Gait Flashcards
Bipedal locomotion
Alternating stance and swing phase
Gait
total body movement that is a combination of phases of both legs
What are the phases of gait?
stance phase
swing phase
Stance phase
From heel strike to push off of one foot
double leg support, single support, and double support with 60% on single leg support
HS, FF, MS, HO, TO
Swing phase
From toe off to touchdown of same foot
Initial and mid swing
Terminal swing
What are the periods of gait?
Two periods of double support (20% of gait cycle)
Two periods of single support (80% of gait cycle)
Inverted pendulum
Single foot on ground for 60% of gait cycle
Exchange of potential and kinetic energy
Takes advantage of momentum
Determinants of gait
Minimize shifts in center of mass —> decrease cost of walking
What is the center of mass shift?
sinusoidal
When are hip abductors important?
Stance phase
Loading response (flat foot)
Midstance
Terminal stance (heel off)
Pelvic tilt
hip adductors prevent hip drop
Knee flexion
decreases vault distance
Pelvic rotation
increases stride length and limits COM shift
Valgus knee
base of support under COM
The knee is naturally in
valgus or “knocked knee”
COM
center of mass
What happens during pelvic tilt?
Gluteus medius and minimus:
Contract during single support to maintain pelvis level
Superior gluteal n.
Positive Trendelenburg sign
What happens during knee flexion?
Knee is flexed in stance phase, decreasing vertical displacement in COM
What is the importance of the Q angle? What does it tell us?
Stresses within the patellarfemoral joint
How big is the angle coming into the knee?
What are the anti-gravity muscles?
erector spinal muscles
plantar flexor muscles
iliopsoas muscles
Gluteal muscles
Where should the center of mass be?
Between the center of the feet
Foot drop
injury to common fibular nerve which leads to loss of dorsiflexion
Someone with foot drop would have the following trouble
Falling up the stairs
What is the function of the arch of the foot?
Aids in propulsion and acts as a springboard
Explain the arch of the foot
Longitudinal: Medial (higher) and lateral parts act as a unit
What is the arch maintained by?
Maintained by passive (shape of bones, ligaments, fibrous tissue) and dynamic (muscle contraction) forces
Common arch types
Normal
High Arch
Flat feet (more common)
Pes planus (flat feet)
Fallen arches
Plantar calcaneonavicular ligament fails to support head of talus ! displaces inferiorly
Pes planus (flat feet) is likely due to
tibialis posterior dysfunction
Hallux valgus
lateral deviation of hallux towards 2nd digit
Causes bunion
(distal end of the joint away from midline)
Motor function in lower limbs can be affected by:
Peripheral neuropathy = nerve impairment
Lumbar foot nerve root lesions (related to disc disorders)
What causes peripheral neuropathy?
injury, infection/disease, autoimmune disorders, repetitive stress, diabetes mellitus, etc
Symptoms of lower limb lesion
paresthesia (numbness/tingling/pin-pricks), muscle wasting or weakness, paralysis
How to test muscle?
Strength: isolation testing against gravity/resistance Function
Tone
Muscularity: how developed? Atrophy (muscle wasting)? Hypertrophy? Muscle wasting can result from decreased innervation
Test sensory function of dermatomes
What is the most common gait?
Antalgic - pain
Hemiplegic gait
half paralysis “spastic”
stroke
brain injury
Diplegic gait
cerebral palsy
global neurological disorder
increased tone in both legs - usually lower extremity
Neuropathic gait
foot drop
lead poisoning, demyelination of the nerve, nerve compression
no dorsiflexion - stomping
“reports of dropping spoons, forks, plates, coffee cup)
Myopathic gait
glut medius
injury/compression to superior gluteal nerve (injury to piriformis)
can mimic sciatic nerve
positive Trandelenburg sign
Choreiform gait
Huntington’s Disease (caudate nucleus - basal ganglia)
hemiballistic movement
neurodegenerative diseases
Ataxic gait
Cerebellum - coordination of movement (most common)
CNS issue
Wide spaced gaits, unbalanced
Alcohol inhibits the cerebellum
Tremor occurs with movement (intention tremor)
Parkinsonian gait
Parkinson’s disease (degeneration in the substantia nigra)
Tremor is at rest
Shuffling gait - rigidity in the muscles because of increased tone
lead pipe rigidity (no movement), pill rolling tremor, cog wheel rigidity (movement)
Sensory gait
stomping gait
Malingering gait
fake gait
