GAIT 2 Flashcards
1
Q
GRF
A
force applied to foot by during stance phase
1
Q
What causes internal moments/forces?
A
muscles/ligaments/joint capsules
these counteract external forces
2
Q
external moments (rotation around an axis)
A
created by gravity, inertia, GRF, in relation to joint center
3
Q
Power generation
A
muscles shortening (concentric contraction)
PUSH
4
Q
power absorption
A
muscles lengthening (eccentric contraction) CUSH
5
Q
How does center of pressure change through gait?
A
IC: posterior lateral heel
LR: through lateral midfoot
TS: medially across ball of foot
Pre-swing: 1 and 2nd toes
6
Q
internal moments in initial contact
A
Hip EXT, Knee FLX, Ankle DF
7
Q
Internal moments in laoding response
A
- Hip EXT, Knee EXT, Ankle DF
8
Q
Internal moments in midstance
A
Hip FLX, Knee FLX, Ankle PF
9
Q
internal moments in terminal stance
A
- Hip FLX, Knee FLX, Ankle PF
10
Q
internal moments in pre-swing
A
Hip FLX, Knee EXT, Ankle PF
11
Q
What is the goal of gait metabolically?
A
efficiency of gait to use as little energy as possible
12
Q
oxygen consumption of walking for 20-30 year olds
A
32%
13
Q
oxygen consumption for walking for 75 year olds or chronically medically ill
A
48%
14
Q
what increases oxygen consumption?
A
pain
15
Q
Other aspects of metabolic energy costs of gait
A
- Sum of potential energy and kinetic energy (translational and rotational)
- Limbs contribute more total energy than HAT
- Power generation and absorption – the balance of concentric and eccentric
forces produce movement of segments and also control speed of moment
16
Q
fulcrum is at the ___during initial contact to loading response
A
heel is rocker (calcaneal inversion to calcaneal eversion)
17
Q
fulcrum is at the ___during loading response to terminal stance
A
ankle is rocker
18
Q
Terminal Stance (heel off) with leg rotating over _____-
A
forefoot is rocker
* Increased MTP extension
19
Q
fulcrum is the ____ at preswing
A
toe (increased toe extension)
20
Q
adductor moment of head, arms and trunk is counteracted by hip ______
A
abductors (minimize movement at stance leg) *prevent contralateral hip drop
21
Q
- Slight trunk flexion at
A
initial contact
* HAT acceleration is counteracted by hip and back extensors
22
Q
slight trunk extension during
A
SLS
23
Q
Pelvic and trunk motion: sagittal plane
A
sinusoidal pattern up and down 4-5 cm with each step
24
step forward: ____rotation of pelvis
anterior rotation with IC
terminal stance/preswing-= posterior rotation
25
with IC, sinusoidal pattern is (low/high) and then (low/high) at midstance
low at IC, high at midstance
26
SLIDE 13
27
erector spinae are most active during
IC (heel strike) and preswing (toe off)
28
abdominal muscles are most active during
active low and variable, related to lateral trunk movement
29
What is postural righting?
dynamic process of re-alignment when changing postures
30
head stability is the process of
maintaining equilibrium orientation of head in space
31
Head stability controls orientation of
sensory receptors (vision, vestibular)
also facilitates gaze stability
32
head motion in sagittal plane is
7-12 degrees
33
arm swinging helps counterbalance ____ and _____body rotation
the swinging leg
decelerate body rotation
34
shoulder ROM during gait
30 deg total (6 deg FLX, 24 deg EXT)
35
elbow ROM during gait
20-45 degrees
36
SLIDE 19
37
Vertical work is _____ and related to _____during stair gait
increased vertical work
related to gravity and step/stair height
38
torque is greater at knee by _____for ascent and descent
3x
knee is more generative during ascent on stairs
39
IC contact on stairs will be more ___- and move ____-
anterior and move posterior
vs gait: posterior to anterior
40
most knee flexion is needed during what phase of stair gait
foot clearance (90-100 degrees)
41
most hip flexion is needed during ____
IC and foot placement (60 degrees)
42
During running, what happens at the knee during impact?
greater joint torque generated
43
GRFs at center of pressure during running
over 200% of body weight
44
SLIDE 24
45
what are some neuro changes with increased age that affects gait?
Brain mass decreased 10-20% by age 90
Degeneration of sensory receptors
Nerve conduction velocity - slowed
reaction time
* Visual acuity & depth perception
* Vestibular input
* Hearing loss
medications: understand what kind of meds they are on
46
MSK changes related to gait
muscle atrophy is __% loss per year in healthy adults
1%
47
estimated ___% loss of max strength by age ___ without exercise
20-40% loss of max strength by age 65
48
Is there a greater loss of type I or type II fibers?
type II fast twitch
atrophy of slow twitch type I too with inactivity
49
Do you lose postural extensors or flexors more with age?
extensors (let gravity hunch you over)
50
with each decade, there is a decrease in gait velocity by ___%
12-16%
51
There is less ____during swing phase for elders
less toe clearance
and dcreased dorsiflexion in double limb support
52
community functional benchmark: gait speed greater than
4 feet/sec
53
community functional benchmark: gait distance greater than
300 m (distance from parking to store or doc office)
54
community functional benchmark: curb height greater than ___ inches
8 inches
55
Gait can be a ____ sign to detect preclinical disability
vital
56
gait with rolling walker
speed
step length
more stance time, less swing time
slower speed 1.5 ft/s
smaller step length 1.1 ft
57
What can cause abnormal gait?
deformity (contracture, abnormal joint contours, congenital disorders)
-muscle weakness
-sensory loss
-pain
-impaired motor control
58
Trunk deviations: backward lean due to weak _________
hip extensors (WA/SLS): hanging on Ys
hip flexors during swing (SLA)
59
trunk deviations: foward lean
shifts LOG to
front of knee and ankle
60
forward lean could also be due to tight ____ or weak_____
tight hip flexors, increased plantar flexion
compensate for weak quads
61
other causes for trunk forward leans
increased visual cues for decreased proprioception
abdominal pain
ADs
62
counterbalance to lean what way if you have a weak hip abductor
lateral lean to the weak side
63
dissociation is
separation of trunk and pelvis (pelvis and trunk rotate in opp directions normally, but with abnormal gait, can have trunk moving with pelvis)
64
forward rotation of trunk may be compensation for
weak leg to advance limb
65
backward rotation of trunk can be compensation for
increased plantarflexion to clear toes
66
With hip hike to clear swinging limb (increased PF, not enough knee flexion making leg longer), pt will use what muscle
ipsilateral QL
67
vault pelvic deviation will be on
stance leg with addition of plantar flexion
68
anterior pelvic tilt due to
weak hip extensors
weak abdominals
tight anterior hip
all lead to tight paraspinals
69
posterior pelvic tilt due to
hip flexor weakness
hip extensor weakness
tight hamstrings
shifts LOG posteriorly (backward trunk lean)
70
lack of forward or backward pelvic rotation can be due to
back pain
surgical fusion
*will decrease step length
71
excessive forward pelvic rotation is due to
need to advance limb (weakness)
72
excessive backward pelvic rotation is due to
walk calf (no heel off in terminal stance)
excessive hip flexion (single leg stance)
73
pelvic drop will likely lead to ____ pain during stance
back
74
adductor spasticity during single leg advancement will cause
ipsilateral drop of pelvis
*contralateral drop during single leg stance
75
what are causes for pelvic drop?
weak calf
scoliosis
leg length discrepancy (shorter LE)
weak hip abductors
adductor spasticity
76
what can cause a hip drop
___hip____weakness
____adductor contracture/spasticity
_____abductor contracture
ipsilateral hip abduction weakness
ipsilateral adduction contracture
contralateral abductor contracture
*also scoliosis
77
decreased hip extension can be caused by
iliopsoas contracture
hip capsule contracture
decreased Knee extension
hip pain
78
early heel rise and/or increased DF may be increasing hip ____
hip flexion
79
hip ____ may be compensation for increased knee flexion/ankle dorsiflexion
or compensation for increased plantarflexion in midswing
80
hip flexion may be compensation /caused by
* HF contracture or spasticity
* IT band tightness/TFL
contracture
* Hip pain
* Compensatory for ↑KF and
ankle ↑DF (SLS)
* Compensatory for ↑PF in
MSw
81
what is past retract?
Voluntary excessive hip flexion & its
release in TSw to rapidly extend a
flaccid knee by using tibial inertia
82
SLIDE 49
83
Compensation for lack of DF may be
external rotation of hip (toes point out)
84
IR hip deviation due to:
* Anteversion
* Contracture/Spasticity of
IRs
* Voluntary to increase
knee stability during
stance if quads weak
* Medial HS spasticity
* ADDuctor spasticity
85
ER hip deviation due to:
Retroversion
* ER contracture
* weak IP
* Glut Max spasticity
* Compensation for PF
contracture
* Compensation for
reference limb too long in
swing
86
hip adduction deviation due to:
Hypertonicity/contracture
* Ipsi glut med weakness
leading to contralateral drop
* Compensation for weak hip
flexors
* Leg length discrepancy
87
hip abduction deviation due to
* Contracture
* long contralateral limb
* Scoliosis w/ pelvic
obliquity
88
Pt has leg length discrepancy. What deviations might you see to compensate?
think
89
decreased knee flexion deviation can be due to
Weak or spastic quads Knee pain
Extension contracture
Impaired proprioception
Hip flexor weakness (swing)
90
limited knee flexion in Loading response ____shock absorption
decreases normal shock absorption (stiff knee)
91
limited knee flexion in preswing makes ___harder
toe off
92
limited knee flexion during in initial swing ____the leg, resulting in _____
lengthens leg, toe drag
93
genu recurvatum (hyperextension) can be due to
weak quads
weak quads and plantar flexors
quad and/or plantar flexor spasticity
PF contracture
94
genu valgus could be from
* Joint or ligamentous
instability
* Bony deformity
* Pain
* Ipsi ABDuctor weakness
* Ipsi trunk lean
95
genu varus could be from
Joint or ligamentous
instability
* Bony deformity
* Degenerative joint
changes
* Pain
96
erector spinae most active during
loading response
