Walking and gait Flashcards
Define gait
The mechanism by which the body is transported using co-ordinated movement of the lower limb
Describe the 2 phases of gait including the approximate amount of time spent in each phase
Stance phase: 60% of the gait cycle when the foot is in constant contact with the ground
Swing phase: 40% of the gait cycle where the foot isn’t in contact with the ground
What is the gait cycle?
The period of time from initial contact of the limb, to the next contact on the same side of the body
What 5 attributes are needed for normal gait?
- stability in stance
- foot clearance during the swing phase
- pre-positioning for the initial contact
- adequate step legnth
- Energy conservation
What part of the foot strikes the ground first in normal gait?
The heel
What is the name of the period where both feet are in contact with the ground?
Double support - happens twice in a normal gait cycle
In terms of the gait cycle, when does running start and what name is given to this period?
When there is a period when neither foot is in contact with the ground Known as ‘double float’
Define stride
The distance from initial contact with one leg to the next initial contact with the same leg
Define step
The distance from initial contact with one leg to the next initial contact with the opposite leg
Define cadence
The number of steps per minute
What is kinematics?
Kinematics describes the motions of gait i.e. joint ankle acceleration and velocities
What is kinetics?
Kinetics describe the forces and moment that cause motion
Describe the kinetics of the ankle joint during the stance phase
- During initial contact Tibialis Anterior contracts
- As the foot is flat on the ground (mid-stance) Tibialis Anterior relaxes
- During terminal stance the posterior compartment contracts(gastronemicus and soleus)
By what 4 ways is energy conserved during normal gait?
- Minimising the excursion of the body’s centre of gravity
- Controlling momentum by eccentric muscle contraction
- Transferring energy passively between body segments
- Phasic muscle contraction (using muscles intermittently)
Describe Antalgic Gait
Patients walk to reduce pain i.e. with a limp to shorten the stance phase of the painful limb
Which hand should the patient hold their walking their walking stick in with antalgic gait?
The hand opposite to the affected limb
Describe Trendelenburg Gait
Hip abductor weakness causes the pelvis to drop on the unaffected side during stance e.g. standing on the left leg and the hip drops on the right means the left leg is affected
The torso therefore swings to the affected side
Name some of the things that can cause Trendelenberg gait
- Superior gluteal nerve lesion (most common)
- muscle pain and inhibition of function
- trauma causing fracture of greater trochanter or dislocation of the hip joint
- biomechanical hip instability
Describe Hemiplegic gait?
Gait caused by paralysis to one side of the body
Patients have a flexed upper limb and cannot extend their lower limb. They lean towards their unaffected side and swing the paralysed leg around
What causes a hemiplegic gait?
- stroke (most common)
- cerebal palsy
- trauma to CNS (head or spinal cord injury)
Describe some of the features of Diplegic gait
- Spasticity that affects both lower limbs
- Patient walks with a narrow based gait, drags the feet and scrapes their toes on the ground
- The hip adductors causes legs to cross the midline known as ‘scissoring’
- Spasticity in the calves causes ankle plantar flexion so the forefoot makes initial contact with the ground
What are some of the things that could cause high steppage gait?
- sciatica
- common peroneal nerve palsy
- neuromuscular disease e.g. Charcot-Marie-Tooth disease
Describe High Steppage gait
- weakness of ankle dorsiflexion
- toes hang down
- excessive hip flexion on the affected side
- foot slaps the ground during initial contact
What is ‘eversion flick’?
If the deep peroneal nerve is damaged, but the superficial perineal nerve is intact the patient compensates for lack of dorsiflexion by everting their foot in a sudden motion
Describe the movement seen in Parkinsonian Gait
- patients find it difficult to initiate movement so trunk is flexed forward
- find it difficult to stop
- short steps called ‘shuffling gate’
- feet are forward flexed
- no arm swing
Describe the movement seen in ataxic gait
Broad based, incooordinated walk as they sway side to side arms out to the side for balance
What are the three causes of Ataxic gait?
- Cerebellar disease
- Vestibular damage (damage to organs of balance in the inner ear)
- Proprioreceptor loss
What are the causes of cerebellar dysfunction that lead to ataxic gait?
- acquired
- inherited
- acute alcohol intoxication
