Exam Flashcards
Anatomical position (5)
- standing
- feet together
- arms to the side
- head and eyes facing forwards
- palms of the hands facing forwards
Medial (1)
Closer to the midline
Lateral (1)
Further from the midline
Superior (1)
Closer to the head
Inferior (1)
Closer to the feet
Proximal (1)
Closer to the origin of a structure
Distal (1)
Further away from the origin of a structure
Posterior/dorsal (1)
Closer to the posterior surface of the body
Anterior/ventral
Closer to the anterior surface of the body
Supine (1)
Face or palm up
Prone (1)
Face or palm down
Flexion (2)
- in non-anatomical language this is bending
- flexion usually means the angle between the body segments on either side of the flexion joint is decreased
Extension (1)
This is the opposite motion to flexion
Range over flexion vs range of extension (1)
For most joints range of flexion is greater than range of extension
Abduction (1)
Moving away from the midline of the body or segment
Adduction (1)
Moving closer to the midline of the body or segment
Internal rotation (2)
- rotation towards the midline
- the anterior aspect of the segment rolls towards the midline
External rotation (1)
The opposite motion to internal rotation
Supination (1)
Rotating the arm and wrist so that the palm faces up
Pronation (1)
Rotating the arm and wrist so that the palm faces down
Valgus (1)
Turned outwards, away from the midline of the body
Varus (1)
Turned inward, towards the midline of the body
Gait cycle (2)
- a reference framework for the walking process
- defines terms for the different phases and events of gait
Stance percentage (1)
60 percent
Swing percentage (1)
40percent
Loading qualities (3)
- shock absorption
- stabilisation of limb
- preservation of progression
Mid stance qualities (1)
-progression of com to level with the supporting foot
Terminal stance qualities (1)
Progression of com to beyond the supporting foot
Pre-swing qualities (2)
- preparation of the limb for swing
- assist with balance as weight is transferred
Initial swing qualities (2)
- clearance of the floor
- advancement of the swinging limb to level with the supporting foot
Mid swing qualities (2)
- clearance of the floor
- advancement of the swinging limb to beyond the supporting foot
Terminal swing qualities (1)
-preparation of the limb for weight acceptance
Cadence (2)
- the number of steps (not strides) per minute
- also known as step rate
Step width (2)
- the distance between the centres of the right and left heels measured perpendicular to the direction of progression
- also known as walking base
Toe-out angle (2)
- the angle between the direction of progression and a line drawn from the centre of the heel running between the 2nd and 3rd toes
- also known as foot progression angle
Kinematics (3)
- the study or description of motion, without regard to the forces which produce it
- the displacements and velocities of the body segments
- the angular displacements and velocities at the joints
Joint angles (1)
-measured in degrees from the neutral position
Kinetics (3)
- the study or description of the forces, moments and masses which bring about the motion
- forces bring about accelerations
- moments bring about angular accelerations
Ground reaction force (4)
- measured with a force platform
- gives the magnitude of the force (Newtons)
- the direction of the force
- and also the point of origin under the foot
Moment (3)
- a turning force
- moment = magnitude of force x shortest distance between line of force and joint centre
- the ground reaction force acts to produce a moment at each of the joints
Moment =
Force x distance
External moment
arises outside the body
Kinematics and kinetics (3)
- if we know the external moment acting at a joint
- and we know how the joint is moving
- therefore we can usually make some inferences about what the muscles are doing
Concentric muscle action (1)
Muscle length decreases as the muscle generated tension ie muscle contracts
Eccentric muscle action (1)
-muscle length increases as the muscle generates tension
Concentric muscle action quantities (2)
- high energy cost, ie muscles fatigue quickly
- mainly concerned with propulsion
Eccentric muscle action quantities (2)
- much lower energy cost than concentric action
- mainly concerned with control in walking
Concentric muscle action motion (1)
-muscle activity causing motion which opposes the external moment
Eccentric muscle action motion (1)
-muscle activity controlling motion which is in the same direction ad the external moment
Negatives about observational gait analysis (3)
- in real time the eye is not fast enough to observe some gait events
- it may not be quantitive and may not even be objective
- subjects may fatigue if much walking is required
Gait features feet sagittal plane (7)
- initial contact by heel, flat or forefoot
- does the foot slap down
- does the heel contact the floor
- if so when does it lift
- are the toes dragging in swing
- can you estimate the peak dorsiflexion in stance
- can you estimate the plantarflexion in swing
Gait features feet coronal (3)
- are the forefeet pronated
- is the hind foot in valgus or varus
- in stance and in swing
Gait features knees (7)
- what is the peak knee extension in stance
- too much or too little
- what is the peak of flexion in swing
- what is the position at initial contace
- are the knees rotated in the transverse plane
- relative to the direction of progression
- relative to the pelvis
Gait features hips (5)
- what is the peak knee extension in stance
- too much or too little
- what is the peak of flexion in swing
- too much or too little
- are these related to the position of the pelvis
Gait features pelvis sagittal (3)
- is the pelvis more anteriorly or posteriorly tilted than normal
- is there a marked lordosis
- does the pelvis tilt through a greater range than normal through the gait cycle
Gait features pelvis coronal and transverse (2)
- is the pelvis higher/more retracted on one side than the other
- does the pelvis move through a greater range than normal through the gait cycle
Gait features upper body (3)
- is there any forward or backward lean
- is there any lateral tilting or flexing
- is arm swing normal
Muscle activity and emg (2)
- when a muscle is active it produces a very low level electrical signal
- this signal can be detected on the surface of the skin and is known as the electromyogram or emg
Normal gait initial contact (1)
By heel
Loading response ankle (3)
- tibialis anterior is active in loading
- it controls the plantarflexor moment and moderates plantarflexion as the foot moves to plantargrade
- also active in swing to lift the foot, ensuring that it clears the ground
Loading response knee (2)
- quads are active in loading
- controlling the external flexor moment to prevent collapse as the knee flexes to absorb shock
Loading response hip (2)
- hip extensors are active in loading
- generating power to extend the hip and progress the body centre of mass forward
Loading response summary (3)
- dorsiflexors acting eccentrically to control motion of foot
- quads acting eccentrically to control motion of the knee
- hip extensors acting concentrically to assist with forward propulsion of centre of mass
Mid stance ankle (2)
- the plantarflexors are active throughout mid and terminal stance
- they oppose the dorsiflexor moment and control dorsiflexion and tibial progression
Mid stance knee (3)
- the quads are still active in midstance
- but activity tails off in terminal stance as the moment crosses over to extensir
- they oppose the external flexor moment to effect extension of the knee
Mid stance hip (3)
- the hip extensors are also still active in mid stance
- and activity also tails off in terminal stance as the moment crosses over to extensor
- they oppose the external flexor moment to continue the extension of the hip
Mid stance summary (3)
- plantarflexors acting eccentrically to control progression of tibia
- quads acting concentrically to effect extension of knee against flexor moment
- hip extensors still acting concentrically to assist with forward propulsion of centre of mass
Pre swing ankle (2)
- the planarflexors are active in the early part of pre swing
- they generate power which plantarflexes the foot against the dorsiflexor moment, and helps to propel the leg forward to initiate the swing phase
Pre swing knee
- the quads are active in pre swing
- even though the knee is starting to flex rapidly, this muscle action is required to moderate the rate of flexion
Pre swing hip (2)
- the hip flexors are active in later preswing
- they generate power to flex the hip at the beginning of swing
Pre swing summary (3)
- plantarflexors acting concentrically in early preswing to plantarflex the foot
- quads acting eccentrically to control rate of flexion of knee
- hip flexors acting concentrically to flex hip in prep for swing
Ways to analyse energy in gait (4)
- mechanical energy
- calculations using kinematic and kinetic data
- metabolic energy
- measurements related to metabolic energy expenditure
Mechanical energy in gait (6)
- pe/ke energy exchange at com
- calculations suggest that energy is transferred between segments during the gait cycle
- may give us insight into the mechanism behind an energy efficient gait
- energy calculations involve motion
- cocontraction?
- isometric contraction?
Metabolic energy in gait (3)
- o2 consumption is an indicator of metabolic energy expenditure
- millimetres of o2 consumed per kilogram body mass per minute (ml/kg/min)
- o2 cost = o2 consumption / speed
Attributes of normal gait (5)
- stability in stance
- adequate foot clearance in swing
- pre-positioning of foot for initial contact
- adequate step length
- energy conservation
Stability in stance (3)
- poor balance
- poor trunk and lower body control
- abnormal foot position
Adequate foot clearance in swing (4)
- loss of dorsiflexion in swing due to
- weakness of the dorsiflexors
- spasticity or shortness in the plantarflexors
- inadequate knee flexion in swing
Pre-positioning of foot for initial contact (4)
- this allows efficient transfer of weight during loading
- compromised by
- poor control of swinging limb
- possibly because of poor stability in stance on the contralateral side
Adequate step length (3)
- poor knee extension in stance
- poor stance stability on the contralateral side
- poor propulsive effort to the swinging limb (poor push off)
Energy conservation in gait (4)
- increased vertical excursion of the centre of mass
- poor control of momentum
- poor control of energy transfer between the body segments
- energy efficiency summaries the degree of severity of all gait deviations
Functional interpretation of the foot (3)
- shock absorption
- weight bearing stability
- progression
Shock absorption mechanisms in gait (7)
- Plantarflexion of foot
- eccentric action of dorsiflexors
- Flexion of knee
- eccentric action of quads
- Adduction of hip
- eccentric action of abductors
- plus functions within the foot
- eccentric action of abductors
Shock absorption mechanisms of foot (2)
- heel fat pad
- subtalar and mid-tarsal joint motion
What planes are important in gait? (3)
- sagittal plane
- coronal/frontal
- transverse
Spina bifida (5)
- a neural tube defect
- involves incomplete development of the brain, spinal cord, and/or their protective coverings
- caused by failure of the foetus’s spine to close properly during he first month of pregnancy
- infants born wit sb may have an open lesion on their spine where significant damage to the nerves and spinal cord has occured
- although the spinal opening can be surgically repaired shortly after birth, the nerve damage is permanent, resulting in varying degrees of paralysis of the lower limbs
S2 knee and foot (7)
- peroneus brevis
- peroneus longus
- Flexor digitorum longus
- flexor hallucis longus
- gastroc
- soleus
- intrinsics
S2 hip and knee (4)
- gluteus maximus
- medial hamstrings
- lateral hamstrings
- external rotators
S3 (4)
Knee and foot:
- flexor digitorum longus
- flexor hallucis longus
- intrinsics
Hip and knee: none
L5 knee and foot (6)
- peroneus brevis
- peroneus longus
- tibialis anterior
- extensor digitorum longus
- extensor hallucis longus
- tibialis posterior
L5 hip and knee (5)
- gluteus maximus
- medial hamstrings
- lateral hamstrings
- abductors
- external rotators
S1 knee and foot (8)
- peroneus brevis
- peroneus longus
- extensor digitorum longus
- extensor hallucis longus
- flexor digitorum longus
- flexor hallucis longus
- gastroc
- soleus
S1 hip and knee (5)
- gluteus maximus
- medial hamstrings
- lateral hamstrings
- abductors
- external rotators
L1 (1)
Knee and foot: none
Hip and knee: hip flexors
L2 (4)
Knee and foot: none
Hip and knee:
- hip flexors
- adductors
- internal rotators
- quads
L3 (5)
Knee and foot: none
Hip and knee:
- hip flexors
- quads
- adductors
- internal rotators
- external rotators
L4 knee and foot (2)
- tibialis anterior
- tibilalis posterior
L4 hip and knee (3)
- adductors
- external rotators
- quads
Knee and foot muscles (11)
- gastroc
- soleus
- peroneus brevis
- peroneus longus
- tibialis anterior
- tibialis posterior
- extensor digitorum longus
- extensor hallucis longus
- flexor digitorum longus
- flexor hallucis longus
- instrinsics
Hip and knee muscles (5)
- gluteus maximus
- lateral hamstrings
- medial hamstrings
- abductors
- external rotators
Weak hip extensors (5)
- hip extensors are active during terminal swing, loading and mid-stance
- hamstrings and gluteus maximus
- a backwards upper body lean will redirect the grf further back
- extension of the hip progresses the trunk forward
- if this is not possible pt may rotate pelvis in the transverse plane
Weak hip abductors (5)
- hip abductors are active during terminal swing, loading and midstance
- in loading and midstance they act to balance the external adductor moment at the hip
- a lateral upper body lean to the stance side will redirect the grf more laterally
- using a stick on the opposite side will produce an opposing moment to assist the hip abductors
- an alternative strategy to lateral lean
Weak dorsiflexors (3)
- the dorsiflexors are active during swing and loading
- in swing they lift the foot to ensure that the toes do not drag along the ground
- in loading they resist the external plantarflexor moment at the ankle and prevent the forefoot from slapping onto the ground
Weak plantarflexors (1)
-the plantarflexors are active during mid and terminal stance
Cerebral palsy (6)
- a group of chronic conditions affecting body movement and muscle coordination
- caused by damage to one or more specific areas of the brain
- usually occuring during foetal development; before during or shortly after birth or during infancy
- not caused by problems in the muscles or nerves
- faulty development or damage to motor areas in the brain disrupt the brains ability to adequately control movement and posture
- not progressive (ie brain damage does not get worse) however secondary conditions, such as muscle length and spasticity and bony deformity and may change over time
3 main types of cp (3)
- spastic cp
- athetoid cp
- ataxic cp
Spastic cp (2)
- muscles become very stiff and weak, especially under effort
- leads to poor control of movement
Athetoid cp (2)
- some loss of control of their posture
- unwanted movements
Ataxic cp (2)
- poor coordination and balance
- maybe also shaky hand movements and irregular speech
Spasticity (1)
Lance definition: spasticity is a motor disorder characterised by a velocity dependent increase in tonic stretch reflexes, with exaggerated tendon jerks resulting from hyperexcitability of the stretch reflex, as one component of the upper motorneurone syndrome
Results from muscle spasticity (6)
- muscle shortness
- joint contracture
- bony deformation
- femoral antevertion
- tibial torsion
- foot deformity
Spasticity cp appearance (3)
- poor selective motor control
- abnormal reflex activity
- weakness
Muscles frequently affected in spastic cp (5)
- gastroc
- soleus
- hamstrings
- rectus femoris
- psoas
Gastroc (3)
- 2 joint
- knee flexor
- plantarflexor
Soleus (2)
- single joint
- plantarflexor
Hamstrings (3)
- 2 joint
- hip extensor
- knee flexor
Rectus femoris (3)
- 2 joint
- hip flexor
- knee extensor
Psoas (2)
- single joint
- hip flexor
Spasticity in psoas (5)
- psoas is a single joint muscle which stretches when the hip extends
- maximal stretch on psoas therefore occurs at max hip extension ie during terminal stance
- shortness and/or spasticity in psoas will cause limited peak hip extension
- also an anteriorly tilted pelvis and lordosis
- but beware this is not the only cause for these
Spasticity in rectus femoris (4)
- maximal stretch on rectus femoris occurs when the knee is flexed and the hip is extended
- max hip extension does not happen at the same time as max knee flexion but they do become close in pre-swing and initial swing
- maximally stretched in pre and initial swing
- shortness and/or tone causes decreased and delayed knee flexion in swing
Spasticity in hamstrings (5)
- maximal stretch on the hamstrings occurs when the hip is maximally flexed and the knee is maximally extended
- this happens around ic ie terminal swing and loading
- flexed knee in terminal swing and loading
- not always because of short hamstrings
- there are several causes for this
Spasticity in gastroc/soleus (1)
-maximal stretch on these muscles occurs during terminal stance
Initial contact (2)
- beginning if gait cycle
- heel strike can not be used for all pathological gait
Foot off (2)
-foot that made ic at beginning of cycle lifts from ground and begins to swing forward
Loading (2)
- starts with ic and finishes with opposite foot off
- period during which weight is transferred from one limb to the other ie when the new stance limb is loaded
Pre-swing (3)
- starts with opposite foot contact and finishes with foot off
- this interval is called preswing because it is the period during which the reference side prepares for the swing phase
- it necessarily corresponds to loading on the opposite side
Loading and pre-swing phases (2)
- both feet are in contact with the ground
- so are called double support phases
One limb in swing and one foot on ground (1)
-known as single support phases
Mid and terminal stance (5)
- single support period between opposite foot off and opposite foot contact
- long interval in a typical gait cycle in which the body’s com progresses from behind the supporting stance foot to infront of it
- therefore divides phase into 2 parts
- first com is behind the stance foot and during second it is infront
- first is called mid stance and 2nd terminal stance
Midstance (6)
- first phase of single support
- finishes when the body weight is aligned over the stance foot
- in nonpathological gait this will correspond to the maximum height attained by the centre of mass
- in practice these events can be difficult to discern by eye and the point at which the feet cross is often taken as a marker of convenience for the end of midstance
- for typical nonpathological gait this will also correspond with the alignment of the com over the stance foot but is not necessarily the case in pathological gait
- note: midstance can sometimes be used to refer to an event rather than a phase
Swing phase (3)
- initial swing
- mid swing
- terminal swing
Initial swing (2)
- phase in which the swing limb accelerates forwards
- finishes when feet cross
Mid swing (4)
- starts when initial swing ends
- the end of midswing is defined by perry as the point at which the swinging limb is forward and the tibia is ivertical
- can not always be used for pathological gait eg crouch gait
- an alternative def for pathological gait is point of maximum hip flexion
Terminal swing (2)
- final phase of the cycle between the end of midswing and initial contact
- in nonpathological gait this is the phase in which advancement of the swinging limb is achieved solely via the extension of the knee
Speed (1)
-usually measured in metres per second (ms-1)
Stride length (1)
-the distance from the point of initial contact of one side to the next point of initial contact of the same side. Usually measured in metres (m)
Step length (3)
- the distance from the point of initial contact of one side to the next point of initial contact of the opposite side
- this step length is attributed to the side which made the second initial contact
- also usually measured in metres (m)
Cadence (2)
- the number of steps (not strides) taken in a given time period
- sometimes called step rate and usually measured in steps per minute
Step width (3)
- the distance between the centres of the right and left heels measured perpindicular to the direction of progression
- also known as walking base
- may be measured in metres (m) centimetres (cm) or millimetres (mm)
Stance and swing times (2)
- the time spent in the stance phase or the swing phase for one or other side
- may be measured in seconds(s) or may be divided by the total time taken for the entire gait cycle and expressed as a percentage (%gait cycle)
Double support time (2)
- the total time spent in double support
- may be measured in seconds (s) but more usually divided by the total time taken for the entire gait cycle, and expressed as a percentage (% gait cycle)
Single support time (2)
- the total time spent in single support
- as for double support may be measured in seconds (s) but more usually expressed as a percentage of the total gait cycle time (% gait cycle)
Toe out angle (3)
- the angle between the direction of progression and a line drawn from the centre of the heel running between the 2nd and 3rd toes
- also known as foot progression angle
- measured in degrees
