Gait Flashcards
Antalgic
a protective gait pattern where the involved step length is decreased in order to avoid WB on the involved side, usually secondary to pain
Ataxic
a gait pattern characterized by staggering and unsteadiness.
- there is usually a wide BOD and movements are exaggerated
Cerebellar gait
-staggering gait pattern seen in cerebellar disease
Circumduction gait
- a gait pattern characterized by circular motion to advance the leg during swing phase; this may be used to compensate for insufficient hip or knee flexion or DF
double step gait
- pattern in which alternate steps are of a different length or at different rate
equine gait
- pattern characterized by high steps; usually involves excessive activity of the gastrocnemius
festinating gait
- pattern where a patient walks on toes as though pushed. it starts slowly, increases and may continue until the patient grasps an object in order to stop
Hemiplegic gait
- pattern in which patients abduct the paralyzed limb, swing it around, and bring it forward so the foot comes to the ground in front of them
Parkinsonian gait
- pattern marked by increased forward flexion of the trunk and knees; gait is shuffling with quick and small steps; festinating may occur
scissor gait
- pattern in which the legs cross midline upon advancement
spastic gait
pattern with stiff movement, toes seeming to catch and drag, legs held together and hip and knee joints slightly flexed. Commonly seen in spastic paraplegia
steppage gait
-pattern in which the feet and toes are lifted through hip and knee flexion to excessive heights; usually secondary to DF weakness. the foot will slap at initial contact with the ground secondary to the decreased control
tabetic gait
- a high stepping ataxic gait pattern in which the feet slap the ground
trendelenburg gait
- pattern that denotes gluteus medius weakness; excessive lateral trunk flexion and weight shifting over the stance leg
vaulting gait
- pattern where the swing leg advances by compensating through the combination of elevation of the pelvis and PF of the stance leg
How much ROM do we need in hip flexion
0-30 degrees
How much ROM do we need in hip extension
0-10
How much ROM do we need in knee flexion
0-60
How much ROM do we need in knee extension
0
How much ROM do we need in ankle DF
0-10
How much ROM do we need in ankle PF
0-20
Initial Contact
- the beginning of the stance phase that occurs when the foot touches the ground
Loading response
- corresponds to the amount of time between initial contact and the beginning of the swing phase for the other leg
Midstance
-The point in stance phase when the other foot is off the floor until the body is directly over the stance limb
terminal stance
- begins when the heel of the stance limb rises and ends when the other foot touches the ground
pre-swing phase
- begins when the other foot touches the` ground and ends when the stance foot reaches toe off
Initial Swing:
- begins when the stance foot lifts from the floor and ends with maximal knee flexion during swing
midswing
begins with maximal knee flexion during swing and ends when the tibia is perpendicular with the ground
terminal swing
- begins when the tibia is perpendicular to the floor and ends when the foot touches teh ground
Heel strike
- is the instant that the heel touches the ground to begin stance phase
foot flat
- foot flat is the point in which the entire foot makes contact with the ground and should occur directly after heel strike
heel off
- point in which the heel of teh stance limb leaves the ground
toe off
- toe off is the point in which only the toe of teh stance limb remains on the ground
acceleration
- begins when toe off is complete and the reference limb swings until positioned directly under the body
deceleration
- begins directly after midswing, as the swing limb begins to extend, and ends just prior to heel strike
What percentage of gait cycle is stance phase? swing phase>
- stance phase represents 60% of the gait cycle
- swing phase represents 40% of the gait cycle
Base of support
- the distance measured between teh left and right foot during progression of gait
- teh distance decreases as cadence incr
- the avg base of support for an adult is two to four nches
Cadence
- The number of steps an individual will walk over a period of time. the avg value for an adult is 110-120 steps per minute
degree of toe-out
the angle formed by each foot’s line of progression and a line intersecting teh center of teh heel and second toe. the avg degree of toe-out for an adult is seven degrees
double support phase:
-double support phase refers to the two times during a gait cycle where both feet are on the ground. the time of double support incr as the speed of gait decr. this phase does not exist with running
pelvic rotation
- rotation of teh pelvis occurs opposite the thorax in orer to maintain balance and regulate speed. teh avg pelvic rotation during gait for an adult is a total of 8 deg
single support phase
- occurs when only one foot is on the ground and occurs twice during a single gait cycle
What muscle activity do we see in Initial Contact?
- The ankle DF place the ankle in DF during heel strike and prepare to lower the foot towards the ground.
- the quadriceps contract to place the knee in extension while teh hamstrings help stabilize the knee and prevent hyperextension
- The hip extensors and abductors contract to stabilize the trunk and pelvis over the leg
What muscle activity do we see in loading response
- The ankle DF act eccentrically to control lowering of teh foot towards the ground.
- the quadriceps contract eccentrically to control knee flexion as the limb accepts the weight of teh body.
- In the latter portion the plantarflexors eccentrically control DF as the tibia moves over the foot
- Simultaneously, the tibialis posterior eccentrically controls pronation of the foot
- the quadriceps contraction becomes concentric to draw the femur forward over the tibia
- throughout the loading response phase, the hip extensors contract concentrically to produce hip extension
What muscle activity do we see in midstance?
- the plantar flexorss continue to act eccentrically to control DF as teh body moves over teh stance limb. activity in the knee musculature is minimal during this phase, though the quads contract concentrically to continue producing closed chain knee extension.
- the hip abductors muscles stabilize the pelvis and prevent contralateral hip drop
- the iliopsoas also begins to contract eccentrically to control hip extension
What muscle activity do we see in terminal stance
- plantar flexors begin to work concentrically to aid the foot in its propulsion of teh body forward
- knee muscle activity remains limited
- the hip abductors continue to stabilize the pelvis and teh iliopsoas continues to slow the rate of hip extension
What muscle activity do we see in pre-swing?
- the plantar flexors are at their peak activity as teh foot”toes off” from the ground.
- the hamstrings begin to produce knee flexion to prepare for teh swing phase, though the momentum of teh body also aids in this motion.
- the iliopsoas begins to work concentrically to produce hip flexion, along with other hip flexors
What muscle activity do we see in initial swing
- andkle dorsiflexors contract concentrically to clear teh foot from the ground, while the hamstrings assist with foot clearance by flexing the knee.
- the hip flexors continue to produce hip flexion to advance the limb forward
What muscle activity do we see in midswing?
- ankle dorsiflexors continue to contrat concentrically to maintain DF.
- Knee and hip muscle activity ar eminimal during this phase since forward momentum allows for advancement of the limb
What muscle activity do we see in terminal swing?
- ankle Dorsiflexors continue to contract concentrically to maintain DF.
- the ankle invertors also contract concentrically to prepare the foot for initial contact
- The quads contract concentrically to place the knee in extension for initial contact, while the hamstrings act eccentrically to control the rate of knee extension. the hip extensors eccentrically slow the rate of hip flexion and prepare the limb for initial contact
Gait deviations in ankle and foot
– foot slap
- weak dorsiflexors
- dorsiflexors paralysis
Gait deviations in ankle and foot
– tow down instead of heel strike
- plantar flexor spasticity
- plantar flexor contratcure
- weak dorsiflexors
- dorsiflexor paralysis
- leg length discrepancy
- hindfoot pain
Gait deviations in ankle and foot
– clawing of toes
- tow flexor spasticity
- positive support reflex
Gait deviations in ankle and foot
– heel lift during midstance
- insufficient dorsiflexion range
- plantar flexor spasticity
Gait deviations in ankle and foot
– no toe off
- forefoot/ toe pain
- weak plantar flexor
- weak toe flexor
- insufficient plantar flexion ROM
Gait deviation in knee
– exaggerated knee flexion at contact
- weak quad
- quad paralysis
- hamstrings spasticity
- insufficient extension ROM
Gait deviation in knee
– hyperextension in stance
- compensation for weak quadriceps
- plantar flexor contracture
Gait deviation in knee
– exaggerated knee flexion at terminal stance
- knee flexion contracture
- hip flexion contracture
Gait deviation in knee
– insufficient flexion with swing
- knee effusion
- quadriceps extension spasticity
- plantar flexorspasticity
- insufficient flexion ROM
Gait deviation in knee
– excessive flexion with swing
- flexor withdrawal reflex
- LE flexor synergy
Gait deviation in Hip
– insufficient hip flexion at initial contact
Weak hip flexors
- hip flexor paralysis
- hip extensor spasticity
- insufficient hip flexion ROM
Gait deviation in Hip
– insufficient hip extension at stance
- insufficient hip extension ROM
- hip flexion contracture
- LE flexor synergy
Gait deviation in Hip
– circumduction during swing
- compensation for weak hip flexors
- compensation for weak dorsiflexors
- compensation for weak hamstrings
Gait deviation in Hip
– hip hiking during swing
- compensation for weak dorsiflexors
- compensation for weak knee flexors
- compensation for extensor synergy pattern
Gait deviation in Hip
– exaggerated hip flexion during swing
- lower extremity flexor synergy
- compensation for insufficient ankle dorsiflexor