Walking

Question 1

what do we need to be able to effectively walk

Answer 1

production of basic locomotive rhythm
support through the lower limb
propulsion of the body forward
dynamic balance
ability to adapt to the movement to changing environmental demands and goals
strength and control play a significant role in these

Question 2

stance phase

Answer 2

lower limb supports the body over one or two feet
-mainly lower limb extensor muscles

balance - maintenance of upright posture over changing base of support by postural adjustments
Propulsion (acceleration of the body in space) generation of mechanical energy to drive forward motion of the body
Absorption : mechnical energy is harnessed for shock absorption and to decrease the body’s forward momentum

Question 3

Swing phase

Answer 3

toe clearance

foot trajectory - prepare the foot for safe landing

Question 4

percentages of swing and stance

Answer 4

swing 40, stance 60,

stance incr with slower walking

Question 5

stance phase broken up

Answer 5

heel contact - weight acceptance/loading
mid stance -
terminal stance
pre-swing - toe off

Question 6

natural cadences

Answer 6

vary from about 101-120 a minute

gender differences women take 7-11 steps more

Question 7

slow walking speeds

Answer 7

associated with risk of falling
disability
poor health outcomes

Question 8

kinematics

Answer 8

describes joint movement independent of internal or external forces

Question 9

planes

Answer 9

movement occurs in all three planes, but mainly sagittal

Question 10

learn the stance phase movements

Answer 10

heel contact - ankle dorsiflexed, knee extended
the ankle plantarflexes to bring forefoot in contact with ground
Hip extends and ankle dorsiflexes to move the COM from behind the stance leg to in front of the stance foot
the knee then flexes (quads eccentrically)
internal rotation of the hip until full weight bearing then external rotation as the foot is about to leave the ground

At mid stance the hip is at neutral and the knee is extended. Lateral horizontal pelvic shift (2.5cm) towards the stance leg occurs and is controlled by abductors (glute med)

at termination of stance the hip is extended 10-15 degrees, the knee is flexed 40 degrees and the ankle is plantarflexing ready for push off and initiation of swing

Question 11

learn the swing phase movements

Answer 11

the hip flexes to swing leg forward and the knee flexes rapidly to 63 degrees for toe clearance
toe clearance of 1cm
flexion at the knee effectively shortens the leg
extension of the knee at the end of swing serves to lengthen the leg again before heel contact so as to position the leg in a more stable configuration and minimise lowering of the trunk

Question 12

stairs

Answer 12

12-20 degrees more flexion and extension at the knee is required than walking
during ascent, concentric contraction of the lower limb extensor muscles raises the body mass vertically, in descent, the body mass is lowered by eccentric muscle activity controlling gravitational forces
Extensor muscles in stair walking have to generate incr forces
incr double support on ascent, decr on descent

Question 13

age related changes

Answer 13

older people slower gaits
shortened steps
reduced cadence 
increase time in double limb support phase 
decreased push off power

Question 14

motor dysfunction

Answer 14

walking dysfunction common in patients with neurological impairments secondary to the lesion and adaptive changes of MSK/Cardioresp systems
muscle weakness, intrinsic muscle stiffness, disordered motor control and soft tissue contractures are major contributors to walking dysfunction

weakness = insufficient motor unit activation,

Question 15

research findings following stroke

Answer 15

decr self selected and maximum speed
decr magnitude of flexion/extension joint angle range in both lower limbs
decr extension of hip at end of stance
incr DL support phase - associated with poor balance
decr vertical ground reaction force at push off - implicating weak plantarflexion
decr DF

decreased endurance - 50% 6MWT pg 103
decr adaptability to environment changes -for example catching the toe or heel while stepping over objects

Question 16

functional strength training

Answer 16

strength of hip flexors and plantarflexes is strongly associated with gait speed

aim to train plantarflexors within the range of 8-10 degrees DF to 16-19 degrees plantarflexion
task practice is required for neural adaptation

Question 17

normal walking speed

Answer 17

1.2 m/s

Question 18

community mobility guidelines

Answer 18

able to walk at 1.1-1.5m/s
able to walk long and far enough to accomplish daily tasks - approx 500m
turn head while walking
use anticipatory strategies to avoid or accommodate obstacles
react quickly enough to slips and trips and avoid a fall by side stepping
negotiate stairs, kerbs, moving footways, and carry objects

Question 19

measuring Rx effects and retention

Answer 19

motor assessment scale
6-10metre walk test 
6MWT
TUG
step test 
obstacle course test (means et al 1996)