03-14: Gait Flashcards by Ken Panganiban

Gait or stride

Activity that occurs between the time one foot touches the ground and the time the same foot touches the ground again

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Step

One half of stride - takes two steps to complete a stride

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Step length

The distance between heel strike of one foot and heel strike of the other foot

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Cadence

Number of steps taken per minute

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Stance phase

Occurs when the foot is in contact with ground - 60%

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Swing phase

Occurs when the foot is not in contact with ground - 40%

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Tasks that must occur during gait cycle (3)

Weight acceptance, single leg support, leg advancement

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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

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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

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Leg Advancement

Swing phase

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Double support

Period of gait cycle where both feet are in contact with the ground - changes with speed

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Nonsupport

Period of gait cycle where neither foot is in contact with the ground (running)

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Single support

Period of gait cycle where one foot is in contact with the ground - occurs twice in cycle

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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

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Traditional vs. RLA - Swing

Acceleration = initial swing
Midswing = midswing
Deceleration = terminal swing

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Initial Contact - Required ROM

Hip: 30˚ Flexion
Knee: 0˚
Ankle: 0˚
Toes: 0˚

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Loading Response - Required ROM

Hip: 25˚ Flexion
Knee: 15˚ Flexion
Ankle: 10˚ Plantar Flexion
Toes: 0˚

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Midstance - Required ROM

Hip: 0˚
Knee: 0˚
Ankle: 5˚ Dorsiflexion
Toes: 0˚

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Terminal Stance - Required ROM

Hip: 10˚ Extension
Knee: 0˚
Ankle: 10˚ Dorsiflexion
Toes: 30˚ MTP Extension

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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