Ambulation & Gait Patterns

Question 1

Most fundamental human locomotion

Answer 1

Bipedal
Reciprocal movement behavior
Symmetrical (displacement and timing)

Question 2

Ambulation Fundamentals

Answer 2

Base of support 
Balance bilateral & unilateral weight bearing 
Muscular Strength
Stabilization strength 
Movement strength  
Movement / muscular control
Gait pattern initiation 
Muscle tone
Control of reciprocal gait pattern
Contraction and relaxation phases

Question 3

Nomenclature of gait pattern

Answer 3

Step

Stride

Question 4

Walking

Answer 4

A form of Bipedal (2 feet) locomotion

Question 5

Step time between right and left steps

Answer 5

Step time between right and left steps is 50/50 (accurate to .04-.06 seconds)

Question 6

Stance to swing time

Answer 6

Stance to swing time is approximately 40/60

Question 7

Average stride length

Answer 7

1.46m for males and 1.28m for females

Question 8

Average step

Answer 8

7-9 cm

Question 9

Average walking speed

Answer 9

Average walking speed is approximately 1.34m/s

Question 10

Muscles of AmbulationStabilizing

Answer 10

Initial contact – load response – double support
Hip abductors – gluteus medius, gluteus minimus, upper fibers of gluteus maximus, tensor fascia lata (levels and stabilizes the pelvis – preparation for single leg stance)
Knee extensors – quadriceps (prevents flexion)
Ankle dorsiflexors – tibialis anterior, extensors of the toes (prevent foot slap)

Question 11

Mid-stance: stabilizing / controling

Answer 11

Hip abductors continue
Hamstring muscles stabilize hip extension (only in active ambulation)
Plantar flexors – soleus, garstrocnemius, tibialis posterior, toe flexors, peronial muscles (eccentrically slows and controls tibial advancement over the foot)

Question 12

Terminal stance

Answer 12

active motion

Plantar flexors – concentric push off

Question 13

Older Adults

Answer 13

Weakness, loss of ROM, decrease in sensory motor control, decrease in balance control, postural misalignment
Slower walking speed – shorter step length
Increased stance phase
Increase step width – larger base of support for balance
Increase fear of falling
Forward flexed close in visual tracking
Encourage forward visual tracking

Question 14

Anterior trunk bending

Answer 14

Forward flexed posture during ambulation
Associated with fear of falling
Ironically makes falling more likely
More energy needed
Associated with spinal and neurologic conditions

Question 15

Posterior trunk bending

Answer 15

Hyper lordotic posture during ambulation
Less muscle active gait strategy (lazy walking)
Increase joint load on knees, hips and lumbar spine
Decreased trunk & pelvic stability

Question 16

Trendelenburg

Answer 16

gluteus medius gait pattern
Contralateral pelvic drop (drop away from week side) secondary to gluteus medius weakness
Compensated by increase in lateral gait sway
Self-perpetuating decline in pelvic strength
With paralysis – there is a lateral lean toward the same side of weakness
A structural short leg will cause a pelvic drop

Question 17

Spastic gait

Answer 17

A gait pattern associated with hypertonic extensor muscles of the lower extremities.
Plantar flexion – knee extension – hip extension with internal rotation

Question 18

Pain gait pattern

Answer 18

Pain promotes a modification of the gait pattern to avoid joint motions, muscle contraction and weight bearing that sustains or increase the pain
The resulting pattern is termed antalgic gait pattern
Changes in gait symmetry – timing and movement
Patient should not ambulate “through the pain”
Increases guarding
Promotes abnormal movement patterns
Produces abnormal forces through joint structures
Uses much more energy
Irritates, inflames and can damage painful involved areas

Question 19

Circumduction

Answer 19

secondary to hip flexor weakness

Question 20

Hip hiking

Answer 20

toward the stance leg
Used to advance the swing leg
Used to control knee extension (hamstring weakness) by increasing the speed of mid-stance

Question 21

Steppage gait pattern

Answer 21

Exaggerated hip and knee flexion used to clear toes in foot drop

Question 22

Vaulting gait pattern

Answer 22

Used to increase ground clearance in swing phase

Used to control knee hyper extension

Question 23

Rehabilitation of Ambulation

Answer 23

Normal gait pattern range of motion
Normal and balanced muscle strength
Normal balance
Stabile structures for weight acceptance
Normal control of reciprocal gait pattern both in symmetry and muscle activation sequence

Question 24

Heel strike

Answer 24

weight acceptance
slow foot down (Tibialis Anterior/ Deep Peroneal)
Decelerate Talocrural joint and eccentric motion

Question 25

muscles that stabilize balance of the subtaylor joint

Answer 25

Tibialis anterior and posterior on medial side (Inversion) Deep peroneal & Tibial
peroneus longus and Brevis on lateral side (Eversion) Superficial Peroneal Nerve

Question 26

Mid stance (Swing phase contralateral)

Answer 26

Gastrocs soleus (Tibial Nerve)

Question 27

If Tibial nerve is damaged what is the change in gait

Answer 27

shorter steps
Trouble decelerating
(That goes for any decelerator)

Question 28

Loss of Decelration

Answer 28

Smaller step

Question 29

Leg is flexion what get it into extension

Answer 29

Gluteus Maximus (concentric)

Question 30

Get leg forward

Answer 30

Flex hip (initiate swing)

Question 31

Hamstrings

Answer 31

Decelerate in swing

Question 32

Extensors

Answer 32

Clear foot

Question 33

Cant lift toes

Answer 33

hip hike

circumduct

Question 34

Muscles of circumduction

Answer 34

Gluteus Medius (Hip Abductors)

Question 35

Damaged proximal Sciatic

Answer 35

slowing knee extension

Question 36

acute posiphsitus

Answer 36

attatchment of greater trochnter

Gluteus Medius

Question 37

Femoral nerve injured

Answer 37

flex forward