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Gait Flashcards

1
Q

Human locomotion compromises compared to primate?

A
  1. Spine
    - curved (kyphosis, lordosis)
    - weak points
  2. Pelvis
    - squashed down to bear weight
  3. Foot
    - made for walking
    - combines hallux into toes
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2
Q

Key requirements for locomotion?

A
  1. Control
    - stability
    - clearance
    - prepositioning
  2. Periodicity
    - control step length
    - cadence (rate of steps)
  3. Propulsion (force)
    - ground reaction forces
    - up and forward, more force going forward
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3
Q

Stride vs step length?

A
  • Stride: 2 steps
  • Step: 1 step (38 cm)
  • step width: heel to heel
  • cadence: steps/time
  • velocity: cadence plus stride length (3 mph)
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4
Q

Center of gravity?

A

5cm anterior to 2nd sacral vertebrae

-below umbilicus

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5
Q

Traditional nomenclature of gait?

A
  1. Heel strike
  2. Foot flat
  3. Midstance
  4. Heel off
  5. Toe off
  6. Acceleration
  7. Midswing
  8. Deceleration
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6
Q

RLA nomenclature of gait?

A
  1. Initial contact
  2. Loading response
  3. Midstance
  4. Terminal stance
  5. Preswing
  6. Initial swing
  7. Midswing
  8. Terminal swing
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7
Q
  1. Heel strike/Initial contact?
A
  1. Lower forefoot: ankle dorsiflexors (eccentric)
  2. Decelerate: Hip extensors (concentric)
  3. Maintain arch: intrinsic muscles and long tendons of foot
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8
Q
  1. Flat foot/Loading response?
A
  1. Accept weight: Knee extensors (eccentric)
  2. Decelerate: Ankle plantar flexors (eccentric)
  3. Stabilize pelvis: Hip Abductors (eccentric)
  4. Maintain arch: intrinsic muscles and long tendons of foot
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9
Q
  1. Midstance?
A
  1. Stabilize knee: Knee extensors (eccentric)
  2. Control Dorsiflexion: Ankle Plantarflexors (eccentric)
  3. Stabilize pelvis: Hip abductors (eccentric)
  4. Maintain arch: intrinsic muscles and long tendons of foot
    - start to generate force
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10
Q
  1. Heel off/terminal stance?
A
  1. Accelerate mass: ankle plantar flexors (concentric)
  2. Stabilize pelvis: Hip abductors (eccentric)
  3. Maintain arch: intrinsic muscles and long tendons of foot
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11
Q
  1. Toe off/preswing?
A
  1. Accelerate mass: long flexor of digits and intrinsic muscles of foot (concentric)
  2. Decelerate thigh: Hip flexors (eccentric)
  3. Maintain arch: long tendons of foot
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12
Q
  1. Acceleration/initial swing?
A
  1. Accelerate thigh: Hip flexors (concentric)

2. Clear foot: ankle dorsiflexors (concentric)

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13
Q
  1. Midswing?
A
  1. Clear foot: ankle dorsiflexors and knee flexors (concentric)
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14
Q
  1. Deceleration/terminal swing?
A
  1. Decelerate thigh: Hip extensors (eccentric)
  2. Decelerate leg: knee flexors (eccentric)
  3. Position foot: ankle dorsiflexors (concentric)
  4. Extend knee: knee extensors (concentric)
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15
Q

Two theories of gait?

A
  1. Six determinants of Gait

2. Inverted pendulum

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16
Q

Six determinants of gait theory?

A
  1. Pelvic rotation
  2. Pelvic tilt
  3. Stance knee flexion
  4. Foot mechanisms
  5. Knee mechanisms
  6. Lateral displacement of pelvis
    - most efficient form of locomotion is with minimized movement of center of mass
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17
Q

Pelvic rotation?

A
  • rotation of the pelvis to the right and left of body axis
  • rotates 4-6 degrees in either direction
  • lengthens both limbs
  • keeps center of mass from dropping
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18
Q

Pelvic tilt?

A
  • rotation of pelvis around either a horizontal axis
  • pelvis rotates 4-5 degrees on swing side
  • lowers center of mass at mid stance
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19
Q

Stance knee flexion?

A
  • knee flexion at mid stance (15 degrees)
  • lowers center of mass
  • combines with pelvic tilt and rotation to reduce vertical displacement of center of mass
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20
Q

Foot and ankle mechanism?

A
  1. at initial contact:
    - ankle plantar flexion
  2. at preswing:
    - ankle elevated (dorsiflexion)
  • smooths passage of center of mass during stance
  • COM higher at points where legs farther apart
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21
Q

Knee mechanisms?

A
  1. associated with foot and ankle:
    - an ankle approaches surface, knee extends
  2. at initial contact:
    - knee extended
  3. during mid stance:
    - knee flexes
  4. at preswing:
    - knee extends

-smooths passage of COM during stance

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22
Q

Lateral pelvic displacement?

A

COM shifted toward stance limb

  • keeps COM over stance foot
  • deviation of COM from base of support requires energy to correct
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23
Q

Inverted pendulum theory?

A
  • inherently unstable, must be actively balanced
  • work expected to elevate center of mass recaptured on decline
  • transition to opposite leg requires movement in coronal plane
  • negative vs positive work
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24
Q

Difference between walking and running?

A
  • flight: double support time lost

- time where neither foot is on ground

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25
Bare feet vs shod while running?
1. provide support and shock absorption with heel strike | 2. minimal difference if running by forefoot strike
26
Comparison of females to males in gait?
1. greater cadence 2. shorter step length 3. narrower step width 4. knee joint valgus 5. pelvis tilted more anterior 6. smaller joint motions 7. sagittal plane hip flexion greater 8. lower swing knee flexion
27
How is pathological gait classified?
1. disease oriented | 2. deficit oriented
28
Disease oriented gait categories?
1. Deformity 2. Muscle weakness 3. Pain 4. Sensory loss 5. Impaired motor control
29
Congenital disorders in children?
1. Developmental defects - torsional profile - anteversion/retroversion - varus/valgus 2. Disease - rickets 3. Injuries/surgery
30
Aged abnormal joint contours a result of?
- disease - degeneration - pain
31
Antalgic?
- posture or gait assumed to lessen pain | - caused by joint pressure
32
Intra-articular pressure increases with what?
- flexion and extension - causes pain - pain inhibits muscle function because body wants to minimize pain
33
Conctracture?
- stiffening of fibrous tissue encompassing the joint capsule or fibrous sheath surrounding muscle - fibrous tissue composed of collagen (inelastic) and proteoglycan (lubricates collagen motion) - with inactivity, proteoglycan deteriorates and loses water, resulting in stiffness (changes within 2 weeks)
34
Two types of contracture?
1. Elastic - yields under body weight to allow near normal function 2. Rigid - obstructs motion in both stance and swing
35
Equinas gait?
weak ankle dorsiflexors, plantar flexor contracture or spasticity
36
What causes muscle atrophy?
-disuse common forms: - limb immobilization - spacefight - bed rest - diaphragm unloading
37
Ataxic gait?
- loss of ability to coordinate muscular movement | - impaired proprioception causes sensory ataxia
38
Impaired selective control?
- selective control required for smooth gait (simultaneous action of knee extensors and ankle dorsiflexors during loading) - impaired control results in muscle weakness - loss of selective control related to loss of inhibition and release of primitive flexor/extensor patterns
39
Primitive control?
- basic reflex responses - simplify function - used when infant
40
Emergence of primitive control?
-occur when suppressive pathways are damaged
41
Two levels of primitive control?
1. postural stretch reflex | 2. locomotor synergies
42
Hypotonia?
muscle weakness
43
Upper motor neuron disease?
- stroke - MS - tumors - spinal cord injury
44
Lower motor neuron disease?
- Amyotrophic Lateral Sclerosis (Lou Gehrig) | - Peripheral Neuropathies (degernation of myelin sheath)
45
Trendelenberg gait?
- excessive trunk lateral flexion | - caused by ipsilateral Gluteus Medius weakness and hip pain
46
Spastic gait or scissors?
- caused by increased muscle contraction of limbs - individual drags leg if on one side or waddle if on both - cause: Cerebral Palsy (spasticity)
47
Foot slap?
- moderately weak dorsiflexors | - initial contact and loading response problem
48
Genu recurvatum?
- hyperextension of knee joint - Quads weakness - achilles tendon contracture - plantar flexor spasticity - initial contact to mid stance
49
Pes cavus?
high arch
50
Pes planus?
flat foot
51
Valgus forefoot?
- plantar aspect of forefoot is everted on frontal plane relative to plantar aspect of rear foot (pronation) - initial contact to mid stance
52
Varus forefoot?
- plantar aspect of forefoot is inverted on frontal plane relative to plantar aspect of rear foot (supination) - initial contact to mid stance
53
Excessive foot supination?
- caused by compensated forefoot valgus deformity - pes cavus - short limb - external rotation or tibia or femur - initial contact to mid stance
54
Excessive foot pronation?
- caused by compensated forefoot or rear foot varus deformity - pes planus - long limb - internal rotation of tibia or femur - weak tibialis posterior - initial contact to mid stance
55
Excessive femoral medial rotation?
- tight medial hamstrings - anteverted femoral shaft - weakness of opposing muscle group - toes and knees inward - initial contact to preswing
56
Excessive femoral lateral rotation?
- tight hamstrings - retroverted femoral shaft - weakness of opposite muscle group - toes and knees outward - initial contact to preswing
57
Normal angles of ante version?
- males: 8 degrees | - females: 14 degrees
58
Increased base of support pathology?
- genu valgum - knock knees - legs are curved inward - increased base of support - abductor muscle contracture - instability - leg length discrepancy - initial contact to preswing
59
Decreased base of support pathology?
- genu varum - bow legged - outward curve of legs - adductor muscle contracture - initial contact to preswing
60
Insufficient push off pathology?
- gastroc soleus weakness - achilles tendon rupture - metatarsalgia - hallus rigidus - midstance to preswing
61
Hallus rigidus?
- big toe won't bend | - midstance to preswing
62
Metatarsalgia?
- forefoot pain | - midstance to preswing
63
Foot drop, high stoppage gait pathology?
- severely weak dorsiflexors - equinus deformity - plantar flexor spasticity - swing phase - surgery: attach plantaris to top of foot
64
Circumduction pathology?
- long limb - abductor muscle shortening or overuse - dorsiflexor weakness - last 4 stages of gait

SPOM (17 decks)

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