L13 - Gait Flashcards
What are some physiological variables that can disturb the gait cycle?
- Obscured vision
- Abnormal balance (e.g. alcohol consumption)
- Muscle fatigue
- Pain in joint
- Stress
List some diseases that can cause abnormal gait.
- Stroke
- Cerebral palsy
- Parkinson disease
- Spinal cord injury
- Motor neuron disease
- Spinal muscular atrophy
- Peripheral neuropathy
- Fracture
What are the 5 prerequisites of normal gait?
1) Stability in stance (need to stand stably)
2) Sufficient foot clearance during swing (e.g. not drag on ground)
3) Appropriate swing phase pre-positioning of foot (put foot in correct position)
4) Adequate step length/ stride (e.g. cervical neuropathy, Parkinson’s = inefficient)
5) Energy conservation (action and reaction)
What are the 2 phases of gait?
Stance phase - 60%
Swing phase - 40%
What are the 7 stages of the gait cycle?
Stance phase:
1) Heel strike (initial contact) - Double support
2) Loading response (foot flat) - Single support
3) Midstance - Single support
4) Terminal stance (heel off) - Single support
All of swing phase is single support*
5) Preswing (toe off) - Double support
6) Initial and Mid-swing
7) Terminal swing
What muscles contract during Heel strike phase?
- Tibialis anterior (dorsiflexes ankle), extensor digitorum longus, extensor hallucis longus
- Gluteus maximus (extends hip), tensor fasciae latae, gluteus medius
What muscles contract during the Loading response phase?
Foot flat:
Quadriceps femoris, sartorius
What muscles contract during the Mid stance phase and Terminal stance (heel off) phase?
- Triceps surae (gastrocnemius + soleus)
- Tibialis posterior (supports foot arches)
- Peroneus longus (supports foot arches)
- Erector spinae
What muscles contract during the Pre-swing (toe off) phase?
- Deep plantarflexors
- Flexors of toes (flexor digitorum longus, flexor hallucis longus)
- Intrinsic foot muscles (flexor digitorum brevis, flexor hallucis brevis, extensor digitorum brevis)
- Rectus femoris (quadriceps femoris) (flexes hip)
What are the phases included in Swing phase of gait cycle?
Initial and mid-swing
Terminal Swing
What muscles contract during initial & mid-swing?
- Iliopsoas (psoas major + iliacus) (flexes hip)
- Rectus femoris, vasti
- Contralateral abductors of hip
What muscles contract during Terminal swing?
- Quadriceps femoris, sartorius
- Hamstrings (flexes knee, extends hip)
- Tibialis anterior, extensor digitorum longus, extensor hallucis longus
What are the phases in Running gait?
Stance (40- 50%) - Power absorption, Propulsion, Tow off
Double float - initial swing
Swing (50-60%) - terminal swing
Double float - terminal swing
What is the 3 prong approach when evaluating gait by history taking?
Approach from 3 angles:
1) CNS - i.e. stroke, cerebral palsy, degenerative disease (e.g. Parkinson disease), spinal cord injury (signal cannot travel down), motor neuron disease, spinal muscular atrophy
2) PNS - i.e. peripheral neuropathy, injury
3) MSS - i.e. - Fracture, muscle weakness, joint contracture, bone deformity
What are some signs of abnormal gait seen in physical examination?
observe from front, back, side
- Dipping shoulder, swinging trunk, unstable pelvis, waltzing
- Tiptoeing / intoeing (may be caused by excessive anteversion of femur) / out-toeing
What is the difference between Kinematics and Kinetics in regard to Gait?
- Kinematic: describes motion without regard to its causes
- Kinetic: the effect of forces and torques on the motion of bodies
Is Range of Motion a Kinematic or Kinetic parameter?
Kinematic
List the things that Kinematics encompass regarding gait?
1) Range of motion:
a) Stride length – distance between 2 successive placements of the same foot
b) Step length – distance by which one foot moves forward in front of the other one
c) Stride/step width – side-to-side distance between the 2 feet
d) Joint rotation (flexion / extension)
2) Velocity: cadence – number of steps in a given time
List the things that Kinetics encompass regarding gait?
1) Ground reaction force
2) Joint moment (extensor / flexor)
3) Joint power (generation / absorption)
Describe the kinematics and kinetics of intoeing gait seen in children?
Intoeing gait with excessive inward foot progression
kinetics»_space; excess inward foot rotation increases force on femoral head anteversion
kinematics»_space; Increase internal rotation angle of tibia
What are the 3 common abnormal gait patterns?
1) Antalgic gait
2) Trendelenburg gait
3) Short limb gait
Describe the observation of Antalgic gait?
Gait is modified to reduce weight-bearing on the painful limb
Uninvolved limb is rapidly advanced to shorten stance phase (different stance time between 2 sides)
Initial contact is avoided to decrease jarring
Gait is often slow, steps are short to limit the weight-bearing period
What causes Trendelenburg gait?
Caused by weakness in hip abductors (e.g. gluteus medius), hip pain in osteoarthritis
Name one disease that can cause Trendelenburg gait?
Perthes disease: necrosis of femoral head changes position of femur = misalignment means gluteus medius not in tension and cannot offset dropping of pelvis
Describe the observation of Trendelenburg gait?
- Upper trunk swing with dropping of pelvis
- Pelvic instability
Bend toward the affected side to:
- Keep the center of gravity directly above the hip joint
- Eliminate the need for hip abductors, lower forces across hip joint
Describe the observation of Short Limb gait?
- Upper trunk swing with shoulder drop on shorter limb side
- Tiptoe on shorter limb
- Knee bending and Circumduction on longer limb
Define Cerebral Palsy?
Cerebral palsy (CP) is caused by abnormal development of the brain or damage to the developing brain that affects a child’s ability to control his or her muscles
What causes Cerebral Palsy?
Congenital CP : Low birthweight, Premature birth, Infection during pregnancy, Jaundice, Birth complication leading to hypoxia …etc
Acquired CP: Infection, trauma, stroke, sickle cell anemia …etc
What are some Common Gait Abnormalities in Cerebral Palsy?
1) Spasticity of calf muscle results in tiptoeing
2) Soft tissue contracture (too tight) results in crouching: Knees were held in flexion and the ankles in dorsiflexion throughout the stance phase
3) Stiff knee gait due to abnormal Rectus femoris contraction
What are some treatment options for cerebral palsy gait?
soft tissue release, selective dorsal rhiztomy to change muscle spasticity, foot stabilization
List some advances in management of abnormal gait?
- Improved technology in gait analysis
- Better understanding of the abnormalities
- Technological advancement e.g.: Robotic assisted gait training/ Exoskeleton for paraplegic patients
