Gait-Lecture 7 Flashcards
What are the two periods of the gait cycle?
Swing and Stance
What are the two tasks in stride?
Weight acceptance
Single limb support
What is the task in swing?
Limb Advancement
What are the phases of weight acceptance?
Initial contact
Loading response
What are the phases of single limb support?
Mid-stance
Terminal Stance
Pre-swing
What are the phases of limb advancement?
pre-swing
initial swing
mid-swing
terminal swing
What is normal movement of the trunk in all phases of gait?
Erect
Neutral
What is the normal position of the Hip, Knee, Ankle, and Toes at initial swing?
Hip: 20 degrees Flexion
Knee: 60 degrees Flexion
Ankle: 10 degrees Plantarflexion
Toes: Neutral
What is the normal position of the Hip, Knee, Ankle, and Toes at midswing?
Hip: 20-30 degrees Flexion
Knee: 60-30 degrees Flexion
Ankle: Neutral
Toes: Neutral
What is the normal position of the Hip, Knee, Ankle, and Toes at Terminal swing?
Hip: 30 degrees Flexion
Knee: 0 degrees Extension
Ankle: Neutral
Toes: Neutral
What is the normal position of the Hip, Knee, Ankle, and Toes at initial contact?
Hip: 30 degrees Flexion
Knee: Full Extension
Ankle: Neutral, Heel first
Toes: Neutral
What is the normal position of the Hip, Knee, Ankle, and Toes at Loading Response?
Hip: 30 Degrees Flexion
Knee: 15 Degrees Flexion
Ankle: 15 degrees Plantarflexion
Toes: Neutral
What is the normal position of the Hip, Knee, Ankle, and Toes at Mid-stance?
Hip: Extending to Neutral
Knee: Extending to Neutral
Ankle: Plantarflexion to 10 degrees Dorsiflexion
Toes: Neutral
What is the normal position of the Hip, Knee, Ankle, and Toes at Terminal stance?
Hip: 10 degrees hyperextension
Knee: Full Extension
Ankle: Neutral with stable tibia
Toes: Neutral IP, extended MP
What is the normal position of the Hip, Knee, Ankle, and Toes at Pre-swing?
Hip: Neutral Extension
Knee: 35 degrees Flexion
Ankle: 20 Degrees Plantarflexion
Toes: Neutral IP, Extended MP
What are the 6 determinants of gait?
Pelvic Rotation Pelvic tilt Knee Flexion to Mid-stance Ankle Motion Knee Motion Lateral Pelvic Motion
What’s the transverse kinematics of the pelvis?
4 degrees
What’s the transverse kinematics of the femur?
7 degrees
What’s the transverse kinematics of the tibia?
9 degrees
What are the 5 possible patient causes of gait deviations?
Muscle weakness Contracture Pain Decreased confidence in the prosthesis or residual limb Habitual/learned behavior
What are the 2 prosthetic causes of gait deviations?
Prosthetic misalignment
Poor prosthetic fit
What are the gait considerations from Dr. Perry?
Ability to ambulate
Quality of the prosthesis
Quality of the residual limb
Knee flexion contracture less than 10 degrees
Kinematic peak differ from normal (motions)
Kinetic peaks differ and are stronger than normal (forces)
What is normal Hip and Hemi gait at initial contact?
• Hip joint motion is 15 degrees or less. Hip
flexion is limited by hip flexion control strap or
spring.
• Axis of support passes from heel up through hip
joint, anterior to knee, producing stability.
• Prosthesis becomes a simple “peg”.
• Sound side is at foot flat.
What is normal hip and hemi gait at initial contact to loading response?
• Trunk advances forward • Foot-floor reaction moves forward • Knee stability maintained by T.K.A. line • Axis of support continues to pass anterior to knee • Hip extension bumper not in contact
What is normal hip and hemi gait at Loading Response to Mid-stance?
• Trunk advances further forward
• Foot-floor reaction point still forward,
maintaining knee stability
• Opposite leg lifts
• At Mid Stance: Alignment essentially the
same as static alignment.
• Momentum carries body forward.
• Hip joint contacts.
• Hip flexion control strap or spring relaxes.
• Opposite foot off.
What is normal hip and hemi gait at mid-stance to terminal stance?
• Trunk remains vertical. Increased pressure on posterior upper
edge of socket.
• Increases pressure on hip joint bumpers.
• Axis of support falls posterior to knee joint, therefore knee,
and knee flexes.
• Opposite foot flat on floor
What is normal hip and hemi gait at terminal stance to mid-swing?
• Toe off - heel rises during knee flexion and pulls the hip joint against the posterior(extension) stop.
• Thigh remains vertical until the knee reverses direction and
contacts the knee stop.
• Then the thigh segment rotates anteriorly, causing hip flexion.
• Prosthesis is at full length during mid-swing,
and since no voluntary control, shorten 1cm for ground clearance.
What are common Hip and Hemi gait deviations?
Insufficient Knee Flexion Insufficient Hip Flexion Excessive Knee Flexion Excessive Hip Flexion Excessive Lumbar Lordosis Lateral Trunk Bending
What are common Trans-tibial gait deviations?
Inadequate flexion Inadequate extension Medial leaning pylon Lateral leaning pylon Drop off Erratic movement Heel lever too short/long Toe lever too short/long Whip(s)
What are common trans-femoral gait deviations?
Foot slap Knee Instability Delayed progression Unequal step length Eternal rotation Lateral trunk bend Abducted gait Pelvic elevation Knee hyper extension Medial/lateral whip Excessive heel rise Inadequate heel rise Circumduction Pistoning Vaulting Terminal impact Reduced velocity
