstance during stance phase

# Components of Gait Cycle What is this stage? During which phase does it occur?

heel off/terminal stance during stance phase

# Components of Gait Cycle What is this stage? During which phase does it occur?

toe off/pre-swing during stance phase

# Components of Gait Cycle What is this stage? During which phase does it occur?

acceleration/initial swing during swing phase

# Components of Gait Cycle What is this stage? During which phase does it occur?

midswing during swing phase

# Components of Gait Cycle What is this stage? During which phase does it occur?

deceleration/terminal swing during swing phase