Activity Level Neuro Physical Therapy Exam: Gait Flashcards
gait
series of rhythmic and cyclical movements of the trunk and limbs resulting in forward progression of the COM
gait cycle
begins w initial contact (IC) of the reference limb and ends when that same limb comes into contact w surface again
what is included in one gait cycle
full stance phase and swing phase of the reference limb and contralateral limb
what % of the gait cycle is stance
60
what happens during the stance phase
reference limb: IC, loading response, midstance, terminal stance, and pre-swing
contralateral limb: in swing phase
function of stance phase (3)
- shock absorption
- stability
- forward progression of body
- make sure other leg gets off the ground
what % of the gait cycle is swing
40
what happens in the swing phase
reference limb not in contact w the ground
- initial swing
- mid swing
- terminal swing
what is the functions of swing phase (3)
- foot clearance
- limb advancement
- forward progression of COM
single limb support % of the gait cycle
76-80
- majority of the gait cycle
what is single limb support phase
period when only one limb is in contact w the ground
what is required to maintain single limb support
high degree of stability and postural control required as entire COM contained over one limb w small BOS
% of the gait cycle is double limb support
20-24
when do you see DLS in the gait cycle
2 different time periods
1 - early stance
2 - late stance
as soon as IC on either leg
how does duration of DLS vary
varies inversely w walking speed
why is DLS a critical itme
wt transference occurs w high level of LE ms activity
what are two categories that gait can be characterized into
spatial parameters
- distance
temporal parameters
- time
what are spatial parameters of gait (3)
step length
stride length
BOS/step width
what are temporal parameters of gait (4)
speed/velocity
cadence
stride time, step time
DLS:SLS ratio
step length
length of one leg taking a step
stride length
both limbs
what do you look at w someone’s BOS
how wide
too wide?
scissoring?
too narrow?
cadence
how many steps are they taking to get to the same place
what is a community ambulator gait speed
1.3m/s
ballpark of cadence
~100
ballpark of stride length
~70
0.4 gait speed implications
housebound
trouble walking in community
gait speed >0.7
independent
what is the gait kinematics of trunk and UE
reciprocal UE swing and trunk rotation in gait cycle
what is the purpose of UE and trunk kinematics during the gait cycle
dec energy demands
what is the function of opposite arm-leg swing
provides counter rotation and limits the excursion of the COG
what determines the magnitude of rotation and UE swing during gait
inc w an inc in walking speed (direct relationship)
what trunk extensors are activated in gait and what is its role
erector spinae
peaks in DLS periods to counter trunk flexion torque
what is trunk flexor activity in gait
variable
primarily obliques, minimal rectus abdominus activity
low level activity at slower speeds and inc w faster speeds
what is the purpose of trunk activation in gait
trunk ms activity minimizes horizontal and med-lat movements of head during gait
keeps head steady allowing for stable platform for eyes/gaze
how do UE ms activate during gait
posterior and middle delts extend UE (concentric) for posterior swing
and eccentrically control forward swing
how does the pelvis move in the transverse plane during gait
forward rotation of 6-8deg on side of swing
- relative posterior rotation to the same deg on the contralateral side
vertical displacement of pelvis during gait
peak of 3-5deg in midstance
pelvis drops about 5-8deg on contralateral side of pelvis w swing
why is control of vertical displacement of the pelvis during gait important
don’t want too much movement bc not efficient
why is gait movement important to gait
plays a key role in efficient gait
when do hamstrings and glut max fire in gait
fire eccentrically to decelerate hip flex during terminal swing
fire concentrically during IC thru loading response
what role do the hamstrings
eccentrically - to keep leg in good place for next step
concentrically - keep knee from buckling while loading
when do glut med and TFL fire
terminal swing - concentrically to stabilize the pelvis and limit drop of pelvis
midstance - eccentrically to prevent contralateral pelvic drop
what is trendelenburg gait pattern often a sign of
weak glut med
- can’t prevent contralateral drop
what does a weak glut med cause
can’t prevent contralateral drop
- results in premature end of swing phase and dec step length
when do ADD fire during gait
early and late stance during DLS along w peak firing of the quads, hamstrings, ABDs, and extensors when wt transfer occurs
what muscles fire at early and late DLS when weight shifting
ADD
quads
hamstrings
ABDs
extensors
what muscles are included in the hip flexor group during gait
iliopsoas
TFL
sartorius
rectus fem
ADD
when do hip flexors fire during gait
brief concentric firing at initial swing, then silent
how can hip flexors only fire briefly at initial swing
ABD and extensors turn on to stabilize the pelvis as is
when do quads fire during gait
peak - eccentrically at IC and loading response
low level concentric in terminal stance to keep knee extended
why do the quads fire eccentrically at IC and in loading response (3)
- decelerate knee flexion
- limit flexion moment
- absorb shock to prevent knee buckling
when do the hamstrings (short head of biceps femoris) and gastroc fire during gait
pre swing - to flex knee
describe the progression of knee flexion during the gait cycle
start w knee flexion, don’t want to be locked out to accept weight
peak flexion when go into swing to clear the toe
when do the rectus fem, TFL, and sartorius fire to control knee movement
concentrically and briefly at start of initial swing to flex hip and extend knee
how does eccentric firing of the hamstrings control knee movement
control knee extension in mid and terminal swing
what does gait w knee snapping back into hyper extension (genu recurvatum) on every step indicate
weak quads
- can’t eccentrically control loading response so snaps back into bone on bone support
describe the position of the ankle through the gait cycle
some DF on IC
go into neutral as come through
lot of PF as start to push off and get foot clearance
when do pretibial muscles (ant tib, EHL, EDL) fire
concentric - swing
- prevent foot drop
eccentric control of foot lowering to ground from IC until foot is flat and loading response begins
what would a compensation for weak pre-tibial ms look like
more hip flex and knee flex
- steppage gait
why do you see a foot slap gait
still have some concentric pre tibs but lack of eccentric control that their foot slaps down once heel makes IC
when does the gastroc fire concentrically in gait
strong firing in terminal stance
weakens at pre-swing for push-off
when does the gastroc fire eccentrically in gait
control of DF in CC to slow and control advancement of tibia at end of loading response and thru mid-stance
NM impairments that impact gait (9)
motor control/strength
ms tone
coordination
motor planning
sensory deficits
perceptual deficits
vestibular issues
visual changes
cognition
what are MSK impairments that impact gait (7)
ROM
pain
postural alignment
ms length
joint integrity
ms power
ms endurance
what are CV impairments that impact gait (3)
- endurance
- hemodynamic responses to change in position and activity
- HR rate and rhythm
what are temporal gait deviations often seen (5)
- asymmetry
- dec gait speed
- inc DLS time
- dec swing duration
- inc or dec cadence
what does temporal asymmetry mean/look like
time difference b/w steps or stride
what are spatial deviations often seen (3)
- asymmetry
- inc or dec step width and/or length
- dec stride length
what are 2 stance deviations at the ankle seen in the neuro population
foot flat during IC or IC w forefoot
dec toe off in terminal stance
what are 2 stance deviations at the knee seen in the neuro population
excessive knee flex at IC or toe off
knee hyperextension at midstance
what is a stance deviation at the hip seen in the neuro population
dec peak hip extension in late stance
what are 2 stance deviations at the pelvis/trunk seen in the neuro population
inc lateral, backward, or forward lean
poorly aligned trunk
how can a deviation at one joint impact the other joints
issue at one can cause undue stress at another
what is one swing deviation at the ankle seen in the neuro population
insufficient DF
what are 2 swing deviations at the knee seen in the neuro population
inc or dec knee flex throughout
dec knee ext during late swing
what are 3 swing deviations at the hip seen in the neuro population
excessive hip flex
dec hip flex
circumduction
why would someone present w a circumduction gait
circle out to the side
- compensation for not being able to knee flex
what are 3 swing deviations at the trunk/pelvis seen in the neuro population
poorly aligned trunk
insufficient forward pelvic rotation
lack of reciprocal arm swing
what are other reasons for a lack of reciprocal arm swing other than NM path
lack of confidence
pain at the trunk - which makes it difficult to move arms
what is a consideration of AD use for gait analysis
if pt doesn’t use AD normally, try gait analysis without at first
- want to see how far from baseline
walker takes out a lot of joint movements (no arm, trunk)
what knowledge is required for a gait analysis
biomechanical factors - normal gait kinematics
forces - kinetics
what should you ask of the patient/ have them do for a thorough gait analysis
shoes on, off
w orthotics
w and w/o AD
dual task
different environments
what are observational general spatial and temporal gait characteristics (8)
UE swing
trunk rotation
velocity
cadence
step length
stride length
DLS:SLS ratio
BOS
what are 3 standardized timed tests
10m walk test
TUG/ DT TUG
6min walk test
what are 2 standardized balance tests
dynamic gait index
functional gait assessment
what is the purpose of doing a TUG
determining if someone is a fall ris
what is the purpose of doing a 6min walk test
endurance and aerobic capacity
functional gait vs dynamic gait testing
functional is more difficult
- eyes closed
- tandem gait
purpose of a 10m walk test
assess walking speed
- preferred speed and/or fast speed
what is a normal gait speed
> 0.8m/s
what is the purpose of a dynamic gait index
looking at balance and at risk for falls
what does functional gait assessment assess
postural stability during various walking tests
