Gait

Question 1

Walking involves all the joints of the lower limb, and is characterised by an ………….motion, in which the body vaults over the non-moving limb.

Answer 1

‘inverted pendulum’ motion, in which the body vaults over the non-moving limb.

Question 2

stages of walking

Answer 2

1. Stance phase
2. Swing phase

Question 3

Stance phase

Answer 3

Accounts for 60% of the gait cycle. It can be divided into the heel strike, support, and toe-off phases.

• Initial contact (heel strike)
• Loading response
• Mid-stance (foot flat)
• Terminal stance (heel off)
• Pre-swing (toe off)

Question 4

Swing phase

Answer 4

Accounts for 40% of the cycle. It can be divided into the leg lift and swing phases.

• Initial swing
• Mid-swing
• Terminal swing

Question 5

heel-strike

Answer 5

In the heel-strike stage, the foot hits the ground heel first. Three muscles/muscle sets are involved, each acting at a different joint:

• Gluteus maximus – acts on the hip to decelerate the forward motion of the lower limb.
• Quadriceps femoris – keeps the leg extended at the knee and the thigh flexed at the hip.
• Anterior compartment of the leg – maintains the ankle dorsiflexion, positioning the heel for the strike.

Question 6

support

Answer 6

After the heel strike stage, the rest of the leading foot hits the ground, and the muscles work to cope with the force passing through the leg. This is known as the support stage.

• Quadriceps femoris – keeps the thigh extended, accepting the weight of the body.
• Foot inverters and everters – contract in a balanced manner to stabilise the foot.
• Gluteus minimus, gluteus medius and tensor fascia lata – abduct the lower limb. Their contraction keeps the pelvis level by counteracting the imbalance created from having most of the body-weight on one leg.

Question 7

Toe-off phase

Answer 7

In the toe-off phase, the foot prepares the leave the ground – heel first, toes last.

• Hamstring muscles – extends the thigh at the hip.
• Quadriceps femoris – maintains the extended position of the knee.
• Posterior compartment of the leg – plantarflexes the ankle. The prime movers include gastrocnemius, soleus and tibialis posterior.

Question 8

leg life

Answer 8

Once the foot has left the ground, the lower limb is raised in preparation for the swing stage.

• Iliopsoas and rectus femoris – flexes the thigh at the hip, driving the knee forwards.
• Hamstring muscles – flexes the leg at the knee joint.
• Anterior compartment of the leg – dorsiflexes the ankle.

Question 9

Swing

Answer 9

In the swing phase, the raised leg is propelled forward. This is where the forward motion of the walk occurs.

• Iliopsoas and rectus femoris – keep the thigh flexed at the hip, resisting gravity as it tries to pull the lower extremity down.
• Quadriceps femoris – extends the leg at the knee, positioning the foot for landing.
• Anterior compartment of the leg – maintains ankle dorsiflexion so that the heel is in place for landing.

Question 10

Summary of the five stages of walking

Answer 10

Question 11

Gait….

Answer 11

The mechanism by which the body is transported using coordinates movements of the major lower limb joints

• Energy efficient interaction of MSK and neurological system

Question 12

normal gait has 5 attributes

Answer 12

• Stability in stance
• Foot clearance in swing
• Pre-positioning for initial contact
• Adequate step length
• Energy conservation

Question 13

gait definitions: stride

Answer 13

distance from initial contact right à initial contact right

Question 14

gait definitions: step

Answer 14

distance from initial contact right à IC left

Question 15

cadence

Answer 15

number of steps per min

Question 17

double support

Answer 17

when both feet are touching the floor at the same time- happens twice during the cycle

Question 18

what about when running?

Answer 18

• 2 stages of double float
  
  • When both feet are off the ground
• Slower jogging shortens the double float phase so that the feet are on the ground much longer than they are off the ground

Question 19

energy conservation

Answer 19

1. Minimise excursion of centre of gravity

2. Control momentum

3. Transfer energy between body segments

4. Phasic muscle action

Question 20

Pathological gaits

Answer 20

• Antalgic/ limp
• Trendelenburg/ waddling
• Spastic
  
  • Hemiplegic
  • Diplegic
• High steppage/ foot drop
• Parkinsonian/festinant
• Ataxic/ cerebellar/ broad-based

Question 21

Antalgic/ limp

Answer 21

• ‘limp’= painful leg
• Short stance phase affected leg
• Lack body weight shift to affected leg
• Short swing phase-unaffected leg
• ‘uneven’
• Use walking stick in opposite hand

Question 22

Trendelenburg gait

Answer 22

• Hip abductor weakness
  
  • Pain
  • Neurological damage
  • Trauma
• Pelvis drops on unaffected side in stance phase
• Torso swings to affected side
• Bilateral
• ‘waddling’

Question 23

Diplegic gait

Answer 23

• Neuromuscular disorders e.g. Cerebral palsy
• Scissoring
• Thigh muscle groups
  
  • Psoas
  • Adductors
  • Hamstrings
  • Calf
• Ankles plantar-flexed
• Forefoot initial contact

Question 24

High steppage

Answer 24

• Foot drop
  
  • Sciatica
  • Common peroneal n. palsy
  • Neuromuscular disorders
• Toes hang down
• Excessive hip flexion affected side
• Foot slap

Question 25

Parkinsonian gait

Answer 25

• Neurological disease- Parkinson’s
• Hard to initiate movement
• Short step
• Shuffling/festinant
• Forward flexed no arm swing

Question 26

Ataxic gait

Answer 26

• Cerebellar disorders
  
  • Inherited
  • Sensory
  • Intoxication
• Broad based
• ‘reeling’
• Inco-ordinated
• Arms balancing
• ‘drunk’