Gait Flashcards
What is active at initial contact?
quads
What do quads do at initial contact?
control knee flexion
What do the pretibial muscles do at initial contact?
work eccentrically to prevent foot slap
What is active during the loading response?
gastrco and soleus from foot flat to midstance
What do gastrco and soleus control during loading response?
Eccentrically control forward tibial advancement
What do hip, knee and ankle extensors do during midstance?
oppose antigravity forces and stabilize the limb
What do hip extensors do during midstance?
control forward motion of the trunk
What do hip abductors do during midstance?
stabilize pelvis during unilateral stance
What do plantarflexors do during midstance?
propel the body forward
What is at peak activity during terminal stance?
plantarflexors (forward propulsion of the body)
What contributes to forward propulsion of the body during preswing?
hip and knee extensors (hams and quads): brief burst of activity
What is active during initial swing?
quad
hip flexors
What do quads do during initial swing?
forward acceleration of the limb
What do hip flexors (iliopsoas) do during initial swing?
aid in forward limb propulsion
When are quads silent/ and why?
midswing: pendular motion is in effect
How is foot clearance achieved in midswing?
contraction of hip and knee flexors and ankle dorsiflexors
What do hamstrings do in terminal swing?
decelerate limb in preparation for heel strike
What do quads and ankle dorsiflexors do in late swing?
become active to prepare for heel strike
Trunk, Pelvis and Hip Deviations during Stance Phase:
Lateral Trunk Bending Trendelenburg Gait Backward Trunk Lean Forward Trunk Lean Excessive Hip Flexion Limited Hip Extension Limited Hip Flexion Antalgic Gait
What is lateral trunk bending a result of?
gluteus medius weakness
In lateral trunk bending, what side does the bending occur?
ipsilateral (same side) of weakness
What other muscles can affect a lateral trunk bend?
hip pain
IT band/ soleus tightness
What side does the pelvis drop in a trendelenburg gait?
contralateral side of glut med weakness
contralateral pelvis drop
What is a compensatory strategy seen in tredelenburg gait?
ipsilateral trunk lean
What is a backward trunk lean a result of?
weak gluteus maximus
limited hip flexion
What is difficult for a patient with a backward trunk lean?
up stairs and/or ramps
What is a forward trunk lean a result of?
weak quads
May also be associated with hip and knee flexion contractures
What does a forward trunk lean do?
decreases the flexor moment at the knee
What is excessive hip flexion a result of?
weak hip extensors or tight hip and /or knee flexors
What is limited hip extension a result of?
tight or spastic hip flexors
What is limited hip flexion a result of?
weak hip flexors or tight extensors
What is antalgic gait?
painful gait
What does abbreviated stance time on painful limb result in with antalgic gait?
uneven gait pattern(limping)
In an antalgic gait, why does the uninvolved limb have a shortened step length?
since it must bear weight sooner than normal
Knee Stance Phase Deviations:
Excessive knee flexion
Hyperextension
What is excessive knee flexion a result of?
weak quadriceps ( the knee wobbles or buckles) or knee flexor contracture
What is difficult for a patient with excessive knee flexion?
going down stairs or ramps
What is a compensation for weak quads?
forward trunk bending
What is hyperextension a result of?
weak quadriceps, plantarflexion contracture or extensor spasticity ( quadriceps and/or plantarflexors)
Foot/Ankle Stance Phase Deviations
Toes first Foot slap Foot flat Excessive dorsiflexion with uncontrolled motion of tibia Excessive plantarflexion Varus foot Claw toes Inadequate push off
What is toes first a result of?
weak dorsiflexors, spastic or tight plantarflexors shorted LE ( leg length discrepancy), painful heel, or a positive support reflex
What is foot slap a result of?
weak dorsiflexors or hypotonia
How is foot slap compensated?
with a steppage gait
What is foot flat a result of?
weak dorsiflexors, limited range of motion, or immature gait pattern
What is Excessive Dorsiflexion with Uncontrolled Forward Motion of the Tibia a result of?
weak plantarflexors
What is excessive plantarflexion a result of?
result of spasticity or contracture of the plantarflexors
Eccentric contraction is poor, as in tibia advancement
What is a varus foot?
At foot contact, the lateral side of the foot touches first
The foot may remain in varus throughout the stance phase
What is varus foot a result of?
spastic toe flexors, possibly a plantar grasp reflex
What is claw toes a result of?
spastic toe flexors, possibly a plantar grasp reflex
What is inadequate push off a result of?
weak plantarflexors, decreased range of motion or pain in the forefoot
Trunk, Pelvis and Hip Swing Phase Deviations
Insufficient forward pelvic rotation
Insufficient hip and knee flexion
Circumducted gait
Hip hiking
Excessive hip and knee flexion
Abnormal synergistic activity or spasticity
Decreased amplitude in trunk and pelvis rotation
What is insufficient forward pelvic rotation?
pelvic retraction
What is insufficient forward pelvic rotation a result of?
weak abdominal muscles and/or weak hip flexor muscles
What is insufficient hip and knee flexion a result of?
weak hip and knee flexors or strong extensor spasticity
What does insufficient hip and knee flexion result in?
inability to lift the LE and move it forward
What is circumducted gait?
LE swings out to the side (abduction/external rotation followed by adduction/internal rotation)
What is circumducted gait a result of?
Result of weak hip and knee flexors
What muscle is acting in hip hiking?
QL action
What is hip hiking a compensatory response for?
weak hip and knee flexors, or extensor spasticity
What is excessive hip and knee flexion?
steppage gait
What is excessive hip and knee flexion compensatory response to?
shortened contralateral lower limb
What can excessive hip and knee flexion also be a result of?
same side dorsiflexor weakness ( resulting from neuritis of the peroneal nerve in patients with diabetes)
Abnormal Synergistic activity or Spasticity:
strong flexor synergy pattern
strong extension synergy patter
stroke patient
Strong flexor synergy pattern:
excessive abduction with hip and knee flexion
Strong extension synergy pattern:
excessive adduction with hip and knee extension and ankle plantarflexion ( scissoring)
Decreased Amplitude in Trunk and Pelvic Rotation
Seen in the elderly and characteristic of several known neurological disorders ( patient with CVA or Parkinson’s)
Knee Swing Phase Gait Deviations:
insufficient knee flexion
excessive knee flexion
What is insufficient knee flexion a result of?
extensor spasticity, pain, decreased range of motion, or weak hamstrings
What is excessive knee flexion a result of?
flexor spasticity; flexor withdrawal reflex
Foot/Ankle Swing Phase Gait Deviations:
foot drop
varus or inverted foot
equinovarus
What is foot drop a result of?
weak or delayed contraction of the dorsiflexors or spastic plantarflexors
What is varus or inverted foot a result of?
spastic invertors ( anterior tibialis), weak peroneals, or an abnormal synergistic pattern
What is equinovarus a result of?
spasticity of the posterior tibialis and/or gastrocnemius/soleus, or structural deformity ( club foot)
step length:
distance from point of heel strike of one extremity to heel strike of opposite extremity
stride length:
distance from point of heel strike of one extremity to point of heel strike of same extremity
