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Orthotics > Typical-Atypical Gait and the Impact of Orthotics > Flashcards

Typical-Atypical Gait and the Impact of Orthotics Flashcards

1
Q

Prerequisites of normal gait

A

*Stability in stance
*Clearance in swing
*Pre-positioning of the foot in
swing
*Adequate step-length
*Conservation of energy

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2
Q

Kinematics

A

Kinematics: Study of positions, angles, velocities, accelerations of
body segments and joints during motion

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3
Q

Kinetics

A

Study of the forces, moments, and
powers acting within and on the body

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4
Q

Moments (or Torques)

A

moment (Nm) = Force x distance
Force is origin, direction, and magnitude

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5
Q

Power

A

Power (W) = moment x joint angular velocity

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6
Q

Initial Contact

A
  • Heel strike
  • GRF passes through the heel
  • Posterior to ankle –> Ankle neutral
  • Anterior to knee –> Knee extended
  • Anterior to hip –> Hip flexed ~30°
  • 1st ankle (heel) rocker –into LR
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7
Q

initial contact - muscle activation

A
  • Hip extensors (G. maximus, hamstrings)
  • Pre-tibial muscles
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8
Q

Loading Response

A
  • Shock absorption
  • GRF passes:
  • Posterior to ankle –> Ankle plantarflexes from neutral ~10°
  • Posterior to knee –> Knee flexes
  • Through the hip –> Hip less flexed; extending
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9
Q

loading response muscle activation

A
  • Pretibial muscles –> Eccentric; control ankle plantarflexion
  • Quadriceps femoris –> Eccentric; control knee flexion
  • G. medius & Adductor magnus –> Concentric; contralat pelvis stabilization
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10
Q

Midstance

A
  • Extrinsic stability of the knee
  • GRF passes:
  • Anterior to both ankle and knee –> Restrained ankle dorsiflexion and Knee extension
  • Posterior to the hip –> Hip stabilization in coronal plane
  • Critical site for dynamic stability shifts from knee to ankle
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11
Q

midstance muscle activation

A
  • Soleus & Gastrocnemius –> Eccentric; control tibial forward advancement / dorsiflexion
  • Gluteus medius –> Concentric; abductors stabilize pelvis in level
    posture
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12
Q

Midstance - lower leg progresses over foot

A
  • Extrinsic stability of knee is provided by eccentric activation of the soleus / Achilles tendon –maintains GRF anterior to the knee →knee extension
  • Plantarflexion / Knee extension
    couple (PF-KE)
  • Relieves the quadriceps; reduces the work of walking
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13
Q

terminal stance - acceleration

A
  • Active ankle plantarflexion & heel rise
  • Free forward fall of the body
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14
Q

Terminal stance GRF

A
  • Anterior to knee & posterior to hips→Knee & hip extension
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15
Q

Terminal stance muscle activation

A
  • Gastrocnemius & Soleus –> Eccentric; Stabilize tibia at the ankle then Concentric; Propulsive force for push off
  • Tensor fascia lata (ant) & Iliopsoas –> Eccentric: restrains hip hyperextension
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16
Q

Preswing

A
  • Weight transfer to contralateral limb
  • Unlock the stance limb for swing
  • Ankle plantarflexion ~20°
  • Knee flexion ~40°
  • Hip flexes to neutral
17
Q

Preswing GRF

A

GRF passes through metatarsals
* Posterior to the knee

18
Q

Pre swing Muscle activation

A

Rectus femoris –> Control excessive knee flexion; Hip flexion
* Iliopsoas
* Adductor longus –> Decelerate passive abduction caused by weight
transfer to other foot

19
Q

Swing phase, 40% of gait cycle

A
  • Swing limb as a pendulum
  • The hip, knee, and ankle must flex
    sufficiently for clearance
20
Q

Muscles provide adequate power to
propel the limb into swing & energy
transfer between body segments:

A
  • Triceps surae (pre-swing)
  • Hip flexors (pre- & initial swing)
  • Contralateral hip extensors pull
    the body forward
21
Q

Initial Swing

A
  • Knee flexion ~60°
  • Hip flexion ~20°
  • Ankle reduces 10° of plantarflexion
22
Q

What does initial swing need?

A
  • Sufficient knee flexion for foot clearance
  • Continuation of pre-swing knee flexion
  • Momentum from rapid hip flexion advances femur while tibial inertia from toe push-off leads to knee flexion
23
Q

Initial swing muscle activation

A

Iliopsoas & Rectus femoris
* Sartorius & gracilis –hip & knee flexion
* Pretibial muscles –ankle dorsiflexion

24
Q

Mid swing

A
  • Transition from knee flexion to extension
  • Hip flexion to ~30
  • Knee flexion decreases to ~30
  • Active ankle dorsiflexes to neutral
25
Q

What 2 things does midswing have

A
  • Passive hip flexion –> Continuing flexion momentum from initial swing
  • Pendular knee motion:
    • Knee extension is purely passive
    • Momentum of hip flexion balances out the pull of
      gravity on the tibia
26
Q

mid swing muscle activation

A

Pretibial muscles –ankle dorsiflexion

27
Q

Terminal swing

A

deceleration of the swing limb

28
Q

what 2 things does terminal swing do

A

Transition from swing to stance:
* Hip flexion maximal
* Knee continues to extend to neutral
* Ankle maintained in dorsiflexion

Passive hip flexion:
* Continuing flexion momentum from initial swing

29
Q

terminal swing muscle activation

A
  • Medial & lateral hamstrings –1st half of TSw –> Restrain hip flexion, Prevent excessive knee extension
  • Quadriceps femoris (Vastii) –2nd half of TSw –> Complete knee extension
  • Pretibial muscles –> Foot and toe clearance
30
Q

look at all the graphs from joe

A
31
Q

plantar flexion extension couple

A
  • Midstance
  • Tibia advances over stationary foot
  • Stance stability & conserve energy
32
Q

normally, with stable foot in line of progression:

A
  • Gastroc-soleus contracts & Achilles tndn lengthens to control forward progression of the tibia over the foot
    →directs GRF anterior to knee
    →provides extensor moment at knee
    →reducing demand on quadriceps
33
Q

look at more joe graphs

A
34
Q

look at all of the atypical patterns of gait

A
35
Q

unintended effects of orthotic usage - Limitations is segmental mobility during ambulation

A
  • Medial/Lateral heel whip
  • Compensatory power generation at the hip
36
Q

unintended effects of orthotic usage - Limitations in higher-level gross motor skills

A
  • Getting up from floor
  • Stair negotiation
37
Q

unintended effects of orthotic usage- Long-term changes in soft tissue characteristics (Creep)

A
  • Posterior ankle/lower leg
  • Results in increased motion at other, adjacent, segments
38
Q

unintended effects of orthotic usage - skin irritation/breakdown

A

typically do not prescribe an orthosis to “correct” a deformity

Orthotics (9 decks)

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