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Exam 2 Flashcards

1
Q

What are the six determinants of gait?

A
  • pelvic rotation
  • pelvic tilt
  • knee flexion
  • foot mechanisms
  • knee mechanisms
  • lateral displacement of pelvis
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2
Q

Six determinants of gait

A

developed by Saunders et al. in 1953; based on three principles: the body attempts to minimize energy expenditure, the body’s COG is just anterior to S2, and the vertical and horizontal displacement of COG moves in a perfect figure 8 pattern

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3
Q

Vertical displacement

A

lowest is at double limb support (50% gait cycle); highest single limb support (25% and 75% gait cycle)

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4
Q

Horizontal displacement

A

lowest is at double limb support (50% gait cycle); highest single limb support (25% and 75% gait cycle)

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5
Q

Which of the six determinants of gait are responsible for depressing the peaks and raising the valleys?

A

pelvic rotation, pelvic tilt, and knee flexion

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6
Q

Which of the six determinants of gait are responsible for smooth transition movements?

A

knee mechanisms, foot mechanisms, and lateral displacement of pelvis

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7
Q

What is the effect of pelvic rotation?

A

pelvis rotates to the right and left about 5˚; effect of pelvic rotation is to somewhat flatten arc of center of gravity, arc less severe, energy cost is reduced

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8
Q

What is the effect of pelvic tilt?

A

pelvis alternately drops 5˚ on the side opposite of the weight bearing limb; relative adduction stance limb and abduction swing limb; effect of pelvic tilt is to somewhat flatten arc of COG, arcs less severe, energy cost reduced

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9
Q

What is the effect of knee flexion?

A

knee flexes during weight acceptance and terminal stance (20˚); effect of knee flexion is to further flatten the arc of COG, arc less severe, energy cost reduced

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10
Q

What are potential causes of gait deviations?

A
  • pain
  • contracture
  • mm weakness
  • decreased proprioception
  • impaired motor control
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11
Q

Excessive ankle plantarflexion at initial contact

A
  • weak ant. tib.
  • PF contracture
  • combo of excessive ankle PF and knee flexion (spasticity in both PF and HS)
  • heel pain
  • short leg
  • voluntary excessive ankle PF to compensate for weak quadriceps
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12
Q

Where should DF occur in a “normal” gait pattern?

A

midstance and terminal stance

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13
Q

Excessive DF is primarily an issue during:

A

stance phase

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14
Q

Excessive DF at loading response

A

increase heel rocker (land more posteriorly on heel) and increased knee flexion in order to achieve foot flat

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15
Q

Excessive DF at midstance

A

increased knee flexion and activation of the quads, unstable tibia

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16
Q

Inadequate knee flexion occurs during:

A

loading response, terminal swing, and initial swing

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17
Q

Inadequate hip flexion

A

stance - interferes with normal knee flexion and ankle PF

swing - reduces limb advancement

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18
Q

What are substitutive actions for inadequate hip flexion?

A
  • anterior pelvic tilt
  • circumduction
  • excessive knee flexion
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19
Q

Pseudo adduction

A

hip flexion combined with internal rotation gives the appearance of excessive hip adduction

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20
Q

Causes of excessive hip adduction

A
  • abductor weakness
  • adductor contracture/spasticity
  • adductor substitute for hip flexor weakness
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21
Q

Causes of excessive internal rotation

A
  • glut max/med activity

- bony deformity

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22
Q

Causes of excessive external rotation

A
  • glut max/med activity

- bony deformity

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23
Q

Causes of increased anterior pelvic tilt

A
  • hip extensor weakness

- hip flexor tightness/spasticity

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24
Q

Causes of increased posterior pelvic tilt

A

trunk/pelvis used to advance the leg

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25
Causes of excessive forward rotation
trunk/pelvis used to advance the leg
26
Causes of backward lean
- hip extensor weakness | - inadequate hip flexion
27
Causes of forward trunk lean
- quadriceps weakness - hip extensor weakness - hip flexion contracture - ankle plantarflexion contracture
28
Causes of lateral trunk lean
- weak hip abductors - contracture - short limb - scoliosis - impaired body image
29
Causes of contralateral pelvic drop
- weak hip abductor | - hip adductor contracture
30
Causes of excessive trunk rotation
- synergy with pelvis - walking aide synergy - arm swing synergy
31
Why do people run?
- function - recreation - developmental milestone
32
What is the main difference between walking and running?
walking involves period of double limb support, while running involves a float phase
33
What are other differences between walking and running?
- joint patterns are similar - excursions are greater (2x) - stance phase occurs over a shorter period of time - velocities are greater - forces are greater (2x)
34
What is the relationship between kinetic and potential energy during walking?
kinetic and potential energy are out of phase during walking; the center of mass falls and rises twice during stance
35
What is the relationship between kinetic and potential energy during running?
kinetic and potential energy are in phase; center of mass falls to a low point in midstance then back to high point during double float
36
Efficient running is achieved through what two mechanisms?
1. elastic structures | 2. two joint muscles
37
At which speed does running become more economical?
2.0 m/s (4.5 mph)
38
What is the limit of possible normal walking speeds
3.5 m/s (7.8 mph)
39
What occurs at the medial longitudinal arch during running?
slightly raised during IC, then collapses during LR, and raises again during propulsion
40
Vertical Loading Rate
can be an average or instantaneous
41
What is the rearfoot angle at FS/IC for FFS/MFS?
FFS have greater PF, INV, and ABD
42
What is the rearfoot angle at propulsion for FFS/MFS?
FFS have greater INV and ABD
43
What is the knee angle at FS/IC for FFS/MFS?
FFS have greater ADD
44
What are the advantages of gait analysis?
- no unique equipment required - not invasive - inexpensive - not time consuming
45
What are the disadvantages of gait analysis?
- required expertise - subjective - subtle changes difficult to detect - no kinetic measurements
46
What are the main gender differences during running?
females land in about 4˚ greater hip adduction and 4˚ greater hip internal rotation
47
What are the most common running injuries?
- patellofemoral pain - iliotibial pain syndrome - tibial stress fracture - plantar fasciitis - patellar tendonitis - achilles tendonitis
48
Iliotibial pain syndrome
Distal factors: coupling of rearfoot eversion and tibial IR causes increased strain on ITB Proximal factors: weak hip abductors and increased hip adduction in runners with ITB
49
What are the three layers of the ITB?
- superficial: lateral aspect of patella - middle: attaches to Gerdy's tubercle - deep: lateral aspect of femoral condyle
50
Retrospective studies indicate the TSF is associated with:
- inc. vertical GRF impact peak - inc. vertical GRF load rate - inc. tibial acceleration - inc. adduction free moment peak
51
Retrospective studies indicate the TSF is associated with:
- inc. vertical GRF impact peak - inc. vertical GRF load rate - inc. tibial acceleration - inc. adduction free moment peak
52
Proprioceptive neuromuscular facilitation
developed by Dr. Herman Kabat; Maggie Knott, PT; and Dorothy Voss, PT Based on the dynamic systems theory
53
What is the first PNF principle developed by Voss?
humans have potentials not fully developed; abilities should be channeled toward the reduction of inabilities
54
What is the fourth PNF principle developed by Voss?
rhythmic/reversing movement re-establish muscular interaction; goal directed activity is composed of these movements
55
D2 Position
arm begins in flexion, abduction, and ER; then ends in extension, adduction, and IR Squeeze, turn, pull down and across; open, turn, push up and out
56
What is the fifth PNF principle developed by Voss?
total patterns and diagonal movement; development of motor behavior proceeds in a sequence of total body patterns; diagonal and rotational movement are the keys to strength
57
What are the sixth and seventh principles developed by Voss?
development is orderly; flexor and extensor dominance are cyclic, alternating between positions helps develop balance
58
What are the sixth and seventh PNF principles developed by Voss?
development is orderly; flexor and extensor dominance are cyclic, alternating between positions helps develop balance
59
What is the seventh PNF principle developed by Voss?
variety of patterns; use of several total patterns and extremity patterns optimizes the rate of mastery of an activity
60
What is the eighth PNF principle developed by Voss?
correction of imbalances; balanced interaction of antagonists, imbalances lead to decreased efficiency of movement and to injury; normal movements and posture depend on balance of antagonists; imbalances are addressed by many approaches including PNF
61
What are the ninth and tenth PNF principles developed by Voss?
improved motor ability is dependent upon motor learning; increased repetitions improves retention in motor learning; increased variability improves motor learning
62
What is the eleventh PNF principle developed by Voss?
goal directed activities; goal direction hastens learning of a total pattern of movement
63
What are the four stages of motor control?
1) mobility 2) stability 3) controlled mobility 4) skill
64
What is motor control like in older adults?
- lose most coordinated movements first - decreased extensor dominance in stance - less eccentric control - decreased rotation; last to develop, first to go
65
What PNF techniques are used for mobility?
- rhythmic initiation - slow reversal - agonist reversal - contract relax - hold relax
66
What PNF techniques are used for stability?
- slow reversal - hold | - rhythmic stabilization
67
What PNF techniques are used for controlled mobility?
techniques applied with distal component stable and movement proximal includes RI, SR, SR-H, and AR
68
What PNF techniques are used for skill?
resisted progression
69
Reciprocal inhibition
muscle spindle; stretch or stimulation of the agonist elicits activation of the agonist and inhibition of the antagonist so the mm works in cooperation slow reversal, agonist reversal, hold-relax-contract
70
Autogenic inhibition
GTO; a tight muscle is activated strongly in an isometric fashion to facilitate a reflexive relaxation and allow stretch hold-relax-contract, contract-relax-contract

Motor Control (3 decks)

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