Gait Flashcards
Stance Phase - Essential Components
- lateral horizontal movement of the pelvis and trunk to transfer weight to the stance limb
- movement into hip extension throughout
- initial flexion of the knee initiated at initial contact, followed by extension and then flexion again at terminal stance
- ankle function requires: DF at IC, eccentric DF, passive DF of ankle as body moves forwards over foot, PF during push off
Muscle forces create overall extension moment
Swing Phase - Essential Components
- rotation of the pelvis forwards on the swing limb
- lateral pelvic downward tilt on the swing limb
- flexion of the knee with hip extension
- hip flexion with a flexed knee
- increasing knee flexion - require 60 degrees mid swing
- knee extension and ankle DF prior to IC
- ankle DF throughout swing phase
Muscle forces create overall flexion moment
Muscle Activity throughout gait cycle
ANKLE
DFs - peak activity is eccentric after IC
PFs - peak activity is concentric after toe off
KNEE
Exts - max activity before and during IC to control loading response of the knee
Flexs - max activity before and after IC to decelerate the leg at the end of swing phase
HIP
Exts - max activity before and after IC
Flexs - max activity after push off to create propulsion for swing phase
- eccentric activity at end of stance phase to decelerate hip extension
Abds - contraction prior to IC and during stance phase to stabilise the pelvis
Typical Problems Hemiplegia - Stance Phase
Initial Stance
- limited ankle DF
- lack of knee flexion OR knee hyperextension
Mid Stance
- lack of knee extension OR knee hyperextension
- limited hip extension and limited ankle DF = failure to bring the body mass forwards over the foot
- excessive lateral pelvic tilt
Late Stance
- lack of knee flexion
- lack of ankle PF - unable to achieve push off
Typical Problems Hemiplegia - Swing Phase
Early and Mid Swing
- limited knee flexion
- limited hip flexion
- limited ankle DF
Late Swing
- limited knee extension
- limited ankle DF
Spatiotemporal Adaptations Hemiplegia
reduced speed of gait reduced step length increased stride width increased time spent in double support phase increased dependence on UL support
Common Adaptations Hemiplegia
- inability to shorten the swing limb = hip hitch and circumduction
- poor pelvic and trunk stability = excessive lateral displacement of the pelvic and trunk allignment
- loss of ankle DF range and hip ext range = decreased step length and failure to achieve terminal stance
- weak flexors = reduced swing quality, causes poor foot clearance and knee hyperextension in stance phase
- weak ankle PF = failure to achieve toe off, reduced forwards momentum
Phases of Mobilisation
- early mobilisation out of bed asap
- restoration of an independent gait (as much as possible)
- improve gait quality, speed and function to meet community requirements and pts goals
Features of early gait retraining
- pt able to stand, weight bear and maintain standing posture
- able to control the last 15 degrees of knee extension
- able to transfer weight laterally and antero-posteriorly
- able to shift weight to one limb whilst maintaining pelvic and trunk alignment
- able to achieve knee flexion in hip extension (difficult with mass synergies)
- able to achieve knee extension with ankle DF in IC (difficult with mass synergies)
Benefits of Partial Weight Support Treadmill Training
- task specific practise
- can start early
- assist with remaining upright
- offers sufficient practise to re-learn functional gait (1000 gait reps)
- can individualise the speed to find the sweet spot so can access central pattern generators for automatic gait
- stimulates the CV system so can improve fitness
Gait Retraining Process
- step with the unaffected leg first
- practise walking - need high intensity! More practise
- facilitate with hands on assistance various components of the gait cycle
- practise each component
- use electrical stimulation as an adjunct to treatment
Typical abnormal gait pattern - stance phase
excessive hip flexion
- due to weak hip extensors and tight hip flexors
- results in hyperextension at the knee and a step to gait
Trendelenburg (increased pelvic tilt to unsupported side)
- due to weak hip abductors
- results in contralateral lateral trunk flexion and increased fatigue
Hyperextesion/Buckling Knee
- due to reduced eccentric quads, tight plantarflexors and abnormal tone
- results in knee damage and pain
Reduced knee ROM
- due to arthrodesed knee, increased tone
Decreased Ankle Control
- due to reduced action of TA
Decreased ankle mobility
- due to contracture of the posterior compartment and stiff joints
- results in knee hyperextension
Foot abnormalities
- due to reduced mobility and muscle power
Excessive pronation and supination
Typical abnormal gait pattern - swing phase
Decreased hip flexion
- due to reduced activity of the hip flexors and increased extensor tone
- results in circumduction, hip hitching, leg abduction, vaulting on the other leg
Reduced passive ROM Knee
- due to increased tone, pain and stiffness
Reduced ankle dorsiflexion
- decreased action of TA
- results in excessive hip and knee flexion to clear the foot and/or hip circumduction
Decreased push off
- due to weak or hypertonic plantar flexors
Reduced trunk rotation and arm swing
- due to hypertonia, stiffness, pain and rigidity
- results in increased fatigue
Ataxic Gait
unsteady with wide base
central instability and/or pelvic, hip or knee instability
jerky propulsive limb placement
arms are fixed and held out from the body to assist with central stability
Parkinsonian Gait
stooped posture shuffling gait smaller steps and slower walking speed decreased range and speed of movement inability to control momentum
STANCE
- incomplete lateral weight shift
- lack of heel strike
- incomplete knee extension during MST
- inability to extend knee and PF at ankle
- forwards trunk lean
- reduced trunk rotation
- reduced or absent arm swing
SWING
- decreased joint motion
- decreased toe clearance due to poor hip and knee flexion
