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P&O Exam 1 > Gait > Flashcards

Gait Flashcards

1
Q

Gait Variables

A

-Temporal-spatial
-kinematic
-kinetic

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2
Q

Temporal-spatial consist of

A

-velocity: rate of linear forward motion (m/s)
-cadence: number of steps/min
-stride length: heel strike to ipsilateral heel strike
-step length: heel strike to contralateral heel strike
-step width: width of BOS

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3
Q

Kinematic gait variables

A

-sagittal plane (flex/ext)
-frontal plane (ab/add)
-transverse plane (rotation)

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4
Q

Kinetic gait variables

A

-forces (vertical, fore-aft, medial/lateral)
-moments, power
-center of pressure

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5
Q

What are the phases of the gait cycle and the percentages?

A

Stance phase (60%)
-IC (0%)
-LR (0-10%)
-Midstance (10-30%)
-Terminal stance (30-50%)
-Preswing (50-60%)

Swing Phase (40%)
-Initial swing (60-73%)
-Midswing (73-87%)
-Terminal swing (87-100%)

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6
Q

Double limb support phases?

A

-IC
-LR
-Preswing

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7
Q

Single limb support phases?

A

-Midstance
-Terminal stance

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8
Q

Walking speed is considered the _____ vital sign?

A

Sixth
-1.4m/s to cross the road
-0.8-1.3m/s - community amubulator
-0.4-0.8 m/s- limited community ambulator
-0-0.4m/s - household walker

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9
Q

1 stride is equal to?

A

1 gait cycle

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10
Q

What are the primary forces that control walking?

A

Internal forces
-internal muscle forces

External forces
-Gravity (body weight)
-Air resistance
-GRF

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11
Q

What is newton’s 1st law of motion?

A

every object in a state of uniform motion tends to remain in that state of motion unless an external force is applied (kinetics of walking)

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12
Q

Etiologies of GRF?

A

-Acceleration of the body’s center of mass
-inertia
-muscle forces
-gravity
-ligaments/bones

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13
Q

What is newton’s 2nd law of motion?

A

F=ma

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14
Q

GRFs in gait?

A

forces applied to the body by the ground, opposing forces applied to the ground during a step

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15
Q

What is newton’s 3rd law of motion?

A

Every action there is an equal and opposite reaction

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16
Q

Which forces of gait produces an external torque/moment?

A

External forces
-GRF
-Can be measured using force plates

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17
Q

Which forces of gait produces an internal torque/moment?

A

Internal forces
-usually in response to external torque created by GRF
-control or generate movement
-possible contributions from ligaments, joint capsulse, muscles, or bony structures

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18
Q

What functional tasks of gait occur during stance phase?

A

-weight acceptance
-single limb support

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19
Q

What functional tasks of gait occur during swing phase?

A

-foot clearance
-swing limb advancement

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20
Q

What are the 3 tasks of gait?

A

-Weight acceptance
-Single limb support
-Swing limb advancement

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21
Q

Weight acceptance occurs at what phase of gait?

A

IC and LR

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22
Q

Initial contact (0%)

A

-the moment the foot strikes the ground
-Ankle: held at neutral
-Knee: extension (5 deg flex), provides stability
-Hip: Peak 20 deg of flex, positioned for optimal fwd progression and stability
-Critical Event: heel contact

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23
Q

Loading Response (0-10%)

A

-shock is absorbed while forward momentum is preserved
-foot-flat position is achieved
-Ankle: Pre-ti muscles eccentrically control PF (5 deg of PF), subtalar eversion, 1st heel rocker
-Knee: 20 deg of flex for shock absorption. Quads active to control knee flexion
-Hip: maintained 20 deg flex. Hip extensors active for stability
-CRITICAL EVENT
—pre-tib eccentric control of PF
-Quads active to control knee flex
-Hip extensors for stability

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24
Q

Single limb support occurs at what phase of gait?

A

-Midstance
-Terminal Stance

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25
Q

Midstance (10-30%)

A

-body progresses over foot in controlled manner.
-contralateral limb provides momentum
-Ankle: DF controlled eccentrically by gastroc/soleus. 2nd ankle rocker
-Knee: extension
-Hip: neutral
-CRITICAL EVENT: DF controlled eccentrically by gastroc/soleus

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26
Q

Terminal Stance (30-50%)

A

-progression of body beyond the support food.
-limb/trunk stability
-Ankle: 20 deg DF. Noted by heel rise. 3rd rocker (forefoot). Decline in gastroc/soleus activity
-Knee: full extension for max step length
-Hip: 20 deg of hyperextension for max step length
CRITICAL EVENT: trailing limb

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27
Q

Swing limb advancement occurs at what phases of gait?

A

-Preswing
-Initial swing
-Mid swing
-Terminal swing

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28
Q

Preswing (50-60%)

A

-forefoot remains on ground
-knee rapidly flexes while weight shifted to other limb
-Ankle: 2nd arc of PF (15 deg), Toe rocker, No gastroc/soleus activity
-Knee: passive knee flexion 40 deg. Prepare limb for toe clearance
-Hip: 10 deg of hyperextension
-CRITICAL EVENT: Passive knee flexion 40 deg

29
Q

Initial Swing (60-73%)

A

-Ankle: neutral
-Knee: Peak knee flex 60 deg for toe clearance. Peak mm activity of biceps femoris short head, gracilis, sartorius
-Hip: 15 deg of flex. Peak mm activity of gracilis/sartorius
CRITICAL EVENT: Peak knee flex at 60 deg and 15 deg of hip flex

30
Q

Midswing (73-87%)

A

-Ankle: neutral to slight DF
-Knee: passive ext caused by momentum of hip flex
-Hip: Peak hip flex 25 deg
CRITICAL EVENT: Neutral to slight DF of ankle

31
Q

Terminal swing (87-100%)

A

-leg reaches out to achieve step length
-prepare for IC
-Ankle: neutral to prepare for heel contact
-Knee: extension to neutral (5 deg flex). Extension controlled eccentrically by hamstrings. Quads turn on in late Swing to prepare for WB
-Hip: 20 deg flex
CRITICAL EVENT: extension to neutral of knee

32
Q

Muscle Activity during Initial contact

A

-Ankle: pre-tib to counter PF moment
-Knee: quads for stability
-Hip: hamstrings/gluteals for stability
External moments:
-hip: flex
-knee: ext
-ankle: PF

33
Q

Muscle Activity during Loading Response

A

-Ankle: pre-tibial to counter PF moment. Calf for stability
-Knee: quads to counter flex
-Hip: hamstrings/gluteals for stability
External moments:
-hip: flex
-knee: flex
-ankle: PF

34
Q

Muscle activity during Midstance

A

-Ankle: calf for stability and counter DF moment
-Knee: quads for stance
-Hip: none
External moments:
-hip: ext
-knee: ext
-ankle: DF

35
Q

Muscle activity during Terminal Stance

A

-Ankle: calf to counter DF moment
-Knee: none
-Hip: none
External moments:
-hip: ext
-knee: ext
-ankle: DF

36
Q

Muscle activity during Pre-swing

A

-Ankle: calf to counter DF moment (early). Pre-tib for foot clearance (late)
-Knee: none
-Hip: Hip flexors to counter extension and intiate swing
External moments:
-hip: ext
-knee: flex
-ankle: DF

37
Q

What key muscles control pelvic motion during gait?

A

hip extensors and abductors

38
Q

What happens to the pelvis during gait in the sagittal plane?

A

-anterior pelvic tilt ~10 deg
-slight increase in anterior pelvic tilt during Tstance and Tswing

39
Q

What happens to the pelvis during gait in the frontal plane?

A

-WA - 4 deg of contralateral pelvic drop
-Pswing - 4 deg of ipsilateral pelvic drop

40
Q

What happens to the pelvis during gait in the transverse plane?

A

-pelvic protraction during Tswing and IC
-pelvic retraction during Stance
-neutral rotation and midswing and midstance

41
Q

What is the average vertical and lateral displacement of the trunk during gait?

A

4.2 cm for vertical
4.5 cm R and L

42
Q

What trunk extensors acts bilaterally during initial contact?

A

multifidus

43
Q

Is shoulder flexion active or passive during contralateral initial contact?

A

passive shoulder movement (8 deg)

44
Q

What muscles control shoulder extension during ipsilateral initial contact?

A

posterior deltoid and teres major

45
Q

What are the critical joint angles and timing of gait cycle?

A

Ankle
-0 deg during swing
-20 deg DF during terminal stance
Knee
-60 deg flex peak during initial swing
-20 deg of flex during loading response
-0 deg of ext at initial contact and midstance
Hip
-25 deg peak flexion in midswing
-20 deg of extension in terminal stance

46
Q

What are the critical muscle activity during gait cycle?

A

Ankle
-anterior tib eccentric during loading response
-anterior tib concentric during swing
-Gastroc eccentric during stance
Knee
-Quads active during stance to control knee flexion
-no hamstring or quad activity during midswing
Hip
-hip flexors concentric during swing
-hip abductors during SL support to prevent hip drop

47
Q

Increased knee ADDUCTION moments have been associated with what diagnoses?

A

Knee OA

48
Q

What are 5 methods of gait?

A

-manual assessment of spatial and temporal parameters
-instrumented walkways
-3-D gait analysis
-Video analysis
-Observational gait analysis

49
Q

What is the main GOAL of gait methods?

A

Is the individual achieving a functional, comfortable, biomechanically efficient, and energy efficient gait

50
Q

What should treatment intervention and outcome measurement tools be based on?

A

-objective
-reliable
-valid assessment

51
Q

What outcome measures can be used for manual assessment of spatial and temporal parameters?

A

-Timed walk test (6MWT, 2MWT)
-10 meter walk test
-physical measurements of step length, width, or cadence

52
Q

What are the advantages and disadvantages of instrumented walkways?

A

Advantages:
-easy to use
-less expensive
-portable
-requires minimal set up and space
-generally produce reliable data

Disadvantages:
-generally limited to temporal spatial data
-limited to number of steps
-artifical environment validity?

53
Q

What does instrumented walkways measure?

A

-temporal spatial parameters
-foot contact patterns

54
Q

What does 3-D gait analysis measure?

A

-temporal spatial parameters
-kinematics
-kinetics

55
Q

What are the advantages and disadvantages of 3-D gait analysis?

A

Advantages
-captures joint kinematics and kientics in all planes
-accurate, good for complicated giat patterns
-can sync with EMG data

Disadvantages
-need large room
-costly
-must have knowledge to process data
-accuracy influenced by body composition and precision of marker placement
-skin artifact

56
Q

GAITRite

A

-2ft wide x 12-24 ft length walkway
-numerous client-specific normal databases can be created and compared against
-can use to track a patient’s progress

57
Q

Motion capture

A

capture rate: minimum 60 Hz, for walking for faster movements must increase rate

58
Q

Detecting gait events

A

-foot strikes on force plates
-velocity of foot
-foot switches

59
Q

Electromyograph (EMG)

A

Surface
-non-invasive
-good for group and/or surface muscle activity
-should be placed at muscle belly
-good for measuring timing of muscle activity
-signal can be “noisy)
-does not work well with thick layer of subcutaneous fat

Fine Wire
-invasive
-good for deep or specific muscle activity
-needles must be sterilized
-time sensitive

60
Q

Plantar pressures

A

-instrumented insoles place in patient’s shoes
-can not use during barefoot walking

61
Q

Inertial Measurment Units (IMU)

A

-self-contained system that measures linear and angular motion with the use of gyroscopes, magnetometers, and accelerometers

62
Q

What are the advantages and disadvantages of video gait analysis?

A

Advantages:
-measures joint angles
-inexpensive
-simple to use

Disadvantages:
-accuracy
-patient conset to video

63
Q

What are some tips for observational gait analysis?

A

-must be familiar with NORMAL gait
-start global then get specific
-breakdown into stance and swing and then further into phases
-can list in order of significance or superior <–> inferior

64
Q

Abnormal joint ROM can cause gait deviations by

A

-joint contractures
-joint arthrodesis
-body malalignments
-compensatory postures
-ligamentous laxity

65
Q

Pain or discomfort can cause gait deviations by

A

-injury
-disease

66
Q

Impaired sensation can cause gait deviations by

A

-hyper- or hyposensitivity
-impaired propriocpetion
-CRPS

67
Q

Impaired motor control can cause gait deviations by

A

Central
-weakness, hypertonicity, lack of selective control, apraxia, ataxia, rigidity

Peripheral
-disuse atrophy, muscle disease or injury, weakness

68
Q

What are the 4 ankle rockers?

A

-1st rocker (heel): arc of ankle plantarflexion right after initial contact
-2nd rocker (ankle): tibial progression forward during midstance
-3rd rocker (forefoot): forefoot dorsiflexion as heel rises
-4th rocker (toe): tibia continues to progress forward as great toe extends

P&O Exam 1 (5 decks)

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