GAIT: Normal Flashcards
Steps to SOLVING gait questions:
- Visual learning
- Draw it out
- Make tables
- Practice!
Practice!
PT observes gait of 34yo male pt. PT suspects LLD. Which of following gait devs will be seen?
THINK! David in one high heel & broken high heel== INC PF short leg!
INCd DF w/ EARLY heel rise of the LONG limb @ HEEL OFF and INCd PF of the SHORT limb (to make it longer) during stance
TIP: If leg is short, you will perform PF to make it LONGER.
DF to make it SHORTER!
GAIT:
I Love Many Types of Pussy In My Tesla
Gait Definitions:
Gait
manner or style of walking
Gait Definitions:
Gait cycle
Beginning of walking by one limb continuing until event is rep’d w/ the same limb
Time from heel strike to next I/L heel strike
Stride
One COMPLETE gait cycle
Step
Beginning of event by one limb until the beginning of the same event with the C/L limb
1 gait cycle= 1 stride length= 2 steps
Phases of Gait Cycle
StrIde vs Step
StrIde= I/L= Ex. R heel strike to R heel strike
Step= C/L= R heel strike to L heel strike
Phases of Gait Cycle
Ex. Looking @ Hip
2 things happen, and what is the result?
Ex. Hip
- Flexors shorten: If WEAK==> Small step length
- Extensors stretch: If TIGHT==> Small step length
Practice!
Pt presents to clinic w/ hx of burns on the L. hip and thigh causing tight hip flexors (don’t like to be stretched!) What gait abnorm will you see?
Remember FLOP
Tip: FLOP= Hip Flexor tightness–> Opp side step length Reduced
A: Shorter step length with the R. Lower extremity
L. hip flexor tight== L hip cannot ext==smaller step length on RLE
What powers us forward?
Rocker functions?
Heel
Ankle
Forefoot
Ant vs Post mm’s job/function
IC= Ant mm’s
- Ant mm’s when landing on ground–bring us forward
MSt= No mm’s
Toe-off= Post mms’s
- Post mm’s when leaving ground–push us against gravity
Rockers
Heel, Ankle, Forefoot
Analysis of Gait by Functional Significance
Problem: Ea. stride (I/L heel strikes) involves changing align. bw body and supporting foot
Solution: Classify and relate ea pattern of mvmt to a distinct functional demand or tasks
Which Phase?
- Wt accept
- SL support
- Limb advance.
Practice!
Following sx of R hip, pt amb’s as shown in pic (STICK TO YOUR PLANE!). Part of intervention, PT opts to include FES to improve gait pattern. Stim should be initiated for?
FES to R abductors during stance on Right
Problem: L pelvic drop, weak R abd’s
Solution: FES
Kinematics of Gait Cycle
STICK TO YOUR PLANE!
A: Sagittal– you watch from SIDE
B: Frontal– you watch from FRONT
C: Horizontal plane
**If stuck on entry lvl exam, pick Sag and Frontal plane as answer
Practice!
PT decides to use FES (more helpful w/ concentric) to improve amb of pt w/ weak Tib Ant. Stim for the weak mm should be initiated in which PHASE of gait cycle?
ISw to MSw– To CLEAR foot–MOST important functionally
TIP:
Problem= weak Tib Ant, causes foot/toe drag and diff w/ clearing ground in SWING
Solution= Activate the DF–strengthen Tib Ant!
Chart:
See ROM, Torque, MM Action
see pics
Practice!
While eval’ing 68yo male, PT observes R. pelvic hike during Swing of R. gait cycle. LEAST LIKELY cause?
R. Ankle PF weakness
All pot. causes:
- Reduced R hip flex
- Inad R knee flexion
- Lack of R ankle DF (will make leg longer)
Kinematic Data on Norms of Jt Angles
ALL FIRST
All needed for Normal Gait:
Hip:
- Stance= 0-30 flexion; 0-10-20 hyperext.
- Swing= 20-30 flexion
Knee:
- Stance= 0-40 flexion
- Swing= 0-60 flexion
Ankle:
- Stance= 0-10 DF; 0-20 PF
- swing= 0-10 PF
ROM @ HIP needed for normal gait:
Stance
- 0-30 flexion; 0 to 10-20 HYPERext
Swing
- 20-30 flexion
ROM @ KNEE needed for normal gait:
Stance
- 0-40 Flexion
Swing
- 0-60 Flexion
ROM @ ANKLE needed for normal gait:
STANCE
- 0-10 DF; 0-20 PF
SWING
- 0-10 PF
Practice!
PT is tx 43yo male who sustained L hip fx. Pt having diff gaining hip flexion ROM. How much MIN hip flex should PT try to obtain for normal gait pattern?
Hip ROM needed
- Stance: 0-30 flexion; 0-10/20 hyperEXT
- Swing: 20-30 flexion
MM Activity in the Gait Cycle
Group: PreTibial Mm’s
Name: Tib Ant, EDL, EHL
Prior to and During Heel Strike
- ECC. contraction– lowers foot to ground
Prio to and During Swing
- CONC contrction– DF, clears toes off ground
MM Activity in the Gait Cycle
Group: Calf Mm’s
Name: Gastroc, Soleus (FDL, FHL, Posterior Tib (Tom, Dick, Harry))
Mid Stance
- ECC contraction– control of tibia over foot
Heel Off
- CONC contraction– Ankle PF
Practice!
PT examines gait of 62yo male. Pt exhibits R early heel off during stance (auto. think tight calves!). Which impairment most likely assocd?
Shortening of the gastroc
Causes early heel off in stance
A: B–> PFs reqd for heel off/push off during gait. When tight, they can cause early heel off.
- Shortening of HS’s will cause excessive knee flexion
- Weakness of the Tib Ant will cause foot slap in STance
- - Weakness of the Iliopsoas will cause backward trunk lean in swing—try it yourself! YOu have to lean BACK to get more hip flex
MM Activity in the Gait Cycle
Group: Quadriceps
Name: Vastus med/lat/intermed, RecFem
Before Heel Strike
- Quads femoris contrcts ECC–controls rapid knee flex to prevent buckling
Pre-Swing
- ECC contraction– slow down leg (tibia)
MM Activity in the Gait Cycle
Group: Hamstrings
Name: Biceps, Semitend, Semimemb
Heel Strike
- ECC contraction–protects knee from HyperEXT
Swing phase:
- CONC contraction– knee flex, hip ext
Practice!
PT is eval’ing 34yo female w/ vague dx of LBP. Pt displays + Thomas Test (tight hip flexors) Which subphase of gait cycle will MOST likley show limitation in hip ROM?
FLOP
Tight Hip Flexors==OPP side step length REduced
A: Terminal Stance– hip EXT compromised bc tight hip flexors
MM Activity in the Gait Cycle
Group: Hip ABDs
Name: Glute med/min, TFL
Stance
- ECC contraction– stabilize pelvis
MM Activity in the Gait Cycle
Group: Hip ADDs
Name: ADD longus/brevis, Gracilis, Add magnus (horiz and vert heads)
Early and Late stance
- CONC contraction– stabilize pelvis
Practice!
74yo contractor has prominent forward lean in STANCE on R lower extremity (Magnet theory!!! STANCE ONLY!!). PT hypothesizes?
Weak QUADS on R side
Magnet Theory in Stance– Trunk goes TOWARDS weak mm’s
- MM somewhere ANTERIORLY saying “come towards met”== Magnet Theory
TIP: Correct answer: Weak quads
- In stance phase, weak mm’s act like magnets and trunk leans TOWARDS weak mm’s. Weak quads on R side will cause a forward trunk lean on the R in stance!
- Weak glute max on L will cause POST trunk lean in stance
- Weak glute med on L will cause L side trunk lean in stance
- Weak HS’s on R side will cause reduced knee flexion, no dev. in stance
