Intro to Normal Gait Flashcards
What is normal gait?
A sequence of pattern of limb-motions that serve to progress the body along a desired path while maintaining weight bearing stability, conserving energy, and absorbing shock of impact
What are the periods of the gait cycle in Rancho Los Amigos?
Loading response –> Mid Stance –> Terminal Stance –> Pre Swing –> Initial Swing –> Mid Swing – Terminal Swing
What is a gait cycle?
A heel strike on one limb to the next ipsilateral heel strike
What is the stance phase?
Entire period the limb is in contact with the ground
What percentage of the gait cycle is the stance phase?
60% of the gait cycle
What is the swing phase?
Begins when the foot comes off the ground
What percentage of the gait cycle is swing phase?
40% of the gait cycle
What periods are apart of stance phase?
Loading response, mid stance, terminal stance, pre swing
What are the events of a gait cycle?
Initial contact –> opposite toe off –> heel rise –> opposite initial contact –> toe off –> feet adjacent –> tibia vertical –> next initial contact
What are the phases of the gait cycle in standard terminology?
Heel strike –> foot flat –> midstance –> heel off –> toe off –> midswing –> heel strike
What is double limb support?
When both feet are in contact with the ground
What is single limb support?
When only one foot is in contact with the ground
What should be happening during the functional task of weight acceptance?
- Initial contact and loading response
- Weight is rapidly loaded on an outstretched limb
- Impact of the GRF is absorbed
- Body continues on a forward path while stability is maintained
- Both feet are in contact with the ground
What should be happening during the functional task of single limb support?
- Mid stance and terminal stance
- Period where body progresses over a single, stable limb
- Weight is transferred from metatarsal heads and the heels come off the ground
What should be happening during the functional task of swing limb advancement?
- Pre-swing, initial swing, mid swing, and terminal swing
- Limb is unloaded and the foot comes off the ground
- Limb is moved from behind the body to in front of the body, reaching out to take the next step
What is the objective of initial contact?
Positioning of the limb to start stance
What is the objective of loading response?
- Shock absorption
- Weight bearing stability
- Forward progression
What is the objective of mid stance?
- Progression of COG over BOS
- Limb and trunk stability
What is the objective of terminal stance?
Progression of COG beyond the BOS
What is the objective of pre-swing?
Position limb for swing
What is the objective of initial swing?
- Foot clerance of the floot
- Limb advancement from trailing position
What is the objective of mid swing?
- Limb advancement
- Foot clearance from the floor
What is the objective of terminal swing?
- Complete limb advancement
- Preparation for stance
What is the normal gait speed (velocity)?
1.37 m/sec
With aging does our gait speed (velocity) increase or decrease?
Decrease
Who has a faster gait speed (velocity), males or females?
Males
If you have a gait speed (velocity) less than 1 m/s what does that mean?
- Might benefit from fall prevention
- Greater than 0.67 m/s to complete self care
- Greater than 0.89 m/s to complete house hold activities
If you have a gait speed (velocity) greater than 1 m/s what does that mean?
- Greater than 1.1 m/s it is predictive of completing yard work
- Greater than 1.3 m/s it is predictive of climbing a flight of stairs
If you have a gait speed (velocity) less than 0.6 m/s m/s what does that mean?
- Predicts future risk of falls and hospitalizations
- Tend to require assistance with ADLs and IADLs
What speed is required to cross the street safely?
Greater than 0.49 m/s
If you have a gait speed (velocity) less than 0.4 m/s m/s what does that mean?
- Longer length of stay in acute care
- Likely to discharge to a skilled nursing, inpatient rehab, or nursing home setting or with home health services
What is the “6th vital sign”?
Walking speed
If you walk slow are you more independent or dependent?
Dependent
What is a gait cadence?
Number of steps per minutes
What is the average adult cadance?
110-120 steps/ min
What are some temporal variables of gait?
- Cadence
- Stance time
- Swing time
- Double support time
- Single support time
What are some spatial variables of gait?
- Stride length
- Step length
- Step/ base width
What is stride length?
Point from initial contact to the next initial contact on the same foot… equal to the gait cycle
What is step length?
Initial contact of the right foot to the initial contact of the left foot… two steps equal a stride
What is step base/ width?
How far apart the two feet are… the wider they are typically the more stable they are and vice versa
What is the average stride length?
56 inches
What is the average step length?
28 inches
How much hip flexion is needed for normal gait?
0 - 30 degrees
How much hip extension is needed for normal gait?
0 - 10 degrees
How much knee flexion is needed for normal gait?
0 - 60 degrees
How much knee extension is needed for normal gait?
0 degrees
How much ankle dorsiflexion is needed for normal gait?
0 - 10 degrees
How much ankle plantarflexion is needed for normal gait?
0 - 20 degrees
What is a foot slap?
- Lack of eccentric activation of the dorsiflexors
- Foot drops “slapping” the ground
- Tibialis anterior cannot control foot
What is a high stepping gait?
- Has to lift leg higher than usual to clear foot
- Increased hip and knee flexion
- Weak dorsiflexors
- Foot drop present
What is a vaulting gait?
- Associated with a limb length discrepancy or a stiff leg
- Spends stance phase of shorter leg on toes
What is a weak quadriceps gait?
Instability in the knee joint or weak quads causing hyper extension of knee and a forward lean to move the base of support forward
What is a trendelenberg gait?
- Glut med weakness
- Back pain, pelvic pain, hip dysfunction, lumbar spine surgery
- Bottoming out: hip cannot (glute med) contract to pull body of base of support
- Contralateral pelvic drop (ex: left side is weak or right pelvis drops)
- If compensating then the patient will bend to weaker side and decrease the moment arm
What is a posterior lurch gait?
Trunk lead posterior with a hyper extended hip during loading response due to a weak glute max
What are things to watch for?
- Sagittal, frontal, and transverse plane movement
- Joint angles (ex: increase
- Increased movement of trunk and/ or pelvis in various planes
What is the goal of observational gait analysis?
to design and implement appropriate treatment interventions based on deviations seen
