Session 5: Gait

Question 1

Define gait.

Answer 1

Mechanism by which the body is transported using coordinated movements of the major lower limb joints.

Question 2

What are the five attributes to have a normal gait?

Answer 2

Stability in stance
Foot clearance during the swing phase
Pre-positioning for initial contact
Adequate step length
Energy conservation

Question 3

Which two phases does gait consist of?

Answer 3

Stance phase which accounts for 60%

Swing phase which accounts for 40%

Question 4

Describe stance phase.

Answer 4

When the foot is in contact with the ground and bearing weight.

Question 5

Describe swing phase.

Answer 5

When the foot is not in contact with the ground and therefore not bearing weight.

Question 6

Define gait cycle.

Answer 6

The period of time from initial contact to next initial contact on the same side of the body.

This means the period of time from when the foot initially contacts the ground until the foot initially contacts the ground next time.

Question 7

What is the period of double support?

Answer 7

When the stance phases of the two feet overlap. Since stance phase is 60% of each foot there must be a time when both feet are in contact with the ground.
These are two periods within the normal gait cycle.

Question 8

When does running commence?

Answer 8

When there is a time in the gait cycle in which neither foot is in contact with the ground.

Question 9

What is it called when neither foot is in contact with the ground?

Answer 9

Double float.

Question 10

What is the definition of sprinting?

Answer 10

When the stance and swing phases reverse. So that the stance phase only constitute 40% and the swing phase accounts for 60%.

Question 11

The stance phase can be further subdivided into five stages. Name them and explain.

Answer 11

Initial contact

Loading response - Period of deceleration where the shock of the impact is absorbed by the knee and ankle joints. Rocking forwards on heel as well.

Mid-stance - foot is flat on ground, centre of gravity shifts to in front of foot to be ready for forward propulsion.

Terminal stance - ankle is plantarflexed and the heel of the supporting leg raises from the ground.

Pre-swing - metatarsophalangeal joints flex to give a push off by the toes.

Question 12

The swing phase can be further divided into:

Answer 12

Initial swing - the knee flexes to enable the foot to clear the ground.

Mid-swing - the hip flexes and the pelvis swings forwards to enable forward progression. Dorsiflexion of the ankle.

Terminal swing - Knee extends and the foot is brought close to the ground in preparation for the initial contact.

Question 13

Define stride.

Answer 13

Distance from initial contact with one leg to the next initial contact of the same leg.

Question 14

Define step.

Answer 14

The distance from initial contact with the one leg to initial contact with the other leg.

Question 15

Define cadence.

Answer 15

The number of steps per minute.

Question 16

There are two elements to gait analysis. Which?

Answer 16

Kinematics and kinetics.

Question 17

Define kinematics.

Answer 17

Describes the motions like the joint angles, displacements, velocities and accelerations that take place during gait.

Question 18

Define kinetics.

Answer 18

Describes the forces and moments that cause motion.

Question 19

What are the types of pathological gaits?

Answer 19

Antalgic gait
Trendelenburg gait
Hemiplegic gait
Diplegic gait
High-steppage gait
Parkinsonian gait
Ataxic gait

Question 20

Explain antalgic gait.

Answer 20

A limp where the patient walks in a manner to reduce the pain in affected limb. This results in a shorter stance phase of affected leg.
There is also a short swing phase of the unaffected leg because you want it to be in stance phase for as long as you can.

A walking stick is used by the opposite hand.

Question 21

Explain trendelenburg gait.

Answer 21

Due to weakness of hip abductors (gluteus medius and gluteus minimus). It can be due to superior gluteal nerve damage for example or muscle pain or trauma (fracture of greater trochanter e.g.)

This causes the pelvis to drop on the unaffected side in stance phase.

The torso also swings to affected side and termed as waddling.

It is also bilateral.

Question 22

Explain hemiplegic gait.

Answer 22

Due to paralysis of one side of the body. This is most commonly caused by a stroke or as a consequence of cerebral palsy and also trauma to the CNS.

The patients has continuous contraction of the affected side of the body. The upper limb will flex and the lower limb will extend.

Pat. will lean towards the unaffected side of the body and circumduct with the paralysed leg.

Question 23

Explain diplegic gait.

Answer 23

Common in patients with cerebral palsy. The spasticity affect both lower limbs. There is spasticity in the hip adductors which can cause the legs to cross the midline which is called scissoring.

The affected muscle groups are usually the poses, adductors, hamstring and calf.

The ankles plantarflex and the forefoot makes the first initial contact.

Question 24

Explain high-steppage gait.

Answer 24

Seen in patients with weakness of ankle dorsiflexion which results in foot drop.

Causes can be due to sciatica and damage to common peroneal nerve or deep peroneal nerve and superficial peroneal nerve. Can also be seen poorly controlled diabetes or neuromuscular disease such as Charcot-marie-tooth disease.

The toes will hang down and assume a position of plantarflexion. To compensate for this the patient has to flex the hip much more than usual in order to lift their foot off the ground and stop their toes from dragging along the ground.

Question 25

What happens if the deep peroneal nerve is damaged but the superficial peroneal remains intact?

Answer 25

The patient may compensate for the lack of dorsiflexion during the swing phase by everting their foot in a sudden motion called eversion flick.

Question 26

Explain parkinsonian gait.

Answer 26

Due to Parkinsons.
It is a gait where the movement is hard to initiate and also hard to stop the movement.
Short steps and shuffling or festinant gait which is the tendency to take accelerating steps. No arm swing as well.

Patients with Parkinson’s flex their neck and trunk forwards to move their centre of gravity in order to compensate for the difficulty in initiating movement.

Question 27

What are the three causes of ataxic gait?

Answer 27

Proprioceptive (loss of awareness of your joints)
Cerebellar disease
Vestibular disease (damage to the organs of balance in the inner ear)

Question 28

Give the major causes of cerebellar dysfunction.

Answer 28

Inherited disorders
Acquired disorders such as stroke
Due to acute alcohol intoxication

Question 29

Explain the gait of ataxia.

Answer 29

Clumsy and staggering movements, to compensate for this the patient will be broad-based.
Arms out wide in order to help with balance.
Standing still patient might be swaying back and forth or side to side which is called titubation.