Gait Concepts Flashcards
What term is defined as the manner or style of walking?
Gait
What term is defined as the evaluation of the manner or style of walking?
Gait analysis
What term is defined as the combination of several successively arranged joints constituting a complex motor unit?
Kinetic chain
What term is defined as a kinetic chain in which the terminal segment can move freely?
Open chain movement
What term is defined as a kinetic chain in which the distal end of the extremity is fixed?
Closed chain movement
What term is defined as the force exerted by the ground on a body in contact with it?
Ground reactive forces
What three motions are involved in the triaxial movement of the hip joint during gait?
1 Flexion-extension (θX)
2 Adduction-abduction (θZ)
3 Internal-external rotation (θY)
Which of the three movements of the hip joint have the largest range during gait?
Flexion-extension (θX)
What three motions are involved in the triaxial movement of the knee joint during gait?
1 Flexion-extension (θX)
2 Internal-external rotation (θY)
3 Adduction-abduction aka varus-valgus (θZ)
What is the primary motion of the knee joint during gait?
Flexion-extension (θX)
What limits the amount of varus-valgus of the knee joint during gait?
Soft tissue and bony constraints
Whenever the distal part is away from the midline, is it called valgus or varus?
Valgus
Whenever the distal part is toward from the midline, is it called valgus or varus?
Varus
Which variation describes the angulation of a limb at a joint?
Varus-valgus
Ankle motion is restricted by the morphologic constraints of which joint?
Talocrural joint
What are the only two movements permitted at the talocrural joint?
Plantar flexion/dorsiflexion
What must be initiated when preparing to begin gait?
A “fall”
What type of control propels the COG outside of the BOS?
Feedfoward
What term is defined as the moment at which the heel strikes the ground and becomes incorporated into the BOS?
Heel strike/heel contact
What term is defined as the moment at which the toe leaves the ground and is no longer incorporated in the BOS?
Toe off
What term is defined as the movement of ONE lower extremity from toe off to heel contact?
Step
What term is defined as two steps (one with each leg)?
Stride
What is another term for “stride” when referring to gait?
Gait cycle
How many steps complete a gait cycle?
2
What term is defined as the distance from the toe of the trailing limb to the heel of the leading limb?
Step length
What term is defined as the distance between two successive placements of the same foot?
Stride length
What does the stride length consist of?
2 step lengths (left and right)
What term is defined as the portion of one gait cycle in which both feet are in contact with the ground?
Double support
What concept distinguishes walking from running and is a period of “non-support” where neither foot is in contact with the ground?
Flight/float
The bipedal gait cycle consists of how many “phases” for each limb?
2 (stance and swing)
Which is the point at which the lower extremity is contacting the ground: stance or swing?
Stance
Which is the point at which the lower extremity is swinging through the air preparing for next impact: stance or swing?
Swing
While walking, how long is the typical gait cycle?
1 second
What is the ratio between the stance phase and swing phase during a normal gait cycle while walking?
60:40 (60% stance phase, 40% swing phase)
Which is a closed chain motion: stance or swing phase?
Stance (distal end of kinetic chain is fixed by ground reactive forces)
Which is an open chain motion: stance or swing phase?
Swing (distal end of kinetic chain is freely mobile)
About how many gait cycles are performed daily?
More than 5,000
When do the two periods of double limb support (both initial and terminal) occur?
When the contralateral foot is in contact with the ground
When does the intermediate period of single limb support occur?
When the contralateral limb is engaged in swing phase
What is the term for the period of “weight shift” during a gait cycle where the sole of the foot comes into contact with the ground and weight of the body is accepted onto the supporting limb?
Loading response ***
What makes up 27% of the stance phase and absorbs shock?
Contact
Where does “contact” begin and end?
Beings at heel strike, ends at foot flat
What is the period of the stance phase that makes up 27-67% of stance when COG is “vaulting” over the foot?
Midstance
When in the stance phase is store energy absorbed in contact to return it in the propulsive phase?
Midstance
What part of the stance phase is where the energy to move up and forward is utilized?
Propulsive
What are the parts of the stance phase?
1 Heel strike
2 Foot flat
3 Midstance
4 Pushoff (propulsive)
What are the parts of the swing phase?
1 Acceleration
2 Midswing
3 Deceleration
What part of the stance phase makes up the final 33%?
Propulsive
When does the propulsive portion of the stance phase begin and end?
Begins at heel lift, ends at toe off
What changes occur while running that changes the timing of the events in the stance phase compared to walking?
1 Increased speed
2 Need for more forceful propulsion
Compare the percentages for each stage of the stance phase while walking.
First 27% = Contact
27-67% = Midstance
Last 33% = Propulsion
Compare the percentages for each stage of the stance phase while running.
0-20% = Contact
20-45% = Midstance
Last 55% = Propulsion
What is the initial swing of the swing phase that begins with the lift of the foot from the floor and ends when the swinging foot is opposite the stance foot?
Acceleration
What part of the swing phase is when the swinging limb overtakes the limb in stance and begins as the swinging limb is opposite the stance limb and ends when the shining limb is forward and the tibia is vertical?
Midswing
What is the terminal swing of the swing phase that begins with a vertical tibia of the swing leg with respect to the floor and ends the moment the foot strikes the floor?
Deceleration
What are the 5 priorities of a normal gait?
1 Stability of weight bearing foot during stance
2 Clearance of non-weight bearing foot during swing
3 Appropriate pre-positioning of the foot during terminal swing for the next gait cycle
4 Adequate step length
5 Energy conservation
What is the relationship between the leg and arm swing during gait?
Swing of the arms is out of phase (opposite) with the legs
What is the point in the spine of rotational transition between the lumbars and thoracic and also the site of greatest rotation between vertebrae?
T6-T7
As the arms move forward during gate, what part of the body should rotate with them?
Shoulders
Do the shoulders and pelvis rotate in or out of phase with one another during gate?
Out of phase (shoulders rotate with arms, pelvis with legs)
Does the thoracic spine move in the same direction as the shoulders or the pelvis during gait?
Same direction as shoulders, OPPOSITE of the pelvis (to enhance stability and balance)
Does the thoracic or lumbar spine tend to rotate with the pelvis during gate?
Lumbar spine (thoracic with shoulders)
How does the innominate bone change in direction of rotation during gait?
Goes from anterior rotation at the point of pre-swing to posterior rotation at the point of initial contact
How does the position of the ilium change as an extremity moves through the loading response to mid stance?
Converts from posteriorly rotated position to neutral
How does the position of the ilium change as an extremity changes from mid stance to terminal stance?
Rotates anteriorly achieving maximum position at terminal stance
How does the sacrum rotate during gait?
Rotates forward around diagonal axis during loading response, reaches maximum position at mid stance, then begins to reverse itself during terminal stance
For normal gait to occur, what two movements must be achieved by the pelvis?
Rotation and tilt
If a patient presents with a dropped pelvis on the left side during the Trendelenburg test, what is the side of weakness and of which muscle?
Weak right gluteus medius
During a failed Trendelenburg test, the pelvis dropped on which side: that of the lifted leg or stance leg?
Lifted leg
During a failed Trendelenburg test, the weakness is on which side: that of the lifted leg or stance leg?
Stance leg
How many times does the knee joint flex and extend during each gait cycle?
Twice for each (once during weight bearing and once during non-weight bearing)
Ankle joint motion during the gait cycle occurs primarily in which body plane?
Sagittal
What is the motion of the ankle joint at initial contact with the ground?
Dorsiflexion
During the loading response, which motions occur at the talocrural joint and subtalar joint?
Talocrural = plantar flexion Subtalar = pronation
Which motions occur at the talocrural joint and subtalar joint at the end of the mid stance interval?
Talocrural = maximum dorsiflexion Subtalar = supination
From the mid stance to the terminal stance, is the foot in pronation or supination?
Supination
Once the ankle is fully close-packed, the force and contraction of which muscles are responsible for the heel being lifted?
Gastrocnemius and soleus
What is another name for the subtalar joint?
Talocalcaneal joint
What bones are involved in the subtalar joint?
Talus and calcaneus
Which joint of the foot functions as a mitered hinge during gait to transmit internal and external rotation from the tibia to rotation about the foot?
Subtalar joint
Eversion and inversion of the foot occur about which orthogonal axis?
Z axis
Which three motions make up supination of the foot?
1 Plantar flexion
2 Adduction
3 Inversion
Which three motions make up pronation of the foot?
1 Dorsiflexion
2 Abduction
3 Eversion
What moment of the subtalar joint occurs at heel strike?
Pronation
What structure maintains the medial arch of the foot?
Plantar fascia
During the holding period of mid stance, which foot is pronated and which is inverted?
Rear foot pronated, forefoot inverted
Rigidity of the foot is absolutely necessary for which movement of gait?
Propulsion
At heel lift, is the subtalar joint supinated or pronated?
Supinated rapidly
What position is enabled by the subtalar joint supinating when the heel lifts during gait?
Close pack position (cuboid and calcaneous lock)
What is the “windlass effect”?
Tight pulling of the plantar fascia in the close pack position
What two events are crucial in creating the rigid lever needed for ambulation?
1 rapid supination of subtalar joint to close pack position
2 plasmar fascia “windlass effect”
What motion allows for the increased arch height necessary for stability during gait?
Dorsiflexion of the toes during propulsion (approximation of rear foot and forefoot)
What muscles help support the pelvis during the swing phase?
Posts major and quadratus lumborum
What muscles are active on the ipsilateral side of swing phase?
Semispinalis, rotators, multifidus, external oblique (psoas major and QL for pelvis)
What muscles are active on the contralateral side during the swing phase?
Erector spinae and internal oblique (hip abductors also for support)
What is the prime mover in the early to mid portion of the swing phase?
Iliopsoas
What muscles are involved in the initial swing of the swing phase?
Rectus femoris, sartorius, gracilis, adductor lungs, TFL, pectinous, short head of biceps femoris
Which muscles are involved in the terminal swing of the swing phase?
Hamstrings and gluteus maximus
Which motions are decelerated by the hamstrings and gluteus maximus during the terminal swing of the swing phase?
Hip flexion and knee extension
Which muscle is involved in the initial stance of the stance phase to support hip extension and also rotate the pelvis externally?
Adductor magnus
Which muscles are involved in stabilizing the pelvis during mid stance of the stance phase?
Abductors (eccentric)
Which muscles remain active during the terminal stance of the stance phase for lateral pelvic stabilization?
Gluteus medius and minimus
When do the quadriceps achieve peak activity during gait?
Loading response
Which muscles contract slightly at the end of the swing period prior to heel strike during the swing phase?
Knee extensors
Co-activation of which muscles during the loading response aids the ligaments in maintaining joint stability by equalizing the articular surface pressure distribution and controlling tibial translation?
Hamstrings
What muscles contract concentrically to dorsiflex and invert the food in preparation for the initial contact during swing phase?
Tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibula’s tertius
Which muscle work eccentrically to lower the foot to the ground during the loading response interval?
Tibialis anterior
Calcaneal eversion is controlled by the eccentric activity of which muscle?
Tibialis posterior
Anterior movement of the tibia and talus is controlled by the eccentric action of which muscles?
Gastrocnemius and soleus
Which muscles contract eccentrically from mid stance to the late stance period to control ankle dorsiflexion as the COG continues to move forward?
Triceps surae
What is stretched in the late stance period as the ankle dorsiflexes?
Achilles tendon
When does the action of the plantar flexors change from eccentric to concentric contraction during the stance phase?
Heel lift
What are the two most important factors in absorbing the shock of impact during gait?
1 pronation of subtalar joint
2 eccentric muscle actions
What represents the concentric action of the tibialis anterior during gait?
Dorsiflexion and inversion of the foot
What represents the eccentric action of the tibialis anterior during gait?
Plantar flexion and pronation after heel strike
What represents the concentric action of the tibialis posterior during gait?
Plantar flexion and inversion of the foot
What represents the eccentric action of the tibialis posterior during gait?
Dorsiflexion and pronation during midstance
What is the most common problem at the knee during the stance period?
Excessive flexion
What is the most common problem at the knee during the swing period?
Inadequate motion
What are the usual issues with the hip joint during gait?
Inadequate power, inappropriate range of motion, malrotation
What are the usual issues with the foot and ankle joints during gait?
Malrotation, varus/valgus deformity, abnormal muscle movements
What are the four major reasons for general gait deviations?
1 weakness
2 abnormal joint position or range of motion
3 muscle contracture
4 pain
What is the clinical term for a pattern of walking style that arises in response to pain as a form of compensation?
Antalgic gait
Which gait syndrome is characterized by a decrease in the stance period on the involved side in an attempt to eliminate the weight from the involved legs and use of the injured body part as much as possible?
Antalgic gait
Which gait is associated with “toe-walking”?
Equinus gait
Which gait syndrome is characterized by forefoot strike to initiate the cycle and premature plantar flexion in early stance to mid stance?
Equinus gait
What type of diplegia is associated with the equinus gait?
Spastic diplegia
What movement characterizes the gluteus maximus gait?
Posterior thrusting of the trunk (in an attempt to maintain hip extension of the stance leg)
What are the results of hip extensor weakness seen through a gluteus maximus gait?
Forward tilt of the pelvis and a resultant hyperlordosis of the spine to maintain posture
What can cause the quadriceps gait?
Peripheral nerve lesion (femoral), spinal nerve root lesion, trauma, or disease (muscular dystrophy)
Which gait requires forward motion to be propagated by circumduction of each leg?
Quadriceps gait
How does a patient compensate with the quadriceps gait?
Lean body toward other side to balance center of gravity (also circumduction of legs for forward movement)
Why are both upper and lower extremities affected by the spastic gait?
Upper motor neuron lesion (unilateral OR bilateral)
Which results from a unilateral UMN lesion: spastic hemiplegic or spastic paraparetic gait?
Spastic hemiplegic (hemiparetic) gait
Which results from a bilateral UMN lesion: spastic hemiplegic or spastic paraparetic gait?
Spastic paraparetic gait
What can cause a spastic hemiplegic gait?
Stroke
What can cause a spastic paraparetic gait?
Cervical myelopathy in adults
Cerebral palsy in children
Which gait syndrome is characterized by a stiff, foot-dragging walk from contracture following an UMN lesion?
Spastic gait
Which gait syndrome is characterized by an unsteady, uncoordinated walk employing a wide base and the feet being thrown out?
Ataxic gait
The ataxic gait is seen in which two principal disorders?
1 Cerebellar disease (cerebellar ataxic gait)
2 Posterior column disease (sensory ataxic gait)
Which gait syndrome is associated with patients who have a foot drop?
Steppage gait
What causes the steppage gait?
Weakness or paralysis of the DORSIFLEXOR muscles due to an injury to the muscles, their peripheral nerve supply, or the nerve roots supplying the muscles
How do patients with the steppage gait compensate?
Lift the leg high enough to clear the flail foot off the floor by flexing excessively at the hip and knee, then the foot slaps on the floor
Which gait syndrome is due to weakness of the hip abductors (gluteus medius and minimus)?
Trendelenburg gait
How does a patient with the Trendelenburg gait compensate?
Trunk is thrust laterally in an attempt to keep the center of gravity over the stance leg (demonstrate lateral list)
What is another name for the Parkinsonian gait?
Festinating gait
Which gait syndrome is characterized by a flexed and stooped posture with flexion of the neck, elbows, metacarpophalangeal joints, trunk, hips, and knees?
Parkinsonian (festinating) gait
What movements does a patient with a Parkinsonian gait have difficulty with?
Imitating moments
What kind of steps are taken by a patient with a Parkinsonian gait?
Short and rapid steps that results in a shuffling type of gait
Which gait syndrome is non-specific and bizarre and doesn’t conform to any specific organic pattern?
Hysterical gait
When does the hysterical gait appear to be minimal or absent in a patient?
When the patient is unaware of being watched or when distracted
