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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
Q

Gait Norms: step width ranges

A

2.54 - 12.7 cm (1 - 5 inches)

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26
Q

Gait Norms: velocity (walking speed) average

A

82 m/mi (3 miles/hr)

  • affected by height, weight, gender, age, and physical impairments
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27
Q

Gait Norms: average O2 rate for walking

A

12mL/kg x min

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28
Q

Gait Deviations, Stance Phase: Trunk and Hip- list of possible deviations

A 
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
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29
Q

Gait Deviations, Stance Phase: Trunk and Hip- Reason for lateral trunk bending

A
  • result of weak glut med
  • will see bending at same side of weakness (Trendelenburg gait)
  • also seen w/ pain in hip
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30
Q

Gait Deviations, Stance Phase: Reason for Trunk and Hip- backward trunk lean

A
  • result of weak glut max

- will see difficulty going up stairs or ramps

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31
Q

Gait Deviations, Stance Phase: Trunk and Hip- Reason for forward trunk lean

A
  • result of weak quads (decreases flexor movement at knee)

- hip and knee flexion contractures

32
Q

Gait Deviations, Stance Phase: Trunk and Hip- Reason for excessive hip flexion

A
  • weak hip extensors or tight hip and/or knee flexors
33
Q

Gait Deviations, Stance Phase: Trunk and Hip- Reason for limited hip extension

A

tight or spastic hip flexors

34
Q

Gait Deviations, Stance Phase: Trunk and Hip- Reason for abnormal synergistic activity

A
  • may be caused by stroke
  • may see excessive hip adduction combined with hip and knee extension with PF
  • scissoring or adducted gait pattern
35
Q

Gait Deviations, Stance Phase: Trunk and Hip- Reason for antalgic gait

A
  • 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
Q

Gait Deviations, Stance Phase: Knee- list of possible deviations

A
  • excessive knee flexion

- hyperextension

37
Q

Gait Deviations, Stance Phase: Knee- Reason for excessive knee flexion

A
  • 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
Q

Gait Deviations, Stance Phase: Knee- Reason for hyper extension

A
  • result of weak quads, PF contracture, or extensor spasticity (at knee or ankle PF)
39
Q

Gait Deviations, Stance Phase: Ankle/Foot- list of possible deviations

A

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
Q

Gait Deviations, Stance Phase: Ankle/Foot- Reason for toes first; toe contact at heel strike

A
  • result of weak DF muscles; spastic or tight PF

- may also be caused by a shortened leg, painful heel, or positive support reflex

41
Q

Gait Deviations, Stance Phase: Ankle/Foot- Reason for foot slap

A
  • result of weak DF muscles or hypotonia

- compensated for w/ steppage gait

42
Q

Gait Deviations, Stance Phase: Ankle/Foot- Reason for foot flat

A
  • result of weak DF muscles or limited ROM

- possible immature gait pattern (neonatal)

43
Q

Gait Deviations, Stance Phase: Ankle/Foot- Reason for excessive DF w/ uncontrolled forward motion of tibia

A
  • result of weak PF muscles
44
Q

Gait Deviations, Stance Phase: Ankle/Foot- Reason for excessive PF (equinus gait)

A
  • heel does not touch ground
  • result of spasticity or contracture of PF muscles
  • will see poor eccentric contraction and advancement of tibia
45
Q

Gait Deviations, Stance Phase: Ankle/Foot- Reason for supination (excessive varus of calcaneus)

A
  • 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
Q

Gait Deviations, Stance Phase: Ankle/Foot- Reason for pronation (excessive valgus of calcaneus)

A
  • possible causes: weak invertors, spasticity, pes valgus, genu valgum
47
Q

Gait Deviations, Stance Phase: Ankle/Foot- Reason for toes claw

A
  • result of spastic toe flexors

- possibly a hyperactive plantar grasp reflex

48
Q

Gait Deviations, Stance Phase: Ankle/Foot- Reason for inadequate push-off

A
  • result of weak PF muscles, decreased ROM, or pain in forefoot
49
Q

Gait Deviations, Swing Phase: Trunk and Hip- list of possible deviations

A 
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
Q

Gait Deviations, Swing Phase: Trunk and Hip- Reason for insufficient forward pelvic rotation

A

(stiff pelvis, pelvic retraction)

  • result of weak ab muscles and/or weak flexor muscles
  • possible cause is stroke
51
Q

Gait Deviations, Swing Phase: Trunk and Hip- Reason for insufficient hip and knee flexion

A
  • result of weak hip and knee flexors

- inability to lift LE and move it foward

52
Q

Gait Deviations, Swing Phase: Trunk and Hip- Reason for circumduction

A
  • result of weak hip and knee flexors

- leg swings out to the side: abduction and ER followed by adduction and IR

53
Q

Gait Deviations, Swing Phase: Trunk and Hip- Reason for hip hiking

A
  • a quadratus lumborum action

- a compensatory response for weak hip and knee flexors or extensor spasticity

54
Q

Gait Deviations, Swing Phase: Trunk and Hip- Reason for excessive hip and knee flexion

A
  • 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
Q

Gait Deviations, Swing Phase: Trunk and Hip- Reason for abnormal synergistic activity

A
  • think stroke

- presents as excessive hip and knee flexion with abduction

56
Q

Gait Deviations, Swing Phase: Knee- list of possible deviations

A

1- insufficient knee flexion

2- excessive knee flexion

57
Q

Gait Deviations, Swing Phase: Knee- Reason for insufficient knee flexion

A
  • result of extensor spasticity, decreased ROM, or weak hamstrings
58
Q

Gait Deviations, Swing Phase: Knee- Reason for excessive knee flexion

A
  • result of flexor spasticity or flexor withdrawal reflex
59
Q

Gait Deviations, Swing Phase: Ankle/Foot- list of possible deviations

A

1- foot drop (equinus)
2- varus or inverted foot
3- equinovarus

60
Q

Gait Deviations, Swing Phase: Ankle/Foot- Reason for foot drop (equinus)

A
  • result of weak or delayed contraction of DF muscles

- may result from spastic PF muscles

61
Q

Gait Deviations, Swing Phase: Ankle/Foot- Reason for varus or inverted foot

A
  • result of spastic invertors (anterior tib), weak peroneals, or abnormal synergistic pattern (stroke)
62
Q

Gait Deviations, Swing Phase: Ankle/Foot- Reason for equinovarus

A
  • result of spasticity of posterior tib and/or gastroc-soleus
  • may result from developmental abnormailty
63
Q

Abnormal Gait Patterns: Antalgic

A

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
Q

Abnormal Gait Patterns: Ataxic

A

a gait pattern characterized by staggering and unsteadiness. There is usually a wide base of support and movements as exaggerated

65
Q

Abnormal Gait Patterns: Cerebellar

A

a staggering gait pattern seen in cerebellar disease

66
Q

Abnormal Gait Patterns: Circumduction

A

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
Q

Abnormal Gait Patterns: Double Step

A

a gait pattern in which alternate steps are of a different length or at a different rate

68
Q

Abnormal Gait Patterns: Equine

A

a gait pattern characterized by high steps; usually involves excessive activity of gastroc

69
Q

Abnormal Gait Patterns: Festinating

A

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
Q

Abnormal Gait Patterns: Hemiplegic

A

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
Q

Abnormal Gait Patterns: Parkinsonian

A

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
Q

Abnormal Gait Patterns: Scissor

A

a gait pattern in which the legs cross midline upon advancement

73
Q

Abnormal Gait Patterns: Spastic

A

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
Q

Abnormal Gait Patterns: Steppage

A

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
Q

Abnormal Gait Patterns: Tabetic

A

a high stepping ataxic gait pattern in which the feet slap the ground

76
Q

Abnormal Gait Patterns: Trendelenburg

A

a gait pattern that denotes glut med weakness; excessive lateral trunk flexion and WS over the stance leg

77
Q

Abnormal Gait Patterns: Vaulting

A

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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