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(3) Neurological Evaluation & Intervention > S1_L3: STS and Walking > Flashcards

S1_L3: STS and Walking Flashcards

1
Q

TRUE OR FALSE: Increasing walking speed, increases time spent in double support

A

False

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2
Q

TRUE OR FALSE: Cadence is the number of steps per unit time

A

True

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3
Q

TRUE OR FALSE: Stride length is the distance from one foot strike to the foot strike of the other foot.

A

False

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4
Q

TRUE OR FALSE: In level walking, the path of the COM describes a sinusoidal cycle

A

True

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5
Q

TRUE OR FALSE: Stance phase ends at heel strike

A

False

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6
Q

TRUE OR FALSE: During push off, the ankle dorsiflexors are actively contracting concentrically.

A

False

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7
Q

TRUE OR FALSE: Extension of the hip is essential in setting up the propulsion of push-off

A

True

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8
Q

TRUE OR FALSE: Swing phase begins at toe off with ankle plantarflexion, knee flexion, and hip extension

A

True

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9
Q

TRUE OR FALSE: The knee is in slight flexion upon heel strike

A

True

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10
Q

TRUE OR FALSE: In pre-swing, there is 20 degrees of ankle dorsiflexion

A

False

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11
Q

TRUE OR FALSE: At midstance, the pelvis shifts laterally 4-5cm toward the stance leg

A

True

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12
Q

TRUE OR FALSE: Movement of the upper body over the stance hip is associated with some external rotation.

A

False

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13
Q

CASE: A pt c chronic (R) hemiplegia came back for re-evaluation and continuation of physical therapy management secondary to persistent gait deviation. Pt states that he still has still difficulty walking. Upon examination you noted forefoot upon initial contact and inadequate hip extension at the end of stance.

The following are the most probable causes of the gait problem of the patient, EXCEPT:

A. tightness of soleus
B. early activation of gastrocnemius
C. weakness of rectus femoris
D. stiffness of calf

A

C. weakness of rectus femoris

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14
Q

CASE: A pt c chronic (R) hemiplegia came back for re-evaluation and continuation of physical therapy management secondary to persistent gait deviation. Pt states that he still has still difficulty walking. Upon examination you noted forefoot upon initial contact and inadequate hip extension at the end of stance.

The following are the most appropriate therapeutic exercise intervention for the patient. (Choose how many answers are applicable)

A. heel raises on the edge of a short platform x30 reps
B. ball kicking outside parallel bars
C. supine hip extension with the foot on a chair
D. heel slides in sitting

A

C & D only

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15
Q

_____ is the ability to move the body mass forward from over a large base of support to a small base of support and to extend the lower limb joints to raise the body mass over the feet

A

Sit-to-stand

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16
Q

BOS in sitting starts from the (1)_____ to tip of (2)_____

A
  1. tip of toe
  2. ischial tuberosity
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17
Q

Determine in which phase are the following movements seen.

  1. Vertical movement of body mass
  2. CKC dorsiflexion of ankles
  3. HAT goes into extension
  4. HAT goes into flexion
  5. Feet move backward posterior to the knee joint

A. Pre-extension Phase
B. Extension Phase

A
  1. B
  2. A
  3. B
  4. A
  5. A
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18
Q

Enumerate the 5 critical components of STS.

A
  1. Initial foot placement
  2. Flexion at the hips with trunk extended
  3. Thighs off
  4. Dorsiflexion of ankles
  5. Extension of hips and knees
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19
Q

The STS phase is separated at the period of the ______.

A

thigh off

NOTE: However, there is actually no clear cut partition between the two phases, instead they form one continuous translatory movement of the body mass from horizontal to vertical movement without a pause.

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20
Q

TRUE OR FALSE: The longer duration of the extension phase of sit-to-stand, the less muscle force is necessary to be generated.

A

False

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21
Q

Determine in which phase are the following movement seen.

  1. Movement of thighs forward as we build the momentum of propelling the body mass from sitting to standing
  2. Flexion at the hips with trunk extended
  3. Extension of hips and knees
  4. Dorsiflexion of ankles
  5. Initial foot placement

A. pre-extension phase
B. extension phase
C. transition phase

A
  1. A & C
  2. A
  3. B
  4. B & C
  5. A
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22
Q

Approximately how many degrees of trunk flexion at the hip is preferred in STS?

A

60 degrees

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23
Q

How many degrees must DF be in STS relative to the anatomical position ?

A

0-10/15 degrees

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24
Q

Extension of hip and knees happens in what kind of kinematic chain?

A

Closed

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25
Q

Fill in the blanks.

Mechanical requirements of STS are the following:

  1. Generation of ____ & _____ momentum
  2. Generation and sustaining of _____ limb joint forces
  3. Postural stability at _______
A
  1. horizontal and vertical
  2. lower
  3. thighs-off
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26
Q

Why is the good leg preferred to take the first step when a pt uses a cane?

A

This is to pre-stretch the iliopsoas, activating its spring component, and contract concentrically

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27
Q

TRUE OR FALSE: Quad cane does not provide a functional capability to stroke pts

A

True

Reliance on these is not optimal. The end goal must be the removal of the quad-cane

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28
Q

Where must a PT guard its patient during STS exercises?

A

posterolateral to the affected side

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29
Q

TRUE OR FALSE: Standing up from the chair and sitting down are functional activities commonly performed on a daily basis. The coupled motion actions are essential for independent living and is a prerequisite for upright mobility.

A

True

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30
Q

TRUE OR FALSE: In standing, BOS is how big your foot is

A

True

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31
Q

The most significant adaptation seen in stroke patients is symmetrical weight bearing during both standing up and sitting down. Lack of independence in standing up and sitting down is a common source of falls.

A. Both statements are correct
B. Both statements are incorrect
C. Only the 1st statement is correct
D. Only the 2nd statement is correct

A

D. Only the 2nd statement is correct

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32
Q

STS phases: Weight shift, transition, lift

A. Schenkmann
B. Millington
C. Rodowski
D. Carr, Shepherd, Gentile

A

B. Millington

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33
Q

STS phases: forward hip thrust phase, extension phase

A. Schenkmann
B. Millington
C. Rodowski
D. Carr, Shepherd, Gentile

A

C. Rodowski

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34
Q

STS phases: Pre-extension and extension phase

A. Schenkmann
B. Millington
C. Rodowski
D. Carr, Shepherd, Gentile

A

D. Carr, Shepherd, Gentile

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35
Q

STS phases: Flexion momentum phase, Momentum transfer phase, Extension phase, Stabilization phase

A. Schenkmann
B. Millington
C. Rodowski
D. Carr, Shepherd, Gentile

A

A. Schenkmann

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36
Q

They are known as the Kings of Motor Learning (Motor Relearning Program)

A

Carr and Shepherd

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37
Q

Determine in which phase are the following movement seen.

  1. Rotation of upper body (head, arms, trunk) forward
  2. Forward movement of thighs
  3. Shank (tibia and fibula) moves forward over the ankle

A. pre-extension phase
B. extension phase
C. both

A
  1. A
  2. C
  3. B
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38
Q
  1. Happens in pre-extension phase
  2. Happens in extension phase
  3. Generated to move body mass forward over the feet
  4. Posterior movement of the trunk
  5. Anterior movement of the thighs

A. Horizontal Momentum
B. Vertical Momentum

A
  1. A
  2. B
  3. A
  4. B
  5. B
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39
Q

Angular motions of the hip, knee, and ankle are critical in the development of _______ of the whole body during the later portion of STS

A

horizontal motion

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40
Q

Angular motions of the knee and hip is important in the development of _______ of the whole body during STS

A

upward or vertical velocity

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41
Q

In sitting, GRF is neutral. In sit-off, GRF decreases

A. Both statements are correct
B. Both statements are incorrect
C. Only the 1st statement is correct
D. Only the 2nd statement is correct

A

C. Only the 1st statement is correct

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42
Q

_______ is known as the force applied towards the ground

A

Ground Reaction Force

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43
Q

GRF varies when a person has a backpack or carries other weights. Nonetheless, the pattern remains the same.

A. Both statements are correct
B. Both statements are incorrect
C. Only the 1st statement is correct
D. Only the 2nd statement is correct

A

A. Both statements are correct

44
Q

GRF enable the (1)______ of the body mass in the desired direction horizontally and vertically in standing up and the (2)_____ of the body mass during (3)______

A
  1. propulsion
  2. control
  3. descent
45
Q

Initial generation of ______ move the body mass forward over the new base of support (trunk)

A

HORIZONTAL (LINEAR) MOMENTUM

46
Q

_______ propels the body mass upward (vertically) to standing position

A

VERTICAL MOMENTUM

47
Q

What should be avoided during STS training of stroke pts?

A. The use of hands
B. The use of feet
C. The use of head
D. The use of shoulders
E. None

A

A. The use of hands

NOTE: It is only applicable for people who uses axillary crutches

48
Q

Why should individuals with LE muscle weakness avoid standing up with feet forward during the initial phases of rehabilitation?

A. Leads to an increase in movement duration and displacement and velocity of upper body flexion
B. Results in increased distance the body mass must be moved forward
C. All of the above
D. None of the above

A

C. All of the above

49
Q

Eccentric motion of trunk extensors

A. Horizontal Momentum
B. Vertical Momentum

A

A. Horizontal Momentum

50
Q

Posterior movement of the lower legs

A. Horizontal Momentum
B. Vertical Momentum

A

B. Vertical Momentum

Note: In the diagrams of vertical momentum, legs move posteriorly

51
Q

concentric contraction of quadriceps

A. Horizontal Momentum
B. Vertical Momentum

A

B. Vertical Momentum

52
Q

TRUE OR FALSE: Increase stress on the foot increases GRF.

53
Q

STS requires asymmetric muscle activity to generate forces against both the seat and ground. Flexor muscle strength is a major contributor to successful performance.

A. Both statements are correct
B. Both statements are incorrect
C. Only the 1st statement is correct
D. Only the 2nd statement is correct

A

B. Both statements are incorrect

54
Q

What muscle moves the feet back into DF?

A

Tibialis Anterior

55
Q

In what manner does the Tibialis Anterior and Hamstrings contract for heel slides over a support surface?

A

concentrically

56
Q

This muscle stabilize the pelvis and produce extension component in the hips

A

Gluteus Maximus

57
Q

TRUE OR FALSE: If the soleus is tight, the pt will have a hard time in DF.

58
Q

Erector Spinae contracts (1)_____ in extension phase
and (2)_____ when sitting down to keep the trunk upright

A
  1. concentrically
  2. isometrically
59
Q

TRUE OR FALSE: the position of the feet affects the distance the BM has to be moved forward

60
Q

Determine the optimal position when standing up.

A. Feet Forward
B. Feet Backward
C. Feet Preferred
D. Feet Neutral

A

B. Feet Backward

NOTE: Around 10 cm or 4 inches back is preferred

61
Q

Determine the optimal position when standing up.

A. Trunk neutral
B. Trunk at 10 degrees extension at the hip
C. Trunk at 30 degrees flexion at the hip
D. Trunk at 60 degrees flexion at the hip

A

D. Trunk at 60 degrees flexion at the hip

62
Q

Determine the wanted speed of movement in STANDING TRAINING.

A. slow speed of movement
B. fast speed of movement
C. preferred speed of movement

A

B. fast speed of movement

NOTE: In sitting down, it should be slow. However, the optimal speed is the patient’s own preferred speed

63
Q

Determine the IDEAL chair height in STS.

A. Knee + 1/3 thigh
B. Knee + 2/3 thigh
C. Knee level
D. Knee with arm rest

A

C. Knee level

64
Q

Determine the OPTIMAL chair in STS.

A. Knee + 1/3 thigh
B. Knee + 2/3 thigh
C. Knee level
D. Knee with arm rest

A

D. Knee with arm rest

This is to promote 90-90 hip knee + 90 deg elbow flexion

65
Q

About how many centimeters should the feet be positioned backward to biomechanically obtain the effective foot position in STS?

66
Q

About how many degrees should the feet be positioned in DF to biomechanically obtain the effective foot position in STS?

A

AAOS:10-20 DF
Carr & Shepherd: 70-75 degrees DF (relative to vertical position)

67
Q

What kind of contraction happens d/t slowness of movement?

68
Q

TRUE OR FALSE: It is easier to sit in a low chair.

69
Q

If your muscle is in resting length position, it will give the optimal strength and cross-bridges.

This concept is derived from what?

A

Length-tension relationship/ curve

70
Q

TRUE OR FALSE: STS should be done with the arms augmented

A

False

It is optimal when they are flexed forward

71
Q

Difficulty generating and timing sufficient force in the lower limb extensor muscles to propel the body mass vertically may be attributed to the following, EXCEPT:

A. Lack of extension of the knee
B. Lack in extension of the trunk
C. Weak quadriceps
D. Weak tibialis anterior
E. Problematic gluteus medius

A

D. Weak tibialis anterior

72
Q

Failure to place one or both feet backward may be attributed to the following, EXCEPT:

A. Tightness of the soleus
B. Weakness of hamstring
C. Weakness of tibialis anterior
D. All of the above
E. None of the above

A

E. None of the above

73
Q

Failure to move the body mass sufficiently far forward at thigh-off may be attributed to the following, EXCEPT:

A. vestibular or balance problem
B. occluded vision
C. weak abdominals
D. fear of movement of the trunk forward
E. None

A

B. occluded vision

74
Q

Uncontrolled descent during SIT may be attributed to what?

A. Quadriceps are not contracting eccentrically
B. Hamstrings are not contracting eccentrically
C. Gluteus Medius are not contracting eccentrically
D. Gluteus Maximus are not contracting eccentrically
E. None

A

A. Quadriceps are not contracting eccentrically

75
Q

TRUE OR FALSE: Sitting down is the reverse of standing up

76
Q

In sitting down, the Quadriceps should control the movement. How must it contract?

A

eccentrically

77
Q

TRUE OR FALSE: Sitting down requires greater muscle strength and control at the hip

A

False

It requires greater muscle strength and control at the knee

78
Q

TRUE OR FALSE: In STS tx, the PT must discourage use of hands. There should also be no pauses between pre-extension and extension phase.

A. Both statements are correct
B. Both statements are incorrect
C. Only the 1st statement is correct
D. Only the 2nd statement is correct

A

A. Both statements are correct

79
Q

TRUE OR FALSE: Practice of weight shifting may be done in sitting.

80
Q

A tight soleus is stretch in a (1)_____ position, while the Gastrocnemius is stretched in a (2)___ position, using a/an (3)______ to further increase put the DF in a positional stretch.

A
  1. sitting
  2. standing
  3. inclined wedge
81
Q

Match the following compensatory strategies in STS.

  1. Trade-off between stability and force requirements
  2. Flexion the trunk prior to STS
  3. For pts with hemiplegia who are very weak
  4. Requires greater force generation from lower limb muscles
  5. For patients with cerebellar pathology who have balance problems

A. Momentum-Transfer Strategy
B. Zero-Momentum Strategy

82
Q

To design a treatment for STS, what must a PT start with?

A

looking for impairments that causes the lack of proper movement or proper fulfillment of the critical components of STS and address them

83
Q

_______ is a complex, whole body skill that requires the cooperation of both lower limbs and coordination of a large number of muscles and joints to function together

84
Q

__________ is the time interval or sequence of motions occurring between two consecutive initial contacts of the same foot

A

(human) gait cycle

85
Q
  1. Initial Swing
  2. 60% of gait cycle
  3. Terminal Swing
  4. 40% of gait cycle
  5. Occurs when the foot is not bearing weight and is moving forward

A. Stance Phase
B. Swing Phase

86
Q
  1. Occurs when the foot is on the ground and bearing weight
  2. Support, balance, propulsion, and absorption
  3. Toe clearance and foot trajectory
  4. Pre-swing
  5. Loading Response

A. Stance Phase
B. Swing Phase

87
Q

TRUE OR FALSE: If the ankle isn’t in relative DF, the gastrocnemius muscle isn’t able to stretch and cannot contract optimally

88
Q

The following is true about the critical components in STANCE, EXCEPT:

A. 10-15 hip extension
B. DF at heel contact
C. PF to foot flat
D. Medial horizontal pelvic shift
E. None

A

D. Medial horizontal pelvic shift

89
Q

The following is true about the critical components in STANCE, EXCEPT:

A. 15º flexion at heel contact to absorb body weight and momentum
B. 35-40º knee flexion at pre-swing
C. Knee extension by midstance
D. All of the above
E. None of the above

A

E. None of the above

90
Q

The following is true about the critical components in STANCE, EXCEPT:

A. Tibialis anterior contract eccentrically in foot flat
B. Dorsiflexors contract isometrically at heel contact
C. Gastrocnemius contract eccentrically at push-off
D. All of the above
E. None of the above

A

C. Gastrocnemius contract eccentrically at push-off

It contracts concentrically

91
Q

The knee goes in extension by midstance. In here, in what manners does the quadriceps muscle contract?

A

concentrically

92
Q

If swing phase is the problem a in gait assessment, the following are absent, EXCEPT:

A. knee extension
B. concentric contraction of quadriceps
C. concentric contraction of iliopsoas
D. concentric contraction of the tibialis anterior
E. None

A

B. concentric contraction of quadriceps

93
Q

TRUE OR FALSE: Training for swing phase uses CKC movements

94
Q

The following is true about the critical components in SWING, EXCEPT:

A. Hip flexion (pull-off) to swing lower limb forward
B. Knee flexion to shorten lower limb
C. Lateral pelvic list upward
D. Rotation of pelvis about the vertical axis
E. None

A

C. Lateral pelvic list upward

95
Q

One of the most common effects of stroke, especially when reaching the stage of spasticity, is the _______ gait

A

circumduction

96
Q

(1)_____ and disorders of (2)_____ are the primary impairments causing gait dysfunction

A
  1. Muscle weakness
  2. motor control
97
Q

Choose the typical kinematic deviation in INITIAL STANCE

A. Limited DF
B. Lack of knee flexion
C. Both
D. Neither

98
Q

Choose the typical kinematic deviation in MIDSTANCE

A. Lack of knee flexion
B. Excessive lateral pelvic shift
C. Both
D. Neither

A

B. Excessive lateral pelvic shift

99
Q

Choose the typical kinematic deviation in MIDSTANCE

A. Limited hip flexion
B. Limited ankle PF
C. Both
D. Neither

A

D. Neither

100
Q

Choose the typical kinematic deviation in LATE STANCE/ PRE-SWING

A. Lack of knee flexion
B. Lack of ankle PF
C. Both
D. Neither

101
Q

Choose the typical kinematic deviation in EARLY/ MID SWING

A. Limited hip flexion at toe-off and midswing
B. Limited knee flexion
C. Both
D. Neither

102
Q

Choose the typical kinematic deviation in LATE SWING

A. Limited ankle DF
B. Limited knee flexion
C. Both
D. Neither

A

A. Limited ankle DF

103
Q

The following are spatiotemporal adaptations in stroke pts, EXCEPT:

A. Decreased walking speed
B. Increased stride width
C. Increased double support phase
D. Dependence on support through the hands
E. Long step and stride lengths

A

E. Long step and stride lengths

104
Q

TRUE OR FALSE: Soft tissue stretching must be done prior to gait training

105
Q

Walking requires greater lower limb strength and range of motion than standing up and stair climbing

A

False

Standing up >

106
Q

TRUE OR FALSE: An adaptation seen in stroke patients is asymmetrical weight bearing during standing up only

A

False

This is seen in sitting as well

(3) Neurological Evaluation & Intervention (12 decks)

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