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Gait > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Initial Contact (IC) Definition

A

the moment when the foot contacts the ground

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2
Q

Loading response (LR) definition

A

weight is rapidly transferred onto the outstretched limb, the first period of double limb support

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3
Q

Midstance (MSt) definition

A

The body progresses over a single limb

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4
Q

Terminal Stance (TSt) definition

A

progression over the stance limb continues. The body moves ahead of the limb and the weight is transferred into the forefoot

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5
Q

Pre-Swing (PSw) definition

A

A rapid unloading of the limb occurs as wight is transferred to the contralateral limb, the second period of double limb support

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6
Q

Initial Swing (ISw) definition

A

the thigh begins to advance as the foot comes off of the floor

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7
Q

Midswing (MSw) definition

A

The thigh continues to advance as the knee begins to extend; the foot clears the ground

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8
Q

Terminal Swing (TSw) definition

A

the knee extends; the limb prepares to contact the ground for initial contact

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9
Q

ROM of ankle at initial contact

A

neutral

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10
Q

ROM of ankle at loading response

A

5 degrees of rapid planter flexion

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11
Q

ROM of ankle at Midstance

A

ankle dorsiflexes 5 degrees as tibia starts to advance

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12
Q

ROM of ankle at Terminal stance

A

ankle dorsiflexes to 10 degrees (due to more tibia advancement). MTP joints extend to 30 degrees

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13
Q

ROM of ankle at Pre-Swing

A

15 degrees of planter flexion and MTP extend to 60 degrees (for toe off)

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14
Q

ROM of ankle at Initial Swing

A

The ankle moves to 5 degrees of planter flexion

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15
Q

ROM of ankle at Mid Swing

A

the ankle dorsiflexes back to neutral

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16
Q

ROM of ankle at Terminal swing

A

neutral

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17
Q

Muscle activation of the ankle at initial contact

A

on: TA and long toe extensors maintain foot position

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18
Q

Muscle activation of the ankle at loading response

A

on early: TA activity peaks initially, EHL and EDL
on later: gastroc and soleus to control tibia advancement

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19
Q

Muscle activation for the ankle at midstance

A

on: gastroc and soleus to control forward progression of the tibia

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20
Q

muscle activation of the ankle at terminal stance

A

on: gastroc, soleus, TP, peak in activity to allow for toe off and prevent forward tibial collapse. Fib long and brev provide stability

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21
Q

muscle activation of the ankle at pre-swing

A

on: calf activity diminishes early in pre-swing but residual activity and passive tension result in planter flexion of foot

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22
Q

muscle activation of the ankle at Initial swing

A

on: EDL, EHL peak in this stage. TA is also on to prepare for dorsiflexion

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23
Q

muscle activation of the ankle at mid swing

A

EDH, EDL, TA

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24
Q

muscle activation of the ankle at terminal swing

A

EDH, EDL, TA

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25
Q

Knee ROM at initial contact

A

knee should appear to be neutral or slightly flexed

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26
Q

Knee ROM at loading response

A

knee flexes to 15 degrees

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27
Q

Knee ROM at mid stance

A

knee will extend back to neutral/ slightly flexed

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28
Q

Knee ROM at terminal stance

A

knee will be neutral

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29
Q

Knee ROM at pre-swing

A

flexes to 40 degrees

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30
Q

Knee ROM at Initial swing

A

knee flexes to 60 degrees

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31
Q

Knee ROM at mid swing

A

knee extends back to 25 degrees as the tibia acguever a vertical position

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32
Q

Knee ROM at terminal swing

A

initially extends to neutral but may move into 5 degrees of flexion

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33
Q

Knee muscle activity at initial contact

A

quads continue to contract in preparation for loading response. The hamstrings co-contract to counteract the extension torque

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34
Q

knee muscle activity in loading response

A

eccentric quads to meet torque demands and absorb shock. Diminishing activity in hamstrings assists in maintaining hip position

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35
Q

knee muscle activity in mid stance

A

quads provide dynamic knee stability until knee extension then the calf muscles stabilize for femur to advance over the tibia

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36
Q

knee muscle activity in terminal stance

A

Biceps femoris short head preventing knee extension

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37
Q

Knee muscle activity in pre-swing

A

gracilis preps for knee flexion

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38
Q

knee muscle activity in initial swing

A

biceps femoris short head, sartorius, and gracilis peak to flex knee

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39
Q

Knee muscle activity in mid swing

A

Knee extension is carried by momentum from gracilis and gravity. The short head of the biceps control the rate of knee extension and hamstrings become active in late mid swing

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40
Q

Knee muscle activity in terminal swing

A

quads are concentrically active to insure full knee extension. Hamstrings will activate to reduce the acceleration of the quads

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41
Q

ROM of hip in Initial contact

A

20 degrees if thigh flexion achieved in terminal swing is maintained. The pelvis in 5 degrees of forward rotation in the horizontal plane

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42
Q

ROM of hip at loading response

A

thigh remains 20 degrees of flexion and pelvis remains in a position of 5 degrees of forward rotation

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43
Q

ROM of hip at mid stance

A

thigh extends to neutral. Pelvis rotates back to neutral

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44
Q

ROM of hip at terminal stance

A

thigh extends to trailing limb postion of 20 degrees of extension

45
Q

ROM of hip at Pre-swing

A

thigh falls forward. It appears to be vertical but is actually slight hyperextended (10 degrees)and pelvis remains in 5 degrees of backward rotation

46
Q

ROM of hip at Inital swing

A

15 degrees of thigh flexion is achieved. Pelvis remains 5 degrees of backward rotation.

47
Q

ROM of hip at mid swing

A

25 degrees of thigh flexion is achieved. The pelvis rotates forward to a postion of neutral rotation

48
Q

ROM of hip at terminal swing

A

thigh falls slightly to 20 degrees of flexion. Pelvis rotates forward 5 degrees

49
Q

Hip Muscle activity at Initial contact

A

hip extensors are active to prepare for stabilization of loading response. Primary muscles are the glute max, and adductor Magnus

50
Q

Hip muscle activity at loading response

A

the lower fibers of the glute max, adductor mag, and the hamstrings are active to counteract flexion torque. TFL, glute med, glute min and upper fibers of glute max peak in activity as they contract to stabilize the pelvis

51
Q

Hip muscle activity in midstance

A

no hip activation required in sagittal plane. The pelvis is stabilized in the frontal plane bu the hip abductors

52
Q

Hip muscle activity in terminal stance

A

activity of the post. fibers of the TFL diminishes while the anterior fibers of TFL become active in terminal stance

53
Q

Hip muscle activity in pre-swing

A

adductor longus activity dynamically contributes to the femur flexing forward

54
Q

Hip muscle activity in initial swing

A

the iliacas, gracilis and sartorius peak in activity. Adductor longus is also active

55
Q

Hip muscle activity in mid swing

A

hamstrings initiate activity in late mid swing

56
Q

Hip muscle activity in terminal swing

A

hamstring activity peaks to decelerate the led. Adductor mag and lower fivers of the gluteus maximus initiate activity in preparation for their role in stabilizing the hip. TFL abd glute medius become active for hip stabilization in weight acceptance

57
Q

Definition of “gait abnormality or deviation”

A

Any variation from the standard gait phases that involve the arms, trunk, pelvis, hip, knee, or ankle. Can be caused by a singular disease or by several systems

58
Q

what are some reasons that could be the etiology of gait abnormality?

A

normal aging, pharmaceutical, disease, injury

59
Q

clinical assessment of gait steps

A

1) take a gait analysis
2) note the deviations using the rancho form and note by swing phase deviations and stance phase deviations
3) additional outcome measures need to be preformed including gait velocity and specific gait measures.

60
Q

Trunk backward lean deviation

A

backward position of the trunk relative to the vertical

61
Q

Trunk forward lean deviation

A

forward position of the trunk relative to the vertical

62
Q

Trunk lateral lean deviation

A

leaning of the trunk to one side relative to the vertical

63
Q

Trunk rotations forward and backward

A

Backward or forward rotation greater than neutral on the reference side

64
Q

Pelvis hike deviation

A

Elevation of one side of the pelvis above neutral, approximating the pelvis to the shoulder.
- increases energy costs, used to clear the swing limb

65
Q

Posterior pelvic tilt

A

tilting the pelvis so that the pubic symphysis is directed upward, flattening the lumbar spine

66
Q

Anterior pelvis tilt

A

tilting the pelvis so that the pubic symphysis is directed downward, increasing lumbar lordosis

67
Q

Lacks forward rotation in the pelvis

A

less then normal forward rotation of a specific phase
-decreases step length of the isilateral limb

68
Q

Lacks backward rotation in the pelvis

A

less then normal backward rotation for a specific phase
-decreases the step length of the contralateral limb

69
Q

excess forward rotation in the pelvis

A

greater than normal forward rotation for a specific phase

70
Q

Ipsilateral pelvic drop

A

iliac crest on the reference limb lower than the iliac creat on the opposite side

71
Q

Contralateral pelvic drop

A

Iliac crest on the opposite side lower than the iliac crest on the reference limb

72
Q

Limited knee flexion

A

less then normal knee flexion for the specific phase
-decreases shock absorption, and forward momentum of the tibia

73
Q

Excess knee flexion

A

greater than normal knee flexion for the specific phase

74
Q

wobbles (knee)

A

alternating flexion and extension of the knee occuring during a single phase
-decreases forward momentum and lim stability and balance

75
Q

hyperextension of the knee

A

position of the knee beyond neutral extension
-decreases shock absorbtion and forward progression of the tibia

76
Q

Extension thrust of the knee

A

forceful movement of the knee toward extension

77
Q

Varus/Valgus of the knee

A

lateral/medial angulation of the tibia relative to the femur
- decreases limb stability and joint instability

78
Q

Excess Contralateral flexion

A

Knee flexion greater than normal during LR, MSt, or TSt of the opposite limb; this occurs during SLA of the reference limb

79
Q

Forefoot contact

A

Initial contact with the ground made by the forefoot
- used to compensate for weak quads. decreases forward momentum of the tibia

80
Q

foot flat contact

A

inital contact of the ground made by the entire foot

81
Q

foot slap

A

uncontrolled planter flexion at the ankle joint after the hell contact accompanied by a slapping sound
- caused by weak TA. decreases forward momentum of the tibia

82
Q

excess planter flexion

A

planter flexion greater than normal for the specific phase

83
Q

excess dorsiflexion

A

dorsiflexion greater than normal for the specific phase

84
Q

Excess inversion/eversion

A

inversion and eversion of the calcaneus or forefoot greater than normal for the specific phase

85
Q

heel off

A

heel not in contact with the ground during LR or MSt
- decreases the base of support

86
Q

No heel off

A

absence of heel rise during PSw
-interferes with progression of the forefoot, decreases step length of the opposite limb

87
Q

drag of the foot

A

contact of the toes, forefoot or heel with the ground during SLA
-secondary to limited hip flexion, limited knee flexion, or limited planter flextion

88
Q

contralateral vaulting of the foot

A

rising on the forefoot of the opposite stance limb during limb advancement of the reference leg.
-compensatory for limited flexion of the swing limb or longer swing limb

89
Q

toes up

A

extension of the toes beyond neutral
- compensatory for weak TA

90
Q

Inadequate extension of toes

A

less matatarsalphalangeal extension than normal for the specific phase
-decreases step length of the opposite limb

91
Q

clawed/hammered toes

A

flexion of the distal IP joints and flexion or extension of the proximal interphalangeal joints
-interferes with forward progression and decreases step length of the opposite limb

92
Q

pathology in observational gait anaylsis

A

clinicians in Physcial rehabilitations assess gait to discern wether the problem is from the skeletal system, muscular system, neurologic system, or weather the pain is attributing to the gait issue

93
Q

skeleton and gait

A

1) supports the body against the pull of gravity
2) supports the body when standing
3) works together as a lever system

94
Q

how to discern skeletal gait problems

A

1) leg length discrepancy is very common
2) limbs move in a predictable but abnormal pattern - is there a consistant gait deviation
3) observe and performs standing alignment, ROM and various limb alignment assessments

95
Q

common skeletal gait abnormalities

A

1) leg length discrepancy
2) foot progression angle: in tow and outtoe gait can come from the hip, knee, or ankle

96
Q

where is limb discrepancy best seen from

A

the frontal view (rear)

97
Q

how much discrepancy is too much? (leg length)

A
  • over 2 cms
    -the culprit is the tibia or the femur
  • previous broken bone is a common reason
    -bone infections, juvenile arthritis or arthropathies
98
Q

measuring leg length

A

1) standing postural assestment (scoliosis or pelvis/shoulder height)
2) Supine leg length (tape measure, hooklying)
3) pain assesment (low back pain or hip and knee pain)

99
Q

what is the normal foot progression angle in adults

A

13-15 degrees
can be caused by skeletal issues such as external tibial torsion, pronation, hip internal rotation

100
Q

what to look for with feet external rotation

A

1) patella coming forward or pronation

101
Q

in toe gait characteristics

A

common is children up to 4 years old. Children will “grow out of the posture” and can be caused by some pathologies

102
Q

when should you suspect femoral anteversion

A

when the angle of hip internal rotation is greater then 50 degrees

103
Q

what is tibial torsion

A

rotation of the tibial relative to the femur

104
Q

what is. in tow posture in the foot

A

-unusual to treat club foot in the us
-orthotics can assist
-in toe pattern

105
Q

exams to asses foot progression angle

A

1) walking assessment
2) standing assessment with dogs
3) femoral anteversion: bilateral hip rotation in prone greater then 50 degrees.
4) tibial torsion: prone thigh foot angle or sitting tibial torsion/ standing assessment with patella alignment
5) foot or forefoot intoeing: prone

106
Q

stance phase mechanics with pronation

A

-tibia internally rotating
-calcaneus everts and subtalar joint pronation
-midtarsal joint unlocks
-midfoot pliability increases
-increases forces during stance in the medial knee
-reduces the efficiency during toe off

107
Q

Neurologic gait deficits

A
  • numerous gait defects in persions with primary neurologic diagnoses
  • synergistic patterns in the limbs is caused by CVA/stroke
108
Q

what should you document with describing gait pattern

A

1) assistive device, supervision level, involvement, and any major gait issues

Gait (1 decks)

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