Gait Flashcards
IC-Ankle
Ankle at Neutral- Isometric Anterior Tibialis
LR- Ankle
10* PF- Eccentric Ant Tib. Calcaneal Eversion Unlocks the Foot during LR
MSt- Ankle
Ankle at neutral- Eccentric gastroc
TSt- Ankle
Eccentric gastroc-10* DF. During TSt and PSw, calcaneal inversion occurs to lock up foot for rigid push off
PSw- Ankle
15* PF-Concentric Gastroc-Soleus, During TSt and PSw, calcaneal inversion occurs to lock up foot for rigid push off
ISw-Ankle
0-5* PF- Concentric Ant Tib
MSw- Ankle
Neutral DF- Isometric Ant Tib
TSw-Ankle
Isometric Anterior Tib-Ankle at neutral
IC-Knee
Neutral- Isometric Quads
LR-Knee
20* Flexion, Eccentric Quads
MSt-Knee
Neutral- Concentric Quadriceps
TSt-Knee
5* Flexion-Quads/HS silent
PSw-Knee
40*Flexion- Concentric Popliteus/Gracilis/Sartorius
ISw-Knee
60* Flexion-Concentric HS
MSw-Knee
25* Flexion-Concentric Quads, Eccentric HS
TSw-Knee
Neutral Knee with Concentric quads and eccentric HS
IC-Hip
20* Flexion- Cocontraction Glute max
LR-Hip
17* Flexion- Concentric glute max with HS
MS-Hip
Neutral- relatively silent glute max and hips
TSt
20* Extension with Eccentric Iliopsoas
PSw
10* Extension with Concentric Hip Flexors
ISw
20* Flexion, Concentric Hip Flexors
MSw
25* Flexion with concentric gracilis and adductor longus
TSw
20* Flexion, Eccentric Gracilis
Pelvis- IC
5* Forward Rotation
Pelvis- LR
4* Pelvic Drop on NWB side. WB leg has eccentric glute med
Pelvis-MSt
Neutral- WB leg concentric glute med
Pelvis-TSt
5* Backward Rotation
What happens to the trunk?
- Trunk moves from neutral to slight
extension throughout gait
- Arm swing and Leg swing are opposite
of each other
- Trunk rotation chases initial contact
*Lumbar spine rotation opposite to hip rotation
Pathology-Foot Slap
an audible ”slap” on the ground immediately following
a heel strike
- What should occur at initial contact?
- Neutral ankle positioning with slow lowering to ankle
plantarflexion immediately afterwards
- What is the impairment?
- Poor dorsiflexion strength/Poor eccentric control
anterior tibialis
• No proper eccentric lowering of the foot to the
ground
Pathology-Vaulting
Excessive ankle plantarflexion on the stance
limb in order to help clear the swing limb.
• What should occur at loading response to
midstance?
• Ankle moves from 10-15 degrees of
plantarflexion to neural ankle positioning
- What is the impairment?
- One limb is longer than the other, so in order to
clear the longer limb the patient must excessive
plantarflexion on the stance side.
• The longer limb is on the swing side
Pathology-Early Heel Off
Early rise of the heel prior to completion of midstance
• Where is the ankle at midstance and what should
occur at midstance to terminal stance?
• Ankle is in neutral during midstance and transitions to
10-15 degrees dorsiflexion
- What is the impairment?
- There is a limitation in dorsiflexion mobility and therefore
the heel quickly moves into heel off
• Tightness/Spasticity of the plantarflexors, diminished
posterior glide of the talus
Pathology-Delayed Heel Off
Delayed rise of the heel at the end of terminal
stance and beginning of pre-swing
- What should occur at terminal stance?
- Ankle moves to 10-15 degrees dorsiflexion
- What is the impairment?
- There is a excessive dorsiflexion mobility or the
plantarflexors lack strength required for propulsion
• Diminished plantarflexion strength, excessive
dorsiflexion mobility
Pathology-Knee Extensor Thrust
A rapid and abrupt locking of knee into extension
- What should occur at loading response?
- Knee moves into 15-20 degrees of flexion
- What is the impairment?
- No proper eccentric lowering of the knee into flexion
- Weak quadriceps, quad spasticity, PF spasticity
Pathology- High Steppage
A quick and excessive increase in hip flexion
during initial swing in order to clear a long limb
• What should occur at pre-swing to initial
swing?
• Hip moves from 10 degrees of extension to 20
degrees of flexion
- What is the impairment?
- Compensatory swing strategy to clear a long limb
- Decreased ankle dorsiflexion, diminished knee
flexion
Pathology-Circumduction
A patient who performs abduction and a semi-circular
movement of the affected hip secondary to the inability
to achieve adequate clearance of the foot.
- What should occur at pre-swing to initial swing?
- Hip moves from 10 degrees of extension to 20 degrees
of flexion
- What is the impairment?
- The patient lacks hip mobility, knee, and ankle mobility
in order to clear the longer limb
• Diminished LE mobility in sagittal plane, diminished hip
strength
Pathology- Trendelenberg
An abnormal lateral trunk lean towards the
stance limb during midstance.
- What should occur during midstance?
- Pelvis moves from 4 degrees to 0 degrees on
the swing side through concentric hip abductors
on the stance side.
- What is the impairment?
- Diminished hip abductor strength causes the body
to compensate by shifting the COM over the stance
limb
• Weak gluteus medius, minimus on the stance limb
Pathology- Steppage Gait
Due to inability to DF ankles. Could be from herniation at L4-5
Pathology- Diminished Forward Rotation
A diminished amount of forward rotation of
the pelvis which limits ipsilateral step
length.
• What should occur during midswing to
terminal swing?
• Pelvis moves from 0 degrees to 4 degrees on
the swing side.
- What is the impairment?
- Diminished hip/pelvis mobility or lack of
pelvic coordination
Pathology- Diminished Backward Rotation
A diminished amount of backward rotation
of the pelvis which limits contralateral step
length.
• What should occur between midstance to
terminal stance?
• Pelvis should rotate backward from neutral to
5 degrees on the stance side.
- What is the impairment?
- Diminished hip/pelvis mobility or lack of
pelvic coordination
Pathology- Backwards Trunk Lean
Excessive extension of the trunk during the early to
mid stance phases secondary to hip extensor
weakness.
• What should occur during heel strike through
midstance?
• The trunk moves maintain pretty close alignment with
the pelvis, slight extension throughout
- What is the impairment?
- Diminished hip extensor strength causes the body to
compensate by shifting the COM behind the pelvis
• Weak gluteus maximus on the stance limb
Pathology- Forward Trunk Lean
Excessive forward trunk lean early to mid stance
phases secondary to lower extremity weakness
or diminished hip mobility.
• What should occur during loading response
through midstance?
• The trunk moves maintain pretty close alignment
with the pelvis, slight extension throughout
- What is the impairment?
- Diminished quad strength causes the body to
compensate by shifting the COM anterior to the
knee.
• Weak quadriceps or hip flexor contracture
What is a cushioned heel?
What is a cushioned heel?
• The heel cushion controls the
lowering of the forefoot to the
ground during initial contact and
weight acceptance.
- Too Soft Cushion Heels
- Similar to a weak anterior
tibialis
- Allows for a foot drop/slap
- Absent Knee flexion @ heel
strike
• Think PF = Knee
extension
- Hard or Stiff Cushion Heels
- AKA ”dorsiflexed foot”
- Think DF = Knee flexion
- Excessive Knee flexion @ heel
strike to midstance
• Causes buckling @ knee and
patient will attempt to force
knee extension
What is an Extension Aide?
• Can be an elastic strap,
spring, or webbing that
assists the prosthesis in
achieve extension.
• Think of the EA “as kinda
like” pseudoquadriceps
Terminal Swing Impact
• Forcible impact as knee
goes into extension at end
of terminal swing phase,
just before heel strike
• Extension aid is set to high
*NPTE will say too little knee friction
What is a socket wall?
High Medial Wall
• Patient wants to
reduce pressure on
pubic ramus
- Abducted gait
- Circumduction
- Lateral Trunk
Bending
Unsupportive Lateral
Wall
• Patient wants to reach a
position of optimal
support on the prosthetic
side
- Abducted gait
- Lateral Trunk Bending
Socket Too
Loose/Inadequate
Suspension
•Socket is sliding off of
the leg during swing
phase
- Pistoning
- Circumducted
Socket Positioning…
SOCKET FLEXION
- Normal is 5-8 degrees
- If excessive, creates knee
instability “buckling”
- Gait Deviation
- Excessive knee flexion
- INSUFFICIENT SOCKET FLEXION
- Abnormal!!!
- If present, creates knee extension
and associated ankle
plantarflexion (prosthesis
plantarflexion)
- Gait Deviation
- Excessive knee extension
Foot Placement…
- Anteriorly Set Foot
- Center of gravity line passes
anterior to the knee but posterior
to the foot during initial contact to
loading response creating an
extensor moment or knee
extension
- Gait deviation
- Excessive knee extension
- Posteriorly Set Foot
- Center of gravity line passes
posteriorly to the knee during
initial contact to loading response
creating an flexor moment or
knee flexion
- Gait deviation
- Knee buckling; excessive knee
flexion
