OSCE

Question 1

what does the hip do in the gait cycle

Answer 1

flexes and extends once

peak flexion- middle of swing phase and is kept flexed until initial contact

peak extension- end of stance phase

Question 2

knee during gait

Answer 2

2 flexion and extension peaks

1st extension at initial contact

1st peak flexion at early mid stance

2nd extension at late mid stance

2nd flexion at initial swing

Question 3

ankle during gait

Answer 3

2 flexion and extension peaks

1st plantar flex at loading response

1st dorsiflex at midstance tibia shift over

2nd plantarflexion before opposite initial contact

2nd dorsi during swing phase to clear ground

Question 4

foot positioning during gait

Answer 4

initial contact- supinated

loading response- pronates

mid stance- supinates

some supination retained throughout swing phase

Question 5

at initial contact what is happening at the hip, knee and ankle

Answer 5

hip- max flexion around 30deg
-hamstrings (prevent knee hyperextension) and glutes start extension of hip

knee- max extension
-quads and hammies

ankle/foot- neutral position, slightly supinated
-tibialis anterior maintaining dorsiflexion during swing and a controlled collapse of forefoot

Question 6

loading response what is happening at the hip, knee and ankle

Answer 6

hip- flexion oritenation of the joint but begins to extend through hip extensors, glute max and hamstrings

knee-flexes with eccentric contraction of quads

ankle- plantarflexion controlled eccentrically by the tibialis anterior, and pronation

tibia- internal rotation with pronation

Question 7

opposite toe off

Answer 7

hip- till in hip flexion angle but continues to extend through concentric contraction of glutes and hamstrings

knee-flexion (quads eccentric to concentric contraction)

ankle-dorsiflexion begins as tibia moves over ankle
tib ant stops and is taken over by triceps surae

Question 8

mid stance

Answer 8

hip- extends moving into an extended position and muscle contraction by glute max and hammies is ceased (taken over by inertia/gravity) but contraction of hip abductors (glute med, tensor fascia lata) to support pelvis

knee-early mid stance flexion into late mid stance extension through a switch of concentric contraction of quads

ankle- (ankle rocker) dorsiflexion with the triceps surae contracting eccentrically, supinated

tibia- external rotation

Question 9

heel rise

Answer 9

hip- extension, hip abductors work until opp initial contact

knee- extension peak contraction of triceps surae

ankle- dorsiflexion peak

Question 10

opp initial contact

Answer 10

hip- peak extension going into flexion through adductor longus

knee-flexion, rectus femoris- quads contracting eccentrically to prevent it occurring too rapidly

ankle- plantarflexion through concentric contraction of triceps surae

foot- max supination, hindfoot inversion and external tibial rotation (lock mid tarsal joint for loadbearing)

Question 11

toe off

Answer 11

hip- continues to flex through gravity and contraction of rectus femoris and adductor longus while in an extended oritenation to the body

knee-flexion due to inertia

ankle- plantarflexion peak triceps surae turn off and tib ant begins to contract to bring ankle up to neutral/dorsiflexion

Question 12

feet adjacent

Answer 12

hip- flexion due to iliospoas

knee-flexion due to hip (passive)

ankle-neutral or dorsiflexion for toe clearance through anterior tibial muscles

Question 13

tibia vertical

Answer 13

hip- flexion ceases

knee-rapid extension (passive) hamstrings controlling hyperextension

ankle-neutral, tibialis anterior holding position