Gait and Posture

Question 1

What does bipedalism refer to?

Answer 1

Walking on 2 feet

Question 2

Give 3 ways in which peoples gait can differ?

Answer 2

1) Stride length
2) Pelvic movement
3) Upper body position

Question 3

What 5 things does normal gait rely on?

Answer 3

1) Joints: intact and well functioning
2) Muscles: adequate muscle strength
3) Nerves: CNS and PNS
4) Vision: info about movement of body and head relative to surroundings
5) Vestibular and auditory systems

Question 4

At what age should children be able to walk alone?

Answer 4

About 1 year (anywhere between 8 and 18 months)

Question 5

Give the 3 most common reasons for gait changes in the elderly?

Answer 5

1) Decreased muscle bulk
2) Decreased strength and flexability
3) Some loss of hearing and vision

Question 6

Give the 5 changes to gait that tend to occur in the elderly?

Answer 6

1) Reduction in the overall velocity
2) Reduction in the step/ stride length
3) Decreased arm swing
4) Decreased rotation of the pelvis
5) More flat foot approach to both heel strike and toe push off (shuffling gait)

Question 7

The center of gravity lies anterior to which vertebra?

Answer 7

S2

Question 8

Where does the center of gravity lie in relation to a) the hip joints b) the knee and ankle joints?

Answer 8

Lies posterior to the hip joints and anterior to the knee and ankle joints

Question 9

How is the need for muscular contraction minimised during standing?

Answer 9

The knees and hips are in their most stable position ie. extension

Question 10

Why is the ankle joint the least stable during standing?

Answer 10

It is flexed rather than extended like the others

Question 11

What is meant by the ‘forward sway’ that exists when standing?

Answer 11

The tendency to fall forward due to the fact that the line of gravity passes anterior to the ankle joint

Question 12

How is the forward sway counteracted when standing?

Answer 12

By contraction of the plantar flexor muscles - particularly soleus

Question 13

What 2 phases can the gait cycle be divided into?

Answer 13

Stance phase

Swing phase

Question 14

What is meant by double support during the gait cycle?

Answer 14

When both of the feet are in contact with the ground

Question 15

The stance phase of the gait cycle comprises which 5 phases?

Answer 15

1) Heel strike
2) Loading response
3) Mid stance
4) Terminal stance
5) Pre-swing/ toe push off

Question 16

The swing phase of the gait cycle comprises which 3 phases?

Answer 16

1) Initial swing
2) Mid swing
3) Terminal swing

Question 17

What are the 2 main types of muscle contraction?

Answer 17

1) Dynamic contraction - muscle contraction with a change in muscle length
2) Isometric contraction - muscle contraction with no change in length

Question 18

What are the 2 types of dynamic muscle contraction?

Answer 18

1) Concentric - muscle contraction results in shortening of muscle
2) Eccentric - muscle contraction results in lengthening of muscle

Question 19

Lowering of the forefoot to the ground during heel strike is controlled by eccentric contraction of what muscle?

Answer 19

Tibialis anterior

Question 20

Deceleration of forward momentum is achieved by what muscle?

Answer 20

Hip extension by gluteus maximus

Question 21

During heel strike which muscles are involved in the preservation of the longitudinal arch of the foot?

Answer 21

Intrinsic muscles

Question 22

Loading response occurs when the foot comes into full contact with the ground and body weight is transferred to the stance limb, what muscle and joint movement is key here?

Answer 22

Extension of the knee by quadriceps femoris to prevent the knee joint from buckling under weight

Question 23

Mid stance is the point at which the opposite limb swings past the stance limb, it requires stabilisation of the pelvis how?

Answer 23

By abduction of the hip to keep pelvis level, achieved by gluteus medius, minimus and tensor fascia lata

Question 24

Terminal stance is the point at which the heel starts to lift of the ground, this is achieved by which 2 muscles?

Answer 24

Plantar flexors - soleus and gastrocnemius (Also accelerates mass forward)

Question 25

Pre swing (toe off) is for preparation for moving into swinging phase - which movement is involved to push off ground and accelerate mass forward?

Answer 25

Powerful plantar flexion of the digits

Question 26

During pre-swing, slowing of hip extensions and preparation for hip flexion is achieved by which muscle?

Answer 26

Eccentric contraction of rectus femoris

Question 27

Which digit is essential for toe - off ?

Answer 27

Hallux

Question 28

Which 2 muscles in hallux stabilised by?

Answer 28

Adductor hallucis and abductor hallucis brevis

Question 29

If a pt has a misaligned or missing hallux, how does this affect their gait? 2

Answer 29

Weak push off so:
Shorter stride length
Decreased gait velocity

Question 30

During initial and mid swing hip flexion is achieved by which 2 muscles?

Answer 30

1) Iliopsoas

2) rectus femoris

Question 31

During initial and mid swing the leg must be shortened to clear the ground, in which 3 ways is this achieved and what muscles are involved in each?

Answer 31

1) Hip flexion - iliopsoas and rectus femoris
2) Toes and foot dorsiflexed - tibialis anterior
3) Knee flexion - hamstrings

Question 32

What 3 movements have to occur in terminal swing, which muscles are involved in each?

Answer 32

1) Knee flexion change to extension - quadriceps
2) Dorsiflexion of ankle - tibialis anterior
3) Deceleration of limb in preparation for heel strike - eccentric contraction of hamstring muscles

Question 33

If a patient has limited knee flexion meaning the limb cant be shortened, how is there gait altered and why?

Answer 33

Limb circumduction

Swinging leg moves in an arc rather than forwards which increases the chance of ground clearance for the swing foot

Question 34

If the foot cant be dorsiflexed ie. foot drop - which nerve is likely to be damaged?

Answer 34

Common fibular

Question 35

How does a pt with foot drop compensate when walking?

Answer 35

Exaggerated flexion of knee and hip to clear floor

Question 36

What 2 shifts occur to a persons center of gravity when walking?

Answer 36

1) Vertical shift

2) Lateral shift

Question 37

What movement reduces the vertical drop in center of gravity when walking?

Answer 37

Pelvic drop
Internal rotation of the stance limb
External rotation of swing limb

Question 38

Which 3 muscles are involved in internal rotation of the stance limb to reduce the vertical drop in COG?

Answer 38

Gluteus medius and minumus and tensor fascia lata

Question 39

What 6 muscles are involved in external rotation of the swing limb to reduce the vertical drop in COG when walking?

Answer 39

1) Piriformis
2) Quadratus femoris
3,4) Obturator internus and externus
5,6) Superior and inferior gemelli

Question 40

What 2 movements limit vertical rise in COG during walking?

Answer 40

1) Knee flexion during stance

2) Pelvic drop to swing side

Question 41

Which movement limits lateral shift in COG when walking?

Answer 41

Hip adduction (adductors pull knee into midline)