11 - Gait Flashcards
What is gait?
- The mechanism by which the body is transported using co-ordinated movements of the major lower limbs
- Requires energy-efficient interaction between MSK and neurological system
What are the phases of gait?
- Stance: foot in contact with ground
- Swing: foot not in contact with ground
Cycle is period of time from initial contact to next inital contact on same side
What are five things essential for normal gait?
- Stability in stance so good neuromuscular and proprioreception
- Foot clearance in swing
- Preprositioning for initial contact (heel first)
- Adequate step length
- Energy conservation
What is double support in gait?
The period of time in which both feet are in contact with the ground. As speed of gait increases, period of double support decreases
How is running defined in the gait cycle?
- When there is double float, period of time where no foot is in contact with the ground
- Stance phase 40% and swing 60%
What are the different phases of the stance phase?
- Initial contact
- Loading response
- Mid-stance
- Terminal stance
- Pre-swing
What are the different phases of the swing phase?
- Double support: pre swing in one limb at same time as loading response in next
1. Initial swing: knee flexion to clear
2. Mid-swing: hip flex, pelvis forward, ankle dorsiflexion
3. Terminal swing: knee extends
Define the following words:
- Stride
- Step
- Cadence
What does gait analysis innvolve?
- Kinematics: motions themselves, joint angles and velocities etc
- Kinetics: Forces and moments that cause the motion, e.g muscles
How are different muscles working in the gait cycle?
- Initial contact: TA working eccentrically so foot does not slap on ground
- Mid stance: TA relax
- Terminal stance: Gastrocnemius and soleus plantarfelx
How is energy conserved in normal gait?
- Minimising excursion of centre of gravity of body
- Controlling momentum with eccentric contaction
- Transferring energy between limbs by ligaements and tendons
- Phasic muscle action so muscles getting rest
When assessing pathological gaits what should you observe?
- Gait
- Arm swing
- Movement of head and sholders
- Stride length
Can be due to pain, nerve lesions, joint instability
What is an antalgic gait?
- Reducing pain
- Walk with limp to shorten stance phase of painful limb so shorten swing phase of unaffected limb
- Walking stick in opposite hand to painful limb so can lean into it during stance phase
What is Trendelenburg gait?
- Often due to superior gluteal nerve injury as in stance phase hip abductors normally contract and flex so drop to one side in stance
Can often ‘waddle’ as shift weight towards affected side
Causes:
- Superior gluteal nerve injury from surgery or IM
- Muscle pain and inhibition of function
- Trauma
- Developmental dysplasia
What is an hemiplegic gait?
- Paralysis on one side of body from stroke, spinal cord, cerebal palsy etc
- Spasticity on affected side most severe in flexor muscles upper limb and extensor muscles lower limb
- Lean towards unaffected side and circumduct paralysed leg
What is diplegic gait?
- Spacisity of both limbs not one, often in cerebal palsy
- Narrow gait scraping toes on ground: scissoring
- Slight flexion of knees and plantarflexion
What is a high steppage gait?
- Weakness of ankle dorsiflexion so ‘foot drop’
Causes: common peroneal nerve palsy, sciatica, neuromuscular disease
- Hip has to flex more with each step to get floor of ground and floor often slaps to ground
What is an eversion flick gait?
- If deep peroneal nerve damage but superficial intact, may evert their foot during swing phase instead of lifting it
(SCOTT FLICK)
What is a Parkinsonian gait?
- In Parkinson’s subtantia nigra degenerate so less dopamine which is vital in regulating body movement
- Find it difficult to initiate movement so flex body forward to move centre of gravity in front of limbs
- Shuffling and festinant gait, due to short steps, loss of arm swing and difficulty stopping
What is an ataxic gait?
Causes: proprioreceptive, cerebellar disease (inherited, aqcuired like stroke, alcohol intoxication), vestibular
- Clumsy staggering movements with feet wide apart, arms out to help them balance.
- Titubation standing still
- Can’t walk heel to toe straight line
What actions do the muscles that the common peroneal and tibial nerves innervate have?
