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Kinesiology > Lecture 8- Gait ROM and Joint Postion / Muscle Activity > Flashcards

Lecture 8- Gait ROM and Joint Postion / Muscle Activity Flashcards

1
Q

ROM AND JOINT POSITION

A

ROM AND JOINT POSITION

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2
Q
  • What is the position of the ankle at initial contact (IC)?

- What also occurs here?

A

Neutral to slight plantar flexion

-Heel Rocker (aka 1st Rocker) is initiated

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3
Q

What is the position of the ankle at loading response (LR)?

A

5° of rapid plantarflexion to get foot flat on the floor

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4
Q
  • What is the position of the ankle and MTP during midstance (MSt) → terminal stance (TSt)?
  • What also occurs here?
A

Closed chain dorsiflexion to about 10°, MTP extension to 30°

-Ankle Rocker and Forefoot Rocker

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5
Q

What is the position of the ankle and MTP during the preswing (PSw)?

A

Transition from max dorsiflexion to max plantarflexion of around 15°, max MTP extension of 60°
-Heel lift off

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6
Q

What is the position of the ankle during initial swing (ISw)?

A

Dorsiflex back to around 5° of plantarflexion

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7
Q

What is the position of the ankle during midswing (MSw) → terminal swing (TSw)?

A

Dorsiflexion to neutral, prepare for heel strike

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8
Q

What are the critical events that happen during each phase of gait at the ankle?

A
  • IC- heel first contact
  • LR- ankle PF
  • MSt- controlled tibial advancement
  • TSt- controlled ankle DF with heel rise
  • PSw- Ankle PF
  • MSw- foot clearance
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9
Q

What are the 3 foot and ankle rockers and their definition?

A 
Heel Rocker (1st Rocker)
-motion of the foot from a dorsiflexed to plantarflexed position during LR to achieve flat foot
Ankle Rocker (2nd Rocker)
-closed chain advancement of the tibia into dorsiflexed position over a fixed foot during MSt
Forefoot Rocker (3rd Rocker)
-begins when center of pressure is over the met heads and heel lift occurs in TSt/PSw
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10
Q

Is the GRFV posterior or anterior to the ankle joint during the heel rocker?

A

posterior, causing plantarflexion moment

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11
Q

What is the forefoot rocker also called?

A

Windlass mechanism

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12
Q

What is the position of the knee at initial contact (IC)?

A

Neutral to 5° flexion

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13
Q
  • What is the position of the knee at loading response (LR)?

- What does this phase allow for?

A

Flexion to 15°

-shock absorption

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14
Q

What is the position of the knee from midstance (MSt) → terminal stance (TSt)?

A

Extenion back to 5° flexion/neutral

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15
Q

What is the position of the knee at preswing (PSw)?

A

Rapid flexion to 40°

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16
Q
  • What is the position of the knee at initial swing (ISw)?

- What does this phase allow for?

A

More flexion to 60°

-limb clearance

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17
Q
  • What is the position of the knee at midswing (MSw)?

- What does this phase allow for?

A

Rapid extension to 25° flexion

-step length

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18
Q

What is the position of the knee at terminal swing (TSw)?

A

Further extension to 5°/neutral

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19
Q

What are the critical events that happen during each phase of gait at the knee?

A
  • LR- controlled knee flexion
  • PSw- passive knee flexion
  • ISw- knee flexion
  • TSw- knee extension
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20
Q

What is the position of the hip at initial contact (IC) → loading response (LR)?

A

20° “leftover” flexion

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21
Q

What is the position of the hip at midstance (MSt)?

A

Extension into a neutral hip position as the body progresses forward

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22
Q

What is the position of the hip at terminal stance (TSt)?

A

Maximum 20° hip extension occurs

-body is past the foot

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23
Q

What is the position of the hip at preswing (PSw)?

A

Flexion to about 10° of hip extension

-reversal from extension to flexion

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24
Q

What is the position of the hip at initial swing (ISw)?

A

Continued flexion to 15°

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25
Q

What is the position of the hip at midswing (MSw) → terminal swing (TSw)?

A

Continued flexion to 25°-30°

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26
Q

What are the critical events that happen during each phase of gait at the hip?

A
  • LR- hip stability
  • ISw- hip flexion
  • MSw- hip flexion
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27
Q

How much ROM do we need at all 3 joints for normal gait?

A

HIP (~40°)

  • Flexion- 25° for step length (TSw)
  • Extension- 20° for trailing limb (TSt)

KNEE (~60°)

  • Flexion- 60° for foot clearance (ISw)
  • Extension- 0° for step length (TSw/IC)

ANKLE (~30°)

  • Plantarflexion- 20° for toe-off (PSw)
  • Dorsiflexion- 10° for tibial advancement (TSt)
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28
Q

Where is CoM at the lowest position?

A

At the midpoint of both periods of double-limb support (5% and 55%)

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29
Q

Where is CoM at the highest position?

A

At the midpoint of both periods of single-limb support (30% and 80%)

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30
Q

What is the total vertical displacement?

A

~5cm

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31
Q

What happens to the foot during IC in the frontal plane?

A

slight inversion of the hindfoot

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32
Q

What happens to the foot during LR → MSt in the frontal plane?

A

eversion of the hindfoot

  • causes pronation
  • forefoot follows hindfoot position
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33
Q

What happens to the foot during TSt → PSw in the frontal plane?

A

inversion

-resupination!

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34
Q

What happens to the foot during Swing Phase in the frontal plane?

A

variable

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35
Q

What happens to the knee in the frontal plane?

A

Not much movement with normal gait (total around 5-10°)

-Genu valgum and genu varum

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36
Q

What happens at the hip and pelvis during IC in the frontal plane?

A

neutral ab/adduction

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37
Q

What happens at the hip and pelvis during LR → MSt in the frontal plane?

A

adduction during weight acceptance

-contralateral hip drop

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38
Q

What happens at the hip and pelvis during MSt → TSt in the frontal plane?

A 
increase adduction (up to 15°)
-weight shift over stance limb
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39
Q

Once the limb is unloaded, the ipsilateral hip ______ and moves into a relatively __________ position for swing phase.

A
  • drops

- abducted

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40
Q

What are the horizontal plane motions that occur at the trunk?

A
  • opposite rotation from pelvic motion

- total excursion- 7° to 9°

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41
Q

What are the horizontal plane motions that occur at the hip?

A
  • forward rotation of the pelvis on the stance limb occurs with hip flexion during swing
  • increases greater step length than that of hip flexion alone
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42
Q

What are the horizontal plane motions that occur at the shoulder?

A
  • opposite sagittal plane motion from ipsilateral hip
  • partially active, particularly shoulder extension
  • balances rotational forces of trunk
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43
Q

How does the CoM displace as we go through gait?

A
  • Maximum shift to the R occurs at the end of midstance

- Maximum shift to the L occurs during midswing of the R leg

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44
Q

What is the total side-to-side displacement of CoM?

A

5cm

45
Q

What phases do we notice decreased great toe extension?

A

TSt and PSw

46
Q

Someone with decreased great toe extension will not complete _______ rocker and ends their _______ phase noticeably early.

A
  • forefoot

- stance

47
Q

What are some causes of decreased great toe extension?

A

-joint hypomobility (hallux rigidus), pain, bone spur, gouty, arthritis, plantar fasciitis

48
Q

What is the result of decreased great toe extension?

A

decreased push off, shortened stance time

49
Q

What phase do we notice someone with Steppage Gait/ Increased Knee Flexion?

A

swing phase

50
Q

Someone with a steppage gait presents with ________ hip and knee flexion and _____ of ankle DF.

A
  • increased

- loss

51
Q

What are some causes of steppage gait?

A

foot drop/nerve disorder, polyneuropathy, equinus deformity

52
Q

What is the result of steppage gait?

A

prolonged swing phase, fall risk, decreased efficiency

53
Q

What phases do we notice someone with Foot Flat Contact?

A

initial contact

54
Q

Someone with foot flat contact has their ____ or ____foot make first contact with the ground instead of the heel.

A

mid or forefoot

55
Q

What are some causes of foot flat contact?

A

excessive knee flexion in late swing, weak/impaired DF

56
Q

What is the result of foot flat contact?

A

absent heel rocker (can have normal ankle rocker)

57
Q

What phase do we notice someone with Circumduction?

A

swing phase

58
Q

Someone with circumduction has a lateral whipping motion of the limb during ______ at the hip.

A

swing

59
Q

What are some causes of circumduction?

A

impaired knee flexion ROM, impaired ankle DF ROM

60
Q

What is the result of circumduction?

A

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

61
Q

What phases do we notice someone with Increased Lumbar Lordosis?

A

terminal stance

62
Q

Someone with increased lumbar lordosis will have an increase during _________ phase.

A

late stance

63
Q

What are some causes of increased lumbar lordosis?

A

hip flexor contracture, hip OA

64
Q

What is the result of increased lumbar lordosis?

A

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

65
Q

MUSCLE ACTIVITY DURING GAIT

A

MUSCLE ACTIVITY DURING GAIT

66
Q

What are the 2 main forces interacting during gait?

A
  • foot forces

- ground reaction forces (GRF)

67
Q

Are foot and ground reaction forces equal?

A

yes, but in opposite directions

68
Q

What is the center of pressure?

A

point where the GRF acts on the foot

69
Q
  • At heel contact, what direction does the GRF move our ankle if the GRF is posterior to it?
  • What internal torque must be produced to counteract and stabilize?
A
  • plantar flexion torque

- dorsiflexion torque

70
Q
  • ________ torque is produced by the GRF and causes movement at each joint of the LE.
  • _________ torque is generated to match or overcome the external torque primarily by __________ but also ______ internal structures.
A

-external

  • internal
  • muscle activation, but also passive internal structures
71
Q
  • _________ muscle activation is when the internal torque is moving the joint in the direction of the muscle’s action.
  • During gait, concentric contractions are used to provide ______ and produce ________ of a segment.
A
  • concentric

- stability, movement

72
Q
  • _________ muscle activation is when the internal torque is moving the joint in the direction opposite of the muscle’s action.
  • During gait, eccentric contractions are used to provide __________ and ________ a limb segment.
A
  • eccentric

- shock absorption, decelerating

73
Q

What are some presentations of muscle dysfunction?

A
  • weakness
  • loss of power
  • decreased endurance
  • spasticity
  • contracture
74
Q

Is muscular dysfunction usually more noticeable during OGA or ROM loss?

A

Observational Gait Analysis (OGA)

75
Q

With muscular dysfunction, does the torque from GRFV change?

A

No, just the patient’s ability to counter it

76
Q

Muscle Activation - IC
HIP
-ALL Hip extensors contract ___________ to prepare for LR

KNEE

  • __________ hamstring contraction to counteract extension torque
  • Knee extensors transition from concentric to eccentric contraction in preparation for loading response

ANKLE
-Pretibials (tib ant, long toe extensors) contract _________

A
  • concentrically
  • eccentric
  • concentrically
77
Q

Muscle Activation - LR
HIP
-__________ contraction of hip extensors
-Gmax, Adductor Magnus, TFL, GMed peak

KNEE

  • ________ contraction of knee extensors
  • __________ activity peaks

ANKLE

  • ___________ contraction of ankle dorsiflexors
  • ____________ activity peaks
  • Transition to eccentric contraction of ankle ____________ in late LR
A

-concentric

  • eccentric
  • quadriceps
  • eccentric
  • tibialis anterior
  • plantarflexors
78
Q

MUSCLE ACTIVATION - MSt
HIP
-No hip muscular activity required in sagittal plane

KNEE
-______ eccentric to no activity

ANKLE
-________ contraction of gastroc/soleus

A
  • quads

- eccentric

79
Q

Muscle Activation - TSt
HIP
-Minimal activity in sagittal plane

KNEE

  • No quad or HS activity
  • Tibial position maintained by ________

ANKLE

  • _________ contraction of ankle plantarflexors to prevent tibial collapse with heel rise
  • ____________ activity peaks
A

-gastroc

  • concentric
  • gastroc/soleus
80
Q

Muscle Activation - PSw
HIP
-____________ contraction of hip flexors
-_______________ peaks

KNEE

  • Knee flexion is mainly ________
  • Slight concentric contraction of ___________ and eccentric ________

ANKLE

  • Ankle _________ activity ceases in early preswing and passive tension contributes to ankle moving into plantar flexion
  • Ankle __________ concentric contraction initiated at the end of PSw
A
  • concentric
  • adductor longus
  • passive
  • knee flexors
  • rectus
  • plantarflexion
  • dorsiflexor
81
Q

Muscle Activation - ISw
HIP
-Continued concentric contraction of __________
-_________ peaks

KNEE

  • Concentric contraction of knee flexors
  • ____________ (SH), __________, _______ peak
  • Flexion continues to be aided by flexion at the _____

ANKLE
-Concentric contraction of ____________
Toe _________ activity peaks

A
  • hip flexors
  • iliacus
  • biceps femoris (SH), sartorious, gracilis
  • hip
  • tib anterior
  • extensor
82
Q

Muscle Activation - MSw
HIP
-Continued concentric contraction of _________
-Initiation of _________ hip extensors (HS) to control hip flexion

KNEE

  • Knee extension created by ________
  • Knee flexors contract ___________ at the end of MSw to control extension

ANKLE
-Continued contraction of ___________

A
  • hip flexors
  • eccentric
  • momentum
  • eccentrically

-dorsiflexors

83
Q

Muscle Activation - TSw
HIP
-Concentric contraction of ____________

KNEE
-Concentric contraction of knee _________ to insure full extension
Peak __________ eccentric contraction to decelerate thigh

ANKLE
-Continued contraction of ____________

A

-hip extensors

  • extensors
  • hamstring

-dorsiflexors

84
Q

Frontal Plane Activation - LR
HIP
-Hip ___________ contraction eccentrically
-_____ and ____________ peak

ANKLE
-________ contracting eccentrically

A
  • abductors
  • GMed and Adductor Magnus

-inverters

85
Q

Frontal Plane Activation - MSt
HIP
-Hip ________ contracting eccentrically then concentrically

ANKLE
-___________ contracting concentrically

A
  • abductors

- inverters

86
Q

Frontal Plane Activation - TSt and PSw
HIP
-Hip _________ contracting concentrically

ANKLE
-___________ contraction concentrically

A
  • abductors

- inverters

87
Q

Frontal Plane Activation - ISw, MSw, and TSw
HIP
-Hip __________ contract concentrically

ANKLE
-________ contracting concentrically

A
  • adductor

- evertors

88
Q

Key Roles - ANKLE Musculature
Ankle Dorsiflexors
-Eccentric activation to control ____________ of the ankle at IC until foot flat

Ankle Plantarflexors

  • Eccentric contraction moving into MSt to control _____________
  • Concentric contraction at ____ assists with forward propulsion

Ankle Inverters

  • Eccentrically contracts to control ________ until MSt
  • Concentrically contracts to _________ the foot for push-off in TSt/PSw

Ankle Everters
-Also activate as co-contraction to counter strong inversion effect occuring during ___/___

A

-plantar flexion

  • tibial advancement
  • TSt
  • pronation
  • supinate

-LR/MSt

89
Q

Key Roles - KNEE Musculature
Knee Extensors
-Eccentrically control knee flexion in ___
-Concentrically to extend the knee and support body in ___

Knee Flexors
-Decelerate knee _________ in preparation for placement of the foot on the ground

A
  • LR
  • MSt

-extension

90
Q

Key Roles - HIP Musculature
Hip Extensors
-Activated in TSw prior to IC to initiate hip __________ and prepare LE for ________________ at the beginning of stance

Hip Flexors
-Advance lower extremity forward during ___
Concentrically lift lower extremity to allow for ____________ during swing

Hip Abductors
-Control the slight lowering of the ___________ pelvis on the side of the swing limb then provide pelvic stability in stance

Hip Adductors
-Assist with initiation of hip ______ after toe-off

A
  • extension
  • weight acceptance
  • ISw
  • toe clearance
  • contralateral
  • hip flexion
91
Q

What phase is Trendelenburg Gait seen?

A

LR-PSw

92
Q

What is observed movement occurring with Trendelenburg Gait?

A

excessive downward drop of contralateral pelvis during stance

93
Q

What is the cause of Trendelenburg Gait?

A

GMed weakness (mild)

94
Q

What are some results of Trendelenburg Gait?

A
  • longer swing limb
  • decreased effeciency
  • possible decreased stance time
95
Q

How can we clinically observe for Trendelenburg Sign?

A

have patient stand on one limb and observe for level pelvis

96
Q

What phase is Compensated Trendelenburg seen?

A

LR-PSw

97
Q

What is observed movement occurring with Compensated Trendelenburg?

A
  • trunk leans toward/over the stance limb

- level pelvis

98
Q

What is the cause of Compensated Trendelenburg?

A

GMed weakness (moderate-severe)

99
Q

What is the result of Compensated Trendelenburg?

A

compensates by not allowing the contralateral pelvis to drop during stance reducing demand on GMed

100
Q

What phase is Foot Slap seen?

A

IC-LR

101
Q

What is observed occurring during Foot Slap?

A

PF torque goes unchecked by anterior tib

102
Q

What is the cause of Foot Slap?

A

Tib Ant weakness

103
Q

What is the result of Foot Slap?

A
  • rapid PF after heel contact, can be audible

- usually can clear foot during swing

104
Q

Foot Slap is similar to ________ gait and ________ gait.

A
  • steppage

- foot flat

105
Q

What phase is Knee Extension Thrust Seen?

A

IC

106
Q

What is observed occurring during Knee Extension Thrust?

A

knee snapping back into extension early in stance phase

107
Q

What is the cause of Knee Extension Thrust?

A

quad spasticity from UMN lesion

108
Q

What is the result of Knee Extension Thrust?

A
  • rapid and often excessive knee extension during LR

- can occur with/cause knee hyperextension over time

Kinesiology (9 decks)

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