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DPT Semester 2 > Kinesiology Cont > Flashcards

Kinesiology Cont Flashcards

1
Q

what produces an external torque during gait?

A

GRF

will cause movement at each joint of the LE

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2
Q

what produces an internal torque during gait?

A

primarily muscle activation

it is produced to match/overcome the external torque

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3
Q

when and why do concentric muscle contractions occur during gait?

A

they occur when the internal torque is moving the joint in the direction of the muscle’s activity

these provide stability and produce movement of a segment

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4
Q

when and why do eccentric muscle contractions occur during gait?

A

they occur when an internal torque is moving the joint in the direction opposite of the muscle’s action

these help with shock absorption and deceleration of a limb segment

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5
Q

what can cause muscular dysfunction and how will it impact gait?

A

Causes:

  1. weakness
  2. loss of power
  3. decreased endurance
  4. spasticity
  5. contracture

leads to altered gait patterns and compensations as the torque GRFV doesn’t change but the individual’s ability to counter it does

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6
Q

what muscles are activated at the hip in the sagittal plane during IC?

A

ALL hip extensors contract concentrically to prepare for LR

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7
Q

what muscles are activated at the knee in the sagittal plane during IC?

A

eccentric hamstring contraction to counteract extension torque

knee extensions transition from concentric to eccentric contraction in preparation for LR

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8
Q

what muscles are activated at the ankle in the sagittal plane during IC?

A

pretibials (tibialis anterior, big toe extensors) contract concentrically

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9
Q

what muscles are activated at the hip in the sagittal plane during LR?

A

concentric contraction of hip extensors

(Glute max, adductor magnus, TFL, Glute med peak)

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10
Q

what muscles are activated at the knee in the sagittal plane during LR?

A

eccentric contraction of knee extensors

(quad activity peaks)

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11
Q

what muscles are activated at the ankle in the sagittal plane during LR?

A

eccentric contraction of ankle DF (tibialis anterior peaks)

Transition to eccentric contraction of ankle PF in late LR

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12
Q

what muscles are activated at the hip in the sagittal plane during MSt?

A

no hip muscular activity requried in the sagittal plane

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13
Q

what muscles are activated at the knee in the sagittal plane during MSt?

A

quads eccentric to no activity

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14
Q

what muscles are activated at the ankle in the sagittal plane during MSt?

A

eccentric contraction of the gastroc/soleus

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15
Q

what muscles are activated at the hip in the sagittal plane during TSt?

A

minimal activity in the sagittal plane

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16
Q

what muscles are activated at the knee in the sagittal plane during TSt?

A

no quad or HS activity

tibial position maintained by gastroc

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17
Q

what muscles are activated at the ankle in the sagittal plane during TSt?

A

concentric contraction of ankle PF to prevent tibial collapse with heel rise

Gastroc/Soleus activity peaks

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18
Q

what muscles are activated at the hip in the sagittal plane during PSw?

A

concentric contraction of hip flexors

adductor longus peaks

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19
Q

what muscles are activated at the knee in the sagittal plane during PSw?

A

knee flexion is mainly passive

slight concentric contraction of knee flexors and eccentric rectus

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20
Q

what muscles are activated at the ankle in the sagittal plane during PSw?

A

ankle PF activity ceases in early PSw and passive tension contributes to ankle moving in PF

ankle DF concentric initiated at the end of PSw

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21
Q

what muscles are activated at the hip in the sagittal plane during ISw?

A

continued concentric contraction of hip flexors

Iliacus peaks

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22
Q

what muscles are activated at the knee in the sagittal plane during ISw?

A

concentric contraction of knee flexors

(biceps femoris SH, sartorius, gracilis peak)

flexion continues to be aided by flexion at the hip

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23
Q

what muscles are activated at the ankle in the sagittal plane during ISw?

A

concentric contraction of tibialis anterior

toe extensor activity peaks

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24
Q

what muscles are activated at the hip in the sagittal plane during MSw?

A

continued concentric contraction of hip flexors

initation of eccentric hip extensors (HS) to control hip flexors

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25
Q

what muscles are activated at the knee in the sagittal plane during MSw?

A

knee extension created by momentum

knee flexors contract eccentrically at the end of MSw to control extension

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26
Q

what muscles are activated at the ankle in the sagittal plane during MSw?

A

continued concentric contraction of DF

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27
Q

what muscles are activated at the hip in the sagittal plane during TSw?

A

concentric contraction of hip extensors

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28
Q

what muscles are activated at the knee in the sagittal plane during TSw?

A

concentric contraction of knee extensors to insure full extension

peak hamstring eccentric contraction to decelerate thigh

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29
Q

what muscles are activated at the ankle in the sagittal plane during TSw?

A

continued concentric contraction of DF

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30
Q

Describe the relative joint position and muscle activity at the hip in the sagittal plane during gait

A

use the chart

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31
Q

describe the relative joint position and muscle activity at the knee in the sagittal plane during gait

A

use the chart

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32
Q

describe the relative joint position and muscle activity at the ankle in the sagittal plane during gait

A

use the chart

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33
Q

what muscles are activated at the hip in the frontal plane during LR and MSt?

A
  1. LR → hip abductors contracting eccentrically
    • Glute med and adductor magnus at peak
  2. MSt → hip abductors contracting eccentrically then concentrically
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34
Q

what muscles are activated at the ankle in the frontal plane during LR and MSt?

A

invertors contracting eccentrically during both phases

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35
Q

what muscles are activated at the hip in the frontal plane during TSt and PSw?

A

hip abductors contracting concentrically

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36
Q

what muscles are activated at the ankle in the frontal plane during TSt and PSw?

A

invertors contracting concentrically

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37
Q

what muscles are activated at the hip in the frontal plane during the entire swing phase?

A

hip adductors contract concentrically

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38
Q

what muscles are activated at the ankle in the frontal plane during the entire swing phase?

A

evertors contract concentrically

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39
Q

describe the relative joint position and muscle activity at the hip in the frontal plane during all of gait

A

use the diagram

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40
Q

describe the relative joint position and muscle activity at the ankle in the frontal plane during all of gait?

A

use the diagram below

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41
Q

what are the key roles of the ankle dorsiflexors during gait?

A

eccentric activation to control plantarflexion of the ankle at IC until foot flat

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42
Q

what are the key roles of the ankle plantarflexors during gait?

A
  1. eccentric contraction moving into MSt to control tibial advancement
  2. concentric contractions at TSt assists with forward propulsion
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43
Q

what are the key roles of the ankle invertors during gait?

A
  1. eccentrically contracts to control pronation until MSt
  2. concentrically contracts to supinate the foot for push off in TSt/PSw
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44
Q

what are the key roles of the ankle evertors during gait?

A

also active as co-contraction to counter strong inversion effect occuring during LR/MSt

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45
Q

what are the key roles of the knee extensors during gait?

A
  1. eccentrically control knee flexion in LR
  2. Concentrically to extend the knee and support the body in MSt
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46
Q

what are the key roles of the knee flexors during gait?

A

Decelerate knee extensors in preparation for placement of the foot on the ground

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47
Q

what are the key roles for the hip extensors during gait?

A

activated in TSw prior to IC to initiate hip extension and prepare LE for weight acceptance at the beginning of stance

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48
Q

what are the key roles for the hip flexors during gait?

A

advance LE forward during ISw

Concentrically lift LE to allow for toe clearance during swing

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49
Q

what are the roles of the hip abductors during gait?

A

Control the slight lowering of the contralateral pelvis on the side of the swing limb then provide pelvic stability in stance

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50
Q

what are the key roles of the hip adductors during gait?

A

assist with the initation of hip flexion after toe off

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51
Q

List some gait deviations

A
  1. Trendelenburg gait
  2. compensated trendelenburg gait
  3. foot slap
  4. knee extension thrust
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52
Q

what phase of gait is Trendelenburg gait observed?

A

LR → PSw

(observed best in frontal plane)

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53
Q

what does Trendelenburg gait look like?

A

excessive downward drop of the contralateral pelvis during stance

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54
Q

what is the cause of both Trendelenburg and compensated Trendelenburg gait?

A

glute medius weakness

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55
Q

what is the result of Trendelenburg gait?

A

a functionally longer swing limb resulting in decreased efficiency and possibly decreased stance time

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56
Q

what differentiates Trendelenburg from compensated Trendelenburg gait?

A

compensated Trendelenburg gait utilizes a trunk lean over the stance leg to try and maintain a level pelvis

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57
Q

what does a foot slap gait look like? what phase of gait is it most noticed and in what plane?

A

PF torque goes unchecked by anterior tib

occurs during IC → LR

best observed in the sagittal plane

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58
Q

what are some potential causes of a foot slap gait?

A

tib anterior weakness

(from a peroneal nerve palsy or peripheral neuropathy)

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59
Q

what is the result/impact of “foot slap” on gait?

A

rapid PF after heel contact which can be audible

usually can clear foot during swing

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60
Q

what does a knee extension thrust during gait look like? what phases does it typically occur in and what plane is the best to view it?

A

knee snapping back into extension early in stance phase

phase → IC

plane → sagittal

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61
Q

what are some potential causes of a knee extension thrust gait deviation?

A

quad spasiticy from UMN lesion

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62
Q

what is the result/impact of a knee extension thrust gait deviation?

A

rapid and often excessive knee extension during LR, can occur w/cause knee hyperextension over time

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63
Q

describe the positioning of the foot and ankle in the sagittal plane during IC

A

neutral to slight PF position

(heel rocker (1st rocker) is initated here)

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64
Q

describe the positioning of the foot and ankle in the sagittal plane during LR

A

5º of rapid PF to get foot flat on the floor

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65
Q

describe the positioning of the foot and ankle in the sagittal plane during the transition from MSt to TSt

A

this transition is a period of CKC DF to about 10º and MTP to 30º

(ankle and forefoot rocker occurs here)

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66
Q

describe the positioning of the foot and ankle in the sagittal plane during PSw

A

there is a transition from time of max DF position toward max PF position

max MTP extension to 60º

heel lift off is occuring

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67
Q

describe the positioning of the foot and ankle in the sagittal plane during ISw

A

DF to move the ankle away from max PF to about 5º of PF

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68
Q

describe the positioning of the foot and ankle in the sagittal plane during the transition of MSw to TSw

A

ankle continues to DF until it reaches a neutral position in preparation for heel strike during IC

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69
Q

what critical events must occur at the ankle during gait and at what phases?

A
  1. IC = heel first contact
  2. LR = ankle PF
  3. MSt = controlled tibial advancement
  4. TSt = controlled ankle DF with heel rise
  5. PSw = ankle PF
  6. MSw = foot clearance
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70
Q

what are the foot and ankle rockers?

A

3 different positions/movement sequences that all aim to move the foot and ankle through gait

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71
Q

List the 3 different foot and ankle rockers

A
  1. heel rocker (1st rocker)
  2. ankle rocker (2nd rocker)
  3. forefoot rocker (3rd rocker)
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72
Q

what occurs during heel rocker (1st rocker)?

A

motion of the foot from a DF to PF position during LR to achieve a flat foot

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73
Q

what occurs during the ankle rocker (2nd rocker)?

A

closed chain advancement of the tibia into a DF position over a fixed foot during MSt

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74
Q

what occurs during the forefoot rocker (3rd rocker)?

A

begins when COP is over the Metatarsals and heel lift occurs in TSt/PSw

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75
Q

what is the purpose of the rockers?

A

they allow for an efficient and smooth gait pattern

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76
Q

describe the positioning of the knee in the sagittal plane during IC

A

neutral to 5º of flexion

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77
Q

describe the positioning of the knee in the sagittal plane during LR

A

flexing to 15º (allows for shock absorption)

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78
Q

describe the positioning of the knee in the sagittal plane during MSt to TSt

A

extension back to 5º flexion/neutral

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79
Q

describe the positioning of the knee in the sagittal plane during PSw

A

rapid flexion to 40º

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80
Q

describe the positioning of the knee in the sagittal plane during ISw

A

more flexion to 60º

needed for limb clearance

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81
Q

describe the positioning of the knee in the sagittal plane during MSw

A

Rapid extension to 25º flexion

determines step length

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82
Q

describe the positioning of the knee in the sagittal plane during TSw

A

further extension to 5º/neutral

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83
Q

what are the critical events that must occur at the knee and which phases do they occur at?

A
  1. LR = controlled knee flexion
  2. PSw = passive knee flexion
  3. ISw = knee flexion
  4. TSw = knee extension
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84
Q

describe the positioning of the hip in the sagittal plane during IC → LR

A

20º flexion

(considered “leftover” from TSw)

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85
Q

describe the positioning of the hip in the sagittal plane during MSt

A

extension into a neutral hip position as the body progresses forward

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86
Q

describe the positioning of the hip in the sagittal plane during TSt

A

maximum (20º) hip extension occurs

the body is past the foot at this point as it begins to transition into PSw

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87
Q

describe the position of the hip in the sagittal plane during PSw

A

flexion (from 20º extension) to about 10º of hip extension

(this is when there is a reversal from extension into flexion)

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88
Q

describe the positioning of the hip in the sagittal plane during ISw

A

continued flexion to 15º

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89
Q

describe the positioning of the hip in the sagittal plane during MSw → TSw

A

continued flexion to 25-30º

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90
Q

what are the critical events that occur at the hip during gait? What phases do they occur at?

A
  1. LR = hip stability
  2. ISw = hip flexion
  3. MSw = hip flexion
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91
Q

how much ROM is needed at the hip, knee and ankle for normal gait?

A
  1. hip = ~40º
    • flexion = 25
    • extension = 20
  2. knee = ~60º
    • flexion = 60
    • extension = 0
  3. ankle = 30º
    • DF = 10
    • PF = 20
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92
Q

how is the COM displaced in the sagittal plane during gait?

A

vertically (~5 cm)

it is at it’s lowest during the halfway point of both double limb support stages

it is at it’s highest during the halfway point of both single limb support stages

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93
Q

describe the position of the ankle in the frontal plane during IC

A

slight inversion of the hindfoot

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94
Q

describe the positioning of the ankle in the frontal plane during LR → MSt

A

eversion of the hindfoot

pronation initially and then the forefoot follows hindfoot position

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95
Q

describe the positioning of the foot and ankle in the frontal plane during TSt → PSw

A

inversion

allows for resupination and the foot becoming a rigid lever so that we can push off of it

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96
Q

describe the positioning of the foot and ankle in the frontal plane during swing phase

A

really variable

can’t really ascribe normal positioning

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97
Q

describe the positioning of the knee in the frontal plane during gait

A

not much movement with normal gait

(total = ~5-10º)

some genu varum/valgum may be observed

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98
Q

describe the positioning of the hip in the frontal plane during IC

A

neutral ab/adduction

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99
Q

describe the positioning of the hip in the frontal plane during LR → MSt

A

adduction during weight acceptance

a contalateral hip drop may be observed

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100
Q

describe the positioning of the hips in the frontal plane during MSt → TSt

A

increased adduction (up to 15º)

weight shifts over to stance leg resulting in relative hip adduction (due to hip hike of swing leg)

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101
Q

describe the horizontal plane motions of the trunk during gait

A

opposite rotation from pelvic motion

total excursion 7-9º

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102
Q

describe the horizontal plane motions that occur at the hips during gait

A

forward rotation of the pelvis on the stnace limb occurs with hip flexion during swing

increases greater step length than that of hip flexion alone

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103
Q

describe the horizontal plane motions that occur at the shoulder during gait

A

opposite sagittal plane motion from ipsilateral hip

motion is partially active and is mostly shoulder extension

the motion balances out rotational forces of the trunk

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104
Q

how is the COM displaced in the horizontal plane during gait?

A

shifts from R to L crossing a midline point to stay over BOS

max shift towards the reference limb occurs at the end of mistance of the reference limb

the max shift away from the reference limb occurs during midswing of the reference limb

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105
Q

List several possible gait deviations

A
  1. decreased great toe extension
  2. steppage gait/increased knee flexion
  3. foot flat contact
  4. circumduction
  5. increased lumbar lordosis
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106
Q

what phases of the gait cycle is decreased great toe extension primarily impacting and what would it look like?

A
  1. phases = TSt and PSw
  2. patient does not complete forefoot rocker and ends stance phase noticeably early
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107
Q

what is the cause of decreased great toe extension?

A
  1. joint hypomobility
  2. pain
  3. bone spur
  4. gouty arthritis
  5. plantar fasciitis
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108
Q

what is the end result of a gait deviation like decreased great toe extension?

A

decreased push off

shortened stance time

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109
Q

what phases of the gait cycle is steppage gait impacting and what does it look like?

A
  1. swing phase
  2. looks like increased hip and knee flexion with loss of ankle DF
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110
Q

what are some potential causes of a gait deviation like steppage gait?

A
  1. foot drop/nerve disorder
  2. polyneuropathy
  3. equinus deformity
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111
Q

what is the end result of a gait deviation like steppage gait?

A

prolonged swing phase

fall risk

decreased efficiency

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112
Q

what phases of the gait cycle is foot flat contact primarily impacting and what would it look like?

A
  1. IC
  2. looks like the mid foot or forefoot make first contact with ground instead of the heel
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113
Q

what are some potential causes of foot flat contact gait deviations?

A
  1. excessive knee flexion in late swing
  2. weak/impaired DF
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114
Q

what is the end result of a gait deviation like foot flat contact?

A

absent heel rocker

(can have normal ankle rocker)

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115
Q

what phases of the gait cycle are primarily impacted by the gait deviation: circumduction? What does it look like?

A
  1. phases = swing
  2. looks like a lateral whipping motion of the limb during swing at the hip
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116
Q

what are some potential causes of the gait deviation circumduction?

A
  1. impaired knee flexion ROM
  2. impaired ankle DF ROM
117
Q

what is the end result of the gait deviation circumduction?

A

compensation for failure to functionally shorten the limb during swing = increased fall risk

118
Q

what phases of the gait cycle are primarily impacted by the gait deviation increased lumbar lordosis? What does it look like?

A
  1. TSt
  2. looks like increased lumbar lordosis during late stance phase
119
Q

what are some potential causes of the gait devaition of increased lumbar lordosis?

A
  1. hip flexor contracture
  2. Hip OA
120
Q

what is the end result of the gait deviation of increased lumbar lordosis?

A

lack of hip extension in terminal stance is compensated for increased lordosis in the spine

121
Q

Define Base of Support

A

area bounded posteriorly by the tips of the heels and anteriorly by a line joining the tips of the toes

122
Q

Define Center of Gravity

A

also called COM

point where mass of body is centered

123
Q

Define postural control

A

maintenance of COM over BOS to control body’s orientation in space and stabilize head w/respect to vertical to orient gaze

124
Q

what 2 responses enable postural control?

A

reactive (compensatory) response

proactice (anticipatory) response

125
Q

what are reactive (compensatory) responses?

A

responses that occur as reactions to external forces that displace the body’s COM

126
Q

what are proactive (anticipatory) responses?

A

responses that occur in anticipation of internally generated destabilizing forces

127
Q

how much postural sway is normal?

A

7 mm during quiet stance

COP can be mapped to determine sway

128
Q

what is the clinical relevance of postural sway?

A

increased sway = increase fall risk due to COM nearing/getting outside of BOS

129
Q

what is the difference between sensory and mechanical perturbations?

A

sensory = may be caused by altering visual input

mechanical = displacement causing changes in the relationship of the body’s COM to BOS

130
Q

what are muscle synergies/strategies (pertaining to postural control)?

A

centerally organized patterns of muscle activity that occur in response to perturbations of standing postures

131
Q

what is the pattern for an ankle strategy? Hip strategy?

A

ankle = distal-to-proximal pattern

hip = proximal-to-distal pattern

132
Q

what are 2 changes in support stategies?

A
  1. stepping strategies
  2. grasping strategies
133
Q

what is the goal of changes in support strategies?

A

move/enlarge the body’s BOS so that it remains under the COM

it is the only strategy that is successful with large perturbations

134
Q

how can you define equilibrium with respect to internal/external forces?

A

sum of internal and external forces equal to zero

135
Q

what occurs if the line of gravity (LoG) passes through a joint axis?

A

no torque is created around the joint

136
Q

what occurs if the LoG passes at a distance from the joint axis?

A

external gravitation moment

this results in rotation around the joint axis unless it is opposed by a counterbalancing internal moment/muscle contraction

137
Q

Direction depends on the ________ of the ________ in relation to the ___________

A

location

LoG

joint axis

138
Q

if the LoG is anterior to the joint axis, the external moment will cause what?

A

anterior motion of the proximal segment supported by that joint

139
Q

what are 3 keys to a successful postural assessment?

A
  1. assess from multiple angles
  2. remove obstructive clothing
  3. observe more than the area of complaint
140
Q

Long-term deviation of the LoG passing through/around joint axis will result in __________

A

structural changes

141
Q

Describe the Ideal Standing Posture

A

ideal alignment palce the LoG:

  1. through external auditory meatus
  2. midway through shoulder
  3. slightly posterior to center of hip joint
  4. slightly anterior to axis of knee joint
  5. slightly anterior to lateral malleolus
142
Q

As the LoG passes anterior to the lateral malleolus, what are the external and internal moments?

A

external = pulling into dorsiflexion

internal = coutner w/plantarflexion (no passive structures contribute, active contraction of solues and gastro)

143
Q

as the LoG passes anterior to the knee joint, what are the external and internal moments?

A

external = pull into extension

internal = counter w/flexion

(prevent knee hyperextension by passive tension of posterior joint capsule and associated ligaments and active contraction of hamstrings and gastroc)

144
Q

as the LoG passes posterior to the hip joint, what are the external and internal moments?

A

external = pull into extension

internal = counter w/flexion

(passive tension of hip ligaments and active contraction of hip flexors)

145
Q

what is the ideal posture at the lumbosacral joint?

A

LoG passes through the body of the L5 causing a slight extension moment

creates shear force rather than a true torque

opposed by anterior longitudinal ligament, iliolumbar ligament, facet joint approximation

146
Q

As the LoG passes through the external auditory meatus and anterior to the axis of the head, what are the external and internal moments?

A

external = flexion of cervical spine

internal = extension of cervical spine

(passive tension of ligamentum nuchae, tectorial membrane, and posterior facet joint capsules)

(active contraction of cervical extensors)

147
Q

Describe the ideal standing posture from the posterior view

A
  1. Midline
    1. head
    2. spine
    3. feet evenly spaced
  2. Shoulder and scapulae
    1. scapulae lie flat on thorax
    2. approximately between T2-T7
    3. approximately 4 inches apart
148
Q

describe the ideal standing posture from the anterior veiw

A
  1. alignment of knees
    1. patellae face directly forward
    2. slight physiological valgus
  2. alignment of ankles
    1. neutral, neither supinated nor pronated
  3. alignment of feet
    1. heels separated by ~3 inches
    2. out-toeing 8-10 degrees
149
Q

what is the difference between a step and a stride?

A

stride = distance between 2 successive heel contacts of the same foot

step = distance between 2 successive heel contacts of 2 different feet

150
Q

define degree of toe-out

A

angle between line of progression of the body and a line intersecting the center of the heel and 2nd toe

normal = 5-7 degrees

151
Q

what are the 3 temporal descriptors of gait?

A
  1. stride time
  2. step time
  3. cadence
152
Q

what is considered a normal cadence for men and women?

A

men = 108 steps/min

women = 118 steps/min

153
Q

what is our spatiotemporal descriptor for gait?

A

gait speed/velocity

154
Q

T/F: gait speed is a very functional measurement of an individual’s walking ability?

A

TRUE

often called the 6th vital sign

155
Q

An individual’s gait speed can be predictive of what?

A
  1. future health status
  2. functional decline
  3. hospitalization rate
  4. mortality rate
156
Q

what are the 2 phases of the gait cycle?

A

stance phase (60%)

swing phase (40%)

157
Q

how much time in the gait cycle is spent in single-limb support?

A

80%

(double limb support = 20%)

158
Q

what system is used to describe the individual phases/parts of the gait cycle?

A

Rancho Los Amigos Terminology

159
Q

what are the stages of the stance phase of gait?

A
  1. initial contact
  2. loading response
  3. midstance
  4. terminal stance
  5. preswing
160
Q

what are the stages of the swing phase of gait?

A
  1. initial swing
  2. mid swing
  3. terminal swing
161
Q

what occurs in the Stance Phase: Initial contact (IC)?

A

the instant the foot hits the ground

critical event = heels first contact

162
Q

what is occuring on the opposite limb during stance phase: initial contact?

A

TSt and PSw

(terminal stance

163
Q

what are the relative joint positions during the Stance Phase: Initial contact?

A
  1. Hip = 20° flexion,
  2. Knee = 0-5° flexion
  3. Ankle = 0°
164
Q

What occurs in the Stance phase: Loading Response (LR)?

A

shock is absorbed as forward momentum is preserved. A flat foot position is achieved

critical event = hip stability, controlled knee flexion, and ankle PF

165
Q

What is occuring on the opposite limb during stance phase: loading response (LR)?

A

PSw

pre-swing

166
Q

what are the relative joint positions for the Stance Phase: loading response?

A
  1. Hip = 20° flexion
  2. Knee = 15° flexion
  3. Ankle = 5° PF
167
Q

Initial contact and loading response combine for what functional task?

A

weight acceptance, shock absorption, and providing a stable base for the body to progress over

absorb impact of GRF

period of dual-limb support

168
Q

What occurs in the stance phase: midstance (MSt)?

A

the body progresses over the foot in a controlled manner. First instance of single limb support

critical events = controlled tibial advancement

169
Q

What is occuring on the opposite leg during stance phase: midstance (MSt)?

A

ISw - MSw

(Initial swing to Midswing)

170
Q

what are the relative joint positions for stance phase: midstance?

A
  1. Hip = 0°
  2. Knee = 5° flexion
  3. Ankle = 5° dorsiflexion
171
Q

what occurs during stance phase: terminal stance (TSt)?

A

progression over the stance limb continues past the forefoot. Body is ahead of stance limb

critical events = controlled ankle DF with heel raise

172
Q

what is occuring on the opposite limb during stance phase: terminal stance (TSt)?

A

TSw

(terminal swing)

173
Q

what are the relative joint positions for stance phase: terminal stance?

A
  1. Hip = 20° extension
  2. Knee = 5° flexion
  3. Ankle = 10° dorsiflexion
174
Q

What occurs during stance phase: pre swing (PSw)?

A

rapid unloading of the limb with weight transfer to opposite limb, starting the second period of double limb support

critical events = passive knee flexion to 40°, Ankle PF, 60° of MTP extension

175
Q

what is occuring in the opposite limb during stance phase: pre swing (PSw)?

A

IC → LR

initial contact into loading response

176
Q

what are the relative joint positions for stance phase: pre-swing (PSw)?

A
  1. Hip = 10° extension
  2. Knee = 40° flexion
  3. Ankle = 15° plantarflexed
177
Q

what occurs during swing phase: initial swing (ISw)?

A

the thigh begins to advance as the foot leaves the floor

critical events = hip flexion, knee flexion

178
Q

what is occuring at the opposite limb during swing phase: initial swing (ISw)?

A

LR → MSt

(loading response into midstance)

179
Q

what are the relative joint positions during swing phase: initial swing (ISw)?

A
  1. Hip = 15° flexion
  2. Knee = 60° flexion
  3. Ankle = 5° plantarflexion
180
Q

what occurs during swing phase: mid swing (MSw)?

A

thigh continues to advance, knee begins to extend as foot clearance is maintained

critical events = continued hip flexion, foot clearance

181
Q

What is occuring in the opposite limb during swing phase: mid swing (MSw)?

A

MSt

midstance

182
Q

what are the relative joint positions for swing phase: mid swing (MSw)?

A
  1. Hip = 25° flexion
  2. Knee = 25° flexion
  3. Ankle = 0° dorsiflexion
183
Q

what occurs during swing phase: terminal swing (TSw)?

A

the leg reaches out to achieve step length

critical events = knee extension

184
Q

What is occuring on the opposite limb during swing phase: terminal swing (TSw)?

A

TSt

terminal stance

185
Q

what are the relative joint positions during swing phase: terminal swing (TSw)?

A
  1. Hip = 20° flexion
  2. Knee = 5° flexion
  3. Ankle = 0° dorsiflexion
186
Q

What are the 3 functional tasks of gait?

A
  1. Weight acceptance
  2. Single limb support
  3. Swing limb advancement
187
Q

When does weight acceptance occur within the gait cycle and what are it’s goals?

A

Occurs during: IC and LR

Goals:

  1. forward progression
  2. stability
  3. shock absorption
188
Q

when does single limb support occur within the gait cycle and what are the goals of this task?

A

occurs in: MSt and TSt

Goals:

  1. stability
  2. forward progression
189
Q

When does swing limb advancement occur within the gait cycle and what are the goals of this task?

A

occurs in: PSw, ISw, MSw, and TSw

Goals:

  1. foot clearance
  2. limb advancement
190
Q

What are some general tips to take into consideration when performing a gait analysis?

A
  1. Big picture first​
  2. Avoid tunnel vision​
  3. Do not let classification of gait dictate your treatment​
  4. Take your time, get it right​
  5. Understand what you are seeing before you try to fix it​
  6. Use anatomical and standard terminology​
  7. Let the patient choose their walking speed
191
Q

What are some general tips to take into consideration when performing a gait analysis?

A
  1. Big picture first​
  2. Avoid tunnel vision​
  3. Do not let classification of gait dictate your treatment​
  4. Take your time, get it right​
  5. Understand what you are seeing before you try to fix it​
  6. Use anatomical and standard terminology​
  7. Let the patient choose their walking speed
192
Q

When does swing limb advancement occur within the gait cycle and what are the goals of this task?

A

occurs in: PSw, ISw, MSw, and TSw

Goals:

  1. foot clearance
  2. limb advancement
193
Q

when does single limb support occur within the gait cycle and what are the goals of this task?

A

occurs in: MSt and TSt

Goals:

  1. stability
  2. forward progression
194
Q

When does weight acceptance occur within the gait cycle and what are it’s goals?

A

Occurs during: IC and LR

Goals:

  1. forward progression
  2. stability
  3. shock absorption
195
Q

What are the 3 functional tasks of gait?

A
  1. Weight acceptance
  2. Single limb support
  3. Swing limb advancement
196
Q

what are the relative joint positions during swing phase: terminal swing (TSw)?

A
  1. Hip = 20° flexion
  2. Knee = 5° flexion
  3. Ankle = 0° dorsiflexion
197
Q

What is occuring on the opposite limb during swing phase: terminal swing (TSw)?

A

TSt

terminal stance

198
Q

what occurs during swing phase: terminal swing (TSw)?

A

the leg reaches out to achieve step length

critical events = knee extension

199
Q

what are the relative joint positions for swing phase: mid swing (MSw)?

A
  1. Hip = 25° flexion
  2. Knee = 25° flexion
  3. Ankle = 0° dorsiflexion
200
Q

What is occuring in the opposite limb during swing phase: mid swing (MSw)?

A

MSt

midstance

201
Q

what occurs during swing phase: mid swing (MSw)?

A

thigh continues to advance, knee begins to extend as foot clearance is maintained

critical events = continued hip flexion, foot clearance

202
Q

what are the relative joint positions during swing phase: initial swing (ISw)?

A
  1. Hip = 15° flexion
  2. Knee = 60° flexion
  3. Ankle = 5° plantarflexion
203
Q

what is occuring at the opposite limb during swing phase: initial swing (ISw)?

A

LR → MSt

(loading response into midstance)

204
Q

what occurs during swing phase: initial swing (ISw)?

A

the thigh begins to advance as the foot leaves the floor

critical events = hip flexion, knee flexion

205
Q

what are the relative joint positions for stance phase: pre-swing (PSw)?

A
  1. Hip = 10° extension
  2. Knee = 40° flexion
  3. Ankle = 15° plantarflexed
206
Q

what is occuring in the opposite limb during stance phase: pre swing (PSw)?

A

IC → LR

initial contact into loading response

207
Q

What occurs during stance phase: pre swing (PSw)?

A

rapid unloading of the limb with weight transfer to opposite limb, starting the second period of double limb support

critical events = passive knee flexion to 40°, Ankle PF, 60° of MTP extension

208
Q

what are the relative joint positions for stance phase: terminal stance?

A
  1. Hip = 20° extension
  2. Knee = 5° flexion
  3. Ankle = 10° dorsiflexion
209
Q

what is occuring on the opposite limb during stance phase: terminal stance (TSt)?

A

TSw

(terminal swing)

210
Q

what occurs during stance phase: terminal stance (TSt)?

A

progression over the stance limb continues past the forefoot. Body is ahead of stance limb

critical events = controlled ankle DF with heel raise

211
Q

what are the relative joint positions for stance phase: midstance?

A
  1. Hip = 0°
  2. Knee = 5° flexion
  3. Ankle = 5° dorsiflexion
212
Q

What is occuring on the opposite leg during stance phase: midstance (MSt)?

A

ISw - MSw

(Initial swing to Midswing)

213
Q

What occurs in the stance phase: midstance (MSt)?

A

the body progresses over the foot in a controlled manner. First instance of single limb support

critical events = controlled tibial advancement

214
Q

Initial contact and loading response combine for what functional task?

A

weight acceptance, shock absorption, and providing a stable base for the body to progress over

absorb impact of GRF

period of dual-limb support

215
Q

what are the relative joint positions for the Stance Phase: loading response?

A
  1. Hip = 20° flexion
  2. Knee = 15° flexion
  3. Ankle = 5° PF
216
Q

What is occuring on the opposite limb during stance phase: loading response (LR)?

A

PSw

pre-swing

217
Q

What occurs in the Stance phase: Loading Response (LR)?

A

shock is absorbed as forward momentum is preserved. A flat foot position is achieved

critical event = hip stability, controlled knee flexion, and ankle PF

218
Q

what are the relative joint positions during the Stance Phase: Initial contact?

A
  1. Hip = 20° flexion,
  2. Knee = 0-5° flexion
  3. Ankle = 0°
219
Q

what is occuring on the opposite limb during stance phase: initial contact?

A

TSt and PSw

(terminal stance

220
Q

what occurs in the Stance Phase: Initial contact (IC)?

A

the instant the foot hits the ground

critical event = heels first contact

221
Q

what are the stages of the swing phase of gait?

A
  1. initial swing
  2. mid swing
  3. terminal swing
222
Q

what are the stages of the stance phase of gait?

A
  1. initial contact
  2. loading response
  3. midstance
  4. terminal stance
  5. preswing
223
Q

what system is used to describe the individual phases/parts of the gait cycle?

A

Rancho Los Amigos Terminology

224
Q

how much time in the gait cycle is spent in single-limb support?

A

80%

(double limb support = 20%)

225
Q

what are the 2 phases of the gait cycle?

A

stance phase (60%)

swing phase (40%)

226
Q

An individual’s gait speed can be predictive of what?

A
  1. future health status
  2. functional decline
  3. hospitalization rate
  4. mortality rate
227
Q

T/F: gait speed is a very functional measurement of an individual’s walking ability?

A

TRUE

often called the 6th vital sign

228
Q

what is our spatiotemporal descriptor for gait?

A

gait speed/velocity

229
Q

what is considered a normal cadence for men and women?

A

men = 108 steps/min

women = 118 steps/min

230
Q

what are the 3 temporal descriptors of gait?

A
  1. stride time
  2. step time
  3. cadence
231
Q

define degree of toe-out

A

angle between line of progression of the body and a line intersecting the center of the heel and 2nd toe

normal = 5-7 degrees

232
Q

what is the difference between a step and a stride?

A

stride = distance between 2 successive heel contacts of the same foot

step = distance between 2 successive heel contacts of 2 different feet

233
Q

describe the ideal standing posture from the anterior veiw

A
  1. alignment of knees
    1. patellae face directly forward
    2. slight physiological valgus
  2. alignment of ankles
    1. neutral, neither supinated nor pronated
  3. alignment of feet
    1. heels separated by ~3 inches
    2. out-toeing 8-10 degrees
234
Q

Describe the ideal standing posture from the posterior view

A
  1. Midline
    1. head
    2. spine
    3. feet evenly spaced
  2. Shoulder and scapulae
    1. scapulae lie flat on thorax
    2. approximately between T2-T7
    3. approximately 4 inches apart
235
Q

As the LoG passes through the external auditory meatus and anterior to the axis of the head, what are the external and internal moments?

A

external = flexion of cervical spine

internal = extension of cervical spine

(passive tension of ligamentum nuchae, tectorial membrane, and posterior facet joint capsules)

(active contraction of cervical extensors)

236
Q

what is the ideal posture at the lumbosacral joint?

A

LoG passes through the body of the L5 causing a slight extension moment

creates shear force rather than a true torque

opposed by anterior longitudinal ligament, iliolumbar ligament, facet joint approximation

237
Q

as the LoG passes posterior to the hip joint, what are the external and internal moments?

A

external = pull into extension

internal = counter w/flexion

(passive tension of hip ligaments and active contraction of hip flexors)

238
Q

as the LoG passes anterior to the knee joint, what are the external and internal moments?

A

external = pull into extension

internal = counter w/flexion

(prevent knee hyperextension by passive tension of posterior joint capsule and associated ligaments and active contraction of hamstrings and gastroc)

239
Q

As the LoG passes anterior to the lateral malleolus, what are the external and internal moments?

A

external = pulling into dorsiflexion

internal = coutner w/plantarflexion (no passive structures contribute, active contraction of solues and gastro)

240
Q

Describe the Ideal Standing Posture

A

ideal alignment palce the LoG:

  1. through external auditory meatus
  2. midway through shoulder
  3. slightly posterior to center of hip joint
  4. slightly anterior to axis of knee joint
  5. slightly anterior to lateral malleolus
241
Q

Long-term deviation of the LoG passing through/around joint axis will result in __________

A

structural changes

242
Q

what are 3 keys to a successful postural assessment?

A
  1. assess from multiple angles
  2. remove obstructive clothing
  3. observe more than the area of complaint
243
Q

if the LoG is anterior to the joint axis, the external moment will cause what?

A

anterior motion of the proximal segment supported by that joint

244
Q

Direction depends on the ________ of the ________ in relation to the ___________

A

location

LoG

joint axis

245
Q

what occurs if the LoG passes at a distance from the joint axis?

A

external gravitation moment

this results in rotation around the joint axis unless it is opposed by a counterbalancing internal moment/muscle contraction

246
Q

what occurs if the line of gravity (LoG) passes through a joint axis?

A

no torque is created around the joint

247
Q

how can you define equilibrium with respect to internal/external forces?

A

sum of internal and external forces equal to zero

248
Q

what is the goal of changes in support strategies?

A

move/enlarge the body’s BOS so that it remains under the COM

it is the only strategy that is successful with large perturbations

249
Q

what are 2 changes in support stategies?

A
  1. stepping strategies
  2. grasping strategies
250
Q

what is the pattern for an ankle strategy? Hip strategy?

A

ankle = distal-to-proximal pattern

hip = proximal-to-distal pattern

251
Q

what are muscle synergies/strategies (pertaining to postural control)?

A

centerally organized patterns of muscle activity that occur in response to perturbations of standing postures

252
Q

what is the difference between sensory and mechanical perturbations?

A

sensory = may be caused by altering visual input

mechanical = displacement causing changes in the relationship of the body’s COM to BOS

253
Q

what is the clinical relevance of postural sway?

A

increased sway = increase fall risk due to COM nearing/getting outside of BOS

254
Q

how much postural sway is normal?

A

7 mm during quiet stance

COP can be mapped to determine sway

255
Q

what are proactive (anticipatory) responses?

A

responses that occur in anticipation of internally generated destabilizing forces

256
Q

what are reactive (compensatory) responses?

A

responses that occur as reactions to external forces that displace the body’s COM

257
Q

what 2 responses enable postural control?

A

reactive (compensatory) response

proactice (anticipatory) response

258
Q

Define postural control

A

maintenance of COM over BOS to control body’s orientation in space and stabilize head w/respect to vertical to orient gaze

259
Q

Define Center of Gravity

A

also called COM

point where mass of body is centered

260
Q

Define Base of Support

A

area bounded posteriorly by the tips of the heels and anteriorly by a line joining the tips of the toes

261
Q

what are the 5 principles of diagnosis for soft tissue injuries?

A
  1. look for “inherent likelihoods”
  2. look for objective physical signs
  3. Palpation
  4. selective tensionoing: non-contractile vs contractile tissue
  5. The “pain” is the pain for which the pt. is seeking treatment
262
Q

T/F: palpation is helpful but can be unreliable

A

TRUE
some things are just naturally tender to palpate which can often be misinterpreted

263
Q

list different types of contractile tissues

A
  1. tendons
  2. muscles
  3. musculotendinous junction
  4. bone adjacent to attachment of tendon
264
Q

a contractile tissue will have stress with what 3 tests/things?

A
  1. isometric contraction
  2. stretching
  3. palpation
265
Q

List different non-contractile tissues

A
  1. joint capsules
  2. ligaments
  3. bursae
  4. aponeuroses
  5. nerves
266
Q

a non-contractile tissue will have stress with what?

A
  1. stretch
  2. palpation

*no increase in discomfort/stress with isometric contraction

267
Q

when testing active and passive movements, what things should you observe/look for?

A
  1. pain
  2. ROM
  3. quality of movement
  4. willingness to move
  5. compare AROM, PROM, resistance testing and palation between involved and uninvolved side
268
Q

T/F: you do not need to manually test a muscle through it’s full ROM

A

It depends

only to rule out/rule in a suspicous area

269
Q

when palpating a stationary joint what things are you looking for?

A
  1. temperature
  2. swelling
  3. gaps
  4. tenderness
  5. pulsation
270
Q

when palpating a moving joint what things are you looking for?

A
  1. crepitus
  2. clicks
  3. end-feel
  4. hypermobility
  5. hypomobility
  6. willingness to move
  7. pain
271
Q

what can you use to help you make a decision/diagnosis when the pt is in severe or slight pain?

A
  1. pt. history
  2. functional testing - try to recreate their pain in a motion
  3. ask them to return when symptom returns
272
Q

what AROM results should you expect for a muscle/tendon strain, tendonitis or possible small tear?

A

likely limited due to pain and/or weakness

may be able to move through full ROM but with pain

273
Q

what PROM results should you expect from a muscle/tendon strain, tendonitis or possible small tear?

A

if truly passive: should have full pain free motion in all directions

EXCEPT

direction which stretches involved area may be limited due to pain (empty end feel)

274
Q

what isometric/MMT results should you expect from a muscle/tendon strain, tendonitis or possible small tear?

A

likely weak and painful when testing involved area

275
Q

what palpation results should you expect when testing a muscle/tendon strain, tendonitis or possible small tear?

A

involved area painful to palpation

276
Q

what AROM results should you expect from a muscle or tendon complete tear?

A

very limited due to weakness

likely not as much pain as seen w/partial tear, but much more weakness

277
Q

what PROM results should you expect from a muscle or tendon complete tear?

A

if truly passive: full pain free motion in all directions

EXCEPT
direction that stretches involved area, may be limited due to pain (empty end feel) if a muscle is guarding in the area

278
Q

what isometric/MMT results should you expect from a muscle or tendon complete tear?

A

extremely weak

279
Q

what palpation results should you expect from a muscle or tendon complete tear?

A

involved area painful to palpation

280
Q

what AROM results should you expect to see from a joint capsule injury?

A

limited

possibly painful at end ranges

281
Q

what PROM results should you expect to see from a joint capsule injury?

A

limited in same direction as AROM with firm end feel

possibly painful at end ranges

282
Q

what Isometrics/MMT results should you expect to see in a joint capsule injury?

A

if done at mid range - shouldn’t produce sig pain and should be strong

may have pain due to compensation or guarding of surrounding muscles

283
Q

what Palpation results should you expect to see in joint capsule injury

A

depends on depth of joint capsule

most of the time, cannot palpate deep enough to feel joint capsule

surrounding structures may be inflammed and cause discomfort with palpation

284
Q

T/F: if the AROM or PROM loss doesn’t match the capsular pattern for that joint it is prob not an issue with the joint capsule

A

FALSE

can still be the joint capsule even if it doesn’f follow the capsular pattern.

285
Q

what AROM results should you expect to see in a ligament injury?

A

full but pain at end ranges that stretch the ligament

286
Q

what PROM results should you expect to see in a ligament injury?

A

full but pain at end range that stretches the ligament

287
Q

what Isometric/MMT results should you expect from a ligament injury?

A

strong and no pain when tested in mid range

UNLESS there is guarding in area

288
Q

What Palpation results should you expect to see in a ligament injury?

A

involved ligaments are painful to palpation

DPT Semester 2 (6 decks)

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