GAIT: Normal

Question 1

Steps to SOLVING gait questions:

Answer 1

1. Visual learning
2. Draw it out
3. Make tables
4. Practice!

Question 2

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!

Answer 2

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!

Question 3

GAIT:

Answer 3

I Love Many Types of Pussy In My Tesla

Question 4

Gait Definitions:

Gait

Answer 4

manner or style of walking

Question 5

Gait Definitions:

Gait cycle

Answer 5

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

Question 6

Stride

Answer 6

One COMPLETE gait cycle

Question 7

Step

Answer 7

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

Question 8

Phases of Gait Cycle
StrIde vs Step

Answer 8

StrIde= I/L= Ex. R heel strike to R heel strike
Step= C/L= R heel strike to L heel strike

Question 9

Phases of Gait Cycle
Ex. Looking @ Hip
2 things happen, and what is the result?

Answer 9

Ex. Hip
- Flexors shorten: If WEAK==> Small step length
- Extensors stretch: If TIGHT==> Small step length

Question 10

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

Answer 10

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

Question 11

What powers us forward?
Rocker functions?

Answer 11

Heel
Ankle
Forefoot

Question 12

Ant vs Post mm’s job/function

Answer 12

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

Question 13

Rockers

Answer 13

Heel, Ankle, Forefoot

Question 14

Analysis of Gait by Functional Significance

Answer 14

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.

Question 15

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?

L hip drop== Weak R abductors!

Answer 15

FES to R abductors during stance on Right
Problem: L pelvic drop, weak R abd’s
Solution: FES

Question 16

Kinematics of Gait Cycle
STICK TO YOUR PLANE!

Answer 16

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

Question 17

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?

Answer 17

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!

Question 18

Chart:
See ROM, Torque, MM Action

Answer 18

see pics

Question 19

Practice!
While eval’ing 68yo male, PT observes R. pelvic hike during Swing of R. gait cycle. LEAST LIKELY cause?

Answer 19

R. Ankle PF weakness
All pot. causes:
- Reduced R hip flex
- Inad R knee flexion
- Lack of R ankle DF (will make leg longer)

Question 20

Kinematic Data on Norms of Jt Angles
ALL FIRST

Answer 20

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

Question 21

ROM @ HIP needed for normal gait:

Answer 21

Stance
- 0-30 flexion; 0 to 10-20 HYPERext

Swing
- 20-30 flexion

Question 22

ROM @ KNEE needed for normal gait:

Answer 22

Stance
- 0-40 Flexion

Swing
- 0-60 Flexion

Question 23

ROM @ ANKLE needed for normal gait:

Answer 23

STANCE
- 0-10 DF; 0-20 PF
SWING
- 0-10 PF

Question 24

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?

Answer 24

Hip ROM needed
- Stance: 0-30 flexion; 0-10/20 hyperEXT
- Swing: 20-30 flexion

Question 25

MM Activity in the Gait Cycle
Group: PreTibial Mm’s

Answer 25

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

Question 26

MM Activity in the Gait Cycle
Group: Calf Mm’s

Answer 26

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

Question 27

Practice!
PT examines gait of 62yo male. Pt exhibits R early heel off during stance (auto. think tight calves!). Which impairment most likely assocd?

Answer 27

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

Question 28

MM Activity in the Gait Cycle
Group: Quadriceps

Answer 28

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)

Question 29

MM Activity in the Gait Cycle
Group: Hamstrings

Answer 29

Name: Biceps, Semitend, Semimemb
Heel Strike
- ECC contraction–protects knee from HyperEXT

Swing phase:
- CONC contraction– knee flex, hip ext

Question 30

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?

Answer 30

FLOP
Tight Hip Flexors==OPP side step length REduced
A: Terminal Stance– hip EXT compromised bc tight hip flexors

Question 31

MM Activity in the Gait Cycle
Group: Hip ABDs

Answer 31

Name: Glute med/min, TFL
Stance
- ECC contraction– stabilize pelvis

Question 32

MM Activity in the Gait Cycle
Group: Hip ADDs

Answer 32

Name: ADD longus/brevis, Gracilis, Add magnus (horiz and vert heads)
Early and Late stance
- CONC contraction– stabilize pelvis

Question 33

Practice!
74yo contractor has prominent forward lean in STANCE on R lower extremity (Magnet theory!!! STANCE ONLY!!). PT hypothesizes?

Answer 33

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