Gait, Stairs, and Posture Flashcards
The gait cycle is 60% _________ and 40% ________
Stance phase, Swing phase
The 7 Steps of the Gait Cycle
Categorize into Stance vs Swing phase
Stance phase
- Heel Strike (initial contact)
- Loading response (flat foot)
- Midstance
- Terminal stance (heel off)
- Preswing (toe off)
Swing phase
- Initial and Mid swing
- Terminal swing
The “push off” section of the gait cycle is during
terminal stance and preswing (toe off)
Why would a patient have a foot slap
weakness of dorsiflexors
What is the function of the foot during initial contact/ heel strike?
This begins the first phase of?
muscle actions of the ankle, knee, and hip (concentric vs eccentric)
-establish contact with the ground surface and initiate weight acceptance
-double support
ankle: concen to eccen dorsiflex
knee: eccen exten
hip: concen extens and eccen flex
Main extensor of the knee
Quad
Extensors of the hip
Glut max, Add mag, Hammy
Where is the start and end of loading phase/flat foot?
How does the foot accept shock?
muscle actions of the ankle, knee, and hip (concentric vs eccentric)
-begins with initial contact and continues until contralateral foot leaves the ground
-rolls into pronation
ankle: eccen dorsif
knee: eccen ext, concen flex
hip: concen ext (gradual ext)
Where is the start and end of mid stance?
How is the body supported?
What phases does it move from?
muscle actions of the ankle, knee, and hip (concentric vs eccentric)
-begins when contral foot leaves ground and continues until ipsi heel lifts off ground
-by a single
-from force absorption at impact to force propulsion forward
ankle: eccen plantarf and concen dorsif (gradual dorsif)
knee: concen ext
hip: concen ext (gradual ext)
Where is the start and end of early swing?
Function?
muscle actions of the ankle, knee, and hip (concentric vs eccentric)
-begins when the foot leaves the ground until it is aligned with contral ankle
-advance limb and shorten limb for foot clearance
ankle: eccen dorsi then concen dorsi and eccen plantar
knee: eccen extens and concen flex
foot: concen flex
Where is the start and end of terminal stance (heel off)?
How is the body supported?
The ____ the body forward.
How is the bodyweight divided?
muscle actions of the ankle, knee, and hip (concentric vs eccentric)
Begins when the heel leaves the floor and continues until the contral foot contacts the ground
-through single leg support and stability
-propels
-over the metatarsal heads
ankle: eccen plantar, then conc plantar
knee: concen ext, then eccen ext and conc flex
hip: eccen flex
Where is the start and end of pre swing/toe off?
Provides the final burst of …
muscle actions of the ankle, knee, and hip (concentric vs eccentric)
-begins when the contral foot contacts the ground and continues until ipsi foot leaves the ground
-propulsion as the toe leaves the ground
ankle: conc platarf
knee: eccen extens
foot: concen flex
Where is the start and end of mid swing?
Function?
muscle actions of the ankle, knee, and hip (concentric vs eccentric)
-begins from the ankle and foot alignment and continues until the swing leg tibia is vertical
-advance limb and shorten limb for foot clearance
ankle: conc dorsi
knee: eccen flex
foot: concen flex
Where is the start and end of late swing/deceleration?
Limb advancement slows …
muscle actions of the ankle, knee, and hip (concentric vs eccentric)
-begins when the swing leg tibia is vertical and ends with initial contact
-limb advancement slows in preperation
ankle: conc dorsi
knee: eccen flex then concen flex
foot: concen flex and eccen exten, then concen extens
Two point gait pattern
AD and contralateral LE advance simul
Three point gait pattern
AD, then involved limb, then uninvolved limb
Four point gait pattern
Device initiates movement; EX left can - right LE - right cane - left LE
Step to gait pattern
This is typically done when
LE in swing phase is advanced only as far as the assistive device (move AD then walk to it)
patient is first learning because it increase time in double stance
Step through gait pattern
progression from?
LE in swing phase is advanced beyond the AD
step to gait
Swing to pattern
both crutches are advanced followd by simul advancement of bLE up to line of AD
Swing through pattern
both crutches are advanced followd by simul advancement of bLE beyong the AD
Tripod alternating pattern
first one crutch then the other following simul B advancement of the LEs
Tripod simul pattern
both crutches advanced simul followed by a simul bLE advancement
Reciprocal pattern
this results in
UE and contralateral LE advanced simul
normal trunk rotation pattern during gait
A few examples of how AD’s meet patient needs
decrease WB on painful side
Increase BOS
improved joint stability
improved efficiency of movement
NWB
TTWB
PWB
WBAT
FWB
n: 0% foot/toes do not touch ground
tt: foot may rest on floor but bearing no weight
p: a percentage of the pt body weight usually 20-50% but can vary
w: limited only by the pt tolerance usually 50-100%
f: 100% no limtations
How to ensure patients are following nwb precautions? (4)
therapist foot (pt foot on therapists)
scale
bws (body weight support)
proper device
Key muscles that help with nwb on one LE
UE and Upper trunk
UE: shoulder depressors, extensors, flexors, elbow extensors, finger flexors
UT: scapular depressors and stabilizers
Key muscles that help with nwb on one LE
Lower trunk and WB extremity
LT: trunk extensors and flexors
WB: hip abductors, extensors, knee extensors, ankle dorsiflexors
Key muscles that help with nwb on one LE
NWB extremity
hip flexors, knee extensors or flexors
General ROM needed fro stairs - knees
up: 8-94
down: 10-92
General ROM needed fro stairs - hips
up: 7-65
down: 15-40
Typically for guarding with a gait belt you stand
If you believe the knee will buckle you should
slightly posterior and to the side
block it
Muscles involved in weight acceptance when going down stairs
single leg support as opp limb advances
glut max and med, TFL, quad
quad, soleus
Muscles involved in weight acceptance when going up stairs
single leg support as opp limb advances
glut max and med, adductor magnus, quad
hammy, gastroc
How to teach a pt which limb to start with when going up or down stairs
Up with the good
Down with the bad
Other challenges that may present while amb or using stairs for a pt (5)
doorway, grass, crowds, opening doors, small children/pets
Why is posture important? (3)
can help avoid aches in the back, neck, and shoulders
helps with balance
can reduce stress on joints
General ROM needed fro stairs - ankle
DF up: 11-24
DF down: 20-34
PF up: 20-31
PF down: 22-44
