Gait Flashcards
where does gait fall in the ICF model?
body fxn w/in body structures and fxns
where does mobility fall in the ICF model?
activity and participation
what is locomotion?
moving from one place to another
what is gait?
achieving locomotion on foot (walking, running, jogging)
what is ambulation?
type of locomotion used
what is involved in walking in daily life?
stops
starts
directional changes
negotiating terrains, inclines, stairs, curbs
acceleration, deceleration
adapt to task and environment
what are the 3 requirements for locomotion?
1) progression
2) postural control
3) adaptation
what are the goals of normal gait?
forward progression
shock absorption
lower quarter mobility
energy conservation
how many phases of gait are there?
8
how many phases of stance are there in the gait cycle?
5
how many phases of swing are there in the gait cycle?
3
what are the 5 stance phases?
initial contact
loading
midstance
terminal stance
preswing
what are the 3 swing phases?
initial swing
midswing
terminal swing
what is a gait cycle (stride)?
IC to IC of the same LE
what % of the 100% gait cycle is the stance phase? swing phase?
stance phase-60%
swing phase-40%
when are there 2 periods of double limb support?
at the beginning and end of stance phase (22%)
what is the % of IC?
0-2%
what is the % of loading response?
2-10%
what is the % of midstance?
10-30%
what is the % of terminal stance?
30-50%
what is the % of preswing?
50-60%
what is the % of initial swing?
60-73%
what is the % of midswing?
73-87%
what is the % of terminal swing?
87-100%
what are the fxnal tasks of gait?
weight acceptance
single limb support
limb advancement
when does weight acceptance occur?
IC and loading response
when does single limb support occur?
midstance, terminal stance (early)
when does limb advancement occur?
terminal stance, preswing, and all swing phases
when is there max knee flexion in the gait cycle?
midswing
what happens in IC?
foot makes context with the surface
weight acceptance
prime muscles: concentric tib ant and glut max/med
ankle: 0 deg
knee: 3-5 deg flex
hip: 25-30 deg flex
what happens in loading response?
weight acceptance
shock absorption
weight transferring onto the limb
ankle: 15 deg PF
knee: 15 deg flex controlled by quads
what happens in midstance?
the body progresses directly over a single limb
single limb support
ankle: 15 deg PF; 15 deg DF
hip: full ext
what happens in terminal stance?
progression continues moving the body forward of the limb and weight is transferred to the forefoot
single limb support
propulsion
ankle: 15 deg DF with tibia moving forward towards PF (20 deg pf needed)
hip: 10 deg ext
knee: moving into full ext
what happens at preswing?
the limb is unloaded quickly as weight is shifted to the opposite LE
propulsion
getting ready to start leg swinging into next step
ankle: 20 deg PF
knee: 40 deg flex
hip: 10 deg ext
what happens at initial swing?
limb shortening for foot clearance
foot comes off the floor and the femur beings to advance forward
ankle: moving into neutral DF out of PF
knee: 40 deg flex
hip: 10 deg ext
what happens in midswing?
the knee beings to extend and the foot clears the ground as the femur continues to advance
limb shortening for foot clearance
momentum generated
ankle: neutral
knee: 60 deg flex
hip: 20-30 deg flex
what happens at terminal swing?
the knee is fully extended as the LE prepares to contact the ground
coming to the end of swing phase, about to start IC
limb advancement
preparing for IC
decelerating so that you’re not falling forward
ankle: neutral
knee: fully ext
hip: 25-30 deg flex
what can decreased ankle ROM lead to in gait?
steppage gait, toe drag, abnormal IC, abnormal push off, lurching gait (trying to get through stance ASAP rocky!)
how much ankle motion is needed for normal gait patterns through all phases when using the least amount of energy?
30 deg
what gait deviations can result from PFPS/reduced knee ext due to surgery or injury
circumduction gait to avoid knee flexion
upslip do the hip
staying on the heel all of stance and swing
limp
accelerated swing phase???
shortened stance phase???
may cause hip pain
unable to fully ext knee at terminal swing or IC
what are the temporal characteristics of gait?
velocity and cadence
what is velocity?
distance covered over a unit of time
what is the average walking speed?
1.4 m (1.5 yd/sec, 80 m/min, 2.5-3 mph)
what is cadence?
of steps per unit of time
what is the range for normal cadence?
50-120/130 steps/min
what cadence is considered slow?
below 100 steps/min
what cadence is considered fast?
above 125 steps/min
what temporal characteristic is important for community ambulation?
cadence
what are the spatial characteristics of gait?
step length
stride length
step width
angle of progression
jt angular displacements
what is step length? (KNOW THIS)
heel of one foot to heel of other foot
what is stride length? (KNOW THIS)
IC of one limb to IC of same limb
what is step width?
midpoint of one heel to midpoint of other heel and distance bw the 2
what is normal step width?
2-4 inches
what is normal angle of progression in gait?
7 deg outtoeing
when is the COM the highest?
midstance
when is the COM the lowest?
at double limb support
how much normal vertical limb displacement is there during gait?
2.5 cm (typically 1in in each direction up/down and side to side)
what happens in the sagittal plane at the hip?
remains relatively level
3 deg ant/post tilt throughout cycle
increases as speed increases
anterior pelvic tilt accompanies what hip motion?
hip extension
posterior pelvic tilt accompanies what hip motion?
hip flexion
what sagittal plane motion of the pelvis occurs at IC through midstance?
post tilt, ant tilt at the end of midstance (accompanying hip ext)
what sagittal plane motion of the pelvis occurs at preswing?
post tilt, then ant tilt, then post tilt in prep for IC
how many degrees of sagittal plane hip motion occurs during gait?
40 deg
what happens in the sagittal plane hip after IC to terminal stance?
the hip is extending w/hyperextension at terminal stance w/ant pelvic tilt and lumbar hyperextension
what happens in the sagittal plane hip at preswing?
the hip moves into flexion then neutral to prepare for lift
what happens in the sagittal plane hip at initial swing to midswing?
the hip flexes to 25-30 deg
what happens in the sagittal plane hip at terminal swing?
moving into extension to prepare for IC
what happens in the sagittal plane knee at IC?
3-5 deg flex after which further flexion occurs
what happens in the sagittal plane knee at the end of loading phase?
knee flexed to 15-20 deg
when does the knee move towards ext, reaching full ext in gait?
at terminal stance
before ___, the knee begins to flex (35-40 deg) and reaches a max of 60-65 deg during ____
preswing, midswing
when is the knee is full ext during gait?
terminal swing
when is the knee the most flexed during gait?
midswing
what happens in the sagittal plane ankle and foot at IC?
neutral
held in OKC by ant tib and ant group EDL and FHL
triceps surae turns on at IC by everting the calcaneous, helping control CKC DF
what happens in the sagittal plane ankle and foot at loading?
rapid PF
PF decelerated eccentrically by the ant tib also control of pronation lowering of MLA
what happens in the sagittal plane ankle and foot through midstance?
tibia advances over the foot to 10 deg DF
soleus decelerates DF and forward motion of the tibia
at preswing, what muscles are working at the ankle to resupinate the foot and stabilize the navicular during pf?
gastrocs and post tib
what muscles work with the ant tib to stabilize the MLA during preswing?
the peroneals
what happens in the sagittal plane ankle from terminal stance to swing?
the ankle movies from a position of PF to neutral or slight DF
how many degrees of extension does the 1st MTP jt need by the end of preswing?
55-60 deg
when does max lateral displacement occur in gait?
during unilateral stance when the COM is highest
t/f: max lateral and vertical displacement occur at the same time in the gait cycle
true
how many cm of lateral shift should there be during the gait cycle
2 cm right and left
how much frontal plane lateral tilt should there be at the pelvis?
8 deg on each side
during unilateral stance, does the pelvis drop 8 deg in the stance or swing side?
swing side
at IC in the frontal plane what is happening at the hip?
adducted 10 deg
at loading in the frontal plane what is happening at hip?
adducted 15 deg
at midstance to terminal stance in the frontal plane, what is happening at the hip?
hip is in neutral
during the swing phase in the frontal plane, what is happening at the hip?
abducted 5 deg
what is happening at the knee in the frontal plane at loading response?
3 deg abduction
when does the knee maximally abducted?
during swing w/peak knee flex
what happens at the subtalar jt at IC in the frontal plane?
slight supination
what happens at the subtalar jt at loading in the frontal plane?
rapid pronation
what happens in the frontal plane subtalar jt during midstance?
begins to supinate
what happens in the frontal plane subtalar jt at preswing?
max supinate 8-11 deg
how much total frontal plane motion is there at the midtarsal jt?
11-15 deg
t/f: during midstance, the arch elevates the midtarsal jt’s to supinate
true
what happens in the transverse plane pelvis during gait?
protraction 4 deg
retraction 4 deg
8 deg total motion
does ant pelvic rot occur with hip flexion or extension?
hip extension
does post pelvic rot occur with hip flexion or extension?
hip flexion
when does max protraction of the pelvis occur in gait?
at IC
at initial contact is the hip laterally rotated or medially rotated?
laterally rotated
at initial swing is the hip in lat or med rot?
lat rot than med rot by terminal swing
how much total hip rotation is there at the hip during gait?
8-14 deg
immediately after IC, does the hip med or lat rotate?
med rotation until extension
in mid to terminal stance, is the hip alt or med rotated?
lat rotation to neutral
by preswing is the hip fully laterally rotated or medially rotated?
laterally rotated
at IC is the knee lat or med rotated?
lat rotated
immediately after IC, does the tibia med rot or alt rotate?
med rotate
at the foot pronates during loading, is the tibia medially or laterally rotating?
med rot
during midstance to terminal stance is the knee lat or med rotating?
lat rot
during preswing is the knee in lat or med rot?
lat rot
when are the GRF the greatest during gait?
IC and preswing
t/f: AP GRFs are shear forces
true
which of the 3 GRFs are the smallest?
LS shear
what is the COP?
the location w/in the foot where GRFs are applied
where is the COP in preswing?
in the forefoot bw the 1st and 2nd metatarsal heads
where does the COP start?
slightly lat to midpoint of the heel
as you put weight into the foot in midstance, where does the COP move?
towards the front and middle of the foot
as you’re about to toe off, where does the COP move?
bw the 1st and 2nd toes
what is the fxnal activity at IC?
shock absorption (quads and DFs)
what muscles are working at IC?
quads and Dfers
gastrocs and ant tib co-contract to maintain stability
hamstring decelerate knee
quads co-contract eccentrically with hamstrings
hip in slight flexion stabilized by the glut max and med
what muscles are working at LR and midstance?
quads and DFers
glutes eccentrically
what muscles are working at preswing/initial swing?
adductor longus and magnus, illiosoas, rectus fem, sartorius accelerating the swing limb with concentric contractions
what muscles are working throughout swing?
isometric tib ant to clear the floor
what muscles are working at terminal swing/IC?
hamstrings, DFers working eccentrically to keep us from falling forward at IC
concentric gastrocs, soleus, and toe flexors
at IC, is the foot pronated or supinated?
supinated
at loading response, is most muscles activity eccentric or concentric?
eccentric
what muscle works to lower the foot to the ground at loading response?
ant tib
what muscles are working at loading response?
ant tib lowering the foot
eccentric quads with slight hamstring flexion as the knee flexes
glut max stabilizes the trunk and prevents excessive hip flexion
what is the primary requirement of midstance?
stability
when is the COM of the highest?
midstance
what is the muscles activity at midstance?
gastrocs and soleus maintain ankle stability
knee is quite and relies on the gastrocs
glut med, min and TFL stabilize the pelvis in the frontal plane
adductors co-contract to stabilize
what is the primary activity at terminal stance and preswing?
concentric activity for propulsion
what is the primary contributor at terminal stance and preswing as the foot plantarflexes and resupinate?
gastrocs
what muscle works at terminal stance and preswing to stabilize the navicular during PF onto the toes?
tib post
what is the primary task of initial swing?
acceleration for limb advancement
task and shortening of the limb
what is the primary task of terminal swing?
deceleration in preparation for IC
are more muscles working during swing or stance?
stance
in the first half of swing, what is the activity of the muscles?
the muscles act as accelerators concentrically working
what muscles are working concentrically in the first half of swing?
illiospoas, rectus fem, and tib ant
in the second half of swing, what is the activity of the muscles?
the muscles act as decelerators eccentrically working
what muscles are working concentrically in the first half of swing?
glut max, hamstrings at the hip, quads co-contract with IC to lengthen step in preparation for IC
when are the hip flexors most active?
in late stance to early swing
what is the fxn of the hip flexors?
accelerate and advance the limb to clear the limb
how do the hip extensors act during terminal swing?
eccentrically to decelerate the limb
how to the hip extensors act during IC?
concentrically to stabilize the trunk and pelvis
when is the glut max most active?
during the loading phase of the hip and decelerating hip adduction for limb stabilization
what is the fxn of the hip abductors?
pelvis stabilization in the frontal plane in unilateral stance
when is the only time the glut med in inactive?
terminal stance
when are the 2 peaks in hip adductor activity?
early and late stance
are the hip adductors more or less active with increased velocity?
more active
when are the knee extensors most active?
terminal swing to 15% of stance eccentrically
what is the fxn of knee extensors?
shock absorption and preventing knee buckling
when is the most quad activity?
in preswing from the rectus fem
when are the knee flexors active?
late mid-swing
co-contract at IC with the quads to stabilize the knee and glut max to extend the hip
what are the ankle DFers?
tib ant, extensor hallicus, digitorum
when are the ankle DFers active?
isometrically throughout swing holding the foot in neutral
when does PF activity begin?
during loading response controlling the tibia over the talus
when is there peak activity of the PFers?
at terminal stance when you’re about to push off
what is the fxn of the peroneals?
stabilize the foot arches and assists in rigid lever preswing
facilitate movement of the COM
what is the fxn of the intrinsics of the foot?
assist supporting the foot in rigid level role, supporting the plantar fascia
when are the intrinsics of the foot activated?
during the last half of stance phase
what is the fxn of UE reciprocal arm swing in gait?
stabilizes the body and minimizes the lat motion of the COM
t/f: with less arm swing, gait is less energy efficient
true
t/f: arm swing keeps the gravity low and momentum moving forward
true
as the arm swings back, what muscles are contracting eccentrically?
post/mid delt, lats, teres major
are flexors of the arm working in arm swing?
no, flexion is from the momentum passively reacting to the stretch pulling back
what is the fxn of the trunk during gait?
minimize head movement so the eyes have a stable platform
t/f: trunk minimizes the movement of the COM
true
what muscles are working in the trunk to counteract torque?
erector spinae, quad lumborum
t/f: there is increased abdominal activity with increased velocity
true
t/f: obliques are active at all speeds
true
how much sagittal plane trunk motion is there?
only about 2-5 degrees
what factors of gait reduce the downward displacement of the COM?
transverse plane pelvic rotation
sagittal plane ankle motion
what factors of gait reduce the upward displacement of COM?
stance phase knee flexion
frontal plane pelvic motion
what are the phases of running gait?
IC, midstance, take off, swing, midswing, terminal swing
t/f: there is no double support in running gait
true
running gait is more of a ____ movement than walking
bouncing
running gait has ___ swing, and ____ stance
longer, shorter
t/f: running gait required greater ROM of all jts
true
what three factors of gait increase in running gait?
velocity, cadence, and step length
are the GRFs increased in walking or running gait?
running gait
is more concentric or eccentric activity required for running gait?
eccentric
is the COM higher or lower in running gait?
lower
what are the 2 phases of running stance?
absorption, propulsion
what are the 2 phases of running swing?
initial, terminal
when is there double float in running gait?
at the beginning of initial swing and end of terminal swing when neither limb is in contact with the floor
what is the absorption phase of stance in running gait?
IC to midstance
lateral heel is in slight supination to quick foot flat
what is the propulsion phase of stance in running gait?
at midstance the COM moves over the WB foot while opposite swings
the heel leaves the ground and initiates propulsion
once the foot leaves the ground, the first double float phase begins
what is the initial swing phase of running swing?
1st half of swing is 1st double float
2nd half of swing, contra limb contacts the ground and swing limb accelerates from momentum
what is the terminal swing phase of running swing?
acceleration to deceleration
2nd double float phase
what are the characterisitics of gait with increased speed?
lowered COM
longer stride
faster cadence
decreased time in stance
longer time in swing
increased ROM requirements of all jts
faster cadence, more trunk lean
hip can have >80 deg flexion in sprinting
IC on toes in sprinting
what is the main force element required to produce forward propulsion in running?
POWER
when are the hip extensors active in running?
late swing and early stance
when are the hip flexors active in running?
after toe off (preswing)
when are the quads, glut med, and PFers active in running?
throughout stance
what is the role of hip abductors in running?
stabilizing the pelvis and some shift
from IC to preswing, what muscles are active?
gmax, HS, quads, PFers
there is an absorption of energy during ____ activity then a release of power ____
eccentrically, concentrically
what two muscles are always active in running?
hip adductors and tib ant
when does independent walking usually begin?
11-15 months old
what are the characteristics of immature gait?
arms in “on guard” position
wide BOS
quick cadence
small steps
limited pelvic motion
ER/outtoeing
limited knee flexion
foot flat
what are the characteristics of mature walking?
stability in stance
sufficient foot clearance in swing
pre-positioning of the foot during swing for IC
adequate step length
efficient energy expenditure
when does mature walking usually begin?
7 yo
what are the gait changes in older adults?
decreased vertical movement
decreased arm swing
decreased velocity
increased stance time and double limb support
decreased swing time
why may there be compensations in gait?
excessive displacemet of COG
higher intensities for prolonged periods of time
t/f: in gait compensations more muscles are recruited to help out
true
what are the neg consequences of gait compensations?
fatigue, jt dysfxn, pain, DJD
what happens when there are flexion weaknesses during gait?
IC occurs at the midfoot if ext is limited
shortened stride length
if the knee doesn’t reach full ext at midstance, the COM remains lower throughout the gait cycle
what are the effects of an AD on gait?
upper extremities must hold onto the device so there is no arm swing
more energy requirements
greater cognitive demands (walking becomes a more conscious activity)
