Gait Lecture 12-13

Question 1

Stride and Step

Answer 1

Stride and Step

Step: initial contact to opposite limb initial contact

Stride: initial contact to subsequent same limb initial contact

Question 2

Foot Progression Angle

Answer 2

Foot Progression Angle

Angle the foot turns outward during walking – from the line of progression of the body and a line from the mid-heel to the second toe

Adult average: 10-14 degrees (0.17 – 0.24 radians)

Question 3

Gait Speed

Answer 3

Step Rate

Number of steps taken per time – Usually steps per minute or second –

Average Adult: 115 step/minute

Gait Speed

Step Rate * Step Length = Gait Speed

(step/second * meters/step = meters/second)

Best clinical outcome measure for gait

• Reliable
• Predictive of health function
• Relatively easy to measure – Known distance (e.g., 5 meters) – Time measured (e.g., 3.8 seconds) – Gait speed (5/3.8 = 1.32 meters/second)

typical adult walking speed:1.4 meters/second

Question 4

Step Rate

Answer 4

Step Rate

Number of steps taken per time – Usually steps per minute or second –

Average Adult: 115 step/minute

Question 5

Gait Cycle

Answer 5

Gait Cycle

Fundamental unit used to describe gait

• The period from foot contact to repeat of foot contact on same side (i.e., stride)
• Common division: Stance Period (limb is in contact with ground) and Swing Period (foot off the ground)

Question 6

Label the Picture

Answer 6

See picture

Question 7

What are the fundamental phases of gait?

Answer 7

• 8 fundamental phases of gait
• Each phase specifically defined by points in time during the gait cycle

1) Initial Contact Start and end: foot contact (normally heel strike)

2) Loading Response foot contact, End: contralateral foot off

3) Mid-Stance contralateral foot off, end: ipsilateral heel off

4) Terminal stance ipsilateral heel off, end: contralateral initial contact

5) Pre-swing contralateral initial contact. end: foot off

6) Initial Swing foot off. End: feet adjacent to one another

7) Mid Swing feet adjacent to one another. End: Ipsilateral vertical tibia

8) Terminal Swing Ipsilateral vertical tibia. End: Foot contact

Question 8

Initial Contact

Stance or Swing Period?

Functional Task

Critical Event

Answer 8

Initial Contact

First phase of gait

Within Stance Period.

Functional Task: weight acceptance

Critical event: Heel contact

START: Foot contact END: Foot contact

Question 9

Loading Response

Stance or Swing Period?

Functional Task

Critical Event

Answer 9

2) Loading Response

second phase of gait

Stance Period

Functional Task: Weight acceptance (weight acceptance also has initial contact and loading response)

Critical Events (3 of them):

- Heel rocker (controlled plantar flexion)

• controlled knee flexion (after locking knee, have buckling knees. Also possible varus valgus?)
• hip/pelvic stability (look for hip rotation, lateral lean, rotation of hip)

Question 10

Mid-Stance

Stance or Swing Period?

Functional Task

Critical Event

Answer 10

MIDSTANCE

Period: Stance

Functional Task: Single limb support (WA(2)), SLS(2)), SLA(4))

Phase: (3) Mid-stance (right after loading response, right before mid-stance

Critical events (#4&5) (3 was controlled knee flexion, 6 is forefoot rocker):

- 4) hip/pelvic stabiliy (continued from LR - hip drop (glut med), think of TFL medial rotation and anterior pelvic tilt))

• 5) Ankle rocker (question:tibial advancement - the tibia starts behind vertical and moves anterior to vertical - could lack it because gastroc is short or joint problem. Would also have short stride)

Question 11

Terminal Stance

Period

Functional Task

Critical Event

Answer 11

(4) Terminal Stance

Heel off to opposite limb initial contact (Ipsilateral heel off Contralateral IniTal Contact)

Period: Stance period (5 phases in stance, 3 in swing)

Functional Task: 2nd part of Single Limb Support (WA(2), SLS(2), SLA)

Phase: Terminal stance (right after midstance, before pre-swing)

critical events:

6) Forefoot rocker (go onto MCP joint, heel comes off the ground, pivet on MTP joint??)

7) Hip extension (10°) (due to short hamstrings (swayback posture for posterior pelvic tilt), due to short hip flexors, weak gluts)

(5 was ankle rocker, 8 is rapid ankle plantar flexion)

Question 12

Pre-swing

Answer 12

(5) Pre-Swing

Second double limb support

Period: Stance (5th part of stance)

Functional Task: 1st part of Swing Limb Advancement (WA(2), SLS(2), SLA(4))

Phase: Pre-swing (right after terminal stance, before initial-swing)

critical events:

7) Rapid ankle PF - look at motion and speed (ankle planter flexes from 10-20 degrees of DF to 30 degrees of PF over a split second RAPIDLY)

8) Passive knee flexion to 40 degrees

(6 was hip extension, 9 is active knee flexion to 60 degrees)

Question 13

Initial Swing

Answer 13

(6) Initial Swing

Foot lift off until both feet are side by side

Period: SWING (1 out 3)

Functional Task: 2nd part (out of 4) of Swing Limb Advancement (WA(2), SLS(2), SLA(4))

Phase: Initial swing (right after pre-swing, before mid-swing)

critical events:

9) Peak Knee Flexion (60 degrees) (if no knee flexion, could have circumduction, elevation at hip, vaulting (PF stance leg) - could be due to weak hamstrings, short quadriceps, joint problem).

(8 was passive knee flexion to 40 degrees, 10 is peak hip flexion)

Question 14

Mid-Swing

Answer 14

(7) Mid-Swing

Feet side by side to vertical tibia orientation

Period: SWING (2 out 3)

Functional Task: 3rd part (out of 4) of Swing Limb Advancement (WA(2), SLS(2), SLA(4))

Phase: Mid swing (right after initial-swing, before terminal-swing)

critical events:

10) Peak hip Flexion (30 degrees - 25 degrees in book) - otherwise there could more of a shuffle- would kinda look like decreased knee flexion?)

11) Ankle DF to neutral (swing the limb through) - could have super weak TA, joint restriction, short plantar flexors

(9 was peak knee flexion (60 degrees) 12 is knee extension to neutral)

Question 15

Terminal Swing

Answer 15

(8) Terminal Swing

Vertical tibia orientation to initial contact

Period: SWING (3 of 3)

Functional Task: 4th part (out of 4) of Swing Limb Advancement (WA(2), SLS(2), SLA(4))

Phase: Terminal swing (right after mid-swing, before initial contact)

critical events:

12) Knee extension to neutral (put some angular momentum at knee but need it to be controlled (eccentric activity of the hamstrings)) - could see lack of control in knee extension and swing leg out, lack of knee extnesion due to short hamstrings, joint problme (would lead to smaller stride/step with lack of knee extension)

(11 was Ankle dorsiflexion to neutral, 1 is heel contact)