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Geriatrics > Chapter 17 - Ambulation > Flashcards

Chapter 17 - Ambulation Flashcards

1
Q

What is normal gait?

A

Series of rhythmical , alternating movements of the trunk & limbs which result in the forward progression of the center of gravity. Series of controlled falls.

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2
Q

What is included in the stance phase?

A 
Loading response (0-10%)
Mid stance (10-30%)
Terminal stance (30-50%)
Preswing (50-60%)
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3
Q

What is included in the swing phase?

A 
Initial swing (60-73%)
Mid swing (73-87%)
Terminal swing (87-100%)
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4
Q

What two events occur during double support phase?

A

Loading response

Preswing

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5
Q

What percent of gait does stance phase make up? Swing phase?

A

60%, 40%

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6
Q

Gait cycle is the single sequence of functions by ______.

A

one limb

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7
Q

When does the gait cycle begin and end?

A 
Begin = foot contacts ground
End = contact of same foot
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8
Q

What muscles are active during heel strike?

A

Tibialis anterior, glute max

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9
Q

What muscles are active during loading response/foot flat?

A

Quads

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10
Q

What muscles are active during mid stance?

A

calf muscles/triceps surae

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11
Q

What muscles are active during terminal stance?

A

triceps surae

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12
Q

What muscles are active during preswing/toe off?

A

rectus femoris, deep plantar flexors and flexors of toes, intrinsic foot muscles

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13
Q

What muscles are active during initial and mid swing?

A

iliopsoas and rectus femoris, contralateral hip abductors

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14
Q

What muscles are active during terminal swing?

A

quadriceps femoris, hamstrings, tibialis anterior

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15
Q

What is step length?

A

Distance between corresponding successive points of heel contact of the opposite feet

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16
Q

What is stride length?

A

Distance between successive points of heel contact of the same foot

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17
Q

What is walking base?

A

Side-to-side distance between the line of the two feet, AKA stride width

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18
Q

What is cadence? What’s normal?

A

Steps per unit time, 100-115 steps/min

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19
Q

How is velocity measured?

A

step length (m) x cadence (steps/min)

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20
Q

What is comfortable walking speed?

A

Least energy consumption per unit distance. Average = 80 m/min or 3 mph

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21
Q

What does a gait speed >1 m/s indicate?

A
  1. 1 = predictive of completing yard work

1. 3 = climb flight of stairs

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22
Q

What does a gait speed

A

benefit from fall prevention
.67 = complete self care
.89 = household activities

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23
Q

What does a gait speed

A

Future risk of falls and hospitalization, tend to require assistance with ADL
.49 = cross the street

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24
Q

What does a gait speed

A

longer length of stay in acute care, likely to DC to SNF, rehab, nursing home

25
Q

Heel contact

A

Initial contact

26
Q

Foot Flat

A

Loading response, initial contact of forefoot with ground

27
Q

Midstance

A

Greater trochanter in alignment with vertical bisector of foot

28
Q

Heel off

A

Terminal stance

29
Q

Toe off

A

Pre-swing

30
Q

Acceleration

A

Initial swing

31
Q

Midswing

A

Swinging limb overtakes the limb in stance

32
Q

Deceleration

A

Terminal swing

33
Q

What percent of gait is in single support? double?

A 
Single = 40%
Double = 20%
34
Q

What occurs to the phases with increased walking speeds?

A

Stance phase decreases
Swing phase increases
Double support decreases

35
Q

What occurs during running?

A

Walking without double support. Ratio to stance/swing reverses. Double swing develops

36
Q

Where is the CG? How does it relate to gait?

A

midway between hips, few cm in front of S2. Least energy consumption if CG travels in straight line

37
Q

When is vertical displacement highest? Lowest?

A 
Highest = mid stance
Lowest = double support
38
Q

What is the average vertical displacement? Describe the path

A

5 cm, extremely smooth sinusoidal curve

39
Q

What is the lateral limit for lateral displacement? Average displacement?

A

midstance, 5 cm

40
Q

What shape is the combined overall displacement?

A

Figure 8

41
Q

What are the 6 determinants of gait?

A
  1. pelvic rotation
  2. pelvic tilt
  3. knee flexion in stance phase
  4. ankle mechanism
  5. foot mechanism
  6. lateral displacement of body
42
Q

What is the typical amount of pelvic rotation?

A

8 degrees on the swing phase side

43
Q

What does pelvic rotation enable?

A

Reduces angle of hip flexion and extension

enables longer step-length without further lowering CG

44
Q

What is the typical amount of pelvic tilt?

A

5 degree dip on swinging side

45
Q

What does the pelvic tilt enable?

A

Reduces the height of the apex of the curve of CG

46
Q

How much knee flexion occurs in stance phase?

A

20 degrees

47
Q

What does knee flexion in stance enable?

A

Shortens the leg in the middle of stance phase, reduces height of the apex of the curve of CG

48
Q

What does the ankle mechanism do?

A

Lengthens the leg at heel contact. Smoothens the curve of CG. Reduces the lowering of CG.

49
Q

What does the foot mechanism do?

A

Lengthens the leg at toe-off as ankle moves from dorsiflexion to plantar flexion. Smoothens the curve of CG, reduces the lowering of CG.

50
Q

Why is it important to minimize the amount of lateral displacement?

A

Reduces muscular energy consumption

51
Q

What are the 4 most important forces in regards to gait?

A

Gravity
Muscular contraction
Inertia
Floor reaction

52
Q

The force that the foot exerts on the floor is due to _____ and is opposed by ____.

A

Gravity and Inertia

Ground reaction force

53
Q

How much strength is needed for gait?

A

20-25% max muscle strength

MMT of 3+

54
Q

What are some signs of a painful gait pattern?

A

Decreased single limb support period (less time on bad leg)
Shorter stride on opposite side
Limp

55
Q

How does someone present with foot drop or steppage gait?

A

Either drag feet or lift high, circumlocution if hip flexors can’t compensate. Cannot walk on heels

56
Q

Spasticity is a ______ motor neuron lesion.

A

upper

57
Q

Spastic hemiparesis is a ___ lesion.

A

corticospinal tract

58
Q

Describe spastic hemiparesis.

A

One arm immobile and close to side with mass muscle group in flexion. Leg extended with plantar flexion of foot. With walking, foot drags or circles outward and forward (circumduction)

59
Q

Scissors Gait

A

Stiff gait, each leg advances slowly, thighs cross forward with short steps

Geriatrics (4 decks)

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