20. Gait Flashcards by Zahraa Alzoubeidi

Walking

Simple but complicated!

Simple – we can do it without having to think

Complicated – involves so many structures in the body
Musculoskeletal system = muscles, tendons, bones, joints,
Nervous system = sensory, motor, autonomic, proprioception
Cardiovascular system = heart, blood vessels
Special senses = vision, hearing
Problem(s) with any of the systems / structures can have an effect on our ability to walk

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Stride

Straight line walking / running
Jumping (…back flip?)
Terrain adjustment
Turning

A combination of movements

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Stride

made of stance and swing

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Stance tasks:

weight acceptance then single limb support

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Swing tasks:

limb advancement

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Weight acceptance phases

Initial contact, loading response

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Single limb support phases

mid stance
terminal stance
preswing (also limb advancement)

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Limb advancement phases

preswing (continuing from single limb support)
Initial swing
mid swing
terminal swing

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Joint positions during initial contact (0-2%)

Hip flexion

Knee neutral/extension

Ankle dorsiflexion/neutral

1st MTPJ dorsiflexion/neutral

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Joint position during loading response (2-12%)

Hip flexion

Knee flexion

Ankle plantarflexion

1st MTPJ neutral

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Muscle activities during initial contact

Hip extensors contract (eccentric) to control hip flexionvia momentum
Gracilis contracts (isometric) to control hip flexion and knee extension
Knee flexors contract (concentric) to start knee flexion
Knee extensors contract (eccentric) to control knee flexion
Ankle dorsiflexors contract (eccentric) to prevent foot slapping

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Muscle activities during loading response

Hip extensors contract (concentric) to start hip extension

Knee flexors contract (concentric) to keep the knee in flexion

Knee extensors contract (eccentric) to control knee flexion

Gastroc contracts (concentric) to keep the knee in flexion

Ankle dorsiflexors contract (eccentric) to prevent foot slapping

Ankle plantarflexors contract (concentric) to bring the foot to the ground

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Joint position mid stance (12-31%)

Hip neutral

Knee extension

Ankle neutral

1st MTPJ neutral

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Joint position terminal stance (31-50%)

Hip extension

Knee full extension

Ankle dorsiflexion

1st MTPJ neutral/dorsiflexion

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Muscle activities mid stance (12-31%)

Hip extensors contract (concentric) to keep the hip in extension

Knee flexors contract (eccentric) to control knee extension via momentum

Gastroc contracts (eccentric) to control knee extension via momentum

Ankle plantarflexors contract (eccentric) to stabilise the foot

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Muscle activities terminal stance (31-50%)

Hip flexors contract (eccentric) to control hip extension via momentum

Gastroc contracts (eccentric) to control knee extension via momentum

Ankle plantarflexors contract (eccentric) to control ankle dorsiflexion via body weight

Joint position during preswing (50-62%)

Hip neutral

Knee flexion

Ankle plantarflexion

1st MTPJ dorsiflexion

joint position at initial swing (62-75%)

Hip neutral/flexion

Knee flexion

Ankle neutral/dorsiflexion

1st MTPJ dorsiflexion/neutral

muscle activities during preswing

Hip flexors contract (concentric) to start hip flexion

Gracilis contracts (concentric) to assist the knee in flexion

Gastroc contracts (concentric) to bring the knee into flexion

Ankle plantarflexors contract (concentric) to propels the body forward THEN Ankle dorsiflexors contract (concentric) to keep the foot off the ground

muscle activities during initial swing

Hip flexors contract (concentric) to keep the hip in flexion

Gracilis contracts (concentric) to keep the knee in flexion

Ankle dorsiflexors contract (concentric) to keep the foot off the ground

Joint position mid wswing (75-87%)

Hip flexion

Knee flexion

Ankle dorsiflexion

1st MTPJ dorsiflexion

Joint position terminal swing

Hip flexion

Knee flexion/neutral

Ankle dorsiflexion

1st MTPJ dorsiflexion

muscle activities mid swing

Hip extensors contract (eccentric) to control hip flexion

Gracilis contracts (concentric) to keep the hip and knee in flexion

Knee flexors contract (concentric) to keep the lower leg off the ground

Ankle dorsiflexors contract (concentric) to keep the foot off the ground

muscle activities terminal swing

Hip extensors contract (eccentric) to control hip flexion via momentum

Gracilis contracts (isometric) to control hip flexion and knee extension

Knee extensors contract (concentric) to bring the knee to extension

Ankle dorsiflexors contract (concentric) to keep the foot off the ground

Types of turning

step turn ipsilateral pivot ipsilateral cross over

Base of support

Defined as the area within an outline of all ground contact points

Centre of mass

COM = Centre of Mass | The average position of all the parts of the system, weighted according to their masses

Terrain adjustment

Stairs – up & down Uneven surfaces Various surface properties (e.g. soft/hard, slippery)

A complete picture of of gait analysis

If you want to get the complete picture, you need to take into account your patient’s movement routines: Daily walking – to & from work / school? Activities – sports? dance? Surfaces – smooth? uneven? soft? hard? Only straight-line walking in clinic is not always sufficient ? Compensatory mechanisms

Conditions causing disruptions in gait

``` Musculoskeletal conditions E.g. Arthritis, Tendinopathy, Ligament injury Neurological conditions E.g. Parkinson’s, Cerebral Palsy, CVA, Peripheral neuropathy Others Pain Behavioural issues Supply of energy ```