Movement Analysis Test 1 Flashcards
1
Q
Ipsilateral pelvic drop
Task, cause, significance
A
All
Compensatory for shortened reference limb (WA, SLS)
Weak hip abductors on opposite limb (SLA)
Intentional to lower the limb for IC (SLA)
Adductor spasticity (SLA)
May result in back pain (WA, SLS)
May decrease opposite stance limb stability (SLA)
Increase relative length of reference limb (SLA)
May increase energy cost (SLA)
2
Q
What is gait?
A
The manner in which a person walks
3
Q
Kinematic variables of gait
A
joint ROM
4
Q
During which phase is greatest ankle DF required?
A
Terminal stance
2nd is Mid-Stance at 5*
5
Q
How does running differ from walking?
A
Running requires greater:
Balance (no double limb support period; “float periods”)
Strength
ROM
6
Q
A significant amount of hip ___ is required for mid-swing
A
Flexion 25*
7
Q
Which phases of the gait cycle are involved in weight acceptance?
A
- Initial contact
2. Loading response
8
Q
How does pronation of the subtalar joint affect the rest of the foot?
A
Unlocks the midtarsal joint for shock absorption during forefoot floor contact
9
Q
The posterior tibialis ___ during initial contact
A
Not typically active
10
Q
The ____ are minimally active in Terminal stance
A
Pretibial
11
Q
Excess PF in WA
Most likely cause
A
PF contracture
12
Q
Contracture intervention
Not short-term effective per research
A
Stretching on QOL, pain, joint mobility
13
Q
Terminal stance
Critical events
A
Controlled ankle DF with heel rise; trailing limb
14
Q
Secondary deviations
A
Gait deviation occurring as a secondary consequence of a more distant or obscure impairment
15
Q
Phase of gait with heel rocker
A
Positioned in Initial contact;
Heel rocker action during Loading Response
16
Q
During pre-swing what is happening at the MTP joints?
A
ROM- move into 60* extension
Torque- extension torque rapidly decreases
Muscle action- calf muscle activity ceases
Functional significance- forefoot on floor assists balance
17
Q
Can no heel off affect swing period of gait?
A
Results in limited knee flexion which can limit limb clearance (drag toes)
Especially in ISw
18
Q
Loading response is completed with __* of ankle __
A
5* PF
19
Q
How does excess eversion affect SLA?
A
May be caused by selective weakness of anterior tibialis or hypertonicity of peroneal muscles
Interferes with foot position for IC
20
Q
Initial swing
Ankle
A
5* PF
Pretibials
21
Q
Terminal stance
Hip
A
20* apparent hyperextension
No muscle activity
22
Q
Mid Swing
Critical events
A
Further hip flexion to 25*
Ankle DF to 0*
23
Q
During mid-stance what is happening at the pelvis?
A
Rotated backward in horizontal plane to neutral
24
Q
Weight acceptance
A
1st task of stance
- Initial contact
- Loading response
Most challenging
Forward progression, limb stability, and shock absorption
25
Contralateral vaulting SLA
| Significance
Increases demand on calf muscles
26
How can impaired motor control contribute to pathological gait?
Peripheral origin:
Weakness
```
Central origin:
Weakness
Hypertonicity
Lack of selective control
Apraxia
Ataxia
Rigidity
```
27
The Ipsilateral erector spinae are active during
Pre-swing as the contralateral limb is loaded
28
How can different types of contracture affect ROM and gait?
1. Elastic
Inactivity or increased stiffness of bully tissues. Yield to forceful stretch.
2. Rigid
May arise from muscle shortness. May be enhanced by scarring. Resistant to considerable force
29
Mid-Stance
| Hip
0*
| Abductors
30
Thigh continues to advance as knee begins to extend. Foot clearance maintained
Mid Swing
31
Orthotic fitting/follow up
conservative:
Days 1-2: 15-30 min NWB if necessary
Days 3-7: WB 15-30 intervals
Days 8+: extend WB as tolerated
Check skin frequently- esp DM patients
Accommodation period- gradually increase wear tins and activity; determine skin tolerance
Enhanced w/ gait training.
Anticipate need for adjustments- no device permanent
32
Phases of swing limb advancement
5. Pre-swing
6. Initial swing
7. Mid-swing
8. Terminal swing
33
___* of knee ___ required for normal single limb support
5* knee flexion
34
How pain contributes to pathological gait
Slowed walking speed
Shortened stance phase on the painful limb
Tendency to stiffen the limb to avoid joint excursion
Absence of forceful foot contact or push-off
35
Most likely cause of forefoot or foot-flat contact in WA?
1. 2ndary to excess knee flex in TSw
2. Compensation for weak quads to avoid LR
3. 2ndary to excess PF in TSw
5. Heel pain
36
Articulated AFO with ankle stops - DF weakness
PF stop
Induces immediate knee flexion moment
Eliminates foot slap from weak DF
Prevents foot drop and steppage gait (equinus) in swing phase
37
3 primary functional tasks of gait
Weight acceptance
Single limb support
Swing limb advancement
38
Neutral position of pelvis in sagittal plane
10* anterior tilt
39
When do rigid contracture causing excess PF manifest in gait?
Consistently through all phases of gait cycle
40
Initiation of heel rocker is critical event in ___ phase
Initial contact
41
Initial swing
| Knee
60* flexion
| Flexors
42
Foot slap in WA
| Most likely cause?
Weak pretibials
43
During initial swing what is happening at the hip joint?
ROM- moves to position of 15* flexion
Torque- hip extension torque initial which approaches 0 by end of phase
Muscle action- iliacus, gracilis, sartorius, and ADD longus active
Functional significance- limb advancement continues
44
Subtalar joint is positioned ___ in initial swing
Near neutral
45
Cadence is...
Number of steps per unit of time
46
The glut max is active during ___ to decelerate the effects of impact, but not to the extents it is during ___.
Initial contact
Loading response
47
Single limb support is the period where...
| Includes ____ phase(s).
Body progresses over a single stable limb.
Weight is transferred onto the metatarsal heads and the heel comes off the ground.
Mid-stance
Terminal stance
48
Subtalar joint inverts and positioned near 2* of eversion in ___.
Terminal stance
49
Mid Swing
| Ankle
0*
| Pretibials
50
The vertical ground reaction force vector begins at___
Center of pressure
51
Initiation of gait:
| Center of pressure shifts...
Posteriorly and briefly toward swing foot
Then towards stance foot heel,
Stance foot forefoot,
And ultimately medial forefoot of stance foot.
52
The glut max is active during ___ to decelerate hip flexion, but not to the extent it is during ___
Terminal swing
Loading response
53
Reactionary torques in gait
Muscle
54
How does treadmill walking differ from walking across ground?
Higher cadence and shorter stance times with treadmill (at comparable speeds)
Push-off forces and maximal ground reaction forces generally lower with treadmill
55
Swing limb advancement
3rd task
5. Pre-swing
6. Initial swing
7. Mid-swing
8. Terminal swing
Foot clearance and limb advancement
56
During terminal stance what is happening at the knee joint?
ROM- unchanged from mid-stance in 5* flexion
Torque- extension torque peaks and then diminishes
Muscle action- calf muscles continue to stabilize knee by restraining tibia; biceps femoris may be active
Functional significance- joint stability maintained m; biceps femoris may act to prevent hyperextension
57
How is step width found?
Linear distance between midpoint of heel of one foot and same point on other foot in completing a step.
58
What is terminal swing?
| Critical events?
Knee extends as the limb prepares for contact with the ground
Deceleration and inhibition of hip flexion
Deceleration at knee
Adequate knee extension
Adequate ankle DF
59
Body progresses past forefoot
Terminal stance
60
Initial contact
| Hip
20* flexion
| Extensors
61
The pretibial muscle eccentrically control DF during
Loading response
62
What is a stride?
Heel strike to next ipsilateral heel strike
63
The thigh begins to advance; knee continues to flex and the foot clears the ground
Initial swing
64
Periods of gait
Stance
| Swing
65
What is heel off deviation?
Deviation
Excess PF and only forefoot contact maintained
Loading response->
Late Mid-Stance
66
Contralateral vaulting SLA
| Most likely cause
Compensatory for limited flex of swing limb
Compensatory for longer swing limb
67
During mid-stance, what is happening at the ankle joint?
ROM - moves into 5* DF
Torque- markedly increasing DF torque
Muscle action- soleus and gastroc contract eccentrically to control forward progression of tibia
Functional significance- calf muscles stabilize knee; ankle rocker action created; body progresses forward
68
Foot orthoses May help..
```
Plantar fasciitis
Ankle sprain
Stress fracture
Metatarsalgia
Tendonitis
1st MP joint sprain
Pea planus/cavus
Hallux valgus
Morton’s neuroma
Tarsal tunnel
Rear foot valgus/varus
Forefoot ADD/ABD
```
69
Major deviations of hip
```
Hike
Ipsilateral drop
Contralateral drop
Lack of forward rotation
Lack of backward rotation
Excess backward rotation
```
70
Anterior pelvic tilt
| Task, cause, significance
All
Weak abdominals
Hip flexion contracture
2ndary to forward trunk lean
May increase energy cost
May increase lordotic curve which may result in LBP
71
During terminal swing what is happening at the pelvis?
Rotates forward 5* in horizontal plane
72
During LR (loading response), what is happening at the hip joint?
ROM- remains at 20* flexion
Torque- rapid, high intensity flexion torque; ADD torque begins
Muscle action- hip extensors and ABD active
Functional significance- hip joint, pelvis, and trunk stabilized in sagittal and frontal planes
73
Past retract
A visible forward and then backward movement of thigh during TSw
74
Pre Swing
| Hip
10* apparent hyperextension
| Adductors
75
Toe-out: normal men
7*
| Decreases as speed of walking increases
76
Stair descent...
1. Weight acceptance
2. Controlled lowering
3. Forward continuance
4. Leg pull-through
5. Foot placement
77
Weakness of ___ causes difficulty during mid-swing
Pretibial muscles
78
Pre Swing
| Critical events
Passive knee flexion to 40*
| Ankle PF
79
Excess eversion-WA
| Significance
Rotary strain in mid foot and knee
80
The initiation of the forefoot rocker is a critical event in...
Terminal stance
81
During terminal stance what is happening at the ankle joint?
ROM- moves into 10* DF
Torque- DF torque peaks
Muscle action- calf muscle activity peaks
Functional significance- maximal forward progression of the tibia; heel allowed to rise
82
Mid Stance
| Critical event
Controlled tibial advancement
83
During terminal swing what is happening at the knee joint?
ROM- extends to neutral, but then may move into 5* flexion
Torque- extension torque
Muscle action- quads active concentrically; hamstrings peak in activity
Functional significance- step length optimized by leg reaching out
84
What is initial swing?
| Critical events?
Thigh begins to advance as foot comes up off floor
Adequate knee flexion
Adequate hip flexion
85
Consequence of excess PF in swing?
Foot clearance (drag)
86
During which phase of gait are quadriceps most active?
Loading response
87
Terminal swing
| Hip
20* flexion
| Hamstrings
88
Loading response
| Hip
20* flexion
| Extensors and Abductors
89
During mid-stance what is happening at the knee?
ROM- extends to 5* flexed
Torque- extension torque
Muscle action- quads stabilize knee until knee extension torque begins; calf muscles restrain tibia
Functional significance- knee stability maintained by knee extension torque and calf muscle activity
90
What is the functional limb varus angle?
Angle between bisection of lower leg and ground.
Increases during running
91
Alternating flexion and extension of knee occurring during a single phase
Wobbles
92
Drag in SLA
| Significance
May result in loss of balance
Interferes with limb advancement
May cause injury to toes
93
Excess PF in WA
| Significance
Poor position for heel rocker
| Decreases shock absorption by limiting knee flex
94
The glut max peaks in activity when acting isometrically to sustain hip flexion during
Loading response
95
Less than normal knee flexion for a specific phase of gait
Limited flexion
96
Mid Swing
| Knee
25* flexion
| Flexors
97
How does excess PF affect Initial contact?
Pretibial muscle weakness or limitations in ankle DF ROM
1. Foot flat contact
2. Forefoot contact
98
What is contralateral vaulting?
Rising on forefoot of contralateral stance limb during SLA of reference limb
99
How does excess eversion affect WA?
May lead to rotatory strain of midfoot and knee
100
During mid-swing what is happening at the hip joint?
ROM- moves to 25* flexion
Torque- gradually increasing hip flexion torque
Muscle action- hamstrings become active late in phase
Functional significance- thigh advancement slows; momentum of swing limb helps carry body past stance limb
101
Running commences at...
Cadence of 180 steps per minute
| Double support disappears
102
During pre-swing what is happening at the pelvis?
Remains in 5* of backward rotation in horizontal plane
103
Step duration
Amount of time spent during a single step.
Usually expressed as seconds per step.
Weakness/pain in extremity = step duration decreased on affected side; increased on in-affected side
104
Excess PF in SLS
| Significance
Decreases forward progression of the tibia over the ankle and forefoot
105
Phase of gait most likely to be affected by pretibial weakness
Loading response
106
Significance of foot slap in WA
1. Decreases forward momentum of tibia
| 2. Decreases shock absorption by limiting knee flex
107
Loading response
| Knee
15* flexion
| Quadriceps
108
Pre Swing
| Ankle
15* PF
| No muscle activity
109
What is included in a single gait cycle?
One stride
110
During terminal stance what is happening at the hip joint?
ROM- thigh moves to trailing position of 20* extension
Torque- hip extension torque; ADD torque rapidly diminishes
Muscle action- posterior fibers of TFL cease; anterior fibers of TFL may become active
Functional significance- body allowed to advance past foot to maximize step length while limb remains stable
111
Initial contact
| Knee
5* flexion
| Quadriceps
112
Solid ankle AFO
DF and PF deficits
Coronal instability of ankle
Places moments on the knee that require fair-good quad strength for control
113
What is terminal stance (TSt)?
| Critical events?
Body moves ahead of limb and weight is transferred to forefoot
Initiation of forefoot rocker
Controlled ankle DF with heel rise
Trailing limb posture
Free forward fall
114
How does excess eversion affect SLS?
Interfere with function of midfoot and forefoot as a rigid lever - which is essential for function of forefoot rocker
115
What happens during termination of gait?
Push-off reduced in stance limb.
| Swing limb provides braking forces at initial contact.
116
No heel off- SLA
| Significance
Decreases step length of opposite limb
| Results in limited knee flex in SLA
117
During terminal stance what is happening at the pelvis?
Anterior tilt and 5* backward rotation in horizontal plane
118
The forefoot remains on the floor. The knee rapidly flexed while weight is shifted to other limb.
Pre-Swing
119
Clawed toes vs Hammered toes
Clawed- flexion of proximal and distal pharyngeal joints
Hammered- flexion: proximal, extension: distal
120
Terminal stance
| Ankle
10* DF
| Calf
121
Loading response
| Critical events
Hip stability
Controlled knee flexion
Ankle PF
122
In mid-swing the glut max is
Minimally active
123
Swing limb advancement
| Accomplishments
Foot clearance
| Limb advancement
124
During mid-swing what is happening at the knee joint?
ROM- rapidly extends to 25* flexion
Torque- transition to knee extension torque late in phase
Muscle action- short head of biceps femoris may control rate of extension
Functional significance- extension necessary for step length begins in this phase
125
What is a step?
Heel strike to next contralateral heel strike
126
How does excess inversion affect gait?
Reduced shock absorption in WA
Decreased limb stability in SLS
Reduced clearance of foot in SLA
127
What creates the torque demands at the joints during gaits
External torque
Gravitational torque
Intersegmental torque
Muscle torque
128
During initial contact (IC) , what is happening at the pelvis?
5* forward rotation in horizontal plane
129
Phases of gait cycle involved in single limb support?
3. Mid-stance
| 4. Terminal stance
130
Terminal swing
| Ankle
0*
| Pretibials
131
Symmetrical gait pattern indication
Right and left step length comparison
132
Phase of gait most likely affected by weak gluteus Maximus
Loading response
133
Excess inversion
| Most likely cause
Tibialis anterior, tibialis posterior or soleus overactivity
Varus contracture
PF contracture
Weak peroneals
Lack of selective motor control of pretibials
Variations in skeletal alignment resulting in high arch
Internal tibial torsion
134
Backward lean of trunk
| Task, cause and significance
All
Cause:
Intentional to decrease the demand on hip extensors (WA and SLS)
Intentional to advance the limb (SLA)
Significance:
May increase energy cost
Decreases forward movement
135
Initial contact
| Critical event
Heel first contact
136
FO (foot orthoses)
Can have effect below talo-crural joint
Hindfoot/subtalar and midfoot anomalies
Prefabricated or custom
137
Major and minor hip deviations
Major:
Limited FLEX
Past retract
Excess FLEX
```
Minor:
ADD
ABD
IR
ER
```
138
Much of the inversion if the subtalar joint occurs through ____ while activity decreases during ___
Terminal stance
Pre-swing as unloading of the limb occurs
139
During mid-swing what is happening at the pelvis?
Rotates forward in horizontal plane to neutral
140
Excess contralateral flexion (knee)
Knee flexion greater than normal during LR, MSt, or TSt of opposite limb;
occurs during SLA of reference limb (PSw -> TSw)
141
During mid-stance what is happening at the subtalar joint?
ROM- eversion position remains relatively unchanged from end of LR (loading response)
Torque- eversion torque diminishes
Muscle action- posterior tibialis, soleus, and peroneals all eccentrically active
Functional significance- control of eversion
142
No heel off- SLS
| Significance
Interferes with progression over forefoot
143
Normal mid-stance requires ___* ankle ___
5* DF
144
Subtalar joint is positioned ___ in pre-swing
Near neutral
145
Drag in SLA
| Most likely cause
2ndary to limited hip flex, knee flex or excess PF
Impaired proprioception
146
No heel off -SLS
| Most likely cause
Weak calf
147
What is foot slap?
Uncontrolled PF after heel contact
Only occurs if pretibial muscles are strong enough to provide heel first contact in IC
148
AFO (ankle/foot orthoses)
```
Crosses talo-crural joint and can effect...
PF/DF
Coronal stability of subtalar joint
Midfoot positioning:
Transverse arch
Longitudinal arch
Forefoot ADD/ABD
```
149
Rupture of Posterior Tibialis tendon- which phase most likely to deviate from normal?
Mid Stance
150
Speed is...
Rate of linear forward motion of the body
151
____ is highly active during single limb support to provide for stability of pelvis in __ plane
Glut med
Frontal
152
Trunk rotates back
| Task, cause and significance
All
Inability to dissociate trunk movements from pelvic or limb movements
Use of UE aids
2ndary to excess PF (TSt)
May increase energy cost
May decrease stability
Decreases forward progression
153
If one leg is beginning initial swing, what is the other leg beginning?
Mid-stance
154
Excess eversion- WA
| Most likely cause
Weak tibialis posterior
155
Ground reaction AFO
Mild/Mod quad weakness
Provides knee extension moment against tibial cuff during Midstance
Must have DF stop to prevent tibial progression
156
Indications for custom FO intervention
Foot/ankle alignment
Moderate: supination, pronation
Sub-Talar deviations
Forefoot ADD/ABD
157
Knee wobbles
| Most likely cause
Impaired proprioception
Quadriceps hypertonicity
PF hypertonicity
158
What happens through the trunk during the gait cycle?
Trunk rotation occurs opposite to direction of rotation of pelvis
Arm swing follows pattern- opposite upper and lower extremities swing forward concurrently during gait
159
Phases of gait cycle
1. Initial contact
2. Loading response
3. Mid-stance
4. Terminal stance
5. Pre-swing
6. Initial swing
7. Mid-swing
8. Terminal swing
160
Initiation of gait starts with....
Bilateral inhibition of plantar flexors and activation of dorsiflexors.
161
Stance defined
62% of gait cycle
| When reference limb is in contact with the ground
162
Heel off- SLS
| Significance
Increases pressure on MT heads
163
Excess inversion
| Significance
Poor position for WA
Rigid foot resulting in decreased shock absorption
Decreased stability in SLS
Decreased foot clearance in SLA
164
Toe-out defined
Angle between:
Center of heel along line of progression
Line of the 2nd toe
165
What is mid-stance?
| Critical events?
Body progresses over a single, stable limb.
Ankle rocker
Restrained ankle DF
Restrained knee extension
Frontal plane hip stabilization
166
During mid-swing what is happening at the ankle joint?
ROM- DF to neutral
Torque- very low level of PF torque
Muscle action- pretibial muscles contract concentrically
Functional significance- foot clears ground by 1cm
167
The ___ are active during mid-swing to maintain ___
Pretibial
| Maintain ankle DF aiding in foot clearance
168
Contralateral pelvic drop- SLA
Cause and significance
Compensatory for shortened opposite limb
May result in back pain
169
During initial swing what is happening at the pelvis?
Remains in 5* of backward rotation in horizontal plane
170
Excess inversion is more often in individuals with ___ disorders than ___disorders
NM disorders > MSK disorders
171
How does the center of pressure change through the gait cycle?
Stance phase- posterolateral heel
Moves linear...and then medially across...
Late stance - 1st/2nd toes
172
How does inadequate extension of toes affect gait pattern
SLS- esp TSt
SLA- esp Pre-swing
Promotes loss of heel rise
173
During initial swing what is happening at the knee joint?
ROM- further rapid flexion to 60*
Torque- knee flexion torque
Muscle action- peak activity of biceps femoris short head, sartorius and gracilis
Functional significance- foot clears floor as thigh begins to advance
174
During initial swing what is happening at the ankle joint?
ROM- moves into 5* PF
Torque- very low level PF torque
Muscle action- pretibial muscles contract concentrically to initiate DF
Functional significance- DF needed to clear foot in next phase begins
175
Terminal swing
| Critical events
Knee extension to neutral (possibly 5* flexion)
176
What is initial contact?
| Critical events?
Moment when foot contacts ground.
Heel first contact
Initiation of heel rocker
Impact deceleration
177
Terminal stance
| Knee
5* flexion
| No muscle activity
178
Initial swing is completed with ankle in __* of ___
5* PF
179
Impairments of central origin
```
Weakness
Hypertonicity
Lack of selective control
Apraxia
Ataxia
Rigidity
```
180
Excess DF in SLS
| Significance
Increases demand on hip and knee extensors
Interferes with heel rise and decreases step length of opposite limb (TSt)
181
Contracture intervention - effective per research - post TBI
Botulin toxin injections
Improvement in DF ankle ROM (26*)
No change in strength
182
Excess DF SLS
| Most likely cause
1. Weak calf
2. 2ndary to excess hip and knee flex
3. Intentional to lower opposite limb for contact (TSt)
4. Excess midfoot DF 2ndary to limited ankle mobility
183
Trunk rotates forward
| Task, cause, significance
All
Inability to disassociate trunk movements from pelvic or limb movements
Excessive use of UE aids
Intentional to advance limb
May increase energy cost
May decrease stability
184
Stair gait- Stance period
64%
1. Weight acceptance
2. Pull up
3. Forward continuance
185
What is loading response (LR) ?
| Critical events?
Weight rapidly transferred onto outstretched limb.
Progression of heel rocker
Restrained ankle plantar flexion
Restrained knee flexion
Sustained hip flexion
186
Single limb support
2nd task
3. Mid-stance
4. Terminal stance
Stability and forward progression
187
Articulated AFO with ankle stops - PF weakness
DF stop
Allowed controlled tibial progression
Prevents drop off in terminal stance from lace of PF strength
188
Mid-Stance
| Ankle
5* DF
| Calf
189
During initial contact (IC) , what is happening at the hip joint?
ROM- flexed 20*
Torque- rapid, high intensity flexion torque begins
Muscle action- all hip extensors active; semimembranosis and biceps femoris long head activity wanes
Functional significance- hip in position of forward reach
190
During pre-swing what is happening at the subtalar joint?
ROM - achieves neutral position
Torque- inversion torque diminishes to 0
Muscle action- anterior tibialis begins to contract
Functional significance- preparation for foot clearing the ground during swing
191
Excess PF SLS
| Most likely cause
1. PF hypertonicity
2. Weak quads
3. Impaired proprioception
4. Ankle pain
192
Completion of heel rocker is critical event in ___ phase
Loading response
193
The glut med is primarily active during ____, which are component(s) of ___.
Loading response
Mid Stance
Weight acceptance
Single limb support
194
___ is required of subtalar joint for normal swing limb advancement.
____ May interfere with ___
Positioning in neutral
Excessive positioning in inversion may interfere with foot clearance
195
What does ankle rocker action provide?
Ankle becomes fulcrum for continued progression of limb over stationary foot
196
Motions at the ___ (joints) in the ___ plane are the most important in contributing to critical events and thus are focus of observational gait analysis
Ankle, knee and hip
| Sagittal plane
197
Speed up to 120 steps per minute brought about by ...
Cadence and stride length.
| Above 120 steps per minute- only cadence increase; length levels off
198
Knee wobbles
| Significance
Decreased forward momentum
| Decreased limb stability and balance
199
Pelvis lacks backward rotation
| Task, cause, significance
SLS
SLA
Impaired motor control of trunk and pelvic muscles
Back pain
2ndary to excess hip flexion
Decreases step length of the opposite limb (TSt)
200
Excess eversion - SLS
| Most likely cause
```
Weak tibialis posterior, soleus
PF contracture
Valgus deformity
Referred from knee or hip joint
Variations in skeletal alignment resulting in low arch
```
201
Heel off - WA
| Most likely cause
2ndary to excess PF
202
Hyperextension/Extension Thrust (knee)
| Functional task
WA
SLS
SLA
203
What if heel does contact ground with excess PF?
Reduced forward progression of tibia over stationary foot
204
Normal range and mean of step width
3.5” mean
| 1-5” range
205
Swing defined
38% gait cycle
| When reference limb is off the ground
206
Deviations to consider:
| Excess PF
```
Foot flat contact
Forefoot contact
Heel off
Drag
Foot slap
```
207
Point of observational gait analysis
Understand abilities and impairments
Assist diagnosis
Inform intervention
Evaluate effectiveness
208
Terminal swing
| Knee
5* flexion
| Quadriceps
209
Phase of gait with ankle rocker
Mid-Stance
210
Impairments can be of __ or ___ origin
Peripheral or central origin
211
What creates external torque in gait
Vertical ground reaction force vector
212
Achievement of adequate ankle PF is a critical event in ___ which is included in the functional task of ___
Pre-swing
| Swing limb advancement
213
During LR (loading response), what is happening at the subtalar joint?
ROM- calcaneus everts 5*; subtalar joint pronates
Torque- reversion torque
Muscle action- both anterior and posterior tibialis muscles contract eccentrically
Functional significance- assists shock absorption; induces IR of tibia which reduces rotatory stress on ankle
214
When do elastic contracture causing excess PF manifest in gait?
Potentially all phases
```
May not be present in stance:
LR,
MSt,
TSt
and/or PSw
```
215
The posterior tibialis ___ during mid-swing
Not typically active
216
During LR (loading response), what is happening at the ankle joint?
ROM- 5* rapid PF
Torque- PF torque forces foot to floor then diminishes
Muscle action- pretibials contract eccentrically; soleus and gastroc act to control tibial advancement
Functional significance- heel rocker action created; momentum carried forward; knee flexion initiated
217
During terminal swing what is happening at the ankle joint?
ROM- remains in neutral
Torque- PF torque diminishes to 0
Muscle action - pretibial muscles contract isometrically
Functional significance- neutral position assures heel contact for initial contact
218
Initial contact
| Ankle
0*
| Pretibials
219
Prefabricated FO
Usually accommodative-
Provide cushion, shock absorption, arch support
Negligible adjustment possible
220
Custom molded FO
Corrective or accommodative
Joint realignment
Provide corrective support: longitudinal arch, transverse arch, metatarsal relief
May be more adjustable
221
The ____ are minimally active in Mid-stance
Pretibial
222
During LR (loading response), what is happening at the knee joint?
ROM- moves to 15* flexion
Torque- rapid, moderate intensity flexion torque
Muscle action- eccentric quad activity; diminishing hamstring activity
Functional significance- shock absorbed; limb stability maintained
223
Swing limb advancement is when....
| Involves ___ phase(s)
Time when limb is unloaded and foot comes off ground.
Limb is moved from behind body to in front, reaching out to take next step.
Pre-swing
Initial swing
Mid-swing
Terminal swing
224
Stair gait- Swing phase
36%
4. Foot clearance
5. Foot placement
225
Common pathologies where AFO (ankle-foot orthoses) may be indicated
```
Muscular imbalances: acquired deformity; altered gait
CVA
CP
Brain injury
Guillain-barre
Ataxia
Parkinson’s
MS
MD
```
226
Impairments of peripheral origin
Weakness
227
During which phase is limitation in hamstring flexibility most likely to affect?
Terminal swing
228
Calf muscle activity peaks during
Terminal stance
229
Loading response
| Ankle
5* PF
| Pretibials
230
1 stride for a normal adult lasts approximately...
1 second
231
During pre-swing what is happening at the ankle joint?
ROM- moves into 15* of PF
Torque- DF torque rapidly decreases
Muscle action- calf muscle activity ceases; pretibial muscle activity initiated
Functional significance- forefoot on floor assists balance; PF assists knee flexion and limb advancement
232
The glut max ___ to aid in decelerating forward advancement of thigh, during swing limb advancement
Becomes active at end of terminal swing
233
How might impaired sensation contribute to pathologic gait?
Inconsistent gait pattern
Prevents prompt substitution
Includes perceptual deficits
234
PTB (patella tendon bearing orthosis)
Axial load bearing pain
Calcaneal Fx
Talocrural degeneration
Arthritis
Intermediate use to allow ambulation
235
Typical cadence for adult
Men: 120 steps per minute
Women: 116 steps per minute
236
The calf muscles begin to become active at __
End of loading response
237
Leg reaches out to achieve step length
Terminal swing
238
Excess PF in SLA
| Significance
Interferes with foot clearance
| Interferes with foot position for IC
239
Antalgic gait
Slowed walking speed
Shortened stance phase
Reduced joint excursion
Reduced limb loading and push off
(Pain gait)
240
What is “no heel off”
Absence of heel rise during TSt or PSw
241
Compressive forces of ankle
1/2 BW during standing
5x BW during walking
13x BW during running
242
Excess DF WA
| Most likely cause
2ndary to excess hip or knee flex
243
During terminal swing what is happening at the subtalar joint?
ROM- maintains neutral position
Torque- none to very slight inversion torque
Muscle action- anterior tibialis stabilizes medially
Functional significance- foot positioned for heel contact
244
How are limited flexion, hyperextension and extension thrust related?
A
245
Hip angle is measured as
Thigh relative to vertical
246
Heel off -WA
| Significance
Decreases BOS due to smaller WB surface
247
Subtalar eversion peaks at __ degrees in ____ during normal gait
5*
| Loading response and Mid-Stance
248
Articulated AFO with adjustable joints
Variable ROM
Can be adjusted as patient progresses in strength and/or range
Request if you anticipate your patient having a significant return
249
Swing limb advancement
| Percentage of gait cycle
50-100%
250
Pre-swing concludes with ankle in ___* of __.
15* PF
251
Phase of gait with forefoot rocker
Terminal stance
252
Gait problem- toes up
| Task, cause, significance
SLA
Cause:
Compensation weak tibialis anterior or insufficient DF
Toe extensor hypertonicity
Significance:
Foot clearance
May cause skin irritation or callouses on dorsum of toes from rubbing against shoes
253
Stair ascent...
1. Weight acceptance
2. Pull-up
3. Forward continuance
4. Foot clearance
5. Foot placement
254
Orthotic treatment patterns - goals
```
Restore function
Prevent further injury and progression
Protection of involved joints
Kinesthetic reminder of previous injury
Return to prior activity levels; work, exercise, leisure
```
255
Lowest vertical ground reaction forces - phases of gait
Mid-stance
256
What does heel rocker action provide?
Facilitates forward progression of entire stance limb
257
Calf muscles are active to decelerate forward advancement in ___, their activity peaks during __
Mid-stance
| Terminal stance
258
Contralateral pelvic drop- WA/SLS
| Cause and significance
Weak hip abductors on reference limb
Intentional to lower opposite limb for IC
Adductor spasticity
May decrease stance limb stability
Increase relative length of opposite limb
May increase energy cost
259
Rectus abdominus activity usually occurs during
Ipsilateral and contralateral Mid and Terminal Swing
260
The ____ are minimally active in Pre-swing
Pretibial
261
Primary deviation
Gait deviation occurring as a direct result of a readily associated impairment
262
The __ is active during ___ to control subtalar joint eversion
Posterior tibialis
| Mid-stance
263
Excess eversion
| Significance
Rotary strain on mid foot and knee
Interferes with rigid lever for forefoot rocker
Can be used to gain DF range when ankle mobility limited
264
2ndary benefits of AFO use
Mild knee alignment and function
Most successful w/ sagittal plane involvement
Mild genu recurvatum
Weaknesses in knee control
265
Pelvis excess forward rotation
| Task, cause, significance
All
Intentional to advance limb
Excess backward rotation of opposite limb
Increases step length (TSw)
266
Lateral lean of trunk
| Task, cause, significance
All
```
Weak hip abductors
Intentional to avoid hip pain
Compensatory for short stance limb
Intentional to clear swing limb
Use of UE aids
```
May increase energy cost
Decreases forward momentum
267
Single limb support
| Percentage of gait cycle
12-50%
268
Heel off -SLS
| Most likely cause
Heel pain
| 2ndary to excess knee flex
269
During terminal stance what is happening at the MTP joints?
ROM- move into 30* extension
Torque- extension torque created
Muscle action- calf muscle activity peaks; posterior tibialis and soleus contract concentrically
Functional significance- forefoot rocker action created; contributes to contralateral step length
270
Mechanisms that contribute to pathological gait
Impaired motor control
Abnormal ROM
Impaired sensation
Pain
271
During LR (loading response), what is happening at the pelvis?
Remains in 5* of forward rotation in horizontal plane
272
Indications for orthosis rx
```
Demonstrated need for:
Support and alignment
Prevention or correction of deformity
Substitution or enhancement of function
Decrease pain
```
273
A stride involves ___.
2 steps: a right and left step
274
During terminal swing what is happening at the hip joint?
ROM- falls slightly to position of 20* flexion
Torque- hip flexion torque diminishes at the end of phase
Muscle action- hamstrings, ADD magnus, glute max, glute med, and TFL active
Functional significance- limb positioned for heel first initial contact
275
Excess eversion- SLA
| Most likely cause
Weak tibialis anterior
| Peroneal hypertonicity
276
Mid-Stance
| Knee
5* flexion
| Quadriceps initially; then no muscle activity
277
Excess DF in WA
| Significance
Increase demand on hip and knee extensors
| Decreases limb stability
278
If only leg is in pre-swing what is opposite leg doing?
Initial contact
| Loading response
279
Initial swing
| Critical events
Hip flexion to 15*
| Flexors
280
Custom molded orthotics
Chronic and progressive prognosis
Long term use
Maximal control
Control needed at multiple joints
281
Posterior pelvic tilt
| Task, cause, significance
All
```
Tight hamstrings
Intentional to decrease demand on hip extensors (WA)
Intentional to advance limb (SLA)
LBP
Limited lumbar extension
```
May increase energy cost
May result in excess knee flexion in SLS
282
During initial contact (IC) , what is happening at the knee joint?
ROM- neutral to 5* flexed
Torque- brief extension torque
Muscle action- quads prep for next phase; hamstrings counter extension torque
Functional significance- extension torque stabilizes knee
283
Mid Swing
| Hip
25* flexion
| Flexors initially, then hamstrings
284
During initial swing what is happening at the MTP joints?
ROM- flexion to neutral position and maintained there throughout swing
Torque- flexion torque which quickly decreased
Muscle action- EHL and EDL peak in activity
Functional significance- toes stabilized allowing EHL and EDL to facilitate DF at ankle
285
Body progresses over the foot in a controlled manner. The contralateral swing limb provides the momentum.
Mid Stance
286
Pelvis lacks forward rotation
| Task, cause, significance
WA
SLA
Retracted pelvis
Compensatory to decrease demand on quads and hip extensors at LR
Lack of backward rotation on opposite limb
Back pain
Decreases step length
287
Gait problem- inadequate extension of toes
| Task, cause, significance
SLS and SLA
```
Cause:
Ltd toe extension ROM- incl hallux valgus or hallux rigidus
Toe flexor hypertonicity
Forefoot pain
2ndary to no heel off
```
Interferes with forward progression
Decreases step length of opposite limb
288
Single limb support
| Accomplishments
Stability
| Forward progression
289
What does the forefoot rocker action provide?
Metatarsal heads serve to facilitate continued forward progression of tibia
290
Deviations to consider:
| Excess DF
No heel off
291
Kinetic variables of gait?
Torque demands
| Muscle actions
292
Knee wobbles
| Phase/function
WA -> LR
SLS -> MSt TSt
293
During mid-stance what is happening at the subtalar joint?
ROM- progressive reduction of eversion to approximately 2* eversion
Torque- inversion torque created as heel rises
Muscle action- posterior tibialis and soleus contract concentrically; peroneals isometrically active
Functional significance- reduction in eversion increases stability of midtarsal joint
294
During initial swing what is happening at the subtalar joint?
ROM- maintains neutral position
Torque- none to very slight inversion torque
Muscle action- anterior tibialis stabilizes medially
Functional significance- foot positioned to clear the ground
295
During mid-stance what is happening at the hip joint?
ROM- extension to neutral
Torque- change from flexion to extension torque; ADD torque continues
Muscle action- no hip muscle activity in sagittal plane; hip ABD active
Functional significance- stable hip joint position achieved in sagittal plane; pelvis stabilized in frontal plane
296
During initial contact (IC) , what is happening at the ankle joint?
ROM- neutral
Torque- PF
Muscle action- isometric contraction of pretibial muscles
Functional significance- foot correctly positioned for heel rocker action in LR (loading response)
297
The ankle rocker is a critical event of this phase
Mid-stance
298
Shock is absorbed as forward momentum is preserved.
| A foot-flat position is achieved
Loading response
299
Excess eversion AKA
Excessive pronation
300
During mid-swing what is happening at the subtalar joint?
ROM- maintains neutral position
Torque- none to very slight inversion torque
Muscle action- anterior tibialis stabilizes medially
Functional significance- foot positioned to clear the ground
301
Highest vertical ground reaction forces - phases of gait
Late loading response
| Towards end of terminal stance
302
Prefabricated orthotics
Short term need
Temporary use
Simple function
Diagnostic
303
Gait problem- clawed/hammered toes
| Task, cause, significance
SLS
Toe flexor/extensor hypertonicity
Imbalance of long toe extensors and intrinsic foot muscles
Compensatory for weak PF
Interferes with forward progression
Decreases step length of opposite limb
304
Free motion ankle joint (AFO)
Coronal control only
Ligamentous Instability
Strength deficits
Requires normal DF/PF strength
305
During pre-swing what is happening at the hip joint?
ROM- thigh flexes forward by falling to position of 10* of extension
Torque- hip extension torque diminishes
Muscle action- ADD longus contracts concentrically; rectus femoris may be active
Functional significance- limb advancement begins; hip flexion motion contributes to knee flexion
306
Weight acceptance
| Accomplishments
Forward progression
Stability
Shock absorption
307
During pre-swing what is happening at the knee joint?
ROM- rapidly flexes to 40*
Torque- flexion torque demand
Muscle action- minimal knee flexor activity from gracilis; rectus femoris may be active
Functional significance- contributes to knee flexion; rectus femoris may restrain speed of knee flexion
308
Difficulty during Swing limb advancement
| Limitation of ___ ROM
Ankle PF ROM
309
During which phase is hypermobility of knee into extension most likely to affect?
Terminal stance
310
Significance of forefoot or flat-foot contact in WA?
1. Poor position for heel rocker
2. Decreases forward momentum of the tibia
3. Decreases shock absorption by limiting knee flex (forefoot contact)
311
Which phase(s) of gait has greatest subtalar joint eversion?
Subtalar eversion peaks at 5* in Loading Response and Mid Stance
312
What to look for in patient evaluation (AFO)
Functional MMT:
Functional strength, muscle tone imbalances, tone triggers
Functional ROM:
Midtarsal, subtalar, talocrural, knee and hip joints
313
Forceful motion of knee towards extension
Extension thrust
314
Limited knee flexion
| Major deviation in phase/function
WA -> LR
SLA -> PSw and ISw
315
Weight acceptance
| Percent of gait cycle
0-12%
316
Pre Swing
| Knee
40* flexion
| No muscle activity
317
Forward trunk lean
| Task, cause, significance
WA
SLS
2ndary to excess hip flex
Intentional to reduce quad demand
Intentional to substitute visual input for impaired proprioception
Use of UE aids
Ltd trunk EXT ROM
Intentional to progress over excessively PF ankle
Abdominal pain
Increases energy cost and demand on hip and trunk extensors
May improve stability and/or forward progression
318
No heel off-SLA
| Most likely cause
Ankle or metatarsal head pain
2ndary to inadequate ext of toes
2ndary to excess DF
319
Weight acceptance includes ___ phase(s).
| This is the period when...
Initial contact
Loading response
Weight rapidly loaded onto outstretched limb.
Impact of the floor-reaction force is absorbed and the body continues in a forward path while stability is maintained.
Both feet are in contact with the ground.
320
When is custom AFO needed
Chronic conditions
Progressive deficits
Moderate weakness and instability
Maximal control of joint needed
321
Pelvis- hike
| Task, cause, significance
SLA
Intentional to clear swing limb
May increase energy cost
322
What is pre-swing?
| Critical events?
Rapid unloading of limb occurs as weight is transferred to contralateral limb
Adequate knee flexion
Adequate ankle PF
323
Hip motion from neutral to 20* extension are required for ___ (functional)
Single limb support
324
What is mid-swing?
| Critical events?
Thigh continues to advance as knee begins to extend
Adequate hip flexion
Adequate ankle DF
325
When does pretibial weakness cause excess PF manifest in gait?
Only in swing phase of gait leading into initial contact
IC
ISw
MSw
TSw
326
Excess PF in SLA
| Most likely cause
1. Weak pretibials
2. PF contracture
3. PF hypertonicity
4. Lack of selective DF control (TSw)
327
S1 radiculopathy- phase of gait most likely to have deviations
Terminal stance
328
Pelvis excess backward rotation
| Task, cause, significance
SLS
SLA
Inability to disassociate pelvis from limb movement
2ndary to excess PF
Compensatory for excess hip flexion (SLS)
Weak calf with no heel-off
May decrease forward progression (WA, SLA)
May decrease limb advancement (SLA)
Intentional to increase forward progression (SLS)
