Gait Flashcards
ROM Requirements for Normal Gait: Hip Flexion
0-30 degrees
ROM Requirements for Normal Gait: Hip Extension
0-10 degrees
ROM Requirements for Normal Gait: Knee Flexion
0-60 degreea
ROM Requirements for Normal Gait: Knee Extension
0 degrees
ROM Requirements for Normal Gait: Ankle Dorsiflexion
0-10 degrees
ROM Requirements for Normal Gait: Ankle Plantarflexion
0-20 degrees
While performing a gait analysis, a PTA observes excessive pronation during foot flat and a lack of supination as a lever for “push- off” in late stance. Weakness in which of the following muscle should the therapist MOST expect to be the cause of the observed gait deviations?
1) Gastrocnemius
2) Tibialis Posterior
3) Fibularis Longus
4) Quadratus Plantae
2
A PTA observes a patient lean backwards during the early stance phase of gait. Weakness in which of the following muscles is MOST likely causing this gait deviation?
1) Gluteus Maximus
2) Gluteus Medius
3) quadriceps
4) iliopspas
1
Which of the following gait deviations would MOST likely be used by a person wearing a knee immobilizer on the right lower extremity?
1) vaulting gait on the right leg
2) stoppage gait of the right leg
3) circumduction of the right hip
4) uncompensated Trendelenburg gait on the left.
3
A PTA examines the gait pattern who sustained an i jury to the deep perineal nerve. Which of the following gait deviations would the therapist MOST likely expect from o observe between heel strike (initial contact) and foot flat (loading response)?
1) Hyperextension of the knee
2) posterior lean of the trunk
3) excessive probation of the foot
4) foot slapping to the ground
4
Which of the following muscles are MOST responsible for keeping the right side of the pelvis from dropping during the stance phase of gait on the left leg?
1) left hip abductors
2) right hip abductors
3) left hip adductors
4) right hip adductors
1
A patient presents with significant weakness of the quadriceps with a muscle grade of poor plus (2+/5). During examination of gait, which of the following deviations would the therapist MOST likely expect to observe?
1) posterior trunk lean in early stance
2) anterior trunk lean in early stance
3) circumduction during swing phase
4) vaulting on the contralateral limb
2
What is the ANKLE doing during heel strike (initial contact) to foot flat (loading response)? What muscle activation would allow this when gravity is helping?
Moving from neutral to PF
ECCENTRIC DF (decelerating ankle into PF)
During heel strike (initial contact) the ankle is at
0 degrees Ankle Neutral
During foot flat (loading response) the ankle is at
15 degrees of PF
What is the ankle doing from foot flat (loading response) to Midstance? What muscle activation would allow this when momentum is helping?
Moving from PF to 10 degrees DF
- ECCENTRIC PF (controlling DF as body moves over the stance leg)
What is the ankle doing during midstance to heel off (terminal stance) and toe off (preswing)? What muscle activation would allow this when working against gravity?
Moving back into PF (against gravity to 20 degrees)
- CONCENTRIC PF (heel off and toe off are often referred together as “push- off” for a reason= propulsion!)
What happens to the ankle during toe off (preswing) to Acceleration (initial swing)? What muscle activation would allow this against gravity?
Moving from PF back into DF to clear the foot
- CONCENTRIC DF to clear the foot from the ground during swing
What is the ankle doing during mid swing to deceleration (terminal swing)? What muscle activation would maintain this?
Maintaining DF to neutral
- CONCENTRIC then ISOMETRIC DF to maintain DF during swing
What is the common gait deviation in stance phase when DF are weak?
Foot Slap
What are the possible gait deviation in the swing phase when DF are weak?
Hip circumduction
- substitute with hip abductors o swing limb
Hip hiking
- substitute with Quadratus Lumborum on swing limb
Steppage gait= Excessive hip/ knee flexion
- substitute with hip/ knee flexors on swing limb
Vaulting on stance limb
- substitute with concentric PF on stance limb, often combined with hip hiking on swing leg
What if the PF are weak during stance and swing phase?
Stance- lack of propulsion or “push off” during late (terminal) stance phase.
PF not active in swing phase,
What is the knee doing during heel strike (initial contact) to foot flat (loading response)? What muscle activation would allow for the control of this?
Moving from full Extension to 15-20 degrees flexion as the limb accepts the weight of the body (loading response)
- eccentric quads to control the amount of knee flexion during loading
During heel strike (initial contact) the knee is in
Full extension 0 degrees
During foot flat (loading response), the knee is at
15- 20 degrees of knee flexion
What is the knee doing during foot flat (loading response) to Midstance? What muscle activation would allow this?
Extending back to neutral
- concentric quads until neutral knee extension (then activity in the knee musculature is minimal during midstance)
What is the knee doing during midstance to heel off (terminal swing) and toe off (preswing)?
Knee muscle activity remains limited in late stance until the hamstrings begin to produce knee flexion at toe off (preswing) in preparation for the swing phase (momentum of body, also aids in this motion)
What is the knee doing during Acceleration (initial swing) to Midswing? What muscle activation would allow this to shorten the swing leg?
Moving into about 60 degrees of knee flexion.
- concentric hamstrings to bend the knee for foot clearance in early swing
What is the knee doing during midswing to deceleration (terminal swing)? what muscle activation would control this?
Momentum of swing is moving the knee back into full extension
- eccentric hamstrings to slow the rate of knee extension during terminal swing
If the quadriceps are weak, what is the common gait deviation seen during stance phase?
Anterior trunk lean in early stance
- compensates for quadriceps weakness by moving the ground reaction force anterior to the knee to “lock” the knee in extension
If the hamstrings are weak, what are the common gait deviation in swing phase?
Poor deceleration in terminal swing
- hamstrings eccentrically slow hip flexion and knee extension (deceleration) during terminal swing (before heel strike)
- hamstrings mainly function during stance phase as a stabilizer for the knee (quadriceps more active in stance phase and hamstrings more active in swing)
What is the hip doing during heel strike (initial contact) to foot flat (loading response)? What muscle activation would allow for this?
Hip is in about 30 degrees flexion and stabilizing (in preparation more movement into extension)
- Isometric hip extensors (gluteus Maximus) and hip abductors (gluteus medius and minimus)
What is the hip doing during foot flat (loading response) to midstance? What muscle activation would allow this?
Moving from 30 degrees flexion into extension (neutral)
- concentric hip extensors (gluteus Maximus) to become more erect with hip abductors still stabilizing hip and pelvis.
What is the hip doing during midstance to Heel off (terminal stance) and toe off (preswing)? What muscle activation would allow this?
Moving from a neutral hip to 10 degrees extension (beyond neutral)
- Eccentric hip flexors (iliopsoas) to control or slow the rate of hip extension
What is the hip doing during acceleration (initial swing) to midswing? What muscle activation would allow this?
Moving from extension into 20-30 degrees of flexion
- concentric hip flexors (iliopsoas) to advance the swing limb forward.
what is the hip doing from midswing to deceleration (terminal swing)? What muscle activation would allow this?
Moving (deceleration) into 30 degrees of flexion
- eccentric hips extensors to slow the rate of hip flexion and prepare the limb for heel strike (initial contact)
If the gluteus Maximus is weak, what is the common gait deviation in stance phase?
Posterior trunk lean
- during early stance compensated for hip extensor weakness by moving the line of gravity of the trunk behind the hip joint to “lock” the hip in extension
If the gluteus medius is weak, what is the common gait deviation seen in stance phase?
Lateral Trunk Lean
- lean toward the stance leg of the weak hip abductors to prevent contralateral drop of the pelvis on the side of the swing leg
Hip Abductors are not active during the
Swing phase in normal gait
Trendelenburg Sign
Contralateral (opposite side) pelvic drop
Trendelenburg gait
The lateral trunk lean toward weak stance limb
If the hip flexors are weak, what is the common gait deviation in swing phase?
Posterior trunk lean
- during early swing phase helps pull the femur forward (anteriorly) to advance the swing limb as a compensation for hip flexor weakness
Other:
- hip circumduction
- insufficient hip flexion at terming swing= shorter step length
If the hip flexors are weak, what gait deviation will be seen in stance phase:
Poor eccentric control of the rate of hip extension during late stance phase
Gait Deviation of Ankle and Foot: Foot Slap
Weak DF
DF paralysis
Gait Deviation Ankle and Foot: Toe Down instead of heel strike
PF spasticity
PF contracture
Weak DF
DF paralysis
Leg Length discrepancy
Hindfoot pain
Gait Deviation of Ankle and Foot: Clawing of toes
Toe Flexor Spasticity
Positive Support Reflex
Gait Deviation of Ankle and Foot: Heel lift during Midstance
Insufficient DF range
PF spasticity
Gait Deviation of Ankle and Foot: No Toe Off
Forefoot/ toe pain
Weak PF
Weak toe flexors
Insufficient PF range of motion
Gait Deviation of Knee: Exaggerated Knee Flexion at Contact
Weak Quads
Quads paralysis
Hamstrings spasticity
Insufficient extension ROM
Gait Deviation of Knee: Hyperextension in Stance
Compensation for weak quads
PF contracture
Gait Deviation of Knee: Exaggerated knee flexion at Terminal Stance
Knee Flexion contracture
Hip Flexion contracture
Gait Deviation of Knee: Insufficient flexion with SWING
Knee effusion
Quads Extension Spasticity
PF spasticity
Insufficient flexion ROM
Gait Deviation of Knee: Excessive flexion with Swing
Flexor withdrawal reflex
Lower Extremity flexor synergy
Gait Deviation of Hip: Insufficient Hip flexion at initial contact
Weak hip flexors
Hip flexor paralysis
Hip extensor spasticity
Insufficient hip flexion ROM
Gait Deviation of Hip: Insufficient Hip Extension at Stance
Insufficient hip extension ROM
Hip flexion contracture
Lower extremity flexor synergy
Gait Deviation of Hip: Circumduction during Swing
Compensation for weak hip flexors
Compensation for weak DF
Compensation for weak Hamstrings
Gait Deviation of Hip: Hip hiking during SWING
Compensation for weak DF
Compensation for weak knee flexors
Compensation for extensor synergy pattern
Gait Deviation of Hip: Exaggerated hip flexion during Swing
Lower extremity flexor synergy
Compensation for insufficient ankle DF
