Gait and Posture Analysis Flashcards
1
Q
What are the 2 main functions of the lower kinetic chain?
A
- To provide a stable BOS in standing
- To propel the body through space with gait
2
Q
What can be defined as controlled instability?
A
gait
3
Q
What are the 3 essential requirements of gait?
A
- Progression
- Postural control
- Adaptation
4
Q
What can be defined as the interval of time between any of the repetitive events of walking?
A
the gait cycle
5
Q
What are the 2 phases of gait?
A
Stance and swing
6
Q
What percentage of the gait cycle consists of the stance phase? Swing phase?
A
stance: 60-65%
swing: 35-40%
7
Q
What are the 3 tasks of the gait cycle?
A
- weight acceptance
- single limb support
- limb advancement
8
Q
What does weight acceptance include?
A
the intervals of initial contact and loading response
9
Q
Initial contact interval accounts for the first __% of the gait cycle
A
10%
10
Q
What does single-leg support include?
A
midstance, terminal stance, and preswing
11
Q
Describe midstance
A
It is the time in which one foot is being lifted until the body weight is aligned over the forefoot
*the first half of the single-limb support task
12
Q
When does the terminal stance begin and end?
A
Begins when the heel of the weight-bearing foot lifts off the ground and continues until the contralateral foot strikes the ground
13
Q
When does preswing begin and end?
A
Begins with initial contact of the contralateral limb and ends with the ipsilateral toe-off
14
Q
What does the swing phase involve?
A
the forward motion of the NWB foot
15
Q
What are the 3 intervals during the swing phase?
A
- Initial swing
- Midswing
- Terminal swing
16
Q
When does initial swing begin and end?
A
Begins with the lifting of the foot from the floor and ends when the swinging foot is opposite the stance foot
17
Q
When does midswing begin and end?
A
Begins as the swinging limb is opposite the stance limb and ends when the swinging limb is forward and the tibia is vertical
18
Q
When does terminal swing begin and end?
A
Begins with a vertical tibia of the swing leg with respect to the floor and ends the moment the foot strikes the floor
19
Q
What is normal step width and what does it form?
A
Normal is 5-10cm (2-4”) and it forms the BOS
20
Q
What can be defined as the distance between the point of initial contact of one foot and the point of initial contact of the opposite foot?
A
Step Length
21
Q
What is average step length?
A
About 28”
22
Q
What can be defined as the distance between successive points of foot to floor contact of the same foot?
A
stride length
23
Q
What makes up a stride length?
A
2 step lengths added together (56”)
24
Q
What is the normal cadence of gait?
A
90-120 steps per minute
25
During gait, the vertical ground reaction force is created by what?
a combination of gravity, body weight, and the firmness of the ground
26
When do the 2 peaks during the gait cycle occur?
- 1st at maximum limb loading during the loading response
| - 2nd during terminal stance
27
Do men or women tend to experience greater cumulative ground reaction forces? Explain why...
Women, because their legs account for a smaller percentage of total body height which means they must strike the ground more often to cover the same distance
28
What does gait involve?
The displacement of body weight in a desired direction
29
What are the 5 priorities of normal gait?
- Stability of the weight bearing foot throughout the stance phase
- Clearance of the NWB foot during the swing phase
- Appropriate prepositioning of the foot during terminal swing for the next gait cycle
- Adequate step length
- Energy conservation
30
In order for gait to be efficient and to conserve energy what must/must not occur?
the COG must undergo minimal displacement
31
What are the 6 determinants have the potential to reduce the energetic cost of human gait?
- Lateral displacement of the pelvis
- Pelvic rotation
- Vertical displacement of the pelvis
- Knee flexion in stance
- Ankle mechanism
- Foot mechanism
32
What is normal lateral displacement of the hips?
1-2” in order to center body weight over the stance leg
33
What does the forward rotation of the pelvis on the swing side prevent?
an excessive drop in the body’s COG
34
What does the vertical displacement of the pelvis do?
Keeps the COG from moving superiorly and inferiorly more than 2” during normal gait
35
If there is a disruption in the vertical displacement of the pelvis, what occurs?
Trendelenburg sign
36
What does knee flexion during midstance prevent?
an excessive rise in the body’s COG during that period of the gait cycle
37
Normal gait requires __ degrees of DF & __ degrees of PF
10
20
38
Describe the ankle mechanism present during gait
The co-action of dorsiflexion and plantarflexion muscles produces a relative lengthening of the leg, which results in a smoothing of the COG during stance phase
39
Describe the foot mechanism present during gait
The controlled lever arm of the forefoot at preswing is helpful as it rounds out the sharp downward reversal of the COG
40
As the upper body moves forward, the trunk twists about a ____ axis
vertical
41
As the upper body moves forward, the thoracic spine and pelvis rotate in ____ directions
opposite
42
As the upper body moves forward, the lumbar spine tends to rotate with the ____.
pelvis
43
As the upper body moves forward, the shoulders and trunk rotate __________.
out of phase with each other
44
When arm swing is prevented during gait, what occurs?
the upper trunk tends to rotate in the same direction as the pelvis, producing an awkward gait
45
What are the functions of the hip during gait?
to extend the leg during stance phase and flex the leg during swing phase
46
The hip rotates approximately __-__ degrees during normal stride
40-45
47
There is __-__ degrees of hip flexion in late swing
30-35
48
There is __ degrees of hip extension at or near toe off
10
49
Describe when hip adduction and abduction occur during gait
Hip adduction occurs in early swing phase
| Slight hip abduction at the end of swing phase
50
When does the greatest force on the hip occur?
during midstance
51
The knee flexes to __ degrees during the loading response of gait
20
52
How many degrees of knee motion is required for adequate foot clearance during normal gait?
60
53
_____ gliding of the femoral condyles “unlocks” the knee during the loading response
Anterior
54
What controls forward gliding at the knee during gait?
passive restraint of the PCL and actively by the quadriceps
55
What are the 4 functions of the knee during gait?
- Bear weight and absorb shock
- Reduce vertical displacement of the COG
- Maintain the stride length
- Allow the foot to move through its swing
56
Describe the position of the ankle joint during initial contact
The heel is slightly inverted, and the subtalar joint is slightly supinated
57
During the loading response, ______ occurs at the talocrural joint and _____ occurs at the Subtalar joint
plantarflexion
pronation
58
What is the significance of pronation at the subtalar joint during the loading phase?
It unlocks the foot and allows maximal ROM of the midtarsal joint, which enhances the foot’s ability to adapt to the support surface
59
At the end of midstance the talocrural joint is maximally ______ and the subtalar joint begins to _____.
dorsiflexed
supinate
60
From midstance to terminal stance is the foot in pronation or supination
supination
61
How should you observe a patient's gait?
Barefoot and with footwear
| Toe walking and heel walking
62
When examining a patient's footwear where should you findthe greatest wear?
- Beneath the ball of the foot
- In the area corresponding to the first, second and third MTP joints
- To the lateral side of the heel
63
What formation can also indicate gait dysfunction?
callus formation
64
A weakness in gait indicates what 2 things?
- There is inadequate internal joint movement
| - There is a loss of the natural force-couple relationship
65
Neuromuscular conditions include what 3 abnormal gait characteristics?
- Abnormalities of muscle tone
- Timing of muscle contractions
- Proprioceptive and sensory disturbances
66
What are the 2 things that can cause abnormal joint position?
- imbalance of flexibility and strength
| - contracture
67
When are elastic contractures apparent during gait?
in the swing phase
68
When are rigid contractures apparent during gait?
during the swing and stance phases
69
What are a few things that can cause antalgic gait?
- Bone disease (fracture, infection, tumor or AVN)
- Muscle disorder (rupture, contusion, cramp, spasm)
- Joint disease (OA, RA, gout, bursitis, hemarthrosis)
- Neurologic disease (lumbar spine disease with nerve root involvement)
- Hip, knee or foot trauma
- Corns, bunions, blisters or ingrown toenails
70
Describe Equinus Gait
The forefoot strikes first to initiate the gait cycle.
There is premature plantarflexion in early midstance.
Increased flexion at the knees in stance phase.
Delayed or diminished knee flexion in swing phase.
Diminished hip extension.
Increased anterior pelvic tilt.
71
Describe Gluteus Maximus Gait
Posterior thrusting of the trunk at initial contact in an attempt to maintain hip extension of the stance leg
Anterior tilt of the pelvis causes hyperlordosis
72
What is gluteus maximus gait due to?
weak hip extensors
73
How do people with weak quadriceps tend to compensate?
The affected LE is circumducted and the patient leans toward the uninvolved side to balance the COG
74
People with weak quadriceps tend have difficulty walking on what types of surfaces?
rough or uneven surfaces
75
What is steppage gait due to?
foot drop
76
Describe steppage gait
There is increased hip and knee flexion to compensate for decreased dorsiflexion and the foot tends to make an audible slap on the floor
77
What is Trendelenburg Gait due to?
weakness of the hip abductors
78
What is plantar flexor gait due to?
Premature firing of the gastroc during the swing phase
79
What is plantar flexor gait characterized by?
toe walking
80
plantar flexor gait is a common deviation in what type of patient?
children with CP
81
What causes spastic hemiplegic gait?
Unilateral UMN lesion
82
Describe spastic hemiplegic gait
The LE circumducts and the UE is carried across the trunk for balance
83
What causes spastic paraparetic gait?
Bilateral UMN lesions
84
Describe spastic paraparetic gait
Slow, stiff and jerky movements
Spastic extension occurs at the knees
Adduction at the hips causing "scissors gait"
85
Describe ataxic gait
Walking is characterized by a widened base, high stepping, staggering or lurching from side to side
86
What is the difference bewteen cerebellar and sensory gait?
Cerebellar: broad based, unsteady and staggering with an irregular sway
Sensory: patient tends to lift the feet too high and slap on the floor in an uncoordinated manner
87
Describe the gait deviations present following TKA
- Slower cadence
- Shorter step length
- Reduced knee excursion
- Altered muscle activation
- Stiff-knee posture
88
Describe the gait deviations present following THA (anterolateral approach)
- Greater trunk forward lean
| - Trendelenburg gait
89
Describe the gait deviations present following THA (posterolateral approach)
- Greater incidence of dislocation
90
What are the 3 indications for using an AD?
- Decreased ability to bear weight through the LEs
- Muscle weakness or paralysis or the trunk or LEs
- Decreased balance and proprioception in the upright posture
91
What can be defined as “the optimal alignment of the patient’s body that allows the neuromuscular system to perform actions requiring the least amount of energy to achieve the desired effect”
Good posture
92
Where should the COG fall?
at S2
93
As the neuromuscular system declines what types of changes tend to occur?
- Increased lumbar lordosis
- Increased thoracic kyphosis
- Decreased hip extension
- Decreased medial-lateral stability
- Increased hip flexed posture
- Decreased stride length
- Greater weight placed on the forefoot
- Increased double-foot stance time
- Decreased proprioception
- Harder heel strike
94
What are 3 gait chances that occur with age?
- A transition from ankle strategy back to hip strategy during gait
- A broadened stance to combat increased med-lat instability
- A shortened stride length to better maintain COG
95
Describe ideal postural alignment
A straight line that passes through:
- The ear lobe
- The bodies of the cervical vertebrae
- The tip of the shoulder
- Midway through the thorax
- Through the bodies of the lumbar vertebrae
- Slightly posterior to the hip joint
- Slightly anterior to the axis of the knee joint
- Slightly anterior to the lateral malleolus
96
Lordotic posture causes what 3 muscle impairments?
- Decreased mobility in the hip flexors
- Decreased mobility in the lumbar extensors
- Stretched and weak abdominal muscles
97
Slouched posture causes decreased mobility in what muscles?
- upper abdominal muscles
- internal intercostals
- hip extensors
- lower lumbar extensors
98
Slouched posture causes which muscles to become stretched and weakened?
- lower abdominals
- distal thoracic extensors
- hip flexors
99
Flat back posture causes decreased mobility in what muscles?
trunk flexors and hip extensors
100
Flat back posture causes which muscles to become stretched and weakened?
lumbar extensors and hip flexors
101
Round back posture with forward head causes decreased mobility in what muscles?
- anterior thorax muscles (intercostals)
- muscles of the UE originating on the thorax (pecs, lats and serratus)
- muscles of the cervical spine and head that attach to the scapulae and upper thorax (levator, SCM, scalenes, upper traps)
- suboccipital muscles (rectus capitis post major and minor, Obliquus capitis inf and sup)
102
Round back posture with forward head causes which muscles to become stretched and weakened?
- lower cervical and upper thoracic erector spinae
- scapular retractor muscles (rhomboids and middle traps)
- anterior throat muscles
- capital flexors
103
What is the purpose of gait interventions?
to alleviate symptoms and educate the patient in correct posture
104
What are the 3 things gait interventions focus on?
Restoration of normal length of the muscles
- Strengthening of the muscles that have become inhibited and weak
- Establishment of optimal motor patterns to secure the best possible protection of the joints and the surrounding soft tissues
