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Year 2 Medicine > Gait > Flashcards

Gait Flashcards

1
Q

Walking

  • A simple yet complicated task:
  • Simple – we can do it without having to think about it too much
  • Complicated – involves so many structures in the body
    • … system = muscles, tendons, bones, joints,
    • … system = sensory, motor, autonomic, proprioception
    • … system = heart, blood vessels
    • Special … = vision, hearing
  • Problem(s) with any of the systems / structures can have an effect on our ability to walk
A
  • A simple yet complicated task:
  • Simple – we can do it without having to think about it too much
  • Complicated – involves so many structures in the body
    • Musculoskeletal system = muscles, tendons, bones, joints,
    • Nervous system = sensory, motor, autonomic, proprioception
    • Cardiovascular system = heart, blood vessels
    • Special senses = vision, hearing
  • Problem(s) with any of the systems / structures can have an effect on our ability to walk
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2
Q

Gait is …

A

the way a person walks

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3
Q

Gait (the way a person walks)

  • … … walking / running
  • Turning
  • … adjustment
    • A combination of movements
A
  • Straight line walking / running
  • Turning
  • Terrain adjustment
    • A combination of movements
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4
Q

Gait (the way a person walks)

  • Straight line walking / running
  • …
  • Terrain adjustment
    • A … of movements
A
  • Straight line walking / running
  • Turning
  • Terrain adjustment
    • A combination of movements
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5
Q

Gait Cycle

  • The … phase of gait begins when the foot first touches the ground and ends when the same foot leaves the ground (60% of cycle)
  • The … phase of gait begins when the foot first leaves the ground and ends when the same foot touches the ground again (40% of cycle)
A
  • The stance phase of gait begins when the foot first touches the ground and ends when the same foot leaves the ground (60% of cycle)
  • The swing phase of gait begins when the foot first leaves the ground and ends when the same foot touches the ground again (40% of cycle)
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6
Q

Gait Cycle

  • The … phase of gait begins when the foot first touches the ground and ends when the same foot leaves the ground (…% of cycle)
  • The … phase of gait begins when the foot first leaves the ground and ends when the same foot touches the ground again (…% of cycle)
A
  • The stance phase of gait begins when the foot first touches the ground and ends when the same foot leaves the ground (60% of cycle)
  • The swing phase of gait begins when the foot first leaves the ground and ends when the same foot touches the ground again (40% of cycle)
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7
Q

Gait Cycle

  • The … phase of gait begins when the foot first touches the ground and ends when the same foot leaves the ground (60% of cycle)
  • The … phase of gait begins when the foot first leaves the ground and ends when the same foot touches the ground again (40% of cycle)
A
  • The stance phase of gait begins when the foot first touches the ground and ends when the same foot leaves the ground (60% of cycle)
  • The swing phase of gait begins when the foot first leaves the ground and ends when the same foot touches the ground again (40% of cycle)
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8
Q

Classic gait terms:

A

Heel strike, foot flat, midtance, heel off, toe off, midwing, heel strike

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9
Q

New gait terms:

A

Initial contact, loading response, mid-stance, terminal stance, preswing, inital swing, mid-swing, terminal swing

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10
Q

Division of the Gait cycle

  • 1 … = 1 gait cycle
    • Stance
      • Weight … (Initial contact and Loading response)
      • … … support (Mid stance, Terminal stance, Pre swing)
    • Swing
      • Limb … (Pre swing, Initial swing, Mid swing, Terminal swing)
A
  • 1 stride = 1 gait cycle
    • Stance
      • Weight acceptance (Initial contact and Loading response)
      • Single limb support (Mid stance, Terminal stance, Pre swing)
    • Swing
      • Limb advancement (Pre swing, Initial swing, Mid swing, Terminal swing)
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11
Q

Division of the Gait cycle

  • 1 stride = 1 gait cycle
    • Stance
      • Weight acceptance (… contact and …. response)
      • Single limb support (… stance, … stance, Pre …)
    • Swing
      • Limb advancement (Pre …, Initial swing, Mid swing, Terminal swing)
A
  • 1 stride = 1 gait cycle
    • Stance
      • Weight acceptance (Initial contact and Loading response)
      • Single limb support (Mid stance, Terminal stance, Pre swing)
    • Swing
      • Limb advancement (Pre swing, Initial swing, Mid swing, Terminal swing)
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12
Q

Division of the Gait cycle

  • 1 stride = 1 gait cycle
    • …
      • Weight acceptance (Initial … and Loading …)
      • Single limb support (Mid stance, Terminal stance, Pre swing)
    • …
      • Limb advancement (Pre swing, Initial swing, Mid swing, Terminal swing)
A
  • 1 stride = 1 gait cycle
    • Stance
      • Weight acceptance (Initial contact and Loading response)
      • Single limb support (Mid stance, Terminal stance, Pre swing)
    • Swing
      • Limb advancement (Pre swing, Initial swing, Mid swing, Terminal swing)
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13
Q

Division of the Gait cycle

  • 1 stride = 1 gait cycle
    • Stance
      • … acceptance (Initial contact and Loading response)
      • … limb support (Mid stance, … stance, Pre swing)
    • Swing
      • Limb advancement (Pre swing, … swing, … swing, … swing)
A
  • 1 stride = 1 gait cycle
    • Stance
      • Weight acceptance (Initial contact and Loading response)
      • Single limb support (Mid stance, Terminal stance, Pre swing)
    • Swing
      • Limb advancement (Pre swing, Initial swing, Mid swing, Terminal swing)
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14
Q

Positions of the joints - Heel Strike vs Foot Flat

  • Heel strike:
    • Hip …
    • Knee …/…
    • Ankle dorsiflexion/neutral
    • 1st MTPJ dorsiflexion/neutral
  • Foot Flat:
    • Hip …
    • Knee …
    • Ankle plantarflexion
    • 1st MTPJ neutral
A
  • Heel strike:
    • Hip flexion
    • Knee neutral/extension
    • Ankle dorsiflexion/neutral
    • 1st MTPJ dorsiflexion/neutral
  • Foot Flat:
    • Hip flexion
    • Knee flexion
    • Ankle plantarflexion
    • 1st MTPJ neutral
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15
Q

Positions of the joints - Heel Strike vs Foot Flat

  • Heel strike:
    • Hip flexion
    • Knee neutral/extension
    • Ankle …/…
    • 1st MTPJ …/…
  • Foot Flat:
    • Hip flexion
    • Knee flexion
    • Ankle …
    • 1st MTPJ …
A
  • Heel strike:
    • Hip flexion
    • Knee neutral/extension
    • Ankle dorsiflexion/neutral
    • 1st MTPJ dorsiflexion/neutral
  • Foot Flat:
    • Hip flexion
    • Knee flexion
    • Ankle plantarflexion
    • 1st MTPJ neutral
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16
Q

Muscle activities - Heel Strike vs Foot Flat

  • Heel Strike:
    • Hip extensors … (eccentric) to control hip flexion via momentum
    • … contracts (isometric) to control hip flexion and knee extension
    • Knee flexors contract (concentric) to start knee flexion
    • Knee extensors contract (eccentric) to control knee flexion
    • Ankle … contract (eccentric) to prevent foot slapping
  • Foot Flat:
    • Hip extensors contract (concentric) to start hip extension
    • Knee flexors contract (concentric) to keep the knee in flexion
    • Knee extensors contract (eccentric) to control knee flexion
    • … contracts (concentric) to keep the knee in flexion
    • Ankle dorsiflexors contract (eccentric) to prevent foot slapping
    • Ankle plantarflexors contract (concentric) to bring the foot to the ground
A
  • Heel Strike:
    • Hip extensors contract (eccentric) to control hip flexion via momentum
    • Gracilis contracts (isometric) to control hip flexion and knee extension
    • Knee flexors contract (concentric) to start knee flexion
    • Knee extensors contract (eccentric) to control knee flexion
    • Ankle dorsiflexors contract (eccentric) to prevent foot slapping
  • Foot Flat:
    • Hip extensors contract (concentric) to start hip extension
    • Knee flexors contract (concentric) to keep the knee in flexion
    • Knee extensors contract (eccentric) to control knee flexion
    • Gastroc contracts (concentric) to keep the knee in flexion
    • Ankle dorsiflexors contract (eccentric) to prevent foot slapping
    • Ankle plantarflexors contract (concentric) to bring the foot to the ground
17
Q

Muscle activities - Heel Strike vs Foot Flat

  • Heel Strike:
    • Hip extensors contract (eccentric) to control hip … via momentum
    • Gracilis contracts (isometric) to control hip flexion and knee …
    • Knee flexors contract (concentric) to start knee flexion
    • Knee extensors contract (eccentric) to control knee flexion
    • Ankle dorsiflexors contract (eccentric) to prevent foot …
  • Foot Flat:
    • Hip extensors contract (concentric) to start hip extension
    • Knee flexors contract (concentric) to keep the knee in flexion
    • Knee extensors contract (eccentric) to control knee flexion
    • Gastroc contracts (concentric) to keep the knee in flexion
    • Ankle dorsiflexors contract (eccentric) to prevent foot …
    • Ankle plantarflexors contract (concentric) to bring the foot to the ground
A
  • Heel Strike:
    • Hip extensors contract (eccentric) to control hip flexion via momentum
    • Gracilis contracts (isometric) to control hip flexion and knee extension
    • Knee flexors contract (concentric) to start knee flexion
    • Knee extensors contract (eccentric) to control knee flexion
    • Ankle dorsiflexors contract (eccentric) to prevent foot slapping
  • Foot Flat:
    • Hip extensors contract (concentric) to start hip extension
    • Knee flexors contract (concentric) to keep the knee in flexion
    • Knee extensors contract (eccentric) to control knee flexion
    • Gastroc contracts (concentric) to keep the knee in flexion
    • Ankle dorsiflexors contract (eccentric) to prevent foot slapping
    • Ankle plantarflexors contract (concentric) to bring the foot to the ground
18
Q

Positions of the joints - Mid Swing vs Terminal Swing

  • Mid swing:
    • Hip flexion
    • Knee flexion
    • Ankle …
    • 1st MTPJ …
  • Terminal swing:
    • Hip flexion
    • Knee flexion/neutral
    • Ankle …
    • 1st MTPJ …
A
  • Mid swing:
    • Hip flexion
    • Knee flexion
    • Ankle dorsiflexion
    • 1st MTPJ dorsiflexion
  • Terminal swing:
    • Hip flexion
    • Knee flexion/neutral
    • Ankle dorsiflexion
    • 1st MTPJ dorsiflexion
19
Q

Muscle activities - Mid Swing vs Terminal Swing

  • Mid swing:
    • Hip … contract (eccentric) to control hip flexion
    • … contracts (concentric) to keep the hip and knee in flexion
    • Knee … contract (concentric) to keep the lower leg off the ground
    • Ankle … contract (concentric) to keep the foot off the ground
  • Terminal swing:
    • Hip … contract (eccentric) to control hip flexion via momentum
    • … contracts (isometric) to control hip flexion and knee extension
    • Knee … contract (concentric) to bring the knee to extension
    • Ankle … contract (concentric) to keep the foot off the ground
A
  • Mid swing:
    • Hip extensors contract (eccentric) to control hip flexion
    • Gracilis contracts (concentric) to keep the hip and knee in flexion
    • Knee flexors contract (concentric) to keep the lower leg off the ground
    • Ankle dorsiflexors contract (concentric) to keep the foot off the ground
  • Terminal swing:
    • Hip extensors contract (eccentric) to control hip flexion via momentum
    • Gracilis contracts (isometric) to control hip flexion and knee extension
    • Knee extensors contract (concentric) to bring the knee to extension
    • Ankle dorsiflexors contract (concentric) to keep the foot off the ground
20
Q

Muscle activities - Mid Swing vs Terminal Swing

  • Mid swing:
    • Hip extensors contract (…) to control hip flexion
    • Gracilis contracts (concentric) to keep the hip and knee in flexion
    • Knee flexors contract (concentric) to keep the lower leg off the ground
    • Ankle dorsiflexors contract (concentric) to keep the foot off the ground
  • Terminal swing:
    • Hip extensors contract (…) to control hip flexion via momentum
    • Gracilis contracts (…) to control hip flexion and knee extension
    • Knee extensors contract (concentric) to bring the knee to extension
    • Ankle dorsiflexors contract (concentric) to keep the foot off the ground
A
  • Mid swing:
    • Hip extensors contract (eccentric) to control hip flexion
    • Gracilis contracts (concentric) to keep the hip and knee in flexion
    • Knee flexors contract (concentric) to keep the lower leg off the ground
    • Ankle dorsiflexors contract (concentric) to keep the foot off the ground
  • Terminal swing:
    • Hip extensors contract (eccentric) to control hip flexion via momentum
    • Gracilis contracts (isometric) to control hip flexion and knee extension
    • Knee extensors contract (concentric) to bring the knee to extension
    • Ankle dorsiflexors contract (concentric) to keep the foot off the ground
21
Q

Positions of the joints - Toe Off vs Initial Swing

  • Toe off:
    • Hip …
    • Knee …
    • Ankle …flexion
    • 1st MTPJ …flexion
  • Initial Swing:
    • Hip …/…
    • Knee …
    • Ankle neutral/…flexion
    • 1st MTPJ …flexion/neutral
A
  • Toe off:
    • Hip neutral
    • Knee flexion
    • Ankle plantarflexion
    • 1st MTPJ dorsiflexion
  • Initial Swing:
    • Hip neutral/flexion
    • Knee flexion
    • Ankle neutral/dorsiflexion
    • 1st MTPJ dorsiflexion/neutral
22
Q

Muscle activities - Toe Off vs Initial Swing

  • Toe off:
    • Hip flexors contract (concentric) to start hip flexion
    • … contracts (concentric) to assist the knee in flexion
    • … contracts (concentric) to bring the knee into flexion
    • Ankle … contract (concentric) to propels the body forward THEN Ankle … contract (concentric) to keep the foot off the ground
  • Initial Swing:
    • Hip flexors contract (concentric) to keep the hip in flexion
    • … contracts (concentric) to keep the knee in flexion
    • Ankle … contract (concentric) to keep the foot off the ground
A
  • Toe off:
    • Hip flexors contract (concentric) to start hip flexion
    • Gracilis contracts (concentric) to assist the knee in flexion
    • Gastroc contracts (concentric) to bring the knee into flexion
    • Ankle plantarflexors contract (concentric) to propels the body forward THEN Ankle dorsiflexors contract (concentric) to keep the foot off the ground
  • Initial Swing:
    • Hip flexors contract (concentric) to keep the hip in flexion
    • Gracilis contracts (concentric) to keep the knee in flexion
    • Ankle dorsiflexors contract (concentric) to keep the foot off the ground
23
Q

Muscle activities - Toe Off vs Initial Swing

  • Toe off:
    • Hip flexors contract (concentric) to start hip flexion
    • Gracilis contracts (concentric) to assist the knee in flexion
    • Gastroc contracts (concentric) to bring the knee into flexion
    • Ankle plantarflexors contract (concentric) to … the body forward THEN Ankle dorsiflexors contract (concentric) to keep the foot off the ground
  • Initial Swing:
    • Hip flexors contract (concentric) to keep the hip in …
    • Gracilis contracts (concentric) to keep the knee in …
    • Ankle dorsiflexors contract (concentric) to keep the foot off the ground
A
  • Toe off:
    • Hip flexors contract (concentric) to start hip flexion
    • Gracilis contracts (concentric) to assist the knee in flexion
    • Gastroc contracts (concentric) to bring the knee into flexion
    • Ankle plantarflexors contract (concentric) to propels the body forward THEN Ankle dorsiflexors contract (concentric) to keep the foot off the ground
  • Initial Swing:
    • Hip flexors contract (concentric) to keep the hip in flexion
    • Gracilis contracts (concentric) to keep the knee in flexion
    • Ankle dorsiflexors contract (concentric) to keep the foot off the ground
24
Q

Gait Terms

  • Both feet in contact with ground (together - stance together) - … support
  • One foot in contact with ground, one in swing - … support
A
  • Both feet in contact with ground (together - stance together) - double support
  • One foot in contact with ground, one in swing - single support
25
Q

Gait Terms

  • Step Length - length when one foot in heel … and other foot in heel … (length between)
  • Stride length - heel … from one foot (full … … completed)
  • Step … - gap between left and right foot
  • Foot angle - how far foot deviates from imaginary line running through midline of body
A
  • Step Length - length when one foot in heel strike and other foot in heel strike (length between)
  • Stride length - heel strike from one foot (full gait cycle completed)
  • Step width - gap between left and right foot
  • Foot angle - how far foot deviates from imaginary line running through midline of body
26
Q

BOS & COM

  • BOS = … of … - Defined as the area within an outline of all ground contact points
  • COM = … of … - The average position of all the parts of the system, weighted according to their masses
A
  • BOS = Base of Support - Defined as the area within an outline of all ground contact points
  • COM = Centre of Mass - The average position of all the parts of the system, weighted according to their masses
27
Q

BOS & COM

  • BOS = Base of Support - Defined as the … within an outline of all … … points
  • COM = Centre of Mass - The … position of all the parts of the system, weighted according to their …
A
  • BOS = Base of Support - Defined as the area within an outline of all ground contact points
  • COM = Centre of Mass - The average position of all the parts of the system, weighted according to their masses
28
Q

Walking speed / ability to turn

  • Normal walking speed for patient?
    • Walking speed can affect ‘how a person walks’ – spatio-…, … and kinematic changes (Kirtley et al., 1985)
  • … walking speed can improve gait … in young and older adults (Kang & Dingwell, 2008)
  • Time and number of steps required for turning
    • Up to 3.1 seconds for non-fallers (Dai et al., 2012)
    • Less than 3 steps for healthy adults (Gill et al., 1995)
A
  • Normal walking speed for patient?
    • Walking speed can affect ‘how a person walks’ – spatio-temporal, kinetic and kinematic changes (Kirtley et al., 1985)
  • Reducing walking speed can improve gait stability in young and older adults (Kang & Dingwell, 2008)
  • Time and number of steps required for turning
    • Up to 3.1 seconds for non-fallers (Dai et al., 2012)
    • Less than 3 steps for healthy adults (Gill et al., 1995)
29
Q

Walking speed / ability to turn

  • Normal walking speed for patient?
    • Walking speed can affect ‘how a person walks’ – spatio-temporal, kinetic and kinematic changes (Kirtley et al., 1985)
  • Reducing walking speed can improve gait stability in young and older adults (Kang & Dingwell, 2008)
  • Time and number of steps required for turning
    • Up to … seconds for non-fallers (Dai et al., 2012)
    • Less than … steps for healthy adults (Gill et al., 1995)
A
  • Normal walking speed for patient?
    • Walking speed can affect ‘how a person walks’ – spatio-temporal, kinetic and kinematic changes (Kirtley et al., 1985)
  • Reducing walking speed can improve gait stability in young and older adults (Kang & Dingwell, 2008)
  • Time and number of steps required for turning
    • Up to 3.1 seconds for non-fallers (Dai et al., 2012)
    • Less than 3 steps for healthy adults (Gill et al., 1995)
30
Q

Terrain adjustment

  • … – up & down
  • … surfaces
  • Various surface …
A
  • Stairs – up & down
  • Uneven surfaces
  • Various surface properties (e.g. soft/hard, slippery)
31
Q

A complete picture of gait analysis

  • If you want to get the complete picture, you need to take into account your patient’s movement routines:
    • … …
    • …
    • …
  • Only straight-line walking in clinic is not always sufficient
  • ? Compensatory mechanisms
A
  • If you want to get the complete picture, you need to take into account your patient’s movement routines:
    • Daily walking – to & from work / school?
    • Activities – sports? dance?
    • Surfaces – smooth? uneven? soft? hard?
  • Only straight-line walking in clinic is not always sufficient
  • ? Compensatory mechanisms
32
Q

Disruptions in gait

  • Musculoskeletal conditions
    • E.g. …, Tendinopathy, … injury
  • Neurological conditions
    • E.g. Parkinson’s, Cerebral …, CVA, … neuropathy
  • Others
    • P..
    • Supply of … (e.g. heart, lungs, blood vessels)
    • … issues
A
  • Musculoskeletal conditions
    • E.g. Arthritis, Tendinopathy, Ligament injury
  • Neurological conditions
    • E.g. Parkinson’s, Cerebral Palsy, CVA, Peripheral neuropathy
  • Others
    • Pain
    • Supply of energy (e.g. heart, lungs, blood vessels)
    • Behavioural issues
33
Q

Disruptions in gait

  • Musculoskeletal conditions
    • E.g. Arthritis, Tendinopathy, Ligament injury
  • Neurological conditions
    • E.g. Parkinson’s, Cerebral Palsy, CVA, Peripheral neuropathy
  • Others
    • Pain
    • Supply of energy (e.g. heart, lungs, blood vessels)
    • Behavioural issues
A
  • Musculoskeletal conditions
    • E.g. Arthritis, Tendinopathy, Ligament injury
  • Neurological conditions
    • E.g. Parkinson’s, Cerebral Palsy, CVA, Peripheral neuropathy
  • Others
    • Pain
    • Supply of energy (e.g. heart, lungs, blood vessels)
    • Behavioural issues
34
Q

Gait Assessment Tools

  • … screening examination
  • GAIT … checklist
A
  • GALS screening examination
  • GAIT observation checklist
35
Q

Case scenario - GAIT

  • A 55 year old lady complains of severe OA in her left knee. She is otherwise ‘healthy’.
  • How will this affect her gait? How will she compensate for the severe OA in her left knee?
A
  • A 55 year old lady complains of severe OA in her left knee. She is otherwise ‘healthy’.
  • How will this affect her gait?
    • OA knee could be related with pain, reduced functions of the knee joint, reduced muscle strength (e.g. quadriceps, hamstrings), etc.
    • Thus, it likely leads to decreased use of the affected knee or ‘guarding’ effect.
  • How will she compensate for the severe OA in her left knee?
    • If a joint (in this case – knee) cannot be used properly, compensations could come from the joint proximal (hip) or distal (ankle) to the affected joint OR from the opposite limb OR the overall gait.
    • In the video, the patient spent more time in swing for the left limb (i.e. avoid weight bearing of the left limb) and more time in stance for the right limb. This means the right limb has to take on weight for a longer period of time.
36
Q
  • Other possible compensations for severe OA in knee include … of the hip, reduced step … in the same limb, reduced walking …, etc.
  • Please note that patients with the same OA knee may not have the same … mechanism. This depends each individual and other characteristics that they may have.
A
  • Other possible compensations for severe OA in knee include circumduction of the hip, reduced step length in the same limb, reduced walking speed, etc.
  • Please note that patients with the same OA knee may not have the same compensatory mechanism. This depends each individual and other characteristics that they may have.

Year 2 Medicine (162 decks)

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