GAIT Flashcards
why is it important to assess gait?
to identify any biomechanical abnormalities in the LE
why may gait pattern be altered?
in order to compensate due to pain, disease, stiffness or weakness that can affect other joint and lead to more complex problems
until what age are gait patterns variable and irregular?
until the age of ~7
what is the property of walking in comparison to running in gait?
walking will always have one foot in contact with the ground
what does the gait cycle correspond to?
it is the stride length and describes what happens in one leg/foot. it thus corresponds to the interval and sequence of motion occuring betweeen two consecutive initial contacts of the SAME foot
what phases compose the gait cycle/
- stance phase
- swing phase
what % of the gait cycle corresponds to the stance phase?
60-65%
what % of the gait cycle corresponds to the swingphase?
35-40%
what are the different periods that make up the stance phase?
two double support phase and one single leg stance phase
what corresponds to the initial contact?
-heel strike
what is the property to describe the stance phase?
foot is on the ground and weight bearing
what sub-phases make up the stance phase of the gait cycle?
- initial contact
- load response
- midstance
- terminal stance
- preswing
how can the inital contact be described as?
period where the foot is accepting BW and absorbing shock, period of double leg stance
how is the foot and the stance in load response?
foot is flat
single leg stance
how can we describe midstance phase?
-single leg stance phase where the stance leg must be able to hold the weight of the body and thus balance off that single leg
how can we describe terminal stance?
the heel lifts off the ground however it remains a double stance
what is the aim of the terminal stance phase?
unloading the bodyweight
what happens in preswing? what is the aim?
goal is to prepare for the swing phase
toes push off the ground
double stance
what are the sub-phases of the swing phase?
initial swing
midswing
terminal swing
when does the swing phase occur?
when the foot is not bearing weight and is moving forward
what does the stance phase allow the toes to do?
allows the toes of the swing leg to clear the floor
what happens during initial swing/
Foot is lifted off the floor, rapid knee flexion and ankle dorsiflexion occur to allow the swing limb to accelerate forward
what happens during midswing?
When the swing leg is adjacent to the weight-bearing leg which is in midstance
what happens during terminal swing?
Swinging leg slows down in preparation for heel strike
what muscles need to be active in the terminal swing phase?
quadriceps and hamstrings
what is the function of the quads in terminal swing phase?
controls knee extension
what is the function of the hamstings in terminal swing phase?
controls the amount of hip flexion
how often does double stance phases occur in the gait cycle?
twice
when does single leg stance occur in the gait cycle?
twice, once per foot
parameters of gait are based on what type of population?
8-45 years old
what is the “standard” base width in gait?
5-10 cm
what happens if the base width is larger than standard parameter?
pathology is to be expected
needed to maintain balance
what is the normal step length to be expected in gait?
72 cm
it should be equal on both legs
it represents the distance between successive contact points on opposite foot
how does step length vary with age?
children tend to take smaller steps than adults
how does step length vary with gender?
females tend to take smaller steps than males
how does step length vary with height?
taller people tend to take larger steps
how does step length vary with aging population (elderly)?
it decreased due to age, fatigue, pain and disease
what happens if the step length is normal and equal with both legs?
rythmn of walking is smooth
what happens to the step length in the event of pain in a given limb?
the rythmn will be altered as the patient tries to take the weight off of that limb as quickly as possible
what is stride length?
the linear distance in the plane of progression between successive points of foot-to-foot contact of the same foot, equivalent to distance done in one gait cycle
144 cm
what factors may cause a decrease in stride length
age
pain
disease
fatigue
when should gait assessment be accomplished?
in any lower limb assessment
can gait be affected even without a pathology in the lower limb?
yes; can be affected by posture of the head, neck, thorax and lumbar spine
what must a PT keep in mind when assessing gait in a patient?
msk pathologues which may cause gait deviations
identify the actions of each body segment and their deviation
history or disease or injury which may cause deviation
how many steps are needed to establish a steady gait pattern?
around 3 steps
what must the examiner watch for when examining gait?
upper limbs trunk lumbar spine pelvis hips knees feet ankle
what should a PT look for in the initial observation of gait of a patient?
general observation for any obvious limp or deformity
that the upper trunk and limbs move in the opposite direction as the lower limbs
how should a PT be placed to observe gait in a patient?
should be positionned in order to observe from the front, side, behind, from prox to distal and then from the foot upwards
when viewing a person’s gait anteriorly how should the pelvis be tilted?
lateral tilt
when viewing a person’s gait anteriorly should a patient have sideways deviation of the trunk?
no
when viewing a person’s gait anteriorly how should the pelvis be rotated about which plane?
rotation about the horizontal plane
when viewing a person’s gait anteriorly how should the trunk and UE be rotated relative to the pelvis?
opposite direction
is reciprocal arm swing a normal aspect of gait?
yes
when viewing a person’s gait anteriorly how should the hips be positionned? what movement should it accomplish?
rotation
abd/add
when viewing a person’s gait anteriorly how should the knee be positionned? what movement should it accomplish?
flexion/extension
when viewing a person’s gait anteriorly how should the ankle/foot be positionned? what movement should it accomplish?
toe in/out
dorsiflexion/plantarflexion
supination/pronation
should a patient show bowing of the tibia or the femur in anterior view of hait?
no
what is the best view used for the weight loading period of the gait cycle?
anterior view
what gait abnormalities can be properly seen in an anterior view?
circumduction or abd of the swing leg
what muscles can be observed for athrophy in an anterior gait view?
anterior thigh muscles
in the lateral view of gait what features/aspects are generally studied?
- rotation of the shoulder/thorax; the arm swing
- spinal posture
- pelvic rotation
what movement should be observed at the hips in a lateral view during gait?
flexion/extension
what movement should be observed at the knee in a lateral view during gait?
flexion/extension
what movement should be observed at the ankle in a lateral view during gait?
dorsiflexion/plantarflexion
what gait parameters can be studied in a lateral view of gait?
-step/stride length
cadence
what structures should be analyzed when viewing gait posteriorly
- lateral tilt of the pelvis
- sideway swing of the trunk
- pelvic rotation about the horizontal plane
- trunk and UE rotation opposite to pelvis
- arm swing present
- same as when viewing anteriorly
what can be studied exclusively from a posterior study of gait?
-heel rise and base of support
-abnormal abd/add movements
lateral body displacements
what should be observed when looking at a patients foot wear?
- wear down at the heels and medial/lateral aspects of the sole
- condition of the shoes
what should be observed when looking at a patients foot?
blisters
callus
corns
bunions
what may also need to be assessed in cases of altered gait?
strength and ROM
what is the compensatory mechanisms in gait?
when the patient tries to use the most energy saving gait possible
why do gait deviations occur?
- due to pathology or injury in a specific joint
- as a compensation for injury or pathology in other joints on the same or opposite side
what is another term for antalgic gait
painful gait
how does antalgic gait arise?
serves as a self-protective mechanism
results from injury to the pelvis. hip, knee, ankle or foot
what type of gait shows a stance phase on the affected side to be shorter?
painful gait
in antalgic gait what happens to the swing phase in the univolved leg?
it is decreased
what type of gait pattern results in shorter step length on the uninvolved side, decreased walking velocity and decreased
cadence
antalgic gait
what does arthrogenic gait result from?
Results from stiffness, laxity or deformity and may be painful or painfree
what happens to gait in the event that hip or knee is fused
the pelvis must be elevated by exaggerated plantar flexion of the
opposite ankle and circumduction of the stiff leg – to provide toe clearance
what is characteristic of arthrogenic gait?
the patient lifts the entire leg higher than normal to clear the ground
produces arc of movements to help decrease the amount of elevation needed to clear the affected leg
what is ataxic gait a result of?
poor sensation or muscle coordination which results in poor balance and hence larger base
in cerebellar ataxia, how are the movements during gait?
stagger, and all movements are exaggerated
how are the feet of patients with sensory ataxia?
they generally slap on the ground because they can not be felt
what type of gait pattern is characterized by irregular, jerky and weaving movements
ataxic gait
what is the function of glute max?
primary hip extensor
what is characteristic of glute max gait? why?
nvolves characteristic backward lurch of the trunk
in order to maintain hip extension of the stance leg the patient will thrust thorax posteriorly
what muscle is affected in the event of trendelenburg gait?
glute min and medius (hip abd) which provide stabilizing effect
what is a positive trendelenburg gait?
the contralateral side drops because the ipsilateral hip abductors do not stabilize the pelvis
what happens in the event of bilateral weakness of glute min/medius?
accentuated side-to-side movements during gait
in what cases does a patient exhibit drop foot gait?
weak or paralyzed dorsiflexors
in the case of weak dorsiflexors how do patients tend to compensate?
steppage gait where knee is lifted higher, the foot however continues to slap the ground due to loss of control
what is lateral pelvic shifT?
side to side movement of the pelvis during walking
what is the lateral pelvic shift needed for?
needed to center the weight of the body over the stance leg for balance
what is considered to be a normal pelvic shift?
5cm
when will the lateral pelvic shift increase?
when the feet are farther apart
what other muscles are affected by the lateral pelvic shift? weakness of that muscle leads to what type of gait?
abductors of the weight bearing limb are activated as it causes adduction of that limb in order to maintain pelvis relatively straight. weakness causes trendelenburg gait
what is the function of verticle pelvic shift?
keeps the center of gravity from moving up and down more than 5cm during normal gait
when does the verticle pelvic shift reach its highest point?
during midstance
when does the verticle pelvic shift reach its lowest point?
during initial contact
in what case would the verticle pelvic shift be higher than normal?
in the event that the patient can not adequately flex the knee or dorsiflex the foot in order to clear the toes during swing phase
why is pelvic rotation necessary?
in order to lessen the angle of the femur with the floor and to lengthen the femur
what is th total angle of pelvic rotation
8 degrees, 4 anterior on swing leg and 4 degrees posterior on the stance leg
what portion of the spine rotates in the opposite direction of the pelvis? why?
thoracic spine
maintain balance
what is said to be the normal cadence in gait?
90-120 steps/min
what factors may causecadence to vary?
height and age
what happens in the event that the velocity of gait cycle increase?
cycle length or stride length decreases
what happens to gait velocity with age?
it decreases
break down the movement of heel strike at the hip, knee, ankle and foot?
hip: 2–40 degree flexion, slight adduction and external rotation
knee: full extension before heel contact, flexes as heel strikes the floor
ankle: dorsiflexion moving into plantarflexion
foot: supination at heel contact
break down the movement of flat foot at the hip, knee, ankle and foot?
hip: moves into extension, adducted and internal rotation
knee: 20 degree flexion moving towards extension
ankle: plantarflexion moving to dorsiflexion over a fixed foot
foot: pronated
break down the movement of midstance at the hip, knee, ankle and foot?
hip: moving through neutral
knee: 15 degree flexion moving into extension
ankle: 3 dorsiflexion
foot: neutral
break down the movement of heel off at the hip, knee, ankle and foot?
hip: 10-15 degree extension, abduction, external rotation
knee: 4 degree flexion moving towards extension
ankle: 15 dorsiflexion towards plantarflexion
foot: sipination as foot becomes rigid to push off
break down the movement of toes off at the hip, knee, ankle and foot?
hip: 10 degree extension, abduction and external rotation
knee: moving from near full extension to 40 degree flexion
ankle: 20 degree plantar flexion
foot: supination
break down the movement of initial swing to midswing at the hip, knee, ankle and foot?
hip: slight flexion (0-15) moving to 30 degree flexion and external rotation to neutral
knee: 30-60 flexion and lateral rotation of the tibia moving neutrally
ankle: 20 dorsiflexion
foot: slight pronation
break down the movement of mmidswing to deceleration at the hip, knee, ankle and foot?
hip: continued flexion at about 30-40 degrees
knee: moving to full extension and slight lateral rotation of the tibia
ankle: neutral
foot: slight supination
what may be the cause fo pain during initial contact?
heel sput, bone bruise, heel fat pad bruise
bursitis
what happens to the initial contact phase in the event of a painful hip, knee or ankle condition?
it gets shortened
what may be a cause of pain in the preswing/toes off phase?
t may be caused by any pathology involving the great
toe, especially the metatarsophalangeal joint of the hallux.
how does a patient tend to compensate for pain in the preswing phase?
unable to push off thge medial aspect of the foot hence pushes off the lateral aspect to compensate for the painful toe
what happens to gait if the plantar flexors are weak
the pushoff may be absent
what device is commonly used to decrease load on limb during gait?
cane
how should a cane be used properly?
upper limb that is contralateral to the injured side, cane tip should touch the side at the same time as the heel
statistically, what percentage of force is reduced by the use of the ane during heel strike? midstance? toeoff?
heelstrike: 34%
midstance: 25%
toe off: 30%
what happens during the initial swing phase in the event of weak quadriceps muscle?
the trunk muscles will thrust the pelvis forward to provide forward momentum of the leg
what happens during midswing if the ankle dorsiflexors are weak>
the patient will show signs of steppage gait where the hip is excessively flexed to allow for the foot to adequately clear the ground
what muscle is contracted in order to slow the swing? weakness of the muscle results in what?
hamstrings
weakness may cause for heelstrike to be excessively harsh to lock the knee in extension
