Gait Flashcards
Define gait
The pattern of movement of the limbs during human locomotion over solid ground.
Name and define the two phases of the gait cycle
- Stance phase (60%) - interval in which the foot is on ground.
- Swing phase (40%)- interval in which foot is not in contact w/ ground.
Name the 5 phases of stance phase.
- Heel strike - initial contact of heel to floor.
- Foot is dorsiflexed & usually inverted.
- Knee is extended (quadriceps) & hip is flexed. - Loading response (foot flat) - weight transferred to this leg.
- Mid-stance - weight aligned & balanced on this leg.
- Terminal stance (heel off) - heel lifts off floor, foot rises, toes remain in contact with floor.
- Pre-swing (toe off) - foot continues to rise, toes lift off floor- foot is plantar flexed & slightly elevated.
NOTE: view diagram on notes
Name the 2 phases of swing phase.
- Midswing - acceleration of leg forwards.
- Terminal swing - deacceleration leading to heel strike.
Toes are prevented from dragging on ground by simultaneous flexion of hip & knee joints & dorsi flexion of foot.
Gait cycle repeats!
NOTE: view diagram on notes
Which muscles are involved in the initial contact (heel strike) phase of the gait cycle?
- Tibialis anterior - dorsiflexion of foot.
- Gluteus maximus - hip flexion
Which muscles are involved in the Loading response phase of the gait cycle?
Quadriceps - extends the knee & flexes the hip.
- Vastus lateralis
- Vastus intermedius
- Vastus medialis
- Rectus femoris
Which muscles are involved in the Midstance phase of the gait cycle?
Triceps surae- stabilises knee during extension whilst standing
- gastrocnemius
- soleus
Which muscles are involved in the Terminal stance phase of the gait cycle?
Triceps surae- flexes knee & plantar flex the foot at the ankle joint
Triceps sure is made up of:
- gastrocnemius
- soleus
Which muscles are involved in the Pre swing phase of the gait cycle?
Rectus femoris - flexes the hip & extends the knee so it propels the swing leg forwards.
Plantar flexors - plantar flex the foot.
Flexors of the toes - lift the toes off the ground.
- Flexor hallucis longus
- Flexor hallucis brevis
- Flexor digitorum longus
- Flexor digitorum brevis
Intrinsic foot muscles - lift toes off ground.
Which muscles are involved in the Initial & midswing phase of the gait cycle?
Iliopsoas & rectus femoris - flexes the hip.
Hamstrings - flex the knee
- Biceps femoris
- Semitendinosus
- Semimembranosus
Contralateral hip abductors (gluteus medius & minimus)
- stops pelvic drop & supports weight.
Which muscles are involved in the Terminal swing phase of the gait cycle?
Quadriceps - hip flexor & knee extensor.
Hamstrings - hip extensor & knee flexor.
Tibialis anterior - dorsiflexion of foot.
Describe the hip and knee cycle on a gait chart.
NOTE: view diagram on notes
0 is neutral
Hip cycle
- Stance phase = flexion followed by extension
- swing phase= flexion
Knee cycle-
- Stance phase = neutral, extension then full extension
- Swing phase= full flexion
Describe a myopathic gait
E.g. trendelengburg
Weakness on 1 side of Hip girdle muscles (abductors) will lead to a drop in pelvis on the contralateral side while walking
With bilateral weakness, will have dropping of pelvis on both sides during walking leading to waddling! This
Seen in patients w/ muscular dystrophy.
NOTE: view Stanford video
Describe a parkinsonian gait
patient has rigidity and bradykinesia.
Early stages:
- involuntary inclination to take accelerating steps
- reduced arm swing
Late stage:
- stooped w/ head & neck forward
- flexion at knees
- whole upper extremity is in flexion
- fingers usually extended.
- slow little steps (shuffling)
- difficulty initiating steps.
- tremors in legs & arm
Describe a ataxic gait
Seen in cerebellar disease
- resembles alcohol intoxication
Clumsy, staggering movements w/ a wide-based gait.
While standing still, body may swagger back & forth & from side to side
- lean towards side of brain affected
Patients will not be able to walk from heel to toe or in a straight line.
Describe a Choreiform gait
Seen w/ certain basal ganglia disorders e.g. Sydenham’s chorea & Huntington’s Disease
patient will display irregular, jerky, involuntary movements in all extremities.
Walking may accentuate their baseline movement disorder.
Describe a neuropathic gait
Seen in patients w/ foot drop (weakness of foot dorsiflexion)
Due to an attempt to lift the leg high enough during walking so that foot does not drag on the floor- i.e. high stepping gait
If unilateral, causes include peroneal nerve palsy & L5 radiculopathy.
If bilateral, causes include amyotrophic lateral sclerosis, Charcot-Marie-Tooth disease & peripheral neuropathies associated w/ uncontrolled diabetes.
Describe a diplegic gait
Both sides affected
spasticity in lower extremities worse than upper extremities- stiff legs
Patient walks w/ abnormally narrow base, dragging both legs & scraping the toes.
Extreme tightness of hip adductors can cause legs to cross midline- scissors gait.
- patients w/ cerebral palsy may have hip adductor release surgery to minimize scissoring.
Seen in cerebral palsy.
Describe a hemiplegic gait
unilateral weakness on affected side, arm flexed, adducted & internally rotated.
Leg on same side is in extension w/ plantar flexion of foot & toes.
Arm bent- spastic or floppy
drags affected leg in a semicircle (circumduction) due to weakness of distal muscles (foot drop) & extensor hypertonia in lower limb
broad stance
unaffected side completely normal
commonly seen in stroke
Describe a sensory gait
Also called stomping gait
As our feet touch the ground, we receive propioreceptive information to tell us their location- gait occurs when there is loss of propioreceptive input
In an effort to know their location, patient will slam the foot hard onto the ground in order to sense it.
- will lift leg very high to hit ground hard
Seen in disorders of the dorsal columns (B12 deficiency or tabes dorsalis) or in diseases affecting peripheral nerves (uncontrolled diabetes)
