Gait #2

Question 1

What occurs in sagittal plane at foot and ankle at initial contact?

Answer 1

Neutral to slight plantar flexion

-Heel rocker (1st) is initiated

Question 2

What occurs in sagittal plane at foot and ankle at Loading response?

Answer 2

rapid plantarflexion to get foot flat on floor

Question 3

What occurs in sagittal plane at foot and ankle at midstance to terminal stance?

Answer 3

time of closed chain dorsiflexion to about 10°, MTP extension to 30°
◦ Ankle Rocker
◦ Forefoot Rocker

Question 4

What occurs in sagittal plane at foot and ankle at preswing?

Answer 4

Transition from time of max dorsiflexed position toward max plantarflexed position
◦ Max MTP extension to 60°
◦ Heel Lift off

Question 5

What occurs in sagittal plane at foot and ankle at initial swing?

Answer 5

Dorsiflexion to about 5° of plantarflexion

Question 6

What occurs in sagittal plane at foot and ankle at midswing to terminal swing?

Answer 6

Dorsiflexion to neutral, prepare for heel strike

Question 7

Critical events of ankle at different phases of gait (IC, LR, MSt, TSt, PSw, MSw)

Answer 7

IC: Heel first contact
 LR: Ankle PF
 MSt: Controlled tibial advancement
 TSt: Controlled ankle DF with heel rise
 PSw: Ankle PF
 MSw: Foot clearance

Question 8

Describe heel rocker (1st rocker):

Answer 8

Motion of the foot from a dorsiflexed to plantarflexed position during LR to achieve foot flat (caused by ground reaction force vector posterior to ankle joint)

Question 9

Describe ankle rocker (2nd rocker):

Answer 9

Closed chain advancement of the tibia into a dorsiflexed position over a fixed foot during MSt

Question 10

Describe forefoot rocker (3rd rocker):

Answer 10

(also called winless mechanism) Begins when center of pressure is over the mets and heel lift occurs in TSt/PSw (ends as soon as toe leaves floor)

Question 11

What do rockers allow for?

Answer 11

Smooth and efficient gate

Question 12

What occurs at the knee in the sagittal plane during IC?

Answer 12

neutral to 5 flexion

Question 13

What occurs at the knee in the sagittal plane during LR?

Answer 13

Flexing to 15

-shock absorption

Question 14

What occurs at the knee in the sagittal plane during MSt -> TSt?

Answer 14

extension back to 5 flex/neutral

Question 15

What occurs at the knee in the sagittal plane during PSw?

Answer 15

rapid flexion to 40

Question 16

What occurs at the knee in the sagittal plane during ISw?

Answer 16

more flexion to 60

-limb clearance

Question 17

What occurs at the knee in the sagittal plane during MSw?

Answer 17

rapid extension to 25 flexion

-step length

Question 18

What occurs at the knee in the sagittal plane during TSw?

Answer 18

further extension to 5/neutral

Question 19

List critical events of knee during different phases of gait (LR, PSw, ISw, TSw):

Answer 19

LR: Controlled knee flexion (we will buckle and fall if 
      not controlled)
PSw: Passive knee flexion
ISw: Knee flexion
TSw: Knee extension

Question 20

What occurs at the hip in the sagittal plane during IC

-> LR?

Answer 20

20 leftover flexion (passive position)

Question 21

What occurs at the hip in the sagittal plane during MSt?

Answer 21

extension into neutral hip position as the body progresses forward

Question 22

What occurs at the hip in the sagittal plane during TSt?

Answer 22

max 20 hip extension occurs

-body past foot

Question 23

What occurs at the hip in the sagittal plane during PSw?

Answer 23

Flexion to about 10° of hip extension

◦ Reversal from extension to flexion

Question 24

What occurs at the hip in the sagittal plane during ISw?

Answer 24

Continued flexion to 15

Question 25

What occurs at the hip in the sagittal plane during MSw -> TSw?

Answer 25

continued flexion to 25-30

Question 26

Critical events at the hip (LR, ISw, MSw):

Answer 26

LR: Hip stability ISw: Hip flexion MSw: Hip flexion

Question 27

What are the ROM of the hip and why are they needed? (Flex/ext)

Answer 27

Hip (~40°) 1. Flexion: 25° - Step length (TSw) 2. Extension :20° - Trailing limb (TSt)

Question 28

What are the ROM of the knee and why are they needed? (Flex/ext)

Answer 28

Knee (~60°) 1. Flexion: 60° - Foot clearance (ISw) 2. Extension: 0° - Step length (TSw/IC)

Question 29

What are the ROM of the ankle and why are they needed? (Flex/ext)

Answer 29

Ankle (~30°) 1. Plantarflexion: 20° - Toe off (PSw) 2. Dorsiflexion: 10° - Tibial Advancement (TSt)

Question 30

CoM is lowest at midpoint of both periods of what?

Answer 30

Double-limb support (5% and 55%)

Question 31

CoM is highest at midpoint of what periods?

Answer 31

Both periods of single limb support (30% and 80%)

Question 32

What occurs in frontal plane at foot and ankle at initial contact?

Answer 32

Slight inversion of the hindfoot

Question 33

What occurs in frontal plane at foot and ankle at LR - MSt?

Answer 33

eversion of the hindfoot ◦ Pronation (flexible foot position for foot to adapt to surface and load) ◦ Forefoot follows hindfoot position

Question 34

What occurs in frontal plane at foot and ankle at TSt - PSw?

Answer 34

Inversion | ◦ Resupination! (rigid lever for stable base)

Question 35

What occurs in frontal plane at foot and ankle at swing phase?

Answer 35

Variable

Question 36

What occurs in frontal plane at knee during gait?

Answer 36

Not much movement with normal gait | ◦ Total movement around 5-10°

Question 37

What occurs in the frontal plane at the hip and pelvis during IC?

Answer 37

neutral ab/duction

Question 38

What occurs in the frontal plane at the hip and pelvis during LR - MSt?

Answer 38

adduction during weight acceptance | ◦ Contralateral hip drop

Question 39

What occurs in the frontal plane at the hip and pelvis during MSt-TSt?

Answer 39

``` increased adduction (up to 15°) ◦ Weight shift over stance limb ```

Question 40

What occurs in horizontal plane at hip during gait?

Answer 40

o Forward rotation of the pelvis on the stance limb occurs with hip flexion during swing o Increases greater step length than that of hip flexion alone

Question 41

What occurs in horizontal plane at trunk during gait?

Answer 41

o Opposite rotation from pelvic motion | o Total excursion 7º - 9º

Question 42

What occurs in horizontal plane at shoulder during gait?

Answer 42

o Opposite sagittal plane motion from ipsilateral hip o Partially active, particularly shoulder extension o Balances rotational forces of the trunk

Question 43

Maximal horizontal shift to R occurs at what phase of gait? (R leg reference)

Answer 43

the end of midstance (30%)

Question 44

Maximal horizontal shift to L occurs at what phase of gait? (R leg reference)

Answer 44

during midswing (80%) of the R leg

Question 45

``` Gait deviation: Decrease Great toe extension What phase? What plane? What would you observe? What could be cause? What would result be? ```

Answer 45

* Phase: TSt, PSw * Plane: Sagittal * Observation: Patient does not complete forefoot rocker and ends stance phase noticeably early * Cause: Joint hypomobility (hallux rigidus), pain, bone spur, gouty arthritis, plantar fasciitis * Result: decreased push off, shortened stance time

Question 46

``` Gait deviation: Steppage Gait/Increased Knee Flexion What phase? What plane? What would you observe? What could be cause? What would result be? ```

Answer 46

* Phase: Swing phase * Plane: Sagittal * Observation: Increased hip and knee flexion with loss of ankle DF * Causes: foot drop/nerve disorder, polyneuropathy, equinus deformity * Result: prolonged swing phase, fall risk, decreased efficiency

Question 47

``` Gait deviation: Foot Flat Contact What phase? What plane? What would you observe? What could be cause? What would result be? ```

Answer 47

* Phase: IC * Plane: Sagittal * Observation: mid foot or forefoot makes first contact with ground instead of heel * Cause: Excessive knee flexion in late swing, weak/impaired DF * Result: absent heel rocker (can have normal ankle rocker)

Question 48

``` Gait deviation: Circumduction What phase? What plane? What would you observe? What could be cause? What would result be? ```

Answer 48

* Phase: Swing * Plane: Frontal * Observation: lateral whipping motion of the limb during swing at the hip * Cause: impaired knee flexion ROM, impaired ankle DF ROM * Result: Compensation for failure to functionally shorten the limb during swing, increased fall risk

Question 49

``` Gait deviation: Increased lumbar lordosis What phase? What plane? What would you observe? What could be cause? What would result be? ```

Answer 49

* Phase: TSt * Plane: Sagittal * Observation: increased lumbar lordosis during late stance phase * Cause: Hip flexor contracture, Hip OA * Result: Lack of hip extension in terminal stance is compensated for by increased lordosis in the spine