Exam 1 Flashcards
Initial Contact (IC) Definition
the moment when the foot contacts the ground
Loading response (LR) definition
weight is rapidly transferred onto the outstretched limb, the first period of double limb support
Midstance (MSt) definition
The body progresses over a single limb
Terminal Stance (TSt) definition
progression over the stance limb continues. The body moves ahead of the limb and the weight is transferred into the forefoot
Pre-Swing (PSw) definition
A rapid unloading of the limb occurs as wight is transferred to the contralateral limb, the second period of double limb support
Initial Swing (ISw) definition
the thigh begins to advance as the foot comes off of the floor
Midswing (MSw) definition
The thigh continues to advance as the knee begins to extend; the foot clears the ground
Terminal Swing (TSw) definition
the knee extends; the limb prepares to contact the ground for initial contact
ROM of ankle at initial contact
neutral
ROM of ankle at loading response
5 degrees of rapid planter flexion
ROM of ankle at Midstance
ankle dorsiflexes 5 degrees as tibia starts to advance
ROM of ankle at Terminal stance
ankle dorsiflexes to 10 degrees (due to more tibia advancement). MTP joints extend to 30 degrees
ROM of ankle at Pre-Swing
15 degrees of planter flexion and MTP extend to 60 degrees (for toe off)
ROM of ankle at Initial Swing
The ankle moves to 5 degrees of planter flexion
ROM of ankle at Mid Swing
the ankle dorsiflexes back to neutral
ROM of ankle at Terminal swing
neutral
Muscle activation of the ankle at initial contact
on: TA and long toe extensors maintain foot position
Muscle activation of the ankle at loading response
on early: TA activity peaks initially, EHL and EDL
on later: gastroc and soleus to control tibia advancement
Muscle activation for the ankle at midstance
on: gastroc and soleus to control forward progression of the tibia
muscle activation of the ankle at terminal stance
on: gastroc, soleus, TP, peak in activity to allow for toe off and prevent forward tibial collapse. Fib long and brev provide stability
muscle activation of the ankle at pre-swing
on: calf activity diminishes early in pre-swing but residual activity and passive tension result in planter flexion of foot
muscle activation of the ankle at Initial swing
on: EDL, EHL peak in this stage. TA is also on to prepare for dorsiflexion
muscle activation of the ankle at mid swing
EDH, EDL, TA
muscle activation of the ankle at terminal swing
EDH, EDL, TA
Knee ROM at initial contact
knee should appear to be neutral or slightly flexed
Knee ROM at loading response
knee flexes to 15 degrees
Knee ROM at mid stance
knee will extend back to neutral/ slightly flexed
Knee ROM at terminal stance
knee will be neutral
Knee ROM at pre-swing
flexes to 40 degrees
Knee ROM at Initial swing
knee flexes to 60 degrees
Knee ROM at mid swing
knee extends back to 25 degrees as the tibia acguever a vertical position
Knee ROM at terminal swing
initially extends to neutral but may move into 5 degrees of flexion
Knee muscle activity at initial contact
quads continue to contract in preparation for loading response. The hamstrings co-contract to counteract the extension torque
knee muscle activity in loading response
eccentric quads to meet torque demands and absorb shock. Diminishing activity in hamstrings assists in maintaining hip position
knee muscle activity in mid stance
quads provide dynamic knee stability until knee extension then the calf muscles stabilize for femur to advance over the tibia
knee muscle activity in terminal stance
Biceps femoris short head preventing knee extension
Knee muscle activity in pre-swing
gracilis preps for knee flexion
knee muscle activity in initial swing
biceps femoris short head, sartorius, and gracilis peak to flex knee
Knee muscle activity in mid swing
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
Knee muscle activity in terminal swing
quads are concentrically active to insure full knee extension. Hamstrings will activate to reduce the acceleration of the quads
ROM of hip in Initial contact
20 degrees if thigh flexion achieved in terminal swing is maintained. The pelvis in 5 degrees of forward rotation in the horizontal plane
ROM of hip at loading response
thigh remains 20 degrees of flexion and pelvis remains in a position of 5 degrees of forward rotation
ROM of hip at mid stance
thigh extends to neutral. Pelvis rotates back to neutral
ROM of hip at terminal stance
thigh extends to trailing limb postion of 20 degrees of extension
ROM of hip at Pre-swing
thigh falls forward. It appears to be vertical but is actually slight hyperextended (10 degrees)and pelvis remains in 5 degrees of backward rotation
ROM of hip at Inital swing
15 degrees of thigh flexion is achieved. Pelvis remains 5 degrees of backward rotation.
ROM of hip at mid swing
25 degrees of thigh flexion is achieved. The pelvis rotates forward to a postion of neutral rotation
ROM of hip at terminal swing
thigh falls slightly to 20 degrees of flexion. Pelvis rotates forward 5 degrees
Hip Muscle activity at Initial contact
hip extensors are active to prepare for stabilization of loading response. Primary muscles are the glute max, and adductor Magnus
Hip muscle activity at loading response
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
Hip muscle activity in midstance
no hip activation required in sagittal plane. The pelvis is stabilized in the frontal plane bu the hip abductors
Hip muscle activity in terminal stance
activity of the post. fibers of the TFL diminishes while the anterior fibers of TFL become active in terminal stance
Hip muscle activity in pre-swing
adductor longus activity dynamically contributes to the femur flexing forward
Hip muscle activity in initial swing
the iliacas, gracilis and sartorius peak in activity. Adductor longus is also active
Hip muscle activity in mid swing
hamstrings initiate activity in late mid swing
Hip muscle activity in terminal swing
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
Definition of “gait abnormality or deviation”
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
what are some reasons that could be the etiology of gait abnormality?
normal aging, pharmaceutical, disease, injury
clinical assessment of gait steps
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.
Trunk backward lean deviation
backward position of the trunk relative to the vertical
Trunk forward lean deviation
forward position of the trunk relative to the vertical
Trunk lateral lean deviation
leaning of the trunk to one side relative to the vertical
Trunk rotations forward and backward
Backward or forward rotation greater than neutral on the reference side
Pelvis hike deviation
Elevation of one side of the pelvis above neutral, approximating the pelvis to the shoulder.
- increases energy costs, used to clear the swing limb
Posterior pelvic tilt
tilting the pelvis so that the pubic symphysis is directed upward, flattening the lumbar spine
Anterior pelvis tilt
tilting the pelvis so that the pubic symphysis is directed downward, increasing lumbar lordosis
Lacks forward rotation in the pelvis
less then normal forward rotation of a specific phase
-decreases step length of the isilateral limb
Lacks backward rotation in the pelvis
less then normal backward rotation for a specific phase
-decreases the step length of the contralateral limb
excess forward rotation in the pelvis
greater than normal forward rotation for a specific phase
Ipsilateral pelvic drop
iliac crest on the reference limb lower than the iliac creat on the opposite side
Contralateral pelvic drop
Iliac crest on the opposite side lower than the iliac crest on the reference limb
Limited knee flexion
less then normal knee flexion for the specific phase
-decreases shock absorption, and forward momentum of the tibia
Excess knee flexion
greater than normal knee flexion for the specific phase
wobbles (knee)
alternating flexion and extension of the knee occuring during a single phase
-decreases forward momentum and lim stability and balance
hyperextension of the knee
position of the knee beyond neutral extension
-decreases shock absorbtion and forward progression of the tibia
Extension thrust of the knee
forceful movement of the knee toward extension
Varus/Valgus of the knee
lateral/medial angulation of the tibia relative to the femur
- decreases limb stability and joint instability
Excess Contralateral flexion
Knee flexion greater than normal during LR, MSt, or TSt of the opposite limb; this occurs during SLA of the reference limb
Forefoot contact
Initial contact with the ground made by the forefoot
- used to compensate for weak quads. decreases forward momentum of the tibia
foot flat contact
inital contact of the ground made by the entire foot
foot slap
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
excess planter flexion
planter flexion greater than normal for the specific phase
excess dorsiflexion
dorsiflexion greater than normal for the specific phase
Excess inversion/eversion
inversion and eversion of the calcaneus or forefoot greater than normal for the specific phase
heel off
heel not in contact with the ground during LR or MSt
- decreases the base of support
No heel off
absence of heel rise during PSw
-interferes with progression of the forefoot, decreases step length of the opposite limb
drag of the foot
contact of the toes, forefoot or heel with the ground during SLA
-secondary to limited hip flexion, limited knee flexion, or limited planter flextion
contralateral vaulting of the foot
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
toes up
extension of the toes beyond neutral
- compensatory for weak TA
Inadequate extension of toes
less matatarsalphalangeal extension than normal for the specific phase
-decreases step length of the opposite limb
clawed/hammered toes
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
pathology in observational gait anaylsis
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
skeleton and gait
1) supports the body against the pull of gravity
2) supports the body when standing
3) works together as a lever system
how to discern skeletal gait problems
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
common skeletal gait abnormalities
1) leg length discrepancy
2) foot progression angle: in tow and outtoe gait can come from the hip, knee, or ankle
where is limb discrepancy best seen from
the frontal view (rear)
how much discrepancy is too much? (leg length)
- over 2 cms
-the culprit is the tibia or the femur - previous broken bone is a common reason
-bone infections, juvenile arthritis or arthropathies
measuring leg length
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)
what is the normal foot progression angle in adults
13-15 degrees
can be caused by skeletal issues such as external tibial torsion, pronation, hip internal rotation
what to look for with feet external rotation
1) patella coming forward or pronation
in toe gait characteristics
common is children up to 4 years old. Children will “grow out of the posture” and can be caused by some pathologies
when should you suspect femoral anteversion
when the angle of hip internal rotation is greater then 50 degrees
what is tibial torsion
rotation of the tibial relative to the femur
what is. in tow posture in the foot
-unusual to treat club foot in the us
-orthotics can assist
-in toe pattern
exams to asses foot progression angle
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
stance phase mechanics with pronation
-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
Neurologic gait deficits
- numerous gait defects in persions with primary neurologic diagnoses
- synergistic patterns in the limbs is caused by CVA/stroke
what should you document with describing gait pattern
1) assistive device, supervision level, involvement, and any major gait issues
