Gait Flashcards
(65 cards)
1
Q
Gait - Priority
A
- Informal gait assessment with all new patients at initial evaluation
- Assess gait speed if patient safety in the community is a concern
- Formal assessment if gait is part of treatment plan of care
2
Q
Are their direct correlations with gait and abnormalities?
A
No! Not always. You cannot make assumptions on gait, solely based on gait. Need to do exam to see if observation correlates with gait presentation.
3
Q
Phases of Gait
A
- Begins with a specific event on one foot and ends when the same event is repeated on the same limb (heel contact to heel contact)
- Heel contact, Foot Flat, Mid Stance, Push Off
- Push Off, early swing, mid swing, late swing
4
Q
Stance and Swing Phase
A
- Stance phase (60% of gait cycle)
– Begins when one foot contacts the ground and ends when that foot leaves the ground - Swing phase (40% of gait cycle)
– Begins when one foot lifts off the ground and ends when that foot contacts the ground
5
Q
Stance Phase Phases:
A
6
Q
Swing Phase Phases:
A
7
Q
People who strike with forefoot are often:
A
Antalgic (Limping)
ann-tal-gic
8
Q
Draw New vs Old Gait Terms
A
9
Q
Stride Length
A
- Linear distance representing how far the body has traveled during one gait cycle (R heel strike to R heel strike)
- Norm: Women avg. 1.3 meters; men avg. 1.5 meters (Don’t need to memorize)
10
Q
Step Length
A
- Linear distance representing how far one foot has traveled relative to the other foot during one gait cycle (R heel strike to L heel strike)
- Norm: Right and left step lengths are equal in one gait cycle
11
Q
Toe out angle
A
- Angle of the foot to the “line of progression”
– Relative to the second toe
12
Q
Cadence
A
- Number of steps taken in a specified amount of time (Amount of R and L heel strikes in one minute)
(The greater the cadence the shorter the step length)
13
Q
Velocity
A
- Speed of ambulation in meters/sec OR meters/min
- Minimum for “community ambulators”: > or = 0.8 meters/sec OR 48m/min (Perry 1995). Able to cross the street in time
- If slower = “household ambulators”
Need to know bolded
14
Q
Width of base of support
A
- Linear distance between the center of the right point of contact and the left point of contact
15
Q
Observational Gait Analysis - Quanitative
Naked Eye
A
Walking Speed/Endurance
-10-meter walk test
- TUG test (Timed up and go)
- 6-minute walk test
Standardized Assessments
- Tinetti Gait test
- Dynamic Gait Index test
16
Q
Observational Gait Analysis - Qualitative
A
- Observational gait: In the clinic with the naked eye. ID variations from “normal”
- Lab based gait assessment: use of technology to observe variations from “normal”. Not the focus of this class!
17
Q
HEEL STRIKE to MID STANCE - Motion
A
- Ankle: at initial contact moves from DF to PF to initiate contact with ground
- Ankle: As COM moves anterior, moves from PF to neutral
- Foot: pronates (arch collapse)
18
Q
MID STANCE to TOE OFF - Motion
A
- Ankle: As COM moves forward, moves from neutral to DF
- Ankle: At heel off, ankle plantarflexes
- Foot: moves into supination (arch raises) as LE externally rotates
- 1st MTP: DF to approximately 70-90°
19
Q
Swing Phase - Motion
A
Ankle: in DF to neutral to clear the leg
20
Q
HEEL STRIKE TO MID STANCE - Muscle Action
A
- Ankle dorsiflexors (Ant. Tib): eccentrically contract to decelerate ankle PF (prevent foot slap) and foot pronation (arch collapse)
- Ankle plantarflexors (Gastroc-Soleus): eccentrically control the forward motion of the tibia (control body as you move forward)
21
Q
MID STANCE to TOE OFF - Muscle Action
A
Ankle plantarflexors (Gastroc-Soleus): change from eccentrically contracting to concentrically contracting to push-off and propel body forward
22
Q
Swing phase - Muscle Action
A
Dorsiflexors(Ant. Tib): concentrically DF the ankle to clear the ground during swing
23
Q
Explain this visual.
A
Dorsiflexors active at beginning and end.
Plantarflexors are active almost enitrely throughout.
Ignore fibularis muscles
24
Q
Knee and leg - Motion
HEEL STRIKE TO MID STANCE
A
Knee: At heel strike, is slightly flexed and flexes approx. 15° in the sagittal plane till foot flat
LE: rotates internally in the transverse plane
25
Knee and leg - Motion
| MID STANCE TO TOE OFF
Knee: Moves from flexion to extension
LE: rotates externally in the transverse plane
26
Knee and leg - Motion
| Swing phase
Knee at Initial: knee flexes
Knee at Terminal: knee extends
27
Knee – Muscle action
| HEEL STRIKE TO MID STANCE
* Knee extensors (Quads): eccentrically control knee flexion and absorb the impact of weight-bearing
* Knee flexors (Hamstrings): eccentrically control (with glut max) forward momentum of trunk
| All eccentrically work. Extensors control trunk
28
Knee – Muscle action
| MID STANCE TO TOE OFF
* Knee extensors: somewhat active to extend knee
* Knee flexors: Little muscle activity except for gracilis (adductors)
29
Knee – Muscle action
| Swing phase
Knee flexors (Hamstrings): just before heel strike eccentrically decelerate forward movement of tibia
30
Explain this graph
Quads and Ham most activate in first half of stance phase and prior to foot coming in contact with the ground. **Most amount of deviatons occur in first half of stance phase!**
| Stance phase; Swing phase
31
Hip and Pelvis - Motion
| HEEL STRIKE TO MID STANCE
Hip: starts in 30° of flexion at heel strike. As COM moves anterior, hip extends to neutral
Hip: Femur internally rotates relative to pelvis
32
Hip and Pelvis - Motion
| MID STANCE TO TOE OFF
Hip: moves from neutral to 10° of extension at terminal stance
Hip: femur externally rotates relative to pelvis
33
Hip and Pelvis - Motion
| Swing phase
Hip: moves from extension to flexion
34
Hip – Muscle action
| HEEL STRIKE TO MID STANCE
Glut max: **eccentrically** (with H/S) control forward momentum of trunk
Glut med/TFL: Isometrically (with adductors and QL) stabilizes pelvis in frontal plane (prevent hip dropping)
Hip external rotators: **eccentrically** control IR of femur
35
Hip – Muscle action
| MID STANCE TO TOE OFF
Glut max: **concentrically** extends hip to propel body forward
Glut med/TFL: Isometrically (with adductors and QL) stabilizes pelvis in frontal plane
Hip external rotators: **concentrically** control ER of femur
36
Hip – Muscle action
| Swing Phase
Hip flexors and adductors: advance the limb forward at initial swing phase
37
Explain this.
Extensors most active when decelerating trunk movement.
38
LE Sagittal Plane Motion where fo you expect hip extension, knee flexion and ankle DF abnormalities?
Easiest to pick up with the naked eye.
Lack Hip Extension: 2nd half of stance phase
Lack knee flexion: Swing phase
Lack Ankle DF: Midstance to toe off/terminal stance
39
Heel strike to midstance is:
General internal rotation and pronation.
40
2nd half of stance phase
external rotation and supination
41
Eversion =
Pronation (arch collapse)
42
Inversion =
Supination (Arch raise)
43
Only frontal plane motion occurs....
* Hip movement
* Looking for hip drop (glute med and quadratus lumborum stabilize)
* 2-3 degrees
44
QUALITATIVE Observation of Gait IN THE CLINIC
* Limited Reliability unless there are BIG DEVIATIONS
* Used to detect **OBVIOUS DEVIATIONS** leading to **potential** interventions (ex: foot slap)
* **NOT** adequate alone for assessing **function** (people accommodate)
45
When observing gait in the clinic what do we look for?
Big Picture
* Anterior, posterior and lateral view
* Speed, cadence, posture, arm swing, assistance, etc.
Region assessment
* Trunk and arms
* Hip/pelvis
* Knee
* Foot/ankle
Identify potential impairments that MAY lead to gait deviation (gait can be habitual as well)
**ASSESS THOSE IMPAIRMENTS AND TREAT APPROPRIATELY. Reassess gait changes.**
46
Limited DF of 1st MTP?
Try to get other foot in contact sooner. Decrease step length and greater toe out angle.
47
Limited DF of the ankle?
Increased cadence due to decreased stride length stance phase. Hip flexion through swing phase. Earlier heel rise during stance phase.
48
Weakness of ankle dorsiflexors?
Foot slap early stance phase. Hip flexion during swing phase.
49
Weakness of ankle plantarflexors?
Decrease step length and stride length, increased cadence.
50
General foot pain?
Decreased stance time, decreased stride length. Increased cadence.
51
Limited Knee extension (Knee “flexor contracture”)?
Smaller step length on involved side. Decrease heel contact -> Forefoot contact.
52
Limited knee flexion motion?
Circumduction during swing phase.
53
Weakness of the Quadriceps?
Decrease flexion, lock knee back during initial stance phase. Quads can't control during this phase in stance.
54
General Knee Pain?
Decrease stance time on the involved side and decrease step length.
55
Limited hip extension?
* Trunk Flexion during entire stage
* Stance time decreased
* Decreased step length with impaired length
56
Weakness or absence of hip extensors
* Trunk Extension
57
Weakness of hip abductors?
Hip drop on uninvolved side, stance phase of gate of involved gate
## Footnote
Uncompensated trendelenburg - Pelvis drops on opposite side
Compensated Trendelenburg - Trunk leans over involved side. COM over hip joint
58
What would you expect associated with PAIN in other following locations?
- General LE pain
- Trunk
- Shoulder or UE
LE pain: Decrease step length and stride length on involved leg
Trunk: Little flex, little extension, minimal movement
Shoulder: Arm stays tight to body or no movement
59
Ataxic Gait
Incoordinated, wide based of support and staggering/ variable foot placement
-- Cerebellar Ataxia
-- Sensory Ataxia (will also watch feet while walking; don't know where there feet are in space)
| Jerk sideways sometimes
60
Scissoring Gait
Cross midline into stance phase
| Tight Adductors
61
Equinovarus
Foot down-and-in -- secondary to abnormal UMN condition (tone; abnormal synergy control, Cerebral palsy)
| Gastrocnemius, Tibialis Posterior, Soleus - Plantarflexion and inversion
62
Steppage Gait
Weakness of ankle DF due to LMN condition (ex: injury to Deep peroneal N.)
| Tibialis Anterior
## Footnote
Lack of heel contact in forefoot position less than 3/5; 3/5 or 3+/5 will have foot slap
63
Hemiplegic Gait
A result of a stroke.
Common observations
* Involved arm is drawn up and across body (flexed, adducted and internally rotated) - decordicate posture
* Control of involved leg is changed – may observe:
-- pelvis retraction (stays back)
-- circumduction of limb during swing
-- knee snap into extension with weight bearing (weakness of quad)
-- Equinovarus foot position (PF and inversion - do to tone of gastrocnemius)
64
Parkinsons gait
Common observations:
* Flexion of trunk and knees (“stooped posture”)
* Hypokinesia: Shuffling gait with small amplitude lift and stride; loss of rotation, reduced arm swing, turning like a statue
* Bradykinesia: slowed
* Akinesia: freezing (trouble stopping or starting movements of gait)
* Festination: uncontrolled stiffness
* Tremor is associated
65
Spastic Diplegic Gait
* (Cerebral Palsy) – Spasticity of both lower limbs
* Hip flexion and adduction and IR
* Knee flexion and valgus
* Equinovarus foot position - downward and inward (lack heel strike)
* Strike on ball of foot
* Spasticity of HS and gastroc
