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Sharlene and MB's PT party > MSK #14- Gait Cycle, Norms, Deviations, and Abnormal Gait Patterns > Flashcards

MSK #14- Gait Cycle, Norms, Deviations, and Abnormal Gait Patterns Flashcards

1
Q

What is happening with muscles of LE during Initial Contact (Heel Strike)

A

1- Tib Anterior and long toe extensors: eccentric contraction to decelerate foot for loading response
2- Quad continues to contract to control small amount of knee flexion and prepare for loading response
3- All hip extensors (gluts AND hamstrings) eccentrically contract while hips in flexion to prepare for loading response

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2
Q

What is happening with muscles of LE during Loading Response (Foot Flat)

A

1- Theray ed says: Gastroc- soleus active from foot flat to midstance to eccentrically control forward tibial advancement
2- Bringman notes say: Tib Anterior eccentrically contracts to decelerate foot
3- Quads eccentrically control knee as it moves into flexion
4- Hip extensors (all of them) eccentrically controlling hips as hips move out of flexion

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3
Q

What is happening with muscles of LE during Midstance

A

1- Gastroc-Soleus muscles fire to control foward progression of tibia as the knee extends
2- All LE extensors active to oppose anti-gravity forces and stabilize limb
2- Quads concentrically move knee into extension
3- Hip abductors stabilize pelvis in the frontal plane

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4
Q

What is happening with muscles of LE during Terminal Stance (Heel Off)

A

1- Gatroc-soleus allow heel to rise and stabilize tibia from anterior translation
2- Muscles general not active at knee (momentum is progressing knee in gait)
3- TFL prevents hyper extension at hip

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5
Q

What is happening with muscles of LE during Pre-Swing (Toe Off)

A

1- Tib Anterior concentrically activate to start moving ankle into DF
2- Great toe extensor active for DF
3- Hamstrings concentrically flexing knee
4- Hip Flexors concentrically flexing hip

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6
Q

What is happening with muscles of LE during Initial Swing (Acceleration)

A

1- Tib Anterior and long toe extensors actively DF ankle
2- knee muscles are fairly quite
3- Hip flexors (iliopsoas) active for foward propulsion of limb

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7
Q

What is happening with muscles of LE during Midswing

A

1- Tib Anterior and long toe extensors concentrically DF

2- Knee and hip flexors active

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8
Q

What is happening with muscles of LE during Terminal Swing (Deceleration)

A

1- Tib Anterior and long toe extensors concentrically DF to prepare for heel strike
2- Quads activate for knee extension to prepare for heel strike
3- Hamstrings active to decelerate LE
4- Glut Max and Adductor Magnus activate to prepare for weight acceptance

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9
Q

When are abdominals active during gait

A

active throughout gait cycle

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10
Q

When are trunk extensors and rotators active during gait

A

during foot flat to counteract flexion torque

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11
Q

When are ipsilateral erector spinae active during gait

A

during toe off as the contralateral limb is loaded

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12
Q

How many degrees is pelvis rotating during gait

A

4 degrees forward on swing limb and 4 degrees backward on stance limb

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13
Q

What is going on with pelvic lateral tilt during gait cycle

A

1- Pelvis moves up and down on the unsupported or swing side about 5 degrees and is controlled by hip abductors
2- high point is during midstance
3- low point is during the period of double support

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14
Q

Peak Activity during Gait Cycle: Tibialis Anterior

A
  • just after heel strike

- responsible for eccentric lowering of the foot into PF

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15
Q

Peak Activity during Gait Cycle: Gastroc- Soleus group

A
  • during late stance phase

- responsible for concentric heel raising during toe off

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16
Q

Peak Activity during Gait Cycle: Quads

A
  • 2 periods of peak activity in periods of single support
  • during early stance phase
  • and just before toe off to initiate swing phase
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17
Q

Peak Activity during Gait Cycle: Hamstrings

A
  • during late swing phase

- responsible for decelerating limb

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18
Q

Gait Norms: Hip Flexion ROM

A

0-30

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19
Q

Gait Norms: Hip Extension ROM

A

0-10

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20
Q

Gait Norms: Knee flexion ROM

A

0-60

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21
Q

Gait Norms: Knee extension ROM

A

0

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22
Q

Gait Norms: Ankle DF ROM

A

0-10

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23
Q

Gait Norms: Ankle PF ROM

A

0-20

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24
Q

Gait Norms: Cadence average

A

113 steps/min

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25
Gait Norms: step width ranges
2.54 - 12.7 cm (1 - 5 inches)
26
Gait Norms: velocity (walking speed) average
82 m/mi (3 miles/hr) * affected by height, weight, gender, age, and physical impairments
27
Gait Norms: average O2 rate for walking
12mL/kg x min
28
Gait Deviations, Stance Phase: Trunk and Hip- list of possible deviations
``` 1- lateral trunk bending 2- backward trunk lean 3- forward trunk lean 4- excessive hip flexion 5- limited hip extension 6- abnormal synergistic activity 7- antalgic gait ```
29
Gait Deviations, Stance Phase: Trunk and Hip- Reason for lateral trunk bending
- result of weak glut med - will see bending at same side of weakness (Trendelenburg gait) - also seen w/ pain in hip
30
Gait Deviations, Stance Phase: Reason for Trunk and Hip- backward trunk lean
- result of weak glut max | - will see difficulty going up stairs or ramps
31
Gait Deviations, Stance Phase: Trunk and Hip- Reason for forward trunk lean
- result of weak quads (decreases flexor movement at knee) | - hip and knee flexion contractures
32
Gait Deviations, Stance Phase: Trunk and Hip- Reason for excessive hip flexion
- weak hip extensors or tight hip and/or knee flexors
33
Gait Deviations, Stance Phase: Trunk and Hip- Reason for limited hip extension
tight or spastic hip flexors
34
Gait Deviations, Stance Phase: Trunk and Hip- Reason for abnormal synergistic activity
- may be caused by stroke - may see excessive hip adduction combined with hip and knee extension with PF - scissoring or adducted gait pattern
35
Gait Deviations, Stance Phase: Trunk and Hip- Reason for antalgic gait
- stance time is abbreviated on the painful limb - results in uneven gait pattern - uninvolved limb has a shortened step length since it must WB sooner than normal
36
Gait Deviations, Stance Phase: Knee- list of possible deviations
- excessive knee flexion | - hyperextension
37
Gait Deviations, Stance Phase: Knee- Reason for excessive knee flexion
- result of weak quads or knee flexion contracture - knee may wobble or buckle if due to weak quads - may have difficulty going down stairs or ramps - forward trunk bending can compensate for weak quads
38
Gait Deviations, Stance Phase: Knee- Reason for hyper extension
- result of weak quads, PF contracture, or extensor spasticity (at knee or ankle PF)
39
Gait Deviations, Stance Phase: Ankle/Foot- list of possible deviations
1- toes first; toe contact at heel strike 2- foot slap 3- foot flat 4- excessive DF w/ uncontrolled forward motion of tibia 5- excessive PF (equinus gait) 6- supination (excessive varus of calcaneus) 7- pronation (excessive valgus of calcaneus) 8- toes claw 9- inadequate push-off
40
Gait Deviations, Stance Phase: Ankle/Foot- Reason for toes first; toe contact at heel strike
- result of weak DF muscles; spastic or tight PF | - may also be caused by a shortened leg, painful heel, or positive support reflex
41
Gait Deviations, Stance Phase: Ankle/Foot- Reason for foot slap
- result of weak DF muscles or hypotonia | - compensated for w/ steppage gait
42
Gait Deviations, Stance Phase: Ankle/Foot- Reason for foot flat
- result of weak DF muscles or limited ROM | - possible immature gait pattern (neonatal)
43
Gait Deviations, Stance Phase: Ankle/Foot- Reason for excessive DF w/ uncontrolled forward motion of tibia
- result of weak PF muscles
44
Gait Deviations, Stance Phase: Ankle/Foot- Reason for excessive PF (equinus gait)
- heel does not touch ground - result of spasticity or contracture of PF muscles - will see poor eccentric contraction and advancement of tibia
45
Gait Deviations, Stance Phase: Ankle/Foot- Reason for supination (excessive varus of calcaneus)
- may occur at initial contact and correct at foot flat with weight acceptance or remain throughout stance - possible causes: spastic invertors, weak evertors, pes varus, or genu varum
46
Gait Deviations, Stance Phase: Ankle/Foot- Reason for pronation (excessive valgus of calcaneus)
- possible causes: weak invertors, spasticity, pes valgus, genu valgum
47
Gait Deviations, Stance Phase: Ankle/Foot- Reason for toes claw
- result of spastic toe flexors | - possibly a hyperactive plantar grasp reflex
48
Gait Deviations, Stance Phase: Ankle/Foot- Reason for inadequate push-off
- result of weak PF muscles, decreased ROM, or pain in forefoot
49
Gait Deviations, Swing Phase: Trunk and Hip- list of possible deviations
``` 1- insufficient forward pelvic rotation 2- insufficient hip and knee flexion 3- circumduction 4- hip hiking 5- excessive hip and knee flexion 6- abnormal synergistic activity ```
50
Gait Deviations, Swing Phase: Trunk and Hip- Reason for insufficient forward pelvic rotation
(stiff pelvis, pelvic retraction) - result of weak ab muscles and/or weak flexor muscles - possible cause is stroke
51
Gait Deviations, Swing Phase: Trunk and Hip- Reason for insufficient hip and knee flexion
- result of weak hip and knee flexors | - inability to lift LE and move it foward
52
Gait Deviations, Swing Phase: Trunk and Hip- Reason for circumduction
- result of weak hip and knee flexors | - leg swings out to the side: abduction and ER followed by adduction and IR
53
Gait Deviations, Swing Phase: Trunk and Hip- Reason for hip hiking
- a quadratus lumborum action | - a compensatory response for weak hip and knee flexors or extensor spasticity
54
Gait Deviations, Swing Phase: Trunk and Hip- Reason for excessive hip and knee flexion
- AKA steppage gait - a compensatory response to shorten the leg - result of weak DF muscles (may be caused by diabetic neuropathy of fibular nerve
55
Gait Deviations, Swing Phase: Trunk and Hip- Reason for abnormal synergistic activity
- think stroke | - presents as excessive hip and knee flexion with abduction
56
Gait Deviations, Swing Phase: Knee- list of possible deviations
1- insufficient knee flexion | 2- excessive knee flexion
57
Gait Deviations, Swing Phase: Knee- Reason for insufficient knee flexion
- result of extensor spasticity, decreased ROM, or weak hamstrings
58
Gait Deviations, Swing Phase: Knee- Reason for excessive knee flexion
- result of flexor spasticity or flexor withdrawal reflex
59
Gait Deviations, Swing Phase: Ankle/Foot- list of possible deviations
1- foot drop (equinus) 2- varus or inverted foot 3- equinovarus
60
Gait Deviations, Swing Phase: Ankle/Foot- Reason for foot drop (equinus)
- result of weak or delayed contraction of DF muscles | - may result from spastic PF muscles
61
Gait Deviations, Swing Phase: Ankle/Foot- Reason for varus or inverted foot
- result of spastic invertors (anterior tib), weak peroneals, or abnormal synergistic pattern (stroke)
62
Gait Deviations, Swing Phase: Ankle/Foot- Reason for equinovarus
- result of spasticity of posterior tib and/or gastroc-soleus - may result from developmental abnormailty
63
Abnormal Gait Patterns: Antalgic
a protective gait pattern where the involved step length is decreased in order to avoid WB on the involved side, usually secondary to pain
64
Abnormal Gait Patterns: Ataxic
a gait pattern characterized by staggering and unsteadiness. There is usually a wide base of support and movements as exaggerated
65
Abnormal Gait Patterns: Cerebellar
a staggering gait pattern seen in cerebellar disease
66
Abnormal Gait Patterns: Circumduction
a gait pattern characterized by a circular motion to advance the leg during swing phase; this may be used to compensate for insufficient hip or knee flexion or dorsiflexion
67
Abnormal Gait Patterns: Double Step
a gait pattern in which alternate steps are of a different length or at a different rate
68
Abnormal Gait Patterns: Equine
a gait pattern characterized by high steps; usually involves excessive activity of gastroc
69
Abnormal Gait Patterns: Festinating
a gait pattern where a patient walks on toes as though pushed. It starts slowly, increases, and may continue until the patient grasps an object in order to stop
70
Abnormal Gait Patterns: Hemiplegic
a gait pattern in which patients abducts the paralyzed limb, swing it around, and bring it forward so the foot comes to the ground in front of them
71
Abnormal Gait Patterns: Parkinsonian
a gait pattern marked by increased forward flexion of the trunk and knees; gait is shuffling with quick and small steps; festinating may occur
72
Abnormal Gait Patterns: Scissor
a gait pattern in which the legs cross midline upon advancement
73
Abnormal Gait Patterns: Spastic
a gait pattern with stiff movement, toes seeming to catch and drag, legs held together, and hip and knee joints slightly flexed. Commonly seen in spastic paraplegia
74
Abnormal Gait Patterns: Steppage
a gait pattern in which the feet and toes are lifted through hip and knee flexion to excessive heights; usually secondary to DF weakness. The foot will slap at initial contact with the ground secondary to decreased control
75
Abnormal Gait Patterns: Tabetic
a high stepping ataxic gait pattern in which the feet slap the ground
76
Abnormal Gait Patterns: Trendelenburg
a gait pattern that denotes glut med weakness; excessive lateral trunk flexion and WS over the stance leg
77
Abnormal Gait Patterns: Vaulting
a gait pattern where the swing leg advances by compensating through the combo of pelvis elevation and PF of stance leg

Sharlene and MB's PT party (35 decks)

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