Gait: Flashcards
What are the phases of gait
stance phase
swing phase
Tasks doing gait
- weight acceptance
- single leg support
- limb advancement
Periods gait
- load response: initial contact to opposite toe off
- mid stance: Opposite toe off to heel raise
- terminal stance: heel raise to opposite initial contact
- Pre swing: opposite initial contact to toe off
- initial swing: toe off and feet adjacent
- mid swing: feet adjacent to tibia vertical
- terminal swing: tibia vertical to next initial contact
Lower extremity kinematics in the sagittal plane: pelvis
- initial contact: loading response the pelvis is posteriorly rotated (less than 5º)
- loading response to midstaalnace: pelvis is neutral
- midstance to terminal stance: pelvis is anterior rotated (less than 5º)
Lower extremity kinematics in the sagittal plane: hip
- 30º hip flexion = initial contact
- 10º hip extension = mid stance to pre swing
- terminal stance –> terminal swing hip flexes
Lower extremity kinematics in the sagittal plane: knee
- initial contact = knee flexed (shock absorber)
- going into loading response flex the knee 20º
- going into mid stance knee extends (5º knee flexion)
- pre swing knee flexes
- midswing terminal knee starts to extension
Lower extremity kinematics in the sagittal plane: ankle
- Initial contact: ankle is neutral
- loading response: PF 10º
- midstance: 10 DF from 10 º PF?
- preswing: starts to PF during pre swing
Lower extremity kinematics in the frontal plane: pelvis
- up and down
Lower extremity kinematics in the frontal plane: hip
- initial contact to Loading response = adduction of the initial contract leg and abduction of the leg that is leaving stance phase
Lower extremity kinematics in the frontal plane: knee
- has to do with natural alignment
- in stance some are more valgus and then that might be exaggerated in the swing phase
Lower extremity kinematics in the frontal plane: ankle (subtler joint)
- Initial contact: inverted position (land on posterior lateral calcareous
- in response to ground reaction force the calcareous shifts to eversion
- midstance towards pressing calcareous everts a little bit
- midstance goes from everted to inverted to get more stability so during pressing there is a edge to live to push off
Lower extremity kinematics in the horizontal plane: Hip
- Right = reference limb
- initial contact ER of the right and IR of the left (terminal stance)
When during gate is COM highest during Gait
- single leg stance increase Potential energy and COM is the highest
when is COM lowest during gait
- double leg stance = increased kinetic energy
GRF during initial contact (in the sagittal plane)
- ankle: falls behind the joint = plantarflexion moment
- knee: passes anterior to the joint = external knee extension moment
- hip falls anterior to the joint = external flexion flexion moment
GRF during loading response (after initial contact) (sagittal plane)
- ankle: external plantarflexion moment
- knee: external flexion moment (shifts behind the joint)
- Hip: external flexion moment
GFR through midstance (sagittal plane)
- ankle: dorsfilexion moment
- knee: external extension moment
- hip: hip extension moment
GFR pre-swing (sagittal plane)
- ankle: dorsiflexion moment
- knee: extension moment
-hip: extension
GRF initial swing (sagittal plane)
- ankle: dorsiflexion moment
- knee: flexion moment (helps to flex the knee to bring closer to axis)
- hip: external extension moment
Review charts in notes
determinants of gait
help maintain COM
- pelvic rotation
- pelvic tilt
- stance phase knee flexion
- ankle mechanism
- foot mechanism
- lateral displacement
Pelvic rotation as a determinant of gait
- minimizes flexion and extension of the hip
- minimizes vertical displacement
pelvic tilt as a determinant of gait
minimizes upward vertical displacement by slightly dropping
- keeps COM from going to high
Stance phase knee flexion as a determinant of gait
- in midstance the knee is slightly flexed to keep it from rising too high
- slight knee flexion at mid stance minimizes upward vertical displacement
ankle mechanism as a determinant of gait
- Calcaneus makes the leg longer due to extended more posterior
- minimizes vertical depression
Foot mechanism as a determinant of gait
- forefoot lengthens from pressing to initial swing by moving from DF to PF minimizes vertical depression
Lateral displacement
- many have valgus knees to narrow the BOS and minimize lateral displacement
- increase BOS and you increase lateral displacement
Running gait cycle
- initial contact
- loading response
- mid stance
- pre swing
- float phase
- early swing
- late swing
- float
running stance phase % and swinging %
- stance = 40%
- swing = 60%
What are the running sagittal plane kinematics
- pelvis
- hip
- knee
- ankle
- pelvis: initial contact = posterior tilt
- hip: IC= 35º of flexion into 5º of extension (harder to control the hip flexion moment)
- knee: IC= 50º flexion into 20º of flexion into 100º flexion
- 30º DF into 15º PF and then back into DF
Running gait kinematics in the frontal plane
- subtalar
-subtalar:
heel strike: inversion into eversion and then back to inversion for push off
GRF during running
- braking impulse: ground sticking in a posterior direction
- propulsion: pushing off the ground pushes you forward
- medial strike of foot and lateral string of the ground
Gait at ambulation onset (around 1 years old)
- high guard= arms up for stability
- no reciprocal arm swing
- hips externally rotated for stabilization
- toe strike
- PF thru stance
- short step length
- increased cadence
- increased lateral displacement
Toddle gait patterns
- wide BOS
- decreased single leg support time
- shorter step length
- slower velocity
- higher cadence
elderly gait patterns
- decrease free walking speeding g
- shorter step length
- shorter stride
- longer duration double-support periods
Gait: CVA
- decreased step length
- decrease stance time on involved leg
- decrease trunk rotation/retracted pelvis (hold involved side in a flexed hip position)
- drop foot: no DF to clear/trouble in the swing phase
- spastic: unequal leg - slightly inverted and PF with knee extended and therefore has to hip hike/circumduct hip
- flaccid: no muscle control
Gait: parkinsons
- muscle rigidity/stiff joints
- increase cadence
- shortened stride
- lack of heel/toe off – shuffle feet
- diminished arm swing
- fenestrated gait: trouble initiating gait but then will speed up
- often deconditioned and then have a high cost of energy while walking
gait: ataxic
- trouble with the cerebellum
- decreased ability tot control balance
- increased BOS
- large side to side deviation
- higher cost of energy while walking
- often have an anterior/posterior jerk
- typical with TBI, cerebral palsy
Gait: gluteus medius weakness
- lateral trunk bending/glute med lurch
- lean toward weak side (does not have to produce as much torque)
- decrease muscle requirements
Gait: glute max weakness
- controls hip flexion in loading response
- posterior trunk lean two reduce the hip flexion moment
- glute max gait
gait: quad weakness
- in the sagittal plane counters knee flexion moment
- forward trunk lean = bring LOG anterior to knee or create external knee extension force
- increase hip extensor/soleus activity
Gait: glute max/quad weakness
- external support of UE on thigh
- counter trunk flexion moment while assisting knee extension
Gait: weak PF
- increase knee flexion and DF during stance
- less than normal step length on unaffected side
- calcaneal gait pattern
- knee buckles with diminished push off
Gait: weak DF
- 3/5 MMT – foot slap= strong enough to clear flood but do not have strength to control
- <3-/5 MMT - foot drop= can’t lift against gravity = longer leg and have to increase hip and knee flexion + toe strike = stoppage
- can also see them circumduct or vault = uninvolved PF to clear involved leg
