Gait Flashcards
Stance phase: standard terminology
1) heel strike
2) foot flat
3) midstance
4) heel off
5) toe off
60% of gait cycle
Stance phase: Rancho Los Amigos
1) initial contact
2) loading response
3) midstance
4) terminal stance
5) preswing
60% of gait cycle
Swing phase: standard terminology
6) acceleration
7) midswing
8) deceleration
40% of gait cycle
Swing phase: Rancho Los Amigos
6) initial swing
7) midswing
8) terminal swing
Heel strike
the instant that the heel touches the ground to begin stance phase
Foot flat
the point in which the entire foot makes contact with the ground and should occur directly after heel strike
Midstance
the point during the stance phase when the entire body weight is directly over the stance limb
Heel off
the point in which the heel of the stance limb leaves the ground
Toe off
the point in which only the toe of the stance limb remains on the ground
Acceleration
begins when toe off is complete and the reference limb swings until positioned directly under the body
Midswing
the point when the swing limb is directly under the body
Deceleration
begins directly after midswing, as the swing limb begins to extend, and ends just prior to heel strike
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
corresponds to 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
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 the ground
Hip flexion: necessary ROM
0-30°
Hip extension- necessary ROM
0-10°
Knee flexion- necessary ROM
0-60°
Knee extension- necessary ROM
0°
Ankle DF- necessary ROM
0-10°
Ankle PF- necessary ROM
0-20°
Initial contact- muscle activity
- Ankle DF place the ankle in DF during heel strike
- Quads activate to place the knee in extension
- HS activate to stabilize the knee and prevent its’ hyperextension
- Hip extensors and abductors contract to stabilize the trunk and pelvis over the leg
Loading response- muscle activity
- the ankle DF activate eccentrically
- quadriceps activate eccentrically to control knee flexion as the stance limb accepts the weight of the body
- in the latter portion of the phase the PF contract eccentrically to control DF as the tibia moves over the foot
- the tib post eccentrically controls pronation of the foot
- the quads contraction becomes concentric to draw the femur forward over the tibia
- throughout the phase the hip extensors remain active concentrically to produce hip extension
Midstance- muscle activity
- PF continue to act eccentrically to control DF as the body moves over the stance limb
- activity of the knee musculature is minimal during this phase though the quads act concentrically to continue producing CKC knee extension
- hip abductor muscles stabilize the pelvis and prevent contralateral hip drop
- iliopsoas also begins to contract eccentrically to control hip extension
Terminal stance- muscle activity
- PF begin to work concentrically to aid the foot in its propulsion of the body forward
- knee muscle activity remains limited
- the hip abductors continue to stabilize the pelvis
- iliopsoas continues to slow the rate of hip extension
Pre-swing- muscle activity
- PF at their peak activity
- HS begin to produce knee flexion, though the momentum of the body also aids this motion
- iliopsoas begins to work concentrically to produce hip flexion, along with the other hip flexors
Initial swing- muscle activity
- ankle DF contract concentrically to clear the foot
- the HS assist with foot clearance
- hip flexors continue to move the limb forward
Midswing- muscle activity
- ankle DF continue to activate concentrically to maintain DF
- knee and hip muscle activity are minimal during this phase because forward momentum allows for limb advancement
Terminal swing- muscle activity
- ankle DF continue to contract concentrically
- ankle invertors contract concentrically to prep the foot for initial contact
- the quads contract concentrically to place the knee in extension for initial contact
- HS act eccentrically to control the rate of knee extension
- hip extensors eccentrically slow the rate of hip flexion and prep the limb for initial contact
BOS
the distance between the left and right foot during progression of gait. The distance decreases as cadence increases. The average BOS for an adult is 2-4 inches.
Cadence
the number of steps an individual will walk over a period of time. The average 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 the center of the heel and second toe. The average degree of toe-out is 7°
Double support phase
refers to the two times during a gait cycle where both feet are on the ground. The time of double support increases as the speed of gait decreases. This phase does not exist during running.
Pelvic rotation
rotation of the pelvis occurs opposite the thorax in order to maintain balance and regulate speed. The average pelvic rotation during gait for an adult is a total of 8° (4° forward with the swing limb and 4° back with the stance)
Single support phase
the single support phase occurs when one foot is on the ground and occurs twice during a single gait cycle
Gait cycle
from initial contact of one limb to the next initial contact of the same limb
step length
the distance between right heel strike and left heel strike. Adult average is 28 inches.
stride length
distance between right heel strike and the following right heel strike. Adult average is 56 inches.
Antalgic
stance time is decreased to avoid WB on the involved side due to pain. This is typically associated with a rapid and shorter swing phase of the uninvolved limb.
Ataxic gait
characterized by staggering and unsteadiness. There is usually a wide BOS and movements are exaggerated.
Cerebellar gait
a staggering gait pattern seen in cerebellar disease
Circumduction gait
characterized by a circular motion to advance the leg during swing; may be used to compensate for insufficient hip or knee flexion or DF.
Double step
alternate steps are of a different length or at a different rate
equine
characterized by high steps; usually involves excessive activity of the gastrocnemius.
festinating
a gait pattern where a pt walks on toes as though pushed. It starts slowly, increases, and may continue until the patient grasps an object in order to stop.
Hemiplegic
pt abducts the paralyzed limb, swings it around, and bring it forward so the foot comes to the ground in front of them.
Parkinsonian
marked by increased forward flexion of the trunk and knees; gait is shuffling with quick and small steps. Festinating may occur.
Scissor
the legs cross midline upon advancement
Spastic
stiff movement, toes seeming to catch and drag, legs held together, and hip and knee joints slightly flexed. Commonly seen in spastic paraplegia
Steppage
feet and toes are lifted through hip and knee flexion to excessive heights; usually secondary to DF weakness.
Tabetic
high stepping ataxic gait pattern in which the feet slap the ground
Trendelenburg
denotes glute med weakness; excessive lateral trunk flexion and weight shifting over stance leg
Vaulting
the swing leg advances by compensating through the combination of elevation of the pelvis and PF of the stance leg.
Gait deviation causes: Foot slap
- weak DF
* DF paralysis
Gait deviation causes: toe down instead of heel strike
- PF spasticity
- PF contracture
- weak DF
- DF paralysis
- leg length discrepency
- hindfoot pain
Gait deviation causes: clawing of toes
- toe flexor spasticity
* positive support reflex
Gait deviation causes: heel lift during midstance
- insufficient DF range
* PF spasticity
Gait deviation causes: no toe off
- forefoot/toe pain
- weak PF
- weak toe flexors
- insufficient PF ROM
Gait deviation causes: exaggerated knee flexion at contact
- weak quads
- quads paralysis
- HS spasticity
- insufficient extension ROM
Gait deviation causes: Hyperextension in stance
- compensation for weak quads
* PF contracture
Gait deviation causes: exaggerated knee flexion at terminal stance
- knee flexion contracture
* hip flexion contracture
Gait deviation causes: insufficient flexion with swing
- knee effusion
- quads extension spasticity
- PF spasticity
- insufficient flexion ROM
Gait deviation causes: Excessive flexion with swing
- flexor withdrawal reflex
* LE flexor synergy
Gait deviation causes: insufficient hip flexion at initial contact
- weak hip flexors
- hip flexor paralysis
- hip extensor spasticity
- insufficient hip flexion ROM
Gait deviation causes: insufficient hip extension at stance
- insufficient hip extension ROM
- hip flexion contracture
- LE flexor synergy
Gait deviation causes: Circumduction during swing
- compensation for weak hip flexors
- compensation for weak DF
- compensation for weak HS
Gait deviation causes: hip hiking during swing
- compensation for weak DF
- compensation for weak knee flexors
- compensation for extensor synergy pattern
Gait deviation causes: exaggerated hip flexion during swing
- LE flexor synergy
* compensation for insufficient DF
