03-14: Gait Flashcards
Gait or stride
Activity that occurs between the time one foot touches the ground and the time the same foot touches the ground again
Step
One half of stride - takes two steps to complete a stride
Step length
The distance between heel strike of one foot and heel strike of the other foot
Cadence
Number of steps taken per minute
Stance phase
Occurs when the foot is in contact with ground - 60%
Swing phase
Occurs when the foot is not in contact with ground - 40%
Tasks that must occur during gait cycle (3)
Weight acceptance, single leg support, leg advancement
Weight Acceptance
Foot touches the ground and body weight begins to shift onto leg - “hip” over foot, teach how to get used to weight-bearing
Single leg support
Body weight is fully shifted to the stance leg, allowing the other leg to begin swing phase - accept weight, cocontraction for stability
Leg Advancement
Swing phase
Double support
Period of gait cycle where both feet are in contact with the ground - changes with speed
Nonsupport
Period of gait cycle where neither foot is in contact with the ground (running)
Single support
Period of gait cycle where one foot is in contact with the ground - occurs twice in cycle
Traditional vs. RLA - Stance
- Heel strike = Initial contact
- Foot flat = loading response
- Midstance = midstance
- Heel-off = terminal stance
- Toe-off = Preswing
- Traditional = points in time
- RLA = periods of time
- Heel off + toe off = push-off
Traditional vs. RLA - Swing
- Acceleration = initial swing
- Midswing = midswing
- Deceleration = terminal swing
Initial Contact - Required ROM
- Hip: 30˚ Flexion
- Knee: 0˚
- Ankle: 0˚
- Toes: 0˚
Loading Response - Required ROM
- Hip: 25˚ Flexion
- Knee: 15˚ Flexion
- Ankle: 10˚ Plantar Flexion
- Toes: 0˚
Midstance - Required ROM
- Hip: 0˚
- Knee: 0˚
- Ankle: 5˚ Dorsiflexion
- Toes: 0˚
Terminal Stance - Required ROM
- Hip: 10˚ Extension
- Knee: 0˚
- Ankle: 10˚ Dorsiflexion
- Toes: 30˚ MTP Extension
Preswing - Required ROM
- Hip: 0˚
- Knee: 40˚ Flexion
- Ankle: 20˚ Plantar Flexion
- Toes: 60˚ MTP Extension
Initial Swing - Required ROM
- Hip: 15˚ Flexion
- Knee: 60˚ Flexion
- Ankle: 10˚ Plantar Flexion
- Toes: 0˚
Midswing - Required ROM
- Hip: 25˚ Flexion
- Knee: 25˚ Flexion
- Ankle: 0˚
- Toes: 0˚
Terminal Swing - Required ROM
- Hip: 35˚ Flexion
- Knee: 0˚
- Ankle: 0˚
- Toes: 0˚
Heel Strike - Muscle Activity (stance)
TA, Quads (con), Hip Flexors (con), Hip Extensors (ec) slows heel down, Erector Spinae
Foot Flat - Muscle Activity (stance)
TA (ec), Quads (ec), Hip Extensors (con)
Issues: Foot Drop
Midstance - Muscle Activity (stance)
Plantar Flexors (ec), Quads (con)
Heel-off - Muscle Activity (stance)
Plantar Flexors (ec to con), Hip Extensors (con), Quads (con to ec)
Push-off - Muscle Activity (stance)
Plantar Flexors (con), Hams (con), Hip Flexors (con)
Acceleration - Muscle Activity (swing)
Hip Flexors (con), Hams (con), Plantar Flexors moving to Dorsiflexors (con)
Midswing - Muscle Activity (swing)
DF (con), Hams, (con), Hip Flexors (con) - all allow foot clearance by shortening limb
Deceleration - Muscle Activity (swing)
DF (con) - holding neutral, Hams (ec), Quads (con), Hip Flexors (Con)
Vertical Displacement
- Weight shifting
- Up to 5 cm of displacement
Width of walking base
2”-4” between steps
Additional determinants of gait
- Vertical displacement
- Horizontal displacement
- Width of walking gait
- Lateral pelvic tilt
Gluteus maximus or medius weakness
- Gluteus Maximus = gluteal lurch
- Gluteus Medius = lateral lurch
Quadriceps weakeness
- Knee extension weakness (cannot fully extend without assistance)
- Manually push leg into extension
Hamstring weakness
- No opposition from hamstring = hyperextension of knee
- genu recurvatum
Dorsiflexor (TA) weakness
- Compensation for dorsiflexion weakness (drop foot)
- Steppage gait, circumduction gait, Vaulting, hip hike
Steppage gait
Most common; exaggerate hip and knee flexion to compensate and clear floor
Circumduction gait
Bring leg around instead of straight gait to compensate and clear floor
Vaulting
Rise up on toes of good leg to help bad leg clear floor
Hip Hike
Hike hip to shorter limb
Triceps Surae weakness
- Results in a “sore foot limb”
- Affects push-off (terminal stance, preswing)
- Hop off affected leg right away because of lock of plantar flexors
Waddling Gait
- Diffuse weakness throughout body (multiple muscle groups)
- Use anything available to move
- Common in muscular dystrophy patients
Hip Flexor contracture: Salutation gait
- Stuck in hip flexion
- When walking, cannot extend hip, so looks like bowing
Fused Hip: Bell-Clapper Gait
- Back and forth of pelvic girdle
- Compensate for lack of movement in hip joint (flexion/extension)
Knee Extension Contractures
- Vaulted Gait, Hip Hike, or Circumducted gait
- Cannot flex knee
Neurological Gaits
- Hemiplegic gait
- Ataxic gait: no proprioception
- Parkinsonian gait: Festinating gait
- Scissoring gait: Adductor has too much tone, cannot adduct (Cerebal palsy)
- Crouch Gait
Antalgic Gait
Sore knee = painful gait