Gait Flashcards
Gait Cycle
The time from heel contact on one side of body to heel contact on same side of body. Contains two phases:
1) Swing Phase
2) Stance Phase
Single vs. Double Limb Support
SINGLE: when one leg is swinging through; only one leg in contact with ground.
DOUBLE: when both feet are in contact with the ground.
Stance Phase of Gait Cycle
First phase of gait cycle. • 60% of gait cycle • 5 Stages (just be familiar): - Initial contact (heel strike) - Load response (foot flat) - Midstance (single leg stance) - Terminal stance (heel off) - Preswing (toe off)
Initial Contact
First stage of the stance phase.
• Weight loading portion of stance phase
• Front foot contacting ground (heel strike); back foot bearing weight/absorbing shock
• Both feet in contact with ground (double limb support)
Load Response and Midstance
Middle stages (2-3) of stance phase.
• Front foot flat on ground (load response)
• Midstance is single limb support; able to accept full weight of body/balance
• Requires lateral hip stability and tibia positioned over the fixed foot* (usually where gait problems arise)
Terminal Stance and Preswing
Final two stages of stance phase.
• When back foot is preparing to leave ground, and body weight transfers to front leg
• When weight shifts, heel comes off ground
• Preswing happens when back toe pushes off, propelling leg forward
Swing Phase of Gait Cycle
2nd phase of Gait Cycle.
• Occurs when foot is not in contact with ground.
• 3 stages (just be familiar):
- Initial Swing (leg accelerates due to knee flexion/dorsiflexion of ankle)
- Mid-Swing (swing leg is next to weight bearing leg)
- Terminal Swing (when leg starts to slow down to prepare to weight-bear)
Abnormal Gait
Refers to when any steps/stages of gait cycle are not functioning as described due to conditions such as: • Decreased strength/balance/stability • Pain (limp) • Amputation • LE surgery • LE fracture
Trendelenberg Gait
- Atypical gait that occurs during stance phase
- Lateral thrust of pelvis due to weakness of gluteus medius/minimus (if right glutes are weak, left pelvis shows lateral thrust)
Footdrop Gait
Abnormal gait also called “steppage gait.”
• Occurs during swing phase
• caused by weakness/loss of dorsiflexion
• Compensates by lifting knee higher
Preparation for Ambulation of Pt.
- Obtain informed consent for ambulation activities
- Assess/evaluate pt.—know capabilities/limits (strength and balance)
- Determine appropriate assistive device and gait pattern based on assessment, weight-bearing status and goals
- Inspect the device for safety (Sharp parts? Good working order?)
- Measure/adjust equipment for Pt.
- Use gait belt and DO NOT LET GO when pt. is standing
- Remove items in environment that may compromise safety (leg rests on w/c, rugs, obstacles)
- Lock the w/c and bed
- Always use good body mechanics and beware of YOUR posture as well as Pt.’s. (Can you catch them if they fall?)
Weight Bearing Terms
NWB = Non Weight Bearing TDWB = Touch Down Weight Bearing TTWB = Toe Touch Weight Bearing PWB = Partial Weight Bearing WBAT = Weight Bearing as Tolerated FWB = Full Weight Bearing
Supportive Assistive Devices, most to least stable
- Most: Parallel bars
- Walker
- Axillary crutches
- Forearm crutches
- 2 canes
- Least: 1 cane
Unilateral Assistive Devices, most to least supportive
- Most: Hemiwalker
- Large based quad cane
- Small based quad cane
- Least: Monopoint or Standard cane
Assistive Devices in order of most to least coordination required
- Least: Parallel bars
- Rolling Walker
- Standard/Reciprocal Walker
- Cane
- Most: Crutches
Axillary Crutches
Crutches that go under armpit (2” from).
• Can be used to restrict weight bearing, on stairs, and may allow a more normal gait pattern/speed
• Pad is NOT for weight bearing; weight is borne through hands on hand grips
Loftstrand/Forearm Crutches
Longer term option than axillary crutches.
• Often easier to use during ADLs
• Used when Pt. doesn’t need trunk stability/support of axillary crutches, but needs more than a cane provides.
• Eliminate danger of injury to axillary vessels/nerves
Canes
- May be metal or wood with single shaft and one handgrip.
- Monopoint cane has one foot at base.
- Quad cane has four feet at base, small or large size/width
- Hemiwalker/Walkercane is considered in cane category
- Not used for limiting weight bearing or NWB status; but, they do provide some support and assist with balance
Walkers
Come in several styles including folding, rolling, reciprocal, and stair climbing. Standard walker has rubber tip at each of four legs and must be picked up to move.
Rolling Walker: When LOB or too much weakness in arms/legs to pick up standard walker. Has 2 or 4 wheels.
Reciprocal Walker: Designed so each side moves forward independently. Do not have to be picked up.
Platform Attachment: Used for individuals who cannot weight bear through wrist/hand due to injuries/deformities/etc. Should NOT be used to support flaccid arm.
Errors when Measuring for Fit of Assistive Devices
- Pt. evaluated with improper posture
- Pt. elevates/hunches shoulders
- Pt. drops shoulders, leans laterally, or flexes at hips
- Measurement made without Pt.’s shoes on
Reciprocal (Alternating) Gait Patterns with Assistive Devices
Most individuals move reciprocally (most typical gait used with devices).
• One foot at a time, alternating with walking aid. Hands and feet move separately/opposing
• Slow but stable, less stressful (on heart and upper limbs)
**INCLUDES: 4 pt., Mod 4 pt., 3 pt., 2 pt., Mod 2 pt. gaits
4 Point Gait
Uses bilateral assistive devices/reciprocal walker.
• 4 separate movements
• (With left foot injury): Right crutch, left foot, left crutch, right foot
• Extremely slow since only 1 item moved at a time, leaving others stable/on ground.
Modified 4 Point Gait
Similar to 4 Point pattern, but only one assistive device (ie: hemiwalker or crutch) is used (unilateral).
• 3 separate movements
• Device forward, opposite LE, then remaining loose arm/LE
• Single device typically placed on side OPPOSITE involved/injured LE
3 Point Gait
Requires use of bilateral assistive devices: crutches, standard walker/rolling walker.
• Device(s) placed forward, then affected LE, taking body weight on the hands, then stepping through with non-affected foot.
• Crutches forward, then limbs.
2 Point Gait
Requires use of bilateral assistive devices or reciprocal walker. “Cross Country Skiing”
• Very similar to 4 Point pattern, but only 2 movements.
• One UE/device moved simultaneously with opposite LE, then remaining UE/device with opposite LE.
Modified 2 Point Gait
Similar to 2 Point pattern but only one assistive device (usually when moving down to a cane).
• Single device placed on Pt.’s non-involved side
• Device and involved LE move forward together, then non-involved foot.
Simultaneous (Swinging) Gait Patterns (about)
These patterns require use of a pair of axillary or forearm crutches. • Fast, but very energy consuming • Usually used by younger/fitter clients • Hard on upper body **Not typically taught by OTAs!
Simultaneous (Swinging) Gait Patterns (list)
- Drag-to-Gait: both crutches advance, feet drag through on floor just behind crutches
- Swing-to-Gait: Both crutches advance, followed by swinging of feet slightly off floor behind crutches
- Swing-Through-Gait: Both crutches advance, feet swing through behind the crutches
Transitional Movement
Changes of posture or movement from one position to another.
Functional Mobility: in Home vs. Community
In the home: when client can ambulate distances greater than 50 feet with or without assistive devices.
In the community: when client can ambulate distances greater than 150 feet with or without assistive devices.
Dynamic vs. Static Balance
DYNAMIC: with movement occurring or to move within a position; maintaining controlled position of head/body during movement.
STATIC: when no movement is occurring; ability to maintain steady position of head/body.
Role of OT in lower extremities
OTPs may collaborate with PTs to:
• Reinforce PT in standing balance/safety
• Functional mobility using appropriate AE
• Functional transfer techniques
• ROM
• Observation of clinical factors, precautions, contraindications
Degrees of Freedom
Ability of a joint to move in different planes. Uniaxial, triaxial, etc. Ex: The hip joint has three degrees of freedom (triaxial joint).
Why ankle inversion/eversion are important
Used when body shifts weight, as well as provide better balance on uneven ground.
Why ankle plantarflexion/dorsiflexion are important
Allow foot to clear ground during walking and enable proper foot placement when foot comes back down.
Excursion
Wandering of body from the usual course of the center of gravity during gait. A consideration for functional ambulation. Could alter energy expenditure, stability and/or efficiency of walking.
Circumduction
Nonfunctional gait pattern with foot drop. During swing phase, pelvis hikes while hip abducts on unsupported side. Leg advances by swinging out to side.
Proper setting for axillary crutches on a Pt.
Axillary bar should be about 2 finger widths below the axilla.
Transitional Movements
Changes of posture or movement from one position to another.
Largest Phase of Gait Cycle
Stance Phase is 60% of gait cycle.
Foot in contact with the ground; 5 stages to this phase, from heel touch to toe off.
Phase of Gait Cycle When Foot Not in Contact with Ground
Swing Phase (2nd phase of gait cycle). (3 Stages to this phase, from initial swing, mid-swing, to terminal swing)
Preswing Stage of Gait Cycle
During the Stance Phase, Preswing occurs at the end when the pack toe pushes off the ground, propelling leg forward.
Phase of Gait Cycle Where Most Gait Problems Arise
Midstance: Middle of Stance Phase, when weight shifts to a single limb.
