Lecutre 7: Gait Analysis , Common Examples Of Patholigc Gait And Rotational Profile Flashcards
- A 15-year-old patient is demonstrating a right compensated Trendelenburg gait pattern.
- Which hip abductor is weak?
- Which direction is the lateral trunk flexion?
- Which hemipelvis will drop?
left
left
right
named after the side the pelvis is dropping
What are the 2 planes that are easiest to see in gait analysis
Sagittal and coronal
What view is the sagittal and coronal
Side
Front
What percent is swing phase and stance phase
40%
60%
When is there double limb support in gait
Loading response and pre swing
What are the 5 attributes of ambulation
- Stability in Stance
- Foot Clearance in Swing
- Pre-positioning of the foot for initial contact
- Adequate Step length
- Energy Conservation
What and when is the first rocker
Heel rocker
IC to LR
What and when is the 2nd rocker
Ankle rocker
Midstance
What and when is the 3rd rocker
Forefoot rocker
Heel rise (terminal stance)
What and when is the 4th rocker
Toe rocker
Pre swing
What plane is excessive trunk motion seen in
Coronal (frontal)
What can excessive adduction in gait be caused by
Adductor tightness and/or abductor weakness
What is malrotation
Excessive internal hip rotation
Anteversion causes excessive hip __
IR
Often in CP what is usually over active relative to their antagonist
HF
ADDuctors
IR
Inadequate power generation caused by mm imbalance can result in what
Compensatory movements or coping responses
What may compensate for the muscular imbalance around the hip
Weight shifts of the upper body
If a patient has L glute med weakness what way will the pelvis drop and what way will they trunk lean
R and L
Hip circumduction can be from inadequate …..
HF and/or KF
Excessive IR
Ankle PF
Stance phase knee deviation errors are usually from what
Abnormal position, malrotation or both
Swing phase knee deviation errors are usually from what
Inadequate ROM and/or weaknesss
What can be the cause if patient has decreased dynamic knee flexion during mid swing
Excessive knee flexion
What are one of the most common stance phase knee deviations
Excessive knee flexion
Where does knee flexion drive the ground force reaction
Posteriorly
If ther is excessive knee flexion in stance what does this increased demand on
The quads and hip extensors —> increased energy expenditure
What is the most common knee deviations in swing phase
Decreased knee flexion
What do children with CP often use to augment hip flexion
Rectus fempris —> 2 joint mm flex’s the hip and extends the knee
Since teh rectus femoris also functions as a knee extensors when there is decreased knee flexion during swing what does it result in
Stiff knee gait pattern
What is stiff knee gait pattern
Inadequate knee flexion during midswing
Is stiff knee gait a swing or stance phase deficit
Swing
What are the 3 major categories of foot/ankle deviations
• Excessive plantar flexion
• Excessive dorsiflexion
• Bony Deformity: malrotation
What does excessive PF during stance phase affect primarily
IC and midstance —> disrupts 1st rocker (heel rocker)
Are are the consequences of excessive PF in stance
Loss of forward progession , shortened step length, loss of stance phase stability
If there is increased PF at IC what ankle rocker is lost
1st
what is the Most common stance phase errors at the ankle caused by excessive PF
excessive PF knee extension couple
In typical gait, during second rocker the ground
reaction force falls in ___ of the ___ and in
___ of the ankle creating knee extension and
ankle DF
Front of the knee
Front
The PF knee extension force couple , first stabilizes where and then later where
Knee and later the hip
If there is excessive plantar flexion at IC then what rocker is absent
First
Knee hyperextension in midstance is often caused by what
PF tightness
What goes with crouch gait
Excessive DF
If someone has a weak soleus , due to over activity of hip flexors and hamstrings what will happen at the foot and what will it result in
Foot will DF excessively and a crouch gait will result
In a typical gait what does teh soleus act to do
Assist in knee extension by stopping the forward progression of the tibia and moving the GRF in front of the knee
What is present with a calcaneal gait
Excessive DF
What is excessive with crouch gait with a calcaneal gait
Hip flexion
Knee flexion
Dorsiflexion
There is an increased demand on what mm during crouch gait
Quads
Where is the GRF during crouch gait at the knee, hip and ankle
Behind the knee , in front of the hip and ankle , causing a flexion moment
What can malrotation of the foot be caused by
Varus or valgus foot deformities
There will be ___ phase ___ with malrotation of the foot
Stance
Instability
What is the malrotation of the foot for a hemiplegic CP
Over activity of the post TiB and gastroc —> puts foot and ankle in equinovarus position (calcaneal inversion)
What is the malrotation of the foot for a diplegia CP
Over activity of the peronus brevis and gastroc —> puts foot and ankle in an equinovalgus position (calcaneal eversion)
What will happen during swing if there is excessive PF
Foot drop , toe drag
What is the foot progression angle
Have patient walk and see where their feet are positioned
normal is ER of 0-10°
never IR
What kind of dysfunction can be the source of many gait deviations in CP
Lever arm dysfucntion
What are th 4 levers arm dysfucntion types
1). Malrotation
2). Loss of Stable Fulcrum
3). Loss of bony rigidity
4). Shortening of the lever arm
During malrotation what is impaired or lost
Power and movement generation
Does internal or external rotation cause out toeing
External
Hip subluxation results in the loss of what
Stable fulcrum bc the femoral head is not completely covered by the acetablum
When u lose a stable fulcrum , there is poor ___ mm control
Abductor
What is a loss of bony rigidity
Pes valgus foot (pronated)
What is pes planovalgus
Subluxation of talus on calcaneus
What is coxa brevia
True shortening of the neck of the femur
What is coxa valga
The neck shaft angle of the femus is increased
Coxa brevia and coxa valga result in ____ in the distance to the center of the hip joint
Reduction
What is the 6 measurements of the rotational profile
- Foot Progression Angle
- Medial and Lateral Hip
rotation - Ryder’s Test – test for
hip anteversion - Thigh-foot Angle
- Transmalleolar axis-
thigh angle - Foot Configuration
What is the normla IR and ER of the hip
45-50°
What does ryders test look at
Hip anteversion
Should thigh foot angle be IR or ER
Always ER
With anteversion how does teh Q angle change
Increases … >20°
With retroversion how does teh Q angle change
Decreased (<15°)
Anteversion is femur ___ rotation
Retroversion is femur ___ rotation
IR
ER
What is a squinting patella
When the patella is moved medially
What has become the standard of care to objectively measure and diagnose the primary gait abnormalities in CP
Motion analysis
What plane does the motion analysis really see
Transverse plane
What is the difference between the kinematic and kinetic for motion analysis
Kinematics is the ROM
Kinetic is the force plat giving us info from ground reaction force plates
In the frontal plane what are the 2 joint motions we can see
Pelvic obliquity
Hip abduction/adduction
In the sagittal plane what are the 4 joint motions we can see
- pelvic tilt
- hip flexion/extension
- knee flexion/extension
- DF/PF
In the transverse plane what are the 2 joint motions we can see
Pelvic rotation
Hip rotation
Is IR of the foot progression okay
No never ,
What is • A method derived to calculate the amount a subject’s gait deviates from an average normal profile, and to represent this deviation as a single number
Gait deviation index (GDI)
What is a typical gait deviation index
100 and a SD of 10
What is a big joint issue in people with UMN issues
2 joint muscles (hammy , gastroc and rectus fem)
Foot clearance in swing can be challenged by what 3 things
• Inadequate hip motion, and/or
• Inadequate knee motion, and/or
• Insufficient ankle DF
What is the key to efficient gait
Energy conservation
What does controlling forward momentum occur by
Eccentric contraction of the soleus during midstance
If someone develops a PF contracture from anterior TiB weakness what kind of impairment is that
Secondary bc the primary impairment is weal ant TiB
What is a standardized assessment tool used to measures a persons ability to walk and perform daily activities
Functional assessment questionnaire
What questionnaire covers several domains including gait function, mobility, activities of daily living, pain, physical activities, appearance,
use of assistive devices, and self-esteem
Goal outcomes assessment list
What questionnaire covers several domains including gait function, mobility, activities of daily living, pain, physical activities, appearance,
use of assistive devices, and self-esteem
