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Cuccurullo Book > Ch 6 - Prosthetics and Orthotics: Gait Analysis > Flashcards

Ch 6 - Prosthetics and Orthotics: Gait Analysis Flashcards

1
Q

What is stride length?

A

Distance b/w corresponding successive points of contact of the same foot (distance b/w heel strike to heel strike of same foot)

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2
Q

What is step length?

A

Linear distance in plane of progression between successive contact points of opposite feet (distance b/w heel strike of one foot with heel strike of opposite foot)

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3
Q

Two phases of the gait cycle and what percentage with normal walking speed is the distribution of time in each one?

A

Stance phase and swing phase
60% stance, 40% swing
Walking faster dec time in stance

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4
Q

What is the stance phase?

A

Time period limb is in contact with the ground

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5
Q

What are the subdivisions of stance phase?

A 
"I Like My Tea Presweetened"
Initial contact
Loading Response
Midstance
Terminal Stance
Preswing
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6
Q

Describe Initial Contact (heel foot strike).

A

Instant foot contacts ground

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7
Q

Describe Loading Response (foot flat).

A

Initial contact to lifting of contralateral limb off the ground

Weight shift occurs

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8
Q

Describe Midstance.

A

Lift of contralateral limb from ground to point where ankles are aligned in frontal (coronal) plane

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9
Q

Describe Terminal stance (heel off).

A

Ankle alignment in frontal plane to just before initial contact of contralateral (the swinging) limb

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10
Q

Describe Preswing (toe off).

A

Initial contact of contralateral limb to just prior to ipsilateral limb lifting from ground (unload weight)

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11
Q

When does double-limb support occur?

A

Beginning and end of stance phase when both feet are in contact with the floor

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12
Q

Describe double-limb support as walking speed increases.

A

Time in double-limb decreases with increased speed.

No double-limbs support period is considered running

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13
Q

When does single-limb support occur?

A

When opposite foot is lifted for swing phase

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14
Q

What % of time in a normal gait cycle is spent in single-limb vs double-limb support?

A

Single-limb: 80%

Double-limb: 20%

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15
Q

What is cadence?

A

Number of steps per unit of time

Comfortable walking speed = 80 m/min or 3 mph

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16
Q

How is walking speed slowed?

A

Reducing the cadence or by decreasing step or stride length

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17
Q

Where is Center of gravity (COG) located?

A

5 cm anterior to the S2 vertebra

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18
Q

How does Center of gravity (COG) change during normal gait?

A

Displaced 5 cm (less than 2 inches) horizontally and 5 cm vertically during an average adult
male step

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19
Q

When is Center of gravity (COG) lowest?

A

During loading response

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20
Q

When is Center of gravity (COG) highest?

A

During midstance

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21
Q

Describe base of support.

A

Space outlined by the feet and any assistive device in contact with the ground
Normal base of support (distance between heels) = 6 to 10 cm

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22
Q

How is falling avoided?

A

COG remains positioned over the base of support

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23
Q

What is swing phase?

A

Time period foot is in air for limb advancement

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24
Q

Describe the subdivisions of swing phase.

A

“In My Teapot”
Initial Swing
Midswing
Terminal Swing

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25
Q

Describe initial swing.

A

Lift of the extremity from the ground to position of maximum knee flexion

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26
Q

Describe midswing.

A

Immediately following knee flexion to vertical tibia position

27
Q

Describe terminal swing.

A

Following vertical tibia position to just prior to initial contact

28
Q

What are the determinants of gait?

A
  1. Pelvic rotation
  2. Pelvic tilt
  3. Knee flexion in stance phase
  4. Foot mechanisms
  5. Knee mechanisms
  6. Lateral displacement of the pelvis
29
Q

What do the determinants of gait help to control?

A

Minimize the excursion of the body’s COG

and help produce forward progression with the least expenditure of energy

30
Q

What is Trendelenburg Gait?

A

Hip abductor muscles (gluteus medius and minimus) are weak, the stabilizing effect of these muscles during gait is lost

31
Q

Describe an uncompensated Trendelenburg gait.

A

Contralateral pelvis drops because the ipsilateral hip abductors do not stabilize the pelvis to prevent the drop

32
Q

Describe a compensated Trendelenburg gait.

A

Patient exhibits an excessive lateral lean in which the

trunk is thrust laterally to keep the COG over the stance leg

33
Q

Describe function of pelvic rotation in determinants of gait.

A

Pelvis rotates medially (anteriorly) on the swinging leg side, lengthening the limb as it prepares to accept weight

34
Q

What does a 4° pelvic

rotation in either direction during double support cause?

A

Limbs are essentially
lengthened in the would-be lowest point of the gait cycle (preventing a
sudden drop of the COG)

35
Q

Describe function of pelvic tilt in determinants of gait.

A

Pelvis on the side of the swinging leg is lowered 4°–5°

This lowers the COG at midstance

36
Q

Describe function of knee flexion instance in determinants of gait.

A

Reduces vertical elevation
Lowers COG
Dec energy expenditure
Absorbs shock impact at heel strike by lengthening quad contraction

37
Q

Describe function of foot mechanisms in determinants of gait.

A

At heel strike, ankle plantar-flexion smoothes the curve of the falling pelvis

38
Q

Describe function of knee mechanisms in determinants of gait.

A

After midstance, the knee extends as the ankle plantar flexes and the foot
supinates to restore the length to the leg and diminish the fall of the pelvis at opposite heel strike

39
Q

Describe function of lateral displacement of the pelvis in determinants of gait.

A

Displacement toward the stance limb so net COG of the body lies above the base of support (the stance foot)

40
Q

Describe muscles that should be strengthened in crutch walking.

A 
– Latissimus dorsi
– Triceps
– Pectoralis major
– Quads
– Hip extensors
– Hip abductors
41
Q

Which muscles are active during initial contact?

A 
Glut max
Glut medius
Hamstrings
Quadriceps
Pretibial muscles
*All eccentric
42
Q

Which muscles are active during loading response?

A 
Glut medius
Hamstrings
Quadriceps
Pretibial muscles
*All eccentric
43
Q

Which muscles are active during midstance?

A

Glut medius
Calf muscles
*All eccentric

44
Q

Which muscles are active during terminal stance?

A

Eccentric: Glut medius
Concentric: Iliopsoas, Calf muscles

45
Q

Which muscles are active during preswing?

A

Eccentric: quadriceps
Concentric: Iliopsoas, Calf muscles

46
Q

Which muscles are active during initial swing?

A

Eccentric: hamtrings, quadriceps
Concentric: Iliopsoas, pretibial muscles

47
Q

Which muscles are active during midswing?

A

Eccentric: hamtrings
Concentric: Iliopsoas, pretibial muscles

48
Q

Which muscles are active during terminal swing?

A

Eccentric: hamtrings
Concentric: pretibial muscles

49
Q

What are causes of foot slap during initial contact?

A

Moderately weak dorsiflexors (grade 3/5)

50
Q

What can cause gait pathology during initial contact through midstance?

A 
– Genu recurvatum
– Excessive foot supination
– Excessive trunk
extension
– Excessive trunk flexion
51
Q

What can cause gait pathology during initial contact through preswing?

A 
– Excessive knee flexion
– Excessive medial femur
rotation
– Excessive lateral femur
rotation
– Wide base of support
– Narrow base of support
52
Q

What can cause gait pathology during loading response through preswing?

A

– Excessive trunk lateral flexion (compensated Trendelenburg gait)
– Pelvic drop (uncompensated Trendelenburg gait)
– Waddling gait

53
Q

What causes Excessive trunk lateral flexion (compensated

Trendelenburg gait)?

A

Ipsilateral gluteus medius weakness

Hip pain

54
Q

What can cause gait pathology during midstance through preswing?

A 
– Excessive foot pronation
– Bouncing or exaggerated
– Insufficient push-off
– Inadequate hip
extension
55
Q

What can cause gait pathology during swing phase?

A

– Steppage gait/foot drop
– Circumduction
– Hip hiking

56
Q

What is the increased metabolic cost above normal ambulation for a Syme’s amputation?

A

15%

57
Q

What is the increased metabolic cost above normal ambulation for a Traumatic TT BKA?

A

25%
(Short BKA—40%
Long BKA—10%)

58
Q

What is the increased metabolic cost above normal ambulation for a Traumatic Bilateral BKA?

A

41%

59
Q

What is the increased metabolic cost above normal ambulation for a Traumatic TF AKA?

A

60% to 70%

60
Q

What is the increased metabolic cost above normal ambulation for a Traumatic Bilateral AKA?

A

> 200%

61
Q

What is the increased metabolic cost above normal ambulation for a Traumatic BKA and AKA?

A

118% net cost

62
Q

What is the increased metabolic cost above normal ambulation for a Vascular TF BKA?

A

40%

63
Q

What is the increased metabolic cost above normal ambulation for a Vascular TF AKA?

A

100%

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