Ch22: Gait

Question 1

Walking

Answer 1

The manner or way in which you move from place to place with your feet.

Question 2

Gait

Answer 2

The process or components of walking. Each person has a unique style, and this style may change slightly with mood. When you are happy, your step is lighter, and there may be a “bounce” in your walk. Conversely, when you are sad or depressed, your step may be heavy.

Question 3

Walking requires…

Answer 3

Balancing on one leg while the other leg moves forward. This requires movement not only of the legs but also of the trunk and arms. To analyze gait, you must first determine what joint motions occur. Then, based upon that information, you must decide which muscles or muscle groups are acting.

Question 4

Gait Cycle

Answer 4

Aka stride, is the activity that occurs between the time one foot touches the floor and the time the same foot touches the floor again

Question 5

Stride Length

Answer 5

The distance traveled during the gait cycle.

Question 6

Step

Answer 6

Basically one-half of a stride. It takes two steps (a right one and a left one) to complete a stride or gait cycle. These steps should be equal

Question 7

Step Length

Answer 7

That distance between the heel strike of one foot and the heel strike of the other foot. With an increased or decreased walking speed, the step length will increase or decrease, respectively. Regardless of speed, the step length of the two legs should remain equal.

Question 8

Walking speed/ Cadence

Answer 8

The number of steps taken per minute. It can vary greatly. Slow walking may be as slow as 70 steps per minute. However, students on their way to an examination have been clocked at much slower speeds. Fast walking may be as fast as 130 steps per minute, although race walkers will walk much faster. Regardless of speed, the gait cycle is the same; all parts occur in their proper place at the proper time.

Question 9

Gait cycle terminology. A right and left step make up a gait cycle (also called stride).

Answer 9

.

Question 10

What are the two phases of the gait cycle?

Answer 10

Stance Phase and Swing Phase

Question 11

Stance Phase

Answer 11

The activity that occurs when the foot is in contact with the ground. It begins with the heel strike of one foot and ends when that foot leaves the ground. This phase accounts for about 60% of the gait cycle.

Question 12

Swing Phase

Answer 12

Occurs when the foot is not in contact with the ground. It begins as soon as the foot leaves the floor and ends when the heel of the same foot touches the floor again. The swing phase makes up about 40% of the gait cycle.

Question 13

Perry (1992) identifies three tasks that need to be accomplished during these phases of the gait cycle:

Answer 13

(1) weight acceptance, (2) single-leg support, and (3) leg advancement

Question 14

Weight acceptance

Answer 14

Occurs at the very beginning of stance phase when the foot touches the ground and the body weight begins to shift onto that leg.

Question 15

Single-leg support

Answer 15

Occurs next after weight acceptance, as the body weight shifts completely onto the stance leg so that the opposite leg can swing forward.

Question 16

Leg Advancement

Answer 16

occurs during swing phase.

Question 17

Phases of the gait cycle.

Answer 17

.

Question 18

How many periods of double support does the gait cycle have? What about single support?

Answer 18

The gait cycle has two periods of double support and two periods of single support

Question 19

Double Support

Answer 19

When both feet are in contact with the ground at the same time. This occurs as one leg is beginning its stance phase and the other leg is ending its stance phase.
The second period of double support occurs as right leg is ending its stance phase and left leg is beginning its stance phase.
Each period of double support takes up about 10% of the gait cycle at an avg walking speed. If you increase your walking speed, you spend less time with both feet on the ground. Conversely, when you walk slowly, you spend more time in double support.

Question 20

Nonsupport

Answer 20

A time during which neither foot is in contact with the ground (does not occur during walking) However, nonsupport does occur during running. Other than speed, this may be the biggest difference between running and walking. Other activities, such as hopping, skipping, and jumping, have a period of nonsupport but lose the order of progression that walking and running have. In other words, these activities do not include all the parts of stance and swing phase that walking and running have.

Question 21

Single Support

Answer 21

Occurs when only one foot is in contact with the ground. Thus, two periods of single support occur in a gait cycle: once when the right foot is on the ground as the left foot is swinging forward, then again when the left foot bears weight and the right leg swings forward. Each single-support period takes up about 40% of the gait cycle

Question 22

Heel Strike (stance phase)

Answer 22

Heel contacts the ground (initial contact)
• Stance phase begins
• Task of weight acceptance begins
• Double leg support begins
• Center of gravity (COG) at lowest point in cycle

Question 23

Foot Flat (stance phase)

Answer 23

Plantar surface of the foot in contact with the ground (loading response).
-Begins with stance (right) foot touching the ground, continues until opposite (left) foot leaves the ground
• Weight shift onto stance leg continues
• Double leg support ends

Question 24

Midstance (stance phase)

Answer 24

Point at which the body passes over the weight bearing leg (mid stance)
-Begins with other leg (left) leaving the ground, continues until body is over stance (right) leg
• COG at highest point in cycle
• Single leg support begins

Question 25

Heel-off (stance phase)

Answer 25

Heel leaves the ground while ball of the foot and toes remain in contact with the ground (terminal stance)
-Begins with right heel rising, continues until other foot (left) touches the ground
• Body moves ahead of foot
• Single-leg support ends

Question 26

Toe-Off (stance phase)

Answer 26

Toes leave the ground, ending stance phase (preswing)
-Begins with other foot touching the ground, continues until toes leave the ground
• Task of leg advancement begins
• Double-leg support begins and ends

Question 27

Acceleration (swing phase)

Answer 27

The swing leg begins to move forward (initial swing)
-Begins with right foot leaving the ground, ends with swinging foot opposite (left) stance foot
• Swing phase (non-weightbearing) begins
• Single leg support begins on contralateral (left) side

Question 28

Midswing (swing phase)

Answer 28

The swing (non-weight-bearing) leg is directly under the body (midswing)
-Begins with foot opposite stance foot (left), ends with tibia in vertical position
• Leg shortens to clear the ground
• Single-leg support on contralateral (left) side continues

Question 29

Deceleration (swing phase)

Answer 29

The leg is slowing down in preparation for heel strike (terminal swing)
-Begins with vertical tibia (right), ends when right foot touches the ground
• Leg advancement task ends
• Single support ends.

Question 30

The five components of stance phase

Answer 30

..

Question 31

Vertical Displacement of the COG

Answer 31

The normal amount of this displacement is approximately 2 inches, being highest at midstance and lowest at heel strike (initial contact). (walking in a line and chalk draws wavy line on board)

Question 32

Horizontal Displacement of the COG

Answer 32

Equal amount of horizontal and vertical displacement. as the body weight shifts from side to side. This displacement is greatest during the single-support phase at midstance. In other words, this represents the distance the body’s center of gravity must shift horizontally onto one foot so that the other foot can swing forward. This side-to-side displacement is usually about 2 inches.

Question 33

Width of Walking Base

Answer 33

When you walk, you do not place your feet one step in front of the other but slightly apart. If lines were drawn through the successive midpoints of heel contact (initial contact) on each foot, this distance would range from 2 to 4 inches

Question 34

Lateral Pelvic Tilt

Answer 34

Occurs when weight is removed from the leg at toe-off (preswing). This slight drop is sometimes referred to as the Trendelenburg sign. The dip would be greater if it were not for the hip abductors on the opposite side (weight-bearing) and the erector spinae on the same side working together, keeping the pelvis essentially level. When the pelvis drops on the right side (the non–weight-bearing side), the left hip (the weight-bearing side) is forced into adduction. To keep the pelvis level, although it actually dips slightly, the left hip abductors contract to prevent hip adduction. At the same time, the right erector spinae muscle, which has attachments on the pelvis, contracts and “pulls up” on the side of the pelvis that wants to drop

Question 35

What should be true of step length, arm swing, trunk rotation, and head during walking?

Answer 35

Step length should normally be equal in both distance and time. The arm should swing with the opposite leg.
The trunk rotates forward as the leg progresses through the swing phase.
Arms swinging in opposition to trunk rotation controls the amount of trunk rotation by providing counterrotation.
The head should be erect, shoulders level, and trunk in extension.

Question 36

Lateral pelvic tilt.

Answer 36

.

Question 37

Muscles working to minimize lateral pelvic tilt. (A) Hip abductors. (B) Erector spinae muscles.

Answer 37

.

Question 38

Young Children Gait Pattern

Answer 38

Tend to walk with a wider walking base, their cadence is faster, and their stride length is shorter. Initial contact with the floor is with a flat foot, as opposed to heel strike. Their knees remain mostly extended during stance phase. In other words, they tend to take more steps that are short and choppy in a faster period of time. They also have little or no reciprocal arm swing. This is easy to observe as a child walks with an adult.

Question 39

Elderly Adult Gait Pattern

Answer 39

There is not universal agreement on the reasons for these changes, it is generally thought that security and fear of falling are major contributors. Typically, older adults lose muscle mass, are less active, and often have poorer hearing and vision. It should be recognized that the effects of age are relative to many factors such as health, activity level, and even attitude. Some 70-year-old people may appear “older” than others who are 10 or more years their senior. Given all of these qualifiers, some general statements can be made regarding the changes in walking pattern of elderly individuals. They tend to walk slower, spending more time in stance phase. Therefore, there are longer periods of double support. Because they take shorter steps, vertical displacement is less. They walk with a wider base, and so have greater horizontal displacement. There are fewer and slower automatic movements, which may increase the chance of stumbling or falling. In turn, these factors may contribute to decreased toe-floor clearance.

Question 40

Causes for abnormal gait:

Answer 40

• Muscular weakness/paralysis
• Joint/muscle range-of-motion (ROM) limitation
• Neurological involvement
• Pain
• Leg length discrepancy.

Question 41

Comparison of Running and Walking

Answer 41

When gait velocity increases to a certain point, it actually takes less energy to run than to “speed walk.” When comparing walking and running, each individual leg progresses through the stance and swing phases the same way, but time spent in each phase differs. During running, each leg completes its entire stance phase while the other leg is in swing phase. There is a period of nonsupport, which does not occur during walking. Unlike running, walking has a period of double support. With running, the amount of time spent in stance phase decreases while the amount of time spent in swing phase increases. This causes the right and left swing phases to overlap, creating periods of nonsupport (see Table).
To conserve energy and minimize demand on supporting muscles, both vertical and horizontal displacement of the body is reduced during running. This is achieved by: (1) keeping the hips and knees in more flexion throughout the gait cycle, which minimizes the peak height of the center of gravity, and (2) narrowing the width of the walking base, thus minimizing the body’s need to shift laterally during single-limb stance. There are, however, increased demands on the body with running. Without periods of double support, and with a narrower walking base, the body is less stable, so good balance and coordination is necessary. Due to the increased velocity of movement, there are also more forces to absorb and a demand for stronger eccentric muscle contractions.

Question 42

Walking vs. Running Gait Cycle

Answer 42

.

Question 43

Depending on the cause or severity of the condition, muscle weakness can range from

Answer 43

Slight weakness to complete paralysis, in which there is no strength at all.

Question 44

With muscle weakness, the body tends to compensate by…

Answer 44

Shifting the center of gravity over, or toward, the part that is involved. Basically, this reduces the moment of force (torque) on the joint, lessening the muscle strength required. Obviously, the portion of the gait cycle affected will be that portion in which the muscles or joints have a major role.

Question 45

Gluteus Maximus Gait

Answer 45

The trunk quickly shifts posteriorly at heel strike (initial contact). This will shift the body’s center of gravity posteriorly over the gluteus maximus, moving the line of force posterior to the hip joints. With the foot in contact with the floor, this requires less muscle strength to maintain the hip in extension during stance phase. This shifting is sometimes referred to as a rocking horse gait because of the extreme backward-forward movement of the trunk.

Question 46

Gluteus maximus gait due to muscle weakness/paralysis on right side.

Answer 46

.

Question 47

Gluteus Medius Gait

Answer 47

The individual shifts the trunk over the affected side during stance phase. In Figure 22-18, the left gluteus medius, or hip abductor, is weak, causing two things to happen: (1) the body leans over the left leg during that leg’s stance phase, and (2) the right side of the pelvis drops when the right leg leaves the ground and begins swing phase. This gait is also referred to as a Trendelenburg gait. Do not confuse it with the normal amount of dipping of the pelvis. Shifting the trunk over the affected side is an attempt to reduce the amount of strength required by the gluteus medius to stabilize the pelvis.

Question 48

Weakness in the quadriceps muscle group (gait)

Answer 48

Several different compensatory mechanisms may be used. Depending on whether only the quadriceps muscles are weak or if there are additional weaknesses in the extremity, various compensatory maneuvers may be used. With quadriceps weakness, the individual may lean the body forward over the quadriceps muscles at the early part of stance phase, as weight is being shifted onto the stance leg. Normally at this time, the line of force falls behind the knee, requiring quadriceps action to keep the knee from buckling. By leaning forward at the hip, the center of gravity is shifted forward and the line of force now falls in front of the knee. This will force the knee backward into extension. Another compensatory maneuver is using the hip extensors and ankle plantar flexors in a closed-chain action to pull the knee into extension at heel strike (initial contact). This reversal of muscle action can be seen in Figure 19-22. In addition, the person may physically push on the anterior thigh during stance phase, holding the knee in extension

Question 49

hamstrings are weak (gait)

Answer 49

2 things may happen. During stance phase, the knee will go into excessive hyperextension, sometimes referred to as genu recurvatum gait. Without the hamstrings to slow the forward swing of the lower leg during the deceleration (terminal swing) part of swing phase, the knee will snap into extension.

Question 50

Amount of weakness of the ankle dorsiflexors (gait)

Answer 50

Determines how an individual may compensate. If there is insufficient strength to move the ankle into dorsiflexion at the beginning of stance phase, the foot will land with a fairly flat foot.

Question 51

Equinus Gait

Answer 51

When there is no ankle dorsiflexion, and the toes strike first.

Question 52

Foot Slap (gait)

Answer 52

Weak ankle dorsiflexors may not be able to support the body weight after heel strike and will thus move toward foot flat (loading response) as they ineffectively eccentrically contract. With the dorsiflexors not being able to slow the descent of the foot, the foot slaps into plantar flexion as more weight is put on the leg.

Question 53

Drop Foot (gait)

Answer 53

During swing phase, they may not be able to dorsiflex the ankle. Gravity will cause the foot to fall into plantar flexion when it is off the ground.

Question 54

Steppage Gait

Answer 54

As a result of drop foot, the knee will need to be lifted higher for the dropped foot to clear the floor. The drum major in a marching band will utilize the elements of this gait when performing.

Question 55

Genu recurvatum gait.

Answer 55

..

Question 56

Weakness, paralysis, or absence of ankle dorsiflexors results in…

Answer 56

(A) equinus gait at heel strike (initial contact – RLA) and (B) steppage gait during swing phase

Question 57

Waddling gait

Answer 57

Commonly seen with muscular and other types of dystrophies, because there is diffuse weakness of many muscle groups. The person stands with the shoulders behind the hips, much like a person with paraplegia would balance resting on the iliofemoral ligament of the hips. There is an increased lumbar lordosis, pelvic instability, and Trendelenburg gait. Little or no reciprocal pelvis and trunk rotation occur. To swing the leg forward, the entire side of the body must swing forward. For example, normally, as the right leg swings forward, the right arm swings backward. In this case, the right arm and leg swing forward together. Add this to the excessive trunk lean of Trendelenburg gait bilaterally, and one can see the waddling nature of the gait. A steppage gait is often also present.

Question 58

Waddling Gait

Answer 58

.

Question 59

hip flexion contracture,

Answer 59

The involved hip is unable to go into hip extension and hyperextension during the midstance and push-off phases (terminal stance). To compensate, the person will commonly assume the salutation or greeting position in which the hip is flexed and the person’s trunk leans forward as if bowing. The involved leg may also simultaneously flex the knee when it normally would be extended.

Question 60

Fused Hip

Answer 60

Increased motion of the lumbar spine and pelvis can greatly compensate for hip motion. A decreased lordosis and posterior pelvic tilt will allow the leg to swing forward, whereas an increased lordosis and anterior pelvic tilt will swing the leg posteriorly. This is sometimes referred to as a bell-clapper gait. A bell swings back and forth, causing the clapper inside to also move back and forth.

Question 61

Salutation greeting resulting from hip flexion contracture.

Answer 61

.

Question 62

Bell-clapper gait resulting from a fused hip.

Answer 62

In (A) the leg swings forward by flattening the lumbar lordosis and tilting the pelvis posteriorly. In (B) the leg swings backward by increasing the lumbar lordosis and tilting the pelvis anteriorly.

Question 63

Knee Flexion Contracture

Answer 63

Will result in excessive dorsiflexion during midstance and an early heel rise during push-off (terminal stance). There is also a shortened step length of the unaffected side.

Question 64

Knee Fusion

Answer 64

The lower leg will be at a fixed length. That length will depend on the position of the joint. If the knee is fused in extension, the leg will be unable to shorten during swing phase. To compensate, the person must (1) rise up on the toes of the uninvolved leg in a vaulting gait, (2) hike the hip of the involved side, (3) swing the leg out to the side, or (4) do some variation of the three methods.

Question 65

Circumducted Gait

Answer 65

The leg begins near the midline at push-off (terminal stance), swings out to the side during swing phase, then returns to the midline for heel strike. It is called an abducted gait if the leg remains in an abducted position throughout the gait cycle.

Question 66

Vaulting gait resulting from a right knee fused in extension. The person must rise up on her toes on the left side to allow the involved right leg to swing through.

Answer 66

.

Question 67

Circumducted gait.

Answer 67

(A) The leg is in the normal position at the end of stance phase. The leg then swings out and around during swing phase (B), returning to the normal position for the beginning of stance phase (C).

Question 68

Triceps Surae Contracture

Answer 68

Depending on the severity of a several things may result. The knee can be forced into excessive extension during midstance, because there is insufficient length of the plantar flexors to allow dorsiflexion. If the gastrocnemius does not have enough extensibility to be stretched over both the ankle and knee, something must give. There will be either limited ankle dorsiflexion or the knee will be pulled into extreme extension. Remember that the gastrocnemius is a two-joint muscle that plantar flexes the ankle and flexes the knee. In weight-bearing, body weight may force a certain amount of dorsiflexion, thus forcing a tight gastrocnemius to pull the knee into extension. In addition, an early heel rise will occur during push-off (terminal stance), the knee will be lifted higher during swing phase, and the toes will land first during heel strike (initial contact). The latter is called a steppage gait.

Question 69

Hemiplegic gait.

Answer 69

.

Question 70

Ankle Fusion

Answer 70

Commonly called a triple arthrodesis because of fusion of the subtalar joint and the two articulations making up the transtarsal joint. This will result in loss of ankle pronation and supination. Plantar flexion and dorsiflexion will remain but will be limited. Usually, there is a shortened stride length. The person will have more difficulty walking on uneven ground because the ability to pronate and supinate the foot has been lost.

Question 71

The amount of gait disturbance depends on the severity of…

Answer 71

Neurological involvement

Question 72

Hemiplegic Gait

Answer 72

Varies depending on the severity of neurological involvement and the presence and amount of spasticity. Generally speaking, with spasticity there is an extension synergy in the involved lower extremity. The hip goes into extension, adduction, and medial rotation. The knee is in extension, though often unstable. The ankle demonstrates a drop foot with ankle plantar flexion and inversion (equinovarus), which is present during both stance phase and swing phase. The involved upper extremity may typically be in a flexion synergy. Usually, there will be no reciprocal arm swing. Step length tends to be lengthened on the involved side and shortened on the uninvolved side.

Question 73

Ataxic Gait

Answer 73

Cerebellar involvement often results in this. Lack of coordination leads to jerky, uneven movements. Balance tends to be poor, and the person walks with a wide base of support (abducted gait). The person usually has difficulty walking in a straight line and tends to stagger. Reciprocal arm motion also appears to be jerky and uneven. All movements appear exaggerated.

Question 74

Parkinsonian Gait

Answer 74

In which one has tremors, demonstrates diminished movement. The posture of the lower extremities and trunk tends to be flexed. The elbows are partially flexed, and there is little or no reciprocal arm swing. Stride length is greatly diminished, and the forward heel does not swing beyond the rear foot. The person walks with a shuffling gait, with the feet flat and weight mostly forward on the toes. he person has difficulty initiating movements. This shuffling gait tends to start slowly and increase in speed, and the person often has difficulty stopping. It gives the appearance that the person’s feet are trying to catch up to the forward-leaning trunk. This is called a festinating gait.

Question 75

Scissors Gait.

Answer 75

Result of spasticity in the hip adductors results This gait is most evident during the swing phase, when the unsupported leg swings against or across the stance leg. Needless to say, the walking base is narrowed. The trunk may lean over the stance leg as the swing phase leg attempts to swing past it

Question 76

Crouch Gait

Answer 76

Describes the bilateral lower extremity involvement seen in the spastic diplegia associated with cerebral palsy. There is often great variation in the gait from what is considered “typical.” There is excessive flexion, adduction, and medial rotation at the hips and flexion at the knees. The ankles are plantar flexed. The pelvis maintains an anterior pelvic tilt, and there is an increased lumbar lordosis. To compensate, the reciprocal arm swing and horizontal displacement are exaggerated

Question 77

When a person has pain in any of the lower extremity joints, the tendency is to…

Answer 77

Shorten the stance phase. In other words, if it hurts to stand on it, do not stand on it. A shortened, often abducted stance phase on the involved side results in a rapid and shortened step length on the uninvolved side. Compensation in the reciprocal arm swing is also evident.

Question 78

Antalgic Gait

Answer 78

Reciprocal arm swinging shortens as the step length is shortened, exaggerated, and often abducted. If the pain is caused by a hip problem, the person will lean over that hip during weight-bearing. This will decrease the torque placed on the joint and the amount of pressure placed on the femoral head. Magee (1987) stated that the amount of pressure will be decreased from more than twice the body weight to approximately that of the person’s body weight.

Question 79

Scissors gait.

Answer 79

.

Question 80

Leg Length Discrepancy

Answer 80

We all have legs of unequal length. Often the discrepancy is as much as approximately one-quarter inch between the right and left legs. Because both feet need to be in contact with the ground while in standing posture, how does the body adjust to the difference in leg length? Clinically, these smaller discrepancies are often corrected by inserting heel lifts of various thicknesses into the shoe. Without any other correction, dropping the pelvis on the shorter leg side (affected side) can compensate for a minimal leg length discrepancy. Although this may not look abnormal, it does place added stress on the lower back, hips, and knees. In addition to increased lateral pelvic tilt, the person may compensate by leaning over the shorter leg. This would result in greater lateral leaning of the upper body. These techniques can accommodate leg length discrepancies of up to approximately 3 inches.

Question 81

Moderate Leg Length Discrepancy

Answer 81

Between approximately 3 and 5 inches (depending on one’s height), dropping the pelvis on the affected side will no longer be effective. The person needs to either shorten the uninvolved leg or make the involved leg functionally longer

Question 82

Equinus Gait.

Answer 82

Occurs when a longer leg is needed, so the person usually walks on the ball of the foot on the involved (shorter) side. The most obvious change in the gait pattern would be loss of heel strike (initial contact) and foot flat (loading response).