Gait Flashcards
1
Q
Who was one of the first people to describe the mechanics of gait?
A
Leonardo da Vinci described the mechanics of the body during standing, walking up and downhill, rising from sitting, jumping, and normal human gait.
2
Q
When was the first scientific work published by Weber and Weber?
A
1836
3
Q
What was the main impetus for the beginning of gait analysis?
A
In 1872, Edward Muybridge investigated whether all four of a horse’s hooves leave the ground during running. He was hired because of a bet on a horse race. This started gait analysis and cinematography.
4
Q
What are Dr. E’s three horses names?
A
Jazz, Mishka, and Keno
5
Q
Does gait only refer to walking?
A
No. Gait is any cyclical, repeatable movement pattern of the LE’s.
6
Q
Why is locomotion not synonymous with gait?
A
Locomotion just means getting from point A to point B. It could be in a car or flying or whatever.
7
Q
What is the goal of gait?
A
Progression of the body
8
Q
True or False
Generally, gait is the same from individual to individual.
A
True. Generally, gait is the same, but there will be individualistic differences.
9
Q
What things can affect gait?
A
- mood
- gender
- anthropometry
- pathology
- surface
10
Q
True or False
Kinetics are descriptive.
A
False
KINEMATICS are descriptive.
Kinetics deals with forces.
11
Q
There are four kinematic variables of gait. What are they?
A
- step length
- stride length
- step width
- toe-out angle
12
Q
True or False
Step length is the same for every individual.
A
False
Step length has a normal, but it will vary a lot based on leg length.
13
Q
How is step length measured?
A
Step length is always measured from the back of one heel to the back of the other heel.
14
Q
What will change step length?
A
- speed of gait
- surface
- gender
- mood
15
Q
What is the normal for stride length?
A
1.2-1.9 m
16
Q
True or False
Stride length is equal to one gait cycle.
A
True!
Stride length is measured from the back of one heel to the back of the same heel. It is the length of one step and is equal to a gait cycle.
17
Q
The normal for step width is... A. 4 cm B. 10 cm C. 8 cm D. 6 cm
A
C. 8 cm
18
Q
You observe a patient walking with their heels close together. What landmarks would you use to measure step width?
A
Step width is measured from the midpoint of one heel to the midpoint of the other heel.
19
Q
What characteristics can affect the step width?
A
It could be affected by wide hips.
20
Q
A patient walks with a wide step width. What are they increasing?
A
They are increasing their base of support.
21
Q
The normal toe-out angle is…
A
7 degrees
22
Q
How do you measure toe-out angle?
A
A straight line is drawn through the midpoint of the heel. Then a line is drawn through the center of the 2nd metatarsal. The angle between these two lines is the toe-out angle.
23
Q
A patient points their toes out when they walk. Would they be more stable or less stable?
A
They would be more stable. Their base of support would be increased.
24
Q
Would someone with anteversion or retroversion have more toe-out?
A
Someone with retroversion would have more toe-out.
25
Is stance time occurring when there is one foot on the ground or two?
Both. There are two phases of stance time. A single limb stance and a double limb stance. Stance time is the amount of time you spend with your foot on the ground.
26
True or False
| Stance time decreases as speed decreases.
False.
| Stance time decreases as speed increases. Stance time increases with a slower gait.
27
Do older or younger people tend to spend more time in stance phase?
Older people spend more time in stance because it increases time with both feet on the ground. Their balance isn't great, so they want the greater base of support.
28
Which gait decreases stance time on that leg?
A. Ataxic gait
B. Antalgic gait
C. Parkinson's gait
B. Antalgic gait decreases stance time on the painful leg.
29
A patient has had a stroke. What modification with gait might you see?
Stance time will be decreased on their bad leg because they don't trust it.
30
True or False
| Swing time is the amount of time that the leg is in the air.
True!
31
True or False
| As stance time increases, you see a similar increase in swing time.
False.
| As stance time goes up, swing time goes down.
32
Do women or men have an increased cadence?
Women have an increased cadence because our legs are typically shorter, so we walk faster to cover the same distance in the same amount of time. Men tend to have longer legs and therefore, a shorter cadence.
33
How is cadence measured?
Cadence is measured in steps permanent.
34
What is a normal cadence for women and men?
```
W = 117
M = 111
Mean = 113
```
35
True or False
| Cadence is something you can use to compare your patients to and help them improve.
True!
36
How is velocity measured?
Velocity = distance/time
37
```
Normal community ambulation is...
A. 1 mph
B. 2 mph
C. 3 mph
D. 4 mph
```
C. 3 mph
| You can use this to make goals for your patients.
38
True or False
| An increase in cadence always means an increase in velocity.
False
| In Parkinson's festinating gait, the cadence is really fast, but the velocity is not.
39
```
Stance phase what percentage of the gait cycle?
A. 40%
B. 70%
C. 50%
D. 60%
```
D. 60%
40
Why is stance phase a greater percentage of the gait cycle than swing phase?
You have two periods of time when both feet are on the ground and one period of time when one foot is on the ground.
41
The patient's heel has just made contact with the ground, should they be in single leg stance or double leg stance?
They should be in double leg stance (22% of gait cycle).
42
The patient is bringing their opposite foot through the swing, are they in single leg stance or double leg stance?
They are in single leg stance (38% of the gait cycle).
43
A patient has a normal gait cycle, what percentage of it will they spend in swing phase?
They will spend about 40% of the cycle in swing phase.
44
A patient comes in and has trouble putting weight through one leg, they have poor body support/stability, and are unable to adapt to surfaces. What phase are they going to have trouble with?
Stance phase. The goals of stance phase are...
- shock absorption
- weight acceptance
- adaptation
- body support/stability
- contribution to body progression
45
True or False
| In stance phase, your body is not progressing forward.
False
| Even in stance phase, your body is progressing forward.
46
What are the goals of the swing phase?
- weight release and transfer
- limb clearance
- transfer of momentum (generate momentum at the hip and transfer it down the leg)
- limb advancement
- contribution to body progression
- preparation for stance
47
True or False
| Walking is a high energy activity.
False
| Walking is a very efficient system. The main goals is to conserve energy.
48
If a patient fatigues easily while walking, what physical property are they probably not using?
Momentum. Momentum helps conserve energy, so if the patient is using too much contraction, they might get fatigued quickly.
49
Which subdivisions of gait occur during the stance phase?
- initial contact
- loading response
- midstance
- terminal stance
- pre-swing is part of the stance phase
50
Which subdivisions of gait occur during the swing phase?
- initial swing
- midswing
- terminal swing
51
You notice that a patient makes initial contact with their posteriomedial heel, is that normal?
No, initial contact should be made with the posteriolateral heel.
52
Why is it important to land on the lateral aspect of the heel?
Hitting on the lateral aspect of the heel causes the ground reaction forces to push the heel up. This causes pronation. As soon as we hit down, the lateral side is shoved up, and we pronate the foot.
53
Which one adapts and absorbs shock better?
A. Pronated foot
B. Supinated foot
A. Pronated foot
| A pronated foot is a flexible foot. This helps us absorb shock and adapt to surfaces.
54
At initial contact, the foot pronates. What does this increase?
It increases impulse. Pronating the foot extends the amount of time that the ground reaction force is applied to the lateral heel which dissipates the shock.
55
Just before initial contact is the foot supinated or pronated?
The foot is supinated just before initial contact. This positions the lateral heel to hit first. A supinated foot is also a functionally longer leg. A pronated foot is a functionally shorter leg.
56
What is the goal of initial contact?
The goal is to get the foot in the right place to bear weight. It serves to position the limb to start stance with a heel rocker. This is a fulcrum that allows the foot to "roll" into PF.
57
How many rockers occur during the stance phase?
There are three rockers that occur during stance phase.
58
True or False
| The purpose of the rockers is to stabilize the body as you put weight on the foot.
False
| The rockers cause the COM to progress forward even though the leg is not moving.
59
What is the first rocker? How does it function?
The heel rocker is the first one.
It occurs during initial contact. A ground reaction force on the heel pushes it up and pushes the foot into plantar flexion. The heel rocker is the movement of the ankle from neutral to pronation. It causes the foot to push down into loading response.
60
True or False
| In closed kinetic chain (CKC), pronation and supination involve the whole foot moving.
False
| In CKC, all the components of supination and pronation come from the talus and the calcaneus.
61
Explain subtalar CKC supination.
- Tibial ER
- Talus abduction. The calcaneus cannot move, so the talus moves instead. The calcaneus cannot adduct, so the talus abducts instead.
- Calcaneal inversion
The chain is affected from the bottom up.
62
A supinated foot increases knee...
A. Varus
B. Valgus
A. Varus
63
Someone has a pronated foot and is complaining of pain. Where might it be located and why?
It might be located in the knee. Someone with a pronated foot is more susceptible to knee pain because it increases knee valgus.
64
Explain subtalar CKC pronation.
- Tibia IR
- Talus adduction
- Calcaneal eversion
65
Explain subtalar open kinetic chain (OKC) supination.
Calcaneal
- inversion
- adduction
- plantarflexion
66
Explain subtalar OKC pronation.
Calcaneal
- eversion
- abduction
- dorsiflexion
67
What are the three rockers involved in stance phase?
- At, initial contact you rock over the heel
- In, midstance you rock over the ankle
- In terminal stance, you rock over the forefoot
68
You are watching a patient walk into the clinic. Their heel has contacted the ground, and they are starting to bear weight through it. What phase of gait are they in?
Loading response.
| It begins immediately after contact is made with the surface.
69
True or False
| Loading response is one of the most stable subdivisions of gait.
False
If a patient is going to fall, it will probably be during loading response. As they start to bear weight, the leg might buckle.
70
During loading response, how many legs are on the ground?
In both initial contact and loading response, both legs are on the ground. Initial contact and loading response blend into each other.
71
```
During loading response, the foot moves into...
A. Supination
B. Inversion
C. Eversion
D. Pronation
```
D. Pronation
72
If a patient has a dorsiflexion contracture and cannot pronate the foot in loading response, what are they losing?
They lose their "mobile adaptor". A pronated foot is flexible. The mobile foot helps with shock absorption. The foot is also pushed into pronation because you are shifting laterally to weight shift.
73
When does midstance begin and end?
Midstance is right after loading response. It begins when the opposite foot is lifted. It ends when the body is aligned over the forefoot.
74
True or False
| Midstance ends DLS and begins period of SLS.
True!
75
How does the body progress forward over a stationary foot in midstance?
This is accomplished by the ankle rocker. The foot is stable in the ankle rocker. The tibia is moving over the talus. During the heel rocker, we are in plantar flexion. During ankle rocker, we move into dorsiflexion.
76
If a patient is wobbly in midstance, what would you work on?
Limb and trunk stability. As you put weight through one foot and pick the other one up, you need limb and trunk stability.
77
What are the goals of midstance?
- limb and trunk stability
- progression over foot
- ankle rocker
78
If a patient's knee buckles during the ankle rocker, what muscles are most likely weak?
The plantar flexors are probably weak. They eccentrically control dorsiflexion. If dorsiflexion is not controlled, the knee will involuntarily buckle.
79
A patient is still on one leg with their heel off the ground. They are about to make contact with the ground with their other foot. What subdivision of gait are they in?
Terminal stance. Begins with heel rise and continues until just prior to initial contact of contralateral foot.
80
True or False
| During terminal stance, the COM is still inside the BOS.
False
End midstance with center of mass over the forefoot close to the edge of our base of support. In terminal stance, the center of mass moves outside the base of support, so you are in free fall. Then you take another step forward to catch yourself.
81
During terminal stance the foot becomes...
A. Supinated
B. Pronated
A. Supinated
As you rise up on the ball of your foot, you supinate. This gives you a rigid foot, so you are stable and have something to push off of.
82
Which rocker occurs during terminal stance?
The forefoot rocker. In the forefoot rocker, you roll over the heads of the metatarsals. The tibia and whole body is rolling over top of the metatarsals.
83
As a patient goes through the gait cycle, what happens to their foot?
Their foot goes through pronation to neutral and then to supination.
84
What are the goals of terminal stance?
- concept of "rigid lever" begins. This is a rigid foot to push off of and generate momentum
- progression of the body over limb continues
- forefoot rocker
85
Which phase is the final stance phase and second period of DLS?
Pre-swing
86
A patient just made IC with the contralateral leg, which phase have they started?
Pre-swing phase. This is a shorter phase. As soon as you hit down with the other foot, you are in preswing. It ends with toe-off.
87
True or False
| In preswing, the limb is actively contributing to transfer of body weight.
False
The limb has NO active contribution to transfer of body weight. You aren't using muscles to shift the weight laterally over the other foot. It mostly happens because of what the foot is doing. This helps in conserving energy.
88
What concept is important in pre-swing?
The rigid lever concept is important. The foot is still supinated. This provides a rigid lever for propulsion.
89
What will a patient progress through during initial swing?
Initial swing begins with lift-off from the ground, and it ends when foot is opposite of stance foot.
90
Swing phase is divided almost equally into...
A. Thirds
B. Fourths
C. Half
A. Thirds
| Initial swing is 1/3 of swing phase.
91
If a patient is scuffing their toe during initial swing, which goal are they not accomplishing?
They are not getting foot clearance.
92
What is the second goal of initial swing?
Advancement of limb
93
When does mid-swing begin and end?
Mid-swing begins when limb is opposite stance limb (foot is parallel to other tibia). It ends when swing leg has advanced and tibia is vertical.
94
True or False
| The goals of mid-swing are the same as initial swing.
True!
- clearance of foot
- advancement of limb
95
A patient is extending the knee of their swing leg and about to hit the ground with their heel. What phase of gait are they in?
Terminal swing.
| It begins with a vertical tibia and ends at IC of the same leg.
96
True or False
| The quads actively contract to straighten the knee during terminal swing.
False
| The shank has moved ahead of the thigh and the knee has extended via momentum.
97
What are the goals of terminal swing?
- completion of limb advancement
- positioning of limb for initial contact. Goal is to extend the limb which is done via momentum. However, the momentum still needs to be controlled
98
What muscles would control the momentum that drives the knee into extension during terminal swing?
The hamstrings would eccentrically control knee extension.
99
When are the hamstrings most likely to be torn in running?
Tears typically happen in when they are eccentrically controlling knee extension during terminal swing.
100
True or False
| The vertical displacement of COM during gait is due to weight shifting.
False
The vertical displacement of COM is in a smooth sinusoidal curve. It is due to phases of double limb stance and single limb stance.
101
The lowest point of the COM sinusoidal curve is when...
A. You are in double limb stance
B. You are in a single limb stance
A. You are in double limb stance
102
When does the highest point of the COM sinusoidal curve occur?
The highest point is in midstance.
103
Why does the COM shift in the frontal plane during gait?
Frontal plane deviation is due to weight shifting. You need your weight to be over the stance leg.
104
How much should the COM move normally?
We only move about 4-5 cm in either direction.
105
A patient displays excessive vertical and frontal plane displacement of COM. Why is this concerning?
They will have a higher energy requirement for gait. The more your COM moves, the more energy and muscle contraction you need to control this. A curve that moves up and down more or side to side more indicates that the person is using more energy than they should, and they will fatigue more quickly.
106
You are watching a patient walk. They are moving side to side quite a bit. What is your job as a therapist?
Our goal as therapists is to minimize the movement of the COM. The 4 cm up and down and side to side is a really efficient gait pattern. We want to get them back to this gait pattern, so they don't need more muscles or energy.
107
True or False
In normal gait, there is a predictable pattern of movement for the center of pressure along the foot as we move over the stance limb.
True!
108
You notice a patient pushing off the lateral side of their foot. Is this normal?
No. You should push off between the first toe and the second toe.
109
True or False
| The center of pressure moves along the midline of the foot.
False
The center of pressure starts on the lateral heel during IC. During LR, it is towards the lateral side. At the end of midstance, it should be in the middle of the ball of the foot. At pre-swing, you push off between the first and second toe.
110
What might cause the center of pressure to change?
A gait deviation could change the COP. It may also vary among subjects and be altered by different footwear.
111
You notice that a patient strikes the ground with the ball of their foot. What path will the COP take?
If someone hits with the ball of their foot first, the COP will move backwards.
112
You want to know if the patient's COP progresses along a normal line. What would you look at?
You can ask the patient to bring in a pair of shoes that they wear often. You can look for the pattern on the bottom of their shoes because they will be worn down in certain places.
113
When your foot strikes the ground, what kind of force is generated?
A ground reaction force is generated.
114
True or False
| A ground reaction force is an equal and opposite force exerted on the LE by the ground when you step.
True!
115
What are two aspects of the body that are directly related to ground reaction forces?
Ground reaction forces are directly related to the body's COM and segment COM.
116
Ground reaction forces are...
A. 1-D
B. 2-D
C. 3-D
C. 3-D
117
As a patient takes a step, which directions are ground reaction forces going?
The ground reaction forces will be exactly opposite the force the patient exerts through their foot. As a patient steps, vertical force is acting on the posterior aspect of the heel. Shear forces are anterior posterior and medial lateral. These keep your foot from sliding.
118
Do ground reaction forces move up or down the chain?
Ground reaction forces move up the chain of the leg. As weight is accepted on stance leg, vertical, horizontal, and rotary forces are generated on the surface. The floor generates the opposite responses on the foot, ankle, and up the chain.
119
What do vertical ground reaction forces result from?
Vertical forces are the result of weight acceptance and result in shock upwards through the LE.
120
A patient is walking. How much ground reaction force are they experiencing?
Normal walking results in a ground reaction force that is 1.2 X your body weight.
121
A patient transitions into running. How much ground reaction force are they experiencing now?
Running produces ground reaction forces that are 2.5 X your body weight.
122
You are working with a volleyball player on landing their jumps correctly. Why is shock absorption so important?
Shock absorption is important because when you land a jump, you experience ground reaction forces that are 4-5 X your body weight.
123
Why are ground reaction forces more than your body weight?
Gravity causes acceleration as your foot goes towards the ground which is why you hit the ground with more than your body weight of force. The mass is accelerating, so the force is higher.
124
You are working on gait with a patient. Which phases will they experience the most ground reaction forces?
Initial contact is the highest force. When you hit the ground it peaks, and when you push off it peaks. Initial contact and pre-swing have the most force.
125
As your foot strikes the ground, what acts as a braking force?
As your foot strikes the ground, your foot is moving anteriorly. Therefore, there is an anterior to posterior ground reaction force that is more of a shearing force and acts as a braking force.
126
What percentage of body weight is the anterior/posterior shearing force?
About 25% of the body weight
127
A patient moves through terminal stance and pre-swing. How do ground reaction forces help them?
During terminal stance and pre-swing, the foot is pushing backwards on the ground. The ground reaction force is thus directed anteriorly and acts as a propulsion force.
128
True or False
During the gait cycle, all the motion at the foot is mainly due to a ground reaction force not us pronating or supinating.
True!
| Study the picture in the power point.
129
When does the foot act as a shock absorber?
The foot acts as a shock absorber at IC, LR, until approximately mid-stance.
130
What mechanisms helps the foot absorb shock?
Mechanisms are subtalar EV and midtarsal/talocrural DF (pronation).
Pronation "unlocks" transverse tarsal joint, thus a flexible foot can absorb shock and adapt to surface. Closed chain pronation causes the talus to adduct and results in tibial IR.
131
What does closed chain pronation consist of?
Closed chain pronation = talar adduction/PF, eversion of calcaneus, dorsiflexion, tibial IR
132
What does closed chain pronation "unlock"?
Closed chain pronation "unlocks" the transverse tarsal joint, and the joint is flexible.
133
What does closed chain supination consist of?
Closed chain supination = talar abduction/DF, calcaneal inversion, dorsiflexion, tibial ER
134
What does closed chain supination "lock"?
Closed chain supination "locks" the transverse tarsal joint, and the foot is rigid
135
True or False
| In closed chain, the talus will still plantar flex or dorsiflex, but it doesn't take the foot with it
True!
136
How is impulse increased during initial contact?
- on the base of our calcaneus, we have a thick fat pad and skin which helps increase impulse
- shoes with a thicker sole can increase impulse
- when you hit the ground and pronate, it decreases shock
- the heel rocker progresses you forward as well as helps you absorb shock
- when we land, our knee flexes a little because of a ground reaction force. This also helps increase impulse and decreases shock
137
What does the HAT consist of?
Head, arms, and trunk
138
What is the HAT also known as?
The passenger unit
139
You are watching a patient walk. How should their head and trunk move?
The head and trunk travel as a unit, following the COM.
140
What role does the neck play in gait?
The neck allows for increased visual field.
141
Stabilization of trunk requires...
A. Minimal activity
B. Maximal activity
A. Minimal activity
142
Which muscles are active for trunk stabilization during gait?
- RA with low levels of constant activity
- External obliques: intermittent very low level especially during midstance and late mid-swing/ early terminal swing
- contralateral ES activity at IC, LR, MSt
- Multifidus, quadratus lumborum active bilaterally at IC
143
Is rotation during gait conscious or unconscious?
Rotation is an unconscious movement to reduce shifting of the COM which conserves energy.
144
What does rotation of the trunk during gait counteract?
Rotation of the trunk counteracts pelvic rotation to decreased movement of the COM. 7 degrees at the shoulder girdle.
145
Patients with Parkinson's have decreased what?
Patients with advanced Parkinson's have a rigid trunk which decreases rotation.
146
If someone is lacking trunk rotation, what will be increased?
Restriction of trunk rotation increases EE by 10%
147
If someone has a decreases arm swing, what are you most concerned about?
Whether their trunk rotation is decreased or not.
148
True or False
| The arm swing is essential in gait
False
The reciprocal, mostly spontaneous UE swing is useful but not essential.
- there is no significant impact on O2 consumption with/without UE swing.
- some believe it increases stability
149
What is the total arc of shoulder motion?
30-40 degrees
150
When is max shoulder extension reached?
Max shoulder extension is at initial contact
151
When is max shoulder flexion reached?
Max flexion is at terminal stance
152
With fast walking, shoulder arc...
A. Increases
B. Decreases
A. Increases
153
Total arc of elbow motion is...
25 degrees, but always flexed
154
What is elbow flexion at IC?
20 degrees
155
What is elbow flexion at terminal stance?
45 degrees
