Gait-Lecture 7

Question 1

What are the two periods of the gait cycle?

Answer 1

Swing and Stance

Question 2

What are the two tasks in stride?

Answer 2

Weight acceptance

Single limb support

Question 3

What is the task in swing?

Answer 3

Limb Advancement

Question 4

What are the phases of weight acceptance?

Answer 4

Initial contact

Loading response

Question 5

What are the phases of single limb support?

Answer 5

Mid-stance
Terminal Stance
Pre-swing

Question 6

What are the phases of limb advancement?

Answer 6

pre-swing
initial swing
mid-swing
terminal swing

Question 7

What is normal movement of the trunk in all phases of gait?

Answer 7

Erect

Neutral

Question 8

What is the normal position of the Hip, Knee, Ankle, and Toes at initial swing?

Answer 8

Hip: 20 degrees Flexion
Knee: 60 degrees Flexion
Ankle: 10 degrees Plantarflexion
Toes: Neutral

Question 9

What is the normal position of the Hip, Knee, Ankle, and Toes at midswing?

Answer 9

Hip: 20-30 degrees Flexion
Knee: 60-30 degrees Flexion
Ankle: Neutral
Toes: Neutral

Question 10

What is the normal position of the Hip, Knee, Ankle, and Toes at Terminal swing?

Answer 10

Hip: 30 degrees Flexion
Knee: 0 degrees Extension
Ankle: Neutral
Toes: Neutral

Question 11

What is the normal position of the Hip, Knee, Ankle, and Toes at initial contact?

Answer 11

Hip: 30 degrees Flexion
Knee: Full Extension
Ankle: Neutral, Heel first
Toes: Neutral

Question 12

What is the normal position of the Hip, Knee, Ankle, and Toes at Loading Response?

Answer 12

Hip: 30 Degrees Flexion
Knee: 15 Degrees Flexion
Ankle: 15 degrees Plantarflexion
Toes: Neutral

Question 13

What is the normal position of the Hip, Knee, Ankle, and Toes at Mid-stance?

Answer 13

Hip: Extending to Neutral
Knee: Extending to Neutral
Ankle: Plantarflexion to 10 degrees Dorsiflexion
Toes: Neutral

Question 14

What is the normal position of the Hip, Knee, Ankle, and Toes at Terminal stance?

Answer 14

Hip: 10 degrees hyperextension
Knee: Full Extension
Ankle: Neutral with stable tibia
Toes: Neutral IP, extended MP

Question 15

What is the normal position of the Hip, Knee, Ankle, and Toes at Pre-swing?

Answer 15

Hip: Neutral Extension
Knee: 35 degrees Flexion
Ankle: 20 Degrees Plantarflexion
Toes: Neutral IP, Extended MP

Question 16

What are the 6 determinants of gait?

Answer 16

Pelvic Rotation
Pelvic tilt
Knee Flexion to Mid-stance
Ankle Motion
Knee Motion
Lateral Pelvic Motion

Question 17

What’s the transverse kinematics of the pelvis?

Answer 17

4 degrees

Question 18

What’s the transverse kinematics of the femur?

Answer 18

7 degrees

Question 19

What’s the transverse kinematics of the tibia?

Answer 19

9 degrees

Question 20

What are the 5 possible patient causes of gait deviations?

Answer 20

Muscle weakness
Contracture
Pain
Decreased confidence in the prosthesis or residual limb
Habitual/learned behavior

Question 21

What are the 2 prosthetic causes of gait deviations?

Answer 21

Prosthetic misalignment

Poor prosthetic fit

Question 22

What are the gait considerations from Dr. Perry?

Answer 22

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)

Question 23

What is normal Hip and Hemi gait at initial contact?

Answer 23

•  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.

Question 24

What is normal hip and hemi gait at initial contact to loading response?

Answer 24

•  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

Question 25

What is normal hip and hemi gait at Loading Response to Mid-stance?

Answer 25

•  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.

Question 26

What is normal hip and hemi gait at mid-stance to terminal stance?

Answer 26

•  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

Question 27

What is normal hip and hemi gait at terminal stance to mid-swing?

Answer 27

•  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.

Question 28

What are common Hip and Hemi gait deviations?

Answer 28

Insufficient Knee Flexion 
Insufficient Hip Flexion 
Excessive Knee Flexion 
Excessive Hip Flexion 
Excessive Lumbar Lordosis 
Lateral Trunk Bending

Question 29

What are common Trans-tibial gait deviations?

Answer 29

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)

Question 30

What are common trans-femoral gait deviations?

Answer 30

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