Gait Flashcards
Human locomotion compromises compared to primate?
- Spine
- curved (kyphosis, lordosis)
- weak points - Pelvis
- squashed down to bear weight - Foot
- made for walking
- combines hallux into toes
Key requirements for locomotion?
- Control
- stability
- clearance
- prepositioning - Periodicity
- control step length
- cadence (rate of steps) - Propulsion (force)
- ground reaction forces
- up and forward, more force going forward
Stride vs step length?
- Stride: 2 steps
- Step: 1 step (38 cm)
- step width: heel to heel
- cadence: steps/time
- velocity: cadence plus stride length (3 mph)
Center of gravity?
5cm anterior to 2nd sacral vertebrae
-below umbilicus
Traditional nomenclature of gait?
- Heel strike
- Foot flat
- Midstance
- Heel off
- Toe off
- Acceleration
- Midswing
- Deceleration
RLA nomenclature of gait?
- Initial contact
- Loading response
- Midstance
- Terminal stance
- Preswing
- Initial swing
- Midswing
- Terminal swing
- Heel strike/Initial contact?
- Lower forefoot: ankle dorsiflexors (eccentric)
- Decelerate: Hip extensors (concentric)
- Maintain arch: intrinsic muscles and long tendons of foot
- Flat foot/Loading response?
- Accept weight: Knee extensors (eccentric)
- Decelerate: Ankle plantar flexors (eccentric)
- Stabilize pelvis: Hip Abductors (eccentric)
- Maintain arch: intrinsic muscles and long tendons of foot
- Midstance?
- Stabilize knee: Knee extensors (eccentric)
- Control Dorsiflexion: Ankle Plantarflexors (eccentric)
- Stabilize pelvis: Hip abductors (eccentric)
- Maintain arch: intrinsic muscles and long tendons of foot
- start to generate force
- Heel off/terminal stance?
- Accelerate mass: ankle plantar flexors (concentric)
- Stabilize pelvis: Hip abductors (eccentric)
- Maintain arch: intrinsic muscles and long tendons of foot
- Toe off/preswing?
- Accelerate mass: long flexor of digits and intrinsic muscles of foot (concentric)
- Decelerate thigh: Hip flexors (eccentric)
- Maintain arch: long tendons of foot
- Acceleration/initial swing?
- Accelerate thigh: Hip flexors (concentric)
2. Clear foot: ankle dorsiflexors (concentric)
- Midswing?
- Clear foot: ankle dorsiflexors and knee flexors (concentric)
- Deceleration/terminal swing?
- Decelerate thigh: Hip extensors (eccentric)
- Decelerate leg: knee flexors (eccentric)
- Position foot: ankle dorsiflexors (concentric)
- Extend knee: knee extensors (concentric)
Two theories of gait?
- Six determinants of Gait
2. Inverted pendulum
Six determinants of gait theory?
- Pelvic rotation
- Pelvic tilt
- Stance knee flexion
- Foot mechanisms
- Knee mechanisms
- Lateral displacement of pelvis
- most efficient form of locomotion is with minimized movement of center of mass
Pelvic rotation?
- 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
Pelvic tilt?
- rotation of pelvis around either a horizontal axis
- pelvis rotates 4-5 degrees on swing side
- lowers center of mass at mid stance
Stance knee flexion?
- 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
Foot and ankle mechanism?
- at initial contact:
- ankle plantar flexion - at preswing:
- ankle elevated (dorsiflexion)
- smooths passage of center of mass during stance
- COM higher at points where legs farther apart
Knee mechanisms?
- associated with foot and ankle:
- an ankle approaches surface, knee extends - at initial contact:
- knee extended - during mid stance:
- knee flexes - at preswing:
- knee extends
-smooths passage of COM during stance
Lateral pelvic displacement?
COM shifted toward stance limb
- keeps COM over stance foot
- deviation of COM from base of support requires energy to correct
Inverted pendulum theory?
- 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
Difference between walking and running?
- flight: double support time lost
- time where neither foot is on ground
Bare feet vs shod while running?
- provide support and shock absorption with heel strike
2. minimal difference if running by forefoot strike
Comparison of females to males in gait?
- greater cadence
- shorter step length
- narrower step width
- knee joint valgus
- pelvis tilted more anterior
- smaller joint motions
- sagittal plane hip flexion greater
- lower swing knee flexion
How is pathological gait classified?
- disease oriented
2. deficit oriented
Disease oriented gait categories?
- Deformity
- Muscle weakness
- Pain
- Sensory loss
- Impaired motor control
Congenital disorders in children?
- Developmental defects
- torsional profile
- anteversion/retroversion
- varus/valgus - Disease
- rickets - Injuries/surgery
Aged abnormal joint contours a result of?
- disease
- degeneration
- pain
Antalgic?
- posture or gait assumed to lessen pain
- caused by joint pressure
Intra-articular pressure increases with what?
- flexion and extension
- causes pain
- pain inhibits muscle function because body wants to minimize pain
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)
Two types of contracture?
- Elastic
- yields under body weight to allow near normal function - Rigid
- obstructs motion in both stance and swing
Equinas gait?
weak ankle dorsiflexors, plantar flexor contracture or spasticity
What causes muscle atrophy?
-disuse
common forms:
- limb immobilization
- spacefight
- bed rest
- diaphragm unloading
Ataxic gait?
- loss of ability to coordinate muscular movement
- impaired proprioception causes sensory ataxia
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
Primitive control?
- basic reflex responses
- simplify function
- used when infant
Emergence of primitive control?
-occur when suppressive pathways are damaged
Two levels of primitive control?
- postural stretch reflex
2. locomotor synergies
Hypotonia?
muscle weakness
Upper motor neuron disease?
- stroke
- MS
- tumors
- spinal cord injury
Lower motor neuron disease?
- Amyotrophic Lateral Sclerosis (Lou Gehrig)
- Peripheral Neuropathies (degernation of myelin sheath)
Trendelenberg gait?
- excessive trunk lateral flexion
- caused by ipsilateral Gluteus Medius weakness and hip pain
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)
Foot slap?
- moderately weak dorsiflexors
- initial contact and loading response problem
Genu recurvatum?
- hyperextension of knee joint
- Quads weakness
- achilles tendon contracture
- plantar flexor spasticity
- initial contact to mid stance
Pes cavus?
high arch
Pes planus?
flat foot
Valgus forefoot?
- plantar aspect of forefoot is everted on frontal plane relative to plantar aspect of rear foot (pronation)
- initial contact to mid stance
Varus forefoot?
- plantar aspect of forefoot is inverted on frontal plane relative to plantar aspect of rear foot (supination)
- initial contact to mid stance
Excessive foot supination?
- caused by compensated forefoot valgus deformity
- pes cavus
- short limb
- external rotation or tibia or femur
- initial contact to mid stance
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
Excessive femoral medial rotation?
- tight medial hamstrings
- anteverted femoral shaft
- weakness of opposing muscle group
- toes and knees inward
- initial contact to preswing
Excessive femoral lateral rotation?
- tight hamstrings
- retroverted femoral shaft
- weakness of opposite muscle group
- toes and knees outward
- initial contact to preswing
Normal angles of ante version?
- males: 8 degrees
- females: 14 degrees
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
Decreased base of support pathology?
- genu varum
- bow legged
- outward curve of legs
- adductor muscle contracture
- initial contact to preswing
Insufficient push off pathology?
- gastroc soleus weakness
- achilles tendon rupture
- metatarsalgia
- hallus rigidus
- midstance to preswing
Hallus rigidus?
- big toe won’t bend
- midstance to preswing
Metatarsalgia?
- forefoot pain
- midstance to preswing
Foot drop, high stoppage gait pathology?
- severely weak dorsiflexors
- equinus deformity
- plantar flexor spasticity
- swing phase
- surgery: attach plantaris to top of foot
Circumduction pathology?
- long limb
- abductor muscle shortening or overuse
- dorsiflexor weakness
- last 4 stages of gait