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Kinesiology > Lecture 7 - Posture and Gait > Flashcards

Lecture 7 - Posture and Gait Flashcards

1
Q

POSTURE

A

POSTURE

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2
Q

What is the difference between static and dynamic posture?

A

Static
-Body and its segments are aligned and maintained in a specific position
Dynamic
-Body and its segments are moving

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3
Q

What are some examples of dynamic posture?

A
  • walking
  • running
  • squating
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4
Q

How is dynamic posture different from motion analysis?

A

Dynamic posture is describing a point during a movement (such as bottom of squat) while motion analysis analyzes entire movement of a squat.

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5
Q

What is meant by the base of support (BoS)?

A

Area bounded posteriorly by the tips of the heels and anteriorly by a line jointing the tips of the toes.

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6
Q

What does center of gravity (CoG) mean?

A

point where gravity is equally distributed

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7
Q

What does center of mass (CoM) mean?

A

point where mass of the body is centered

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8
Q

Where does normal center of mass lie on humans?

A

anterior to S1/S2

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9
Q

When do we see instability in regards to our CoM?

A
  • when our CoM falls outside our base of support (BoS)

- CoM should be centered over BoS

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10
Q

The _______ the BoS and the ______ the CoG, the harder it is to get off balance.

A
  • wider

- lower

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11
Q

Using an assistive device __________ the size of an individual’s BoS, providing for more ___________.

A

increases

-postural support

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12
Q

Postural Control involves maintenance of ______________ over ___________ to control body’s orientation in space and stabilize _____ with respect to vertical to orient gaze

A
  • center of mass (CoM)
  • base of support (BoS)
  • head
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13
Q

Postural control requires CNS control, what are the afferent inputs and efferent outputs involved?

A 
Afferent
-somatosensory
-vestibular
-visual
Efferent
-muscular contraction
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14
Q

Responses that occur as reactions to EXTERNAL FORCES that displace the bodies CoM is called what?

A

Reactive (compensatory) responses

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15
Q

Responses that occur in anticipation of INTERNALLY generated destabilizing forces is called what?

A

Proactive (anticipatory) responses

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16
Q

What is an example of reactive response?

A

-taking a step to keep balance as bus moves

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17
Q

What is an example of proactive response?

A
  • raising arms to catch ball

- bending forward to tie shoe

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18
Q

What is postural sway?

A

normal small oscillations in which the body sways anteriorly, posteriorly, and side to side

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19
Q

What is a normal postural sway during quiet stance?

A

up to 7mm

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20
Q

What is one way to determine postural sway?

A

Mapping the center of pressure through the feet

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21
Q

Increased postural sway = ____________

Why?

A
  • increased fall risk

- CoM nearing or leaving BoS

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22
Q

What are some examples of health conditions that can lead to increased postural sway?

A
  • Hemiparesis
  • Sensory deficits
  • Flat and high-arched feet
  • Vestibular dysfunction
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23
Q

Posture may be altered and stability may be compromised with __________ or ________ inputs.

A

altered or absent

-ie. decreased sensation of the LE or post-injury

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24
Q

Alterations in ________ also comprimise posture

A

outputs

-ie. inability of muscles to respond appropriately to signals from CNS due to a neuromuscular disorder

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25
Q

Maintenance of standing posture is the result of ________ controls

A

dynamic

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26
Q

A normal functioning CNS selects the most appropriate combo of muscles to complete the task at hand after analyzing __________.

A

sensory input

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27
Q

What is perturbation?

A

Sudden change in condition that displaces body away from equilibrium

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28
Q

What are the 3 components of sensory perturbation?

A
  • somatosensory
  • visual
  • vestibular
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29
Q

What is mechanical perturbation?

A

displacement causing changes in the relationship of the body’s CoM to BoS

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30
Q

What are the 2 main muscular strategies for postural stability?

A
  • Ankle Strategy

- Hip Strategy

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31
Q

Ankle Strategy
-Discrete bursts of muscle activity that occur in a ________ to _______ pattern.

Hip Strategy
-Discrete bursts of muscle activity that occur in a ________ to _______ pattern.

A
  • distal to proximal

- proximal to distal

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32
Q

What strategy is typically utilized first, ankle or hip?

A

ankle

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33
Q

Ankle strategy is better for _______ perturbations and ________ losses of postural equilibrium.

A
  • smaller

- smaller

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34
Q

Hip strategy is better for _______ perturbations and ________ losses of postural equilibrium.

A
  • larger

- larger

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35
Q

Both ankle and hip strategies are examples of fixed support strategies. What does this mean?

A

Feet remain fixed while stability is regained through movements of the body without having to take a step.

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36
Q

What are the muscles that are activated for forward sway in both ankle and hip strategy?
List order of activation as well.

A

Ankle

  1. ) gastrocnemius
  2. ) hamstrings
  3. ) paraspinals

Hip

  1. ) abdominals
  2. ) quadriceps
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37
Q

What are the muscles that are activated for backward sway in both ankle and hip strategy?
List order of activation as well.

A

Ankle

  1. ) tibialis anterior
  2. ) quadriceps
  3. ) abdominals

Hip

  1. ) paraspinals
  2. ) hamstrings
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38
Q

What are the 2 strategies that are used when equilibrium has to be obtained by moving?

A
  • Stepping Strategies

- Grasping Strategies

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39
Q

Both stepping and grasping strategies move or enlarge the body’s _____ so that it remains under the ____. These strategies are successful with a ________ perturbation.

A
  • BoS
  • CoM
  • large
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40
Q

What is the difference between older and younger patients in regards to stepping strategies?

A

Younger individuals usually only take 1 step whereas older individuals more commonly take multiple shorter steps

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41
Q

Muscle strategies are examples of ______ forces to counteract _______ forces affecting our equilibrium.

A
  • internal

- external

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42
Q

What is equilibrium in regards to internal and external forces?

A

sum of internal and external forces = 0

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43
Q

What is the Ground Reaction Force Vector (GRFV)?

A

Force of the ground pushing back on the body in standing

44
Q

What is the Line of Gravity (LoG)?

A

Line extending from center of gravity to the base of support

45
Q

If we are standing in quiet stance the GRFV matches what?

A

Line of Gravity (LoG)

46
Q

What is the Center of Pressure and where is it usually located?

A
  • point of application of the GRFV

- located between the feet in bilateral stance

47
Q

The further the Line of Gravity (LoG) is from a joint axis, the ____ movement we get at that joint.
What is needed to counteract this?

A
  • more

- internal moment of muscle contraction

48
Q

The magnitude of the external moment ________ as the distance between the LoG and joint axis increases.

A

increases

49
Q

If LoG is anterior to joint axis, external moment will cause anterior motion of the _________ segment supported by that joint.

A

proximal

50
Q

What are the internal moments that must occur at each section if the GRFV passes posterior to the ankle, anterior to the knee, and anterior to the hip?

A

Ankle
-internal dorsiflexor moment to counteract external plantarflexor moment
Knee
-internal flexor moment to counteract external extensor moment
Hip
-internal extensor moment to counteract external flexor moment

51
Q

What is a postural assessment?

A

systematic observation of a patient, paying special attention to deviations from the norm

52
Q

What are the goals of a postural assessment?

A
  • Appreciate static positioning of body segments with relation to each other
  • Relate back to patient’s main complaints
  • Apply to potential functional impairments
53
Q

What are the keys to success of a postural assessment?

A
  • Assess from multiple angles
  • Remove obstructive clothing
  • Observe more than the area of complaint
54
Q

In an ideal standing posture side view the LoG passes through or very close to all joint axes. What does this minimize?

A
  • minimizes external moments

- balanced by internal moments

55
Q

Large deviations of LoG passing through the body results in:

  • excessive strain on ________ structures
  • _______ muscular activity
A
  • passive

- increased

56
Q

Long-term deviation results in _________ changes.

A

structural

57
Q

What are the ideal alignment placed of the LoG from the ground up? Most Important Ones

A
  • Slightly anterior to the lateral malleolus
  • Slightly anterior to the axis of the knee joint
  • Slightly posterior to the center of the hip joint
  • Midway through the shoulder
  • Through the external auditory meatus
58
Q

Ideal Posture: Ankle

  • LoG passes slightly _______ to lateral malleolus
  • External moment = __________
  • Internal moment = _________
  • Active contraction of ________, with contribution from ____________
A
  • anterior
  • dorsiflexion
  • plantarflexion
  • soleus, gastrocnemius
59
Q

Ideal Posture: Knee

  • LoG passes ________ to midline of the knee and __________ to patella
  • External moment = __________
  • Internal moment = ____________
  • The internal moment prevents knee hyperextension via passive tension of ________ joint capsule and associated ligaments as well as active contraction of ___________ and ___________.
A
  • anterior, posterior
  • extension
  • flexion
  • posterior, hamstrings and gastrocnemius
60
Q

Ideal Posture: Hip

  • LoG passes slightly _________ to axis of hip
  • External moment = _________
  • Internal moment = _________
  • Passive tension of hip ligaments and active contraction of _________.
A
  • posterior
  • extension
  • flexion
  • iliopsoas
61
Q

Ideal Posture: Lumbosacral Joint

  • LoG passes through the body of ___ causing slight _________ moment.
  • Lumbosacral angle is about ___ degrees, increased anterior pelvic tilt would ________ lumbosacral angle.
  • Creates ____ force rather than true torque that is opposed by ALL, iliolumbar ligaments, and facet joint approximation.
A
  • L5, extension
  • 30, increase
  • shear
62
Q

Ideal Posture: Head and Neck

  • LoG passes through _________________
  • External moment = ___________
  • Internal moment = ___________
  • Internal moment occurs from passive tension of ligamentum nuchae, tectorial membrane and posterior facet joint capsules as well as active contraction of _______________.
A
  • external auditory meatus
  • flexion of cervical spine
  • extension of cervical spine
  • cervical extensors
63
Q

Ideal Standing Posture: Posterior View

  • Looking for midline of head, spine, and evenly spaced feet
  • Can also assess shoulder and scapula. The scapula should be approximately between T_ and T_ and __ inches apart (give or take).
A
  • T2 and T7

- 4

64
Q

Ideal Standing Posture: Anterior View

  • Patella face directly forward with a slight physiological _______.
  • Ankles are neither _________ or _________.
  • Heels seperated by about __ inches, out-toeing about - degrees.
A
  • valgus
  • supinated or pronated
  • 3 inches, 8-10 degrees
65
Q

The shoulder of a patients dominant arm is often ______ than the shoulder of their non-dominant arm.

A

lower

66
Q

GAIT

A

GAIT

67
Q

Stride is synonymous with a _________.

A

gait cycle

68
Q

Step is a sequence of events that occurs within heel contacts of _________ feet. Therefore a gait cycle has ____ steps.

A
  • opposite

- 2

69
Q

What is the difference between a stride length and a step length?

A

Stride Length
-distance between two successive heel contacts of the SAME foot

Step Length
-distance between successive heel contacts of 2 DIFFERENT feet

70
Q

What is the normal stride length of males and females?

A
  • Male = 1.51m

- Female = 1.32m

71
Q

What is a normal degree of toe-out?

A

5-7 degrees

72
Q

What is step width and what is the average?

A
  • lateral distance between heel centers of 2 consecutive foot contacts
  • 7-10cm
73
Q

Temporal Descriptors of Gait (Time)

  • What is stride time?
  • What is step time?
  • What is cadence?
A
  • time for a full gait cycle
  • time for completion of a R or L step
  • number of steps/minute, also described as step rate
74
Q

What is a normal cadence for males and females?

A

Males- 108 steps/min

Females- 118 steps/min

75
Q

What is a spatitemporal descriptor a combination of?

A

spatial and temporal descriptors of gait

76
Q

What is gait velocity and what is the normal for males and females?

A
  • distance covered in a given amount of time
  • Males- 1.37m/sec *****
  • Females- 1.30m/sec *****
77
Q

What is the best and most functional measurement of individuals walking ability?

A

Gait Velocity

78
Q

What are the 2 ways to increase gait velocity?

A
  • increase step/stride length

- increase cadence

79
Q

What is the “6th vital sign”?

A

Gait speed

80
Q

How is the 10M Walk Test performed?

A
  • 2m acceleration zone
  • 10m walk/timed section
  • 2m deceleration zone
81
Q

At a normal walking speed, ___% of our time spent in stance phase with the other ___% being spent in swing phase.

A
  • 60%

- 40%

82
Q

Single-limb support account for ___% of the gait cycle with the other ___% being double-limb support.

A
  • 80%

- 20%

83
Q

Stance phase is the time from R ____ contact to R ___ off.

A
  • heel

- toe

84
Q

Rancho Los Amigos terminology breaks up stance and swing phase into additional phases. What are they?

A

STANCE

  • Initial contact
  • Loading response
  • Midstance
  • Terminal stance
  • Preswing

SWING

  • Initial swing
  • Mid swing
  • Terminal swing
85
Q
  • Describe Initial Contact (IC).
  • What is the critical event?
  • What phase is the opposite limb in during initial contact?
A
  • The instant the foot hits the ground.
  • heel first contact
  • terminal stance (TSt) / Preswing (PSw)
86
Q

-What are the positions and major muscles of the hip, knee, and ankle during initial contact?

A

Hip

  • 20° flexion
  • extensors

Knee

  • 0-5° flexion
  • quadriceps

Ankle

  • 0°
  • pretibials
87
Q
  • Describe Loading Response (LR).
  • What are the critical events?
  • What phase is the opposite limb in during loading response?
A
  • Shock is absorbed as forward momentum is preserved. A foot flat position is achieved.
  • hip stability, controlled knee flexion, and ankle PF
  • Preswing (PSw)
88
Q

-What are the positions and major muscles of the hip, knee, and ankle during loading response?

A

Hip

  • 20° flexion
  • extensors, abductors

Knee

  • 15° flexion
  • quadriceps

Ankle

  • 5° PF
  • pretibials
89
Q

When does Loading Response (LR) turn into midstance (MSt)?

A

As soon as the opposite foot leaves the floor

90
Q

Initial contact (IC) and loading response (LR) combine for the functional goal of ______ acceptance, ______ absorption, and to provide a stable base for the body to progress over.

A
  • weight

- shock

91
Q
  • Describe Midstance (MSt).
  • What is the critical event?
  • What phase is the opposite limb in during midstance?
A
  • The body progresses over the foot in a controlled manner. First instance of single limb support.
  • controlled tibial advancement
  • midswing (MSw)
92
Q

-What are the positions and major muscles of the hip, knee, and ankle during midstance?

A

Hip

  • 0°
  • abductors

Knee

  • 5° flexion
  • quadriceps ->quiet

Ankle

  • 5° DF
  • Gastroc-soleus
93
Q
  • Describe Terminal Stance (TSt).
  • What is the critical event?
  • What phase is the opposite limb in during terminal stance?
A
  • Progression over the stance limb continues past the forefoot. Body is ahead of stance limb.
  • controlled ankle DF with heel rise
  • terminal swing (TSw)
94
Q

-What are the positions and major muscles of the hip, knee, and ankle during terminal stance?

A

Hip

  • 20° extension
  • none

Knee

  • 5° flexion
  • none

Ankle

  • 10° DF
  • Gastroc-soleus
95
Q
  • Describe Pre-swing (PSw).
  • What are the critical events?
  • What phase is the opposite limb in during pre-swing?
A
  • Rapid unloading of the limb with weight transfer to opposite limb, starting the second period of double limb support.
  • passive knee flexion to 40°, ankle PF, 60° MTP ext
  • initial contact (IC) -> loading response (LR)
96
Q

-What are the positions and major muscles of the hip, knee, and ankle during pre-swing?

A

Hip

  • 10° extension
  • adductors

Knee

  • 40° flexion
  • none

Ankle

  • 15° PF
  • None -> Tib Ant
97
Q
  • Describe Initial Swing (ISw).
  • What are the critical events?
  • What phase is the opposite limb in during initial swing?
A
  • The thigh begins to advance as the foot leaves the floor
  • hip flexion, knee flexion
  • loading response (LR) -> midstance (MSt)
98
Q

-What are the positions and major muscles of the hip, knee, and ankle during initial swing?

A

Hip

  • 15° flexion
  • flexors

Knee

  • 60° flexion
  • flexors

Ankle

  • 5° PF
  • pretibials
99
Q
  • Describe Mid Swing (MSw).
  • What are the critical events?
  • What phase is the opposite limb in during mid swing?
A
  • Thigh continues to advance, knee begins to extend as foot clearance is maintained.
  • continued hip flexion, foot clearance
  • midstance (MSt)
100
Q

-What are the positions and major muscles of the hip, knee, and ankle during mid swing?

A

Hip

  • 25° flexion
  • flexors

Knee

  • 25° flexion
  • flexors

Ankle

  • 0° DF
  • pretibials
101
Q
  • Describe Terminal Swing (TSw).
  • What are the critical events?
  • What phase is the opposite limb in during terminal swing?
A
  • The leg reaches out to achieve step length
  • knee extension
  • terminal stance(TSt)
102
Q

-What are the positions and major muscles of the hip, knee, and ankle during terminal swing?

A

Hip

  • 20° flexion
  • extensors

Knee

  • 5° flexion
  • quadriceps

Ankle

  • 0° DF
  • pretibials
103
Q

What are the 3 functional tasks of gait?

A
  • Weight Acceptance
  • Single Limb Support
  • Swing Limb Advancement
104
Q
  • What are the phases involved in weight acceptance?

- What are the main goals in weight acceptance?

A
  • initial contact (IC)
  • loading response (LR)

-forward progression, stability, and shock absorption

105
Q
  • What are the phases involved in single limb support?

- What are the main goals in single limb support?

A
  • mid stance (MSt)
  • terminal stance (TSt)

-stability and forward progression

106
Q
  • What are the phases involved in swing limb advancement?

- What are the main goals in swing limb advancement?

A
  • preswing (PSw)
  • initial swing (ISw)
  • mid swing (MSw)
  • terminal swing (TSw)

-foot clearance and limb advancement

Kinesiology (9 decks)

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