Posture & Gait Flashcards
What is posture?
Position of body parts in relationship to each other at any given time
What are the elements of ideal posture?
- Minimises stresses on the body
- Requires muscular effort
What is posture affected by?
- Structural factors
- Positioning factors
What are the normal spinal curves?
- Cervical curvature (lordosis)
- Thoracic curvature (kyphosis)
- Lumbar curvature (lordosis)
- Sacral curvature (kyphosis)
What are the results of positioning changes/static postures?
- Pain or injury
- Joint stiffness, muscle tightness or weakness
- Poor ergonomic set up, environment
- Task confines/repetitive movements
- Habit or lack of awareness
What is ideal sitting posture?
- Head centred on shoulders
- Shoulders level & on top of pelvis
- Hips & knees bent at 90 degrees
- Feet flat on floor
- Lower back curve maintained
- Invisible line through ear lobe, shoulder, midline of trunk & hips down to floor
What is forward head posture?
- Upper cervical spine in extension (around neck)
- Lower cervical spine in flexion (around shoulders)
What are some of the poor shoulder postures?
- Shoulders slumped forwards, winging of scapulae
- Shoulders pulled back too far
What are some of the poor lumbar spine postures?
- Slump: Decreased lordosis, posterior pelvic tilt
- Overextended: Increased lordosis, anterior pelvic tilt
What is the ideal standing posture?
- Head & spine straight
- Shoulders & pelvis level
- Knees & ankles level
- Line through ear lobe, shoulder, midway through trunk, greater trochanter, slightly anterior to knee & ankle
What is the difference between foot pronation & supination?
Pronation: Lowering of medial edge by turning it outwards
Supination: Raising of medial edge by turning it inwards
What ankle movements are pronation and supination a combination of?
Pronation: Eversion, abduction, DF
Supination: Inversion, adduction, PF
What are the arches of the foot formed & strengthened by?
Formed by position & shape of the foot bones & strengthened by tendons & ligaments
What are the functions of the arches of the foot?
- Support body weight
- Allow flexibly for movement & balance
- Allow shock absorption & stored energy to be returned to movement (e.g. spring)
What is pes cavus and pes planus?
- Pes canus: Excessive high arch with claw foot
- Pes planus: No or minimal arch with flat feet
What can poor posture lead to?
Muscle, joint & ligament strain causing pain & injury
What can postural correction help with?
Treatment & prevention of injuries relating to poor loading of the spine
What is postural control?
Ability to control the body’s position in space for the purpose of orientation & stability
What is the outcome of postural control?
Maintenance of upright head to:
- Maximise sensory input
- Maximise weight through proprioceptors, minimal sway, minimal energy requirements, linkage of adjacent musculoskeletal segments
What is postural stability?
Ability to maintain centre of mass over base of support
What does postural control involve the integration of?
- Sensory & motor systems
- Autonomic & reflexive responses to stabilise, anticipate & react
What are the feedback and feed forward mechanisms of postural control?
- Feedback: Sensory inputs, processing & integration
- Feed forward: Motor control/effects
How does the cognitive system affect postural control?
- Attention
- Adaptation
- Anticipation
- Confidence/fear
What are the types of postural control?
- Steady state (static): Control of COM relative to BOS at rest
- Reactive: Ability to recover postural control when disturbed (e.g. push)
- Proactive: Ability to modify postural control prior to disturbance or to avoid instability (e.g. kicking)
How does the motor, sensory and cognitive system affect steady state postural control?
- Motor: Alignment, control strength, joint range, tone
- Sensory: Integration of sensory info
- Cognitive: Attention, dual tasking, functional tasks
How does the motor, sensory and cognitive system affect reactive postural control?
- Motor: Synergy, fixed BOS strategies, changing BOS strategies
- Sensory: Integration of sensory info
- Cognitive: Attention, adaptation, anticipation
What are some of the strategies for changing BOS?
- Ankle
- Hip
- Stepping
- Reaching
How does the motor, sensory and cognitive system affect proactive postural control?
- Motor: Similar to reactive, depends on direction, sped, force of planned movement
- Sensory: Used to predict trajectory, estimate forces, scale response
- Cognitive: Anticipation, feed-forward system
Define:
- Step length
- Stride length
- Step width
- Foot angle
- Step length: L heel strike to R heel strike
- Stride length: L heel strike to L heel strike
- Step width: Distance between heel centre of two foot contacts
- Foot angle: Degree of toe out
What are the two components of mobility functions?
- Gait (walk, run)
- Transfers (sit to stand, supine to sit)
What are the two phases of the gait cycle (1 stride)
- Stance phase: Heel strike - toe off (60% of cycle)
- Swing phase: Toe off - heel strike (40% of cycle)
When does double limb support occur in walking and running?
(Both feet on ground)
- Walking: First 0-10% of gait cycle, then last 50-60% of gait cycle
- Running: No double limb support
What is the normal positioning during the gait cycle?
- COM anterior to S2
- 5cm vertical displacement
- 4cm medial-lateral displacement
What forces are involved during the stance phase?
- Horizontal: Against support surfaces, allows body to move forward
- Vertical: Against gravity, supports body
What are the 4 phases of the stance phase?
- Loading response: Between initial contact & opposite toe off
- Mid stance: Weight over mid foot, opposite toe off to heel rise
- Terminal stance: Opposite foot in contact with ground
- Pre-swing/toe off: Other foot in loading response
Define:
- Cadence
- Stride time
- Step time
- Cadence: Steps/min
- Stride time: Time for full gait cycle
- Step time: Time for completion of L or R step
What is the movement of glute max throughout gait?
- Eccentric activation at terminal swing
- Concentric activation at hell contact-mid stance
What is the movement of iliopsoas throughout gait?
- Eccentric activation prior to toe off
- Concentric activation at toe off and initial to mid swing
When are the abductors most active in the gait cycle/
During single leg support stance (control dropping of pelvis to side of swing leg through eccentric contraction)
What are the postural control outcome measures?
- Functional reach
- Tinetti test
- Berg’s balance test
- Timed up & go (TUG)
- Trunk impairment scale
- Motor assessment scale
What are the gait outcome measures?
- Time up & go (TUG)
- 6 minute walk test (6MWT)
- Rivermead mobility index (RMI)
- 12 minute walk test (12MWT)
- Dynamic gait index (DGI)
- Functional gait assessment (FGA)
- Stops walking when talking test (SWWTT)
- Physical performance & mobility examination (PPME)
- Emory functional ambulation profile
