Gait Rehab: A Kinetic Approach

Question 1

Kinematic Analysis of Gait:
Internal Forces

Answer 1

Muscular forces that produce ambulation vs. external forces resisting the body

Question 2

Kinematic Analysis of Gait:
External Forces

Answer 2

Inertia, Gravity, and Friction

Question 3

Methods to analyze Gait and Promote Treatment:
Shock Absorption

Answer 3

Muscles as shock absorbers

Evident in initial contact, slow down, or smooth out movement

(Quads 1st 15% of stance)

Question 4

Methods to analyze Gait and Promote Treatment:
Muscles as Accelerators

Answer 4

Pre Swing to Iliopsoas and Gastro-soleus

Question 5

Methods to analyze Gait and Promote Treatment:
Muscles as Decelerators

Answer 5

Eccentric activity, Hamstrings during swing, anterior tib during initial contact

Question 6

Methods to analyze Gait and Promote Treatment:
Muscles as Decelerators

Answer 6

Eccentric activity, HS during swing, TA during Initial Contact

Question 7

Methods to analyze Gait and Promote Treatment:
Stabilizers

Answer 7

Maintain equilibirum and hold segments stable (ISOMETRIC)

Glute Med, Max, and Adductors

Question 8

What is the main focus of gait rehabilitation for neurologic clients?

Answer 8

Gait mechanics, task-based activities, exercise, and sensory input.

Question 9

Greatest Energy is at what phase?

Answer 9

Stance Phase

Last 10% of stance phase requires the greatest energy source

Question 10

Swing Phase

Answer 10

The first burst of Hip Flexion activates swing

Question 11

What does ground reaction force (GRF) refer to?

Answer 11

The equal and opposite force produced by the ground when the body imparts force during a step.

Question 12

What are the three directions in which forces are applied during gait?

Answer 12

Vertical, anterior-posterior, and medial-lateral.

Question 13

During initial contact in normal gait, what type of torque is created?

Answer 13

Plantarflexion torque

Arises from the posterior Calcaneus and causes eccentric activaiton of DF

Question 14

What role do quadriceps play during the loading response phase of gait?

Answer 14

Act as shock absorbers

Loading response is posterior to the limb, but anterior to the hip joint

Question 15

Loading Response

Answer 15

Eccentric activity at the quads with co-activaiton of the hamstrings

Ant Tib is working eccentrically

Isometric contraction of glute med and max to reduce falling forward

Question 16

Midstance

Answer 16

Eccentric work in the Soleus for ankle stability

Ankle and forefoot become supinated and rigid for late stance

Quads stay active until COM moves over the foot w/ stabilizers of the hip

Question 17

Toe Off

Answer 17

Posterior Calf muscles create Torque of Momentus for Propulsion

Center of Pressure on 1st MT head

Knee Flexion is passive & Hip is preparing for acceleration

Question 18

What is the significance of the center of pressure (CoP) in gait?

Answer 18

It indicates where ground reaction forces are applied within the foot.

Moves along a path through the foot from heel to toes (Lateral Calcaneus)

Question 19

Fill in the blank: The _______ is the location within the foot where the ground reaction forces are applied.

Answer 19

center of pressure (CoP).

Question 20

Sensory Input, Biomechanics, and Motor Output work together

Answer 20

Peripheral Mechanoreceptors detect displacement, velocity, and acceleration of the skin

Somatosensory receptors respond to constant stimuli

Question 21

Analyzing Ground Reaction Forces

Answer 21

Stride length creates difference force vectors

Longer stride length = Greater forward vector in preping for Toe Off

Question 22

Factors during Gait Rehabilitation

Answer 22

Integration of postural control
-Postural alignment (Hip Ext)
-Postural Responses

Tasks Based Training

Sensory Input

Question 23

What are the two essential sensory elements of gait mentioned?

Answer 23

Hip extension position and loading.

Question 24

Basis of Central pattern Generation

Answer 24

Flexion of Swing Limb
Loading enhances stance
Sensory input modulates gait

Question 25

True or False: Golgi tendon organs in the ankle extensor muscles inhibit flexor bursts during locomotion.

Answer 25

True.

Question 26

What is the impact of increased body weight loading on hip extensor muscle activation?

Answer 26

Hip extensor activation was directly proportional to Loading More Loading = More Ext.

Question 27

Increased Level of Loading

Answer 27

Leg movements in combination with loading of the legs led to appropriate leg muscle activation

Question 28

Stabilization of Extensors: Limb Peak Load

Answer 28

Limb peak load was associated with modulation of extensor EMG amplitude rather than muscle stretch

Question 29

Beneficial effects of Locomotor Training

Answer 29

Depends on the Initial degree of body unloading and reloading during the course of the training period

Question 30

Hip and Sensory Input

Answer 30

Proprioceptors responding to hip extension are important for initiating swing Vibration stimulates the primary and secondary endings fo muscle spindles in hip flexor muscles

Question 31

Sensory Input in the Hip

Answer 31

Hip extension in late stance stretches the hip flexors and trigger forward swing of the limb Standing PNF patterns assist

Question 32

Neurologic Gait Training for the Hip

Answer 32

Loading the limb (through the calcaneus) drives extensor activity Requires GRF and stabilization of glute max to setup propulsion and stretch of the iliopsoas

Question 33

Whole Body Vibration

Answer 33

Galileo side-to-side (6-30 hz) Activates the muscle spindle for increased velocity, stretch, and contact ability Medically used for muscle strength and spasticity

Question 34

Important Details for Gait

Answer 34

Facilitate upright standing and proper use of AD Ensure the leg hits the ground before a forearm crutch for better load bearing Sychronize hip ext. and unloading with simultaneous loading of the other limb for swing initiation

Question 35

What does task-based training in gait rehabilitation emphasize?

Answer 35

Paretic limb weight-bearing, aerobic activity, functional strengthening, and balance. Ideal programs have a combination of activities

Question 36

What does the term 'task-oriented training' refer to in gait rehabilitation?

Answer 36

Training that assists the natural pattern of functional recovery.

Question 37

What was found to be strongly related to knee joint hyperextension in hemiparetic stroke patients?

Answer 37

Ankle plantarflexor weakness.

Question 38

Fill in the blank: The _______ phase is when knee hyperextension was found to have a strong relationship with ankle plantarflexor weakness.

Answer 38

midstance.

Question 39

What is a common contributor to knee joint hyperextension during gait?

Answer 39

Weak posterior knee stabilization, particularly from the gastrocnemius and hamstrings.

Question 40

What is the recommended frequency of incorporating gait activities into rehabilitation sessions?

Answer 40

Incorporate gait activities into every session.

Question 41

What is the function of whole body vibration in gait training?

Answer 41

Increase muscle strength and decrease spasticity.

Question 42

True or False: Evidence supports that one specific rehabilitation technique is more effective than others in promoting gait recovery.

Answer 42

False.

Question 43

What type of training is effective for improving walking speed in patients?

Answer 43

Treadmill training, particularly at faster speeds.

Question 44

What is the role of sensory input in the initiation of swing during gait?

Answer 44

Proprioceptors responding to hip extension are important for initiating swing.

Question 45

What is a key finding regarding the role of hip position in gait?

Answer 45

Preferred hip position is extension in late stance, triggering forward swing.

Question 46

What does effective gait rehabilitation require in terms of postural control?

Answer 46

Anticipatory and reactive postural control.

Question 47

Fill in the blank: _______ is critical for negotiating realistic environments during walking.

Answer 47

Visual sampling.

Question 48

What was the conclusion regarding the relationship between lower limb muscle weakness and knee hyperextension during loading response?

Answer 48

No relationship was found.

Question 49

Mechanics of Hemiplegic Genu Recavatum

Answer 49

Hamstring weakness Gastroc spasticity and weakness Weak quads and strong enough hip extensors to extend femur posteriorly