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P & O > Week 1 Gait > Flashcards

Week 1 Gait Flashcards

1
Q

Orthosis

A

an external appliance worn to restrict or assist motion or to transfer load from one area to another

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2
Q

Synonym for orthosis

A

brace

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3
Q

Plural for orthosis

A

orthoses

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4
Q

Prothesis

A

a replacement of all or part of the leg or arm

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5
Q

Plural of prothesis

A

protheses

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6
Q

Certified orthotist/prothetis

A

bachelor degree in O&P
or
post grad O&P
and
clinical residency

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7
Q

CPO responsibilities

A

Patient assessment, formulation of treatment plan, patient follow- up
Select appropriate device and materials
Design, fabricate, and fit orthoses
Design, fabricate and fit prostheses
Demonstrate how to use device to patient

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8
Q

O&P Assistant

A

Practice under guidance of CPO, assist with O&P procedures and tasks related to patient mgmt.
Fabricates, repairs, and maintenance of devices
American Board for Certification in O&P:
High school degree (or higher) AND 3 semester hours in human anatomy, general/fundament physics, and medical terminology AND 1-1.5 yrs of clinical experience under CPO

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9
Q

O&P Technicians

A

Fabricates, repairs, and maintains orthoses and/or prostheses. Must be proficient in current fabricating techniques, familiar with material properties and skilled in use of necessary equipment
American Board for Certification in O&P:
Completion of accredited program OR high school degree (or higher) and 2 yrs experience under CPO or assistant

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10
Q

PTs Role in O&P

A

Assessment for identified purposes
Preparation for use
Evaluation of fit
Education in fit and training in use (donning/doffing)
Gait Training, Transfer Training, High-Level Training
Assessment and quantification of functional benefits and uses

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11
Q

Level I code

A

current procedural terminology

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12
Q

Level II code

A

Codes that identify services, products and supplies not included in CPT codes, such as prosthetic and orthotics. “L- Codes”

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13
Q

heel strike

A

initial contact

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14
Q

foot flat

A

loading response

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15
Q

midstance

A

midstance

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16
Q

heel off

A

terminal stance

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17
Q

toe off

A

pre-swing

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18
Q

Acceleration

A

initial swing

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19
Q

midswing

A

midswing

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20
Q

deceleration

A

terminal stance

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21
Q

percentage of gait cycle

A

100

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22
Q

stance phase percentage

A

60

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23
Q

swing phase percentage

A

40

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24
Q

initial contact percentage

A

0

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25
Q

loading response percentage

A

0-10

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26
Q

mid stance percentage

A

10-30

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27
Q

terminal stance percentage

A

30-50

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28
Q

pre swing percentage

A

50-60

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29
Q

initial swing percentage

A

60-73

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30
Q

mid swing percentage

A

73-87

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31
Q

terminal swing percentage

A

87-100

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32
Q

What are the phases of stance phase

A

initial contact
loading response
mid stance
terminal stance
pre swing

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33
Q

What are the phase of swing phase

A

initial swing
mid stance
terminal swing

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34
Q

velocity

A

rate of linear forward motion of the body (m/sec)

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35
Q

Cadence

A

number of steps taken per unit of time (steps/min)

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36
Q

Stride length

A

heel strike to ipsilateral heel strike

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37
Q

step length

A

heel strike to contralateral heel strike

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38
Q

Step width

A

width of base of support

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39
Q

sagittal plane

A

flx/ext

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40
Q

frontal plane

A

abd/add

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41
Q

Transverse plane

A

rotation

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42
Q

What is the sixth vital sign

A

walking speed

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43
Q

1 stride =

A

1 gait cycle

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44
Q

Primary forces that control walking

A

internal muscle forces
gravity (body weight)
air resistance
GFRs

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45
Q

GRFs in gait

A

forces applied to the body by the ground, opposing forces applied to the ground during a step

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46
Q

External forces

A

produce external torque/movement
GRF
can measure with force plates

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47
Q

Internal forces

A

produces internal torque/movement
response to external torque by GRF
Can control or generate movement
Possible contributions from ligaments, joint capsules, muscles, or bony structures

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48
Q

movement = torque

A

potential for a force, acting a distance from the axis of rotation, to produce rotation of a segment

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49
Q

Torque =

A

force x movement arm

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50
Q

Movement arm

A

perpendicular distance btw axis of rotation and line of action of the force

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51
Q

Internal torque =

A

IF x Ima

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52
Q

External Torque =

A

EF x Ema

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53
Q

static equilibrium

A

INT = EXT

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54
Q

Functional task of stance

A

weight acceptance
single limb support

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55
Q

Functional task of Swing

A

foot clearance
single limb advancement

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56
Q

Weight acceptance

A

initial contact
loading response

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57
Q

Initial contact objectives

A

start of 1st rocker
impact deceleration

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58
Q

loading response objects

A

shock absorption
weight-bearing stability
preservation of progression

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59
Q

IC - ankle

A

held at neutral by pre-tibial muscles

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60
Q

IC - knee

A

full ext
provide stability

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61
Q

IC - hip

A

peak flexion (20 deg)
positioned for optimal fwd progression and stability

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62
Q

IC critical event

A

heel contact

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63
Q

Muscle activity for hip stability in IC

A

hamstrings and gluteals

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64
Q

Muscle activity for knee stability in IC

A

qaudricep

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65
Q

What counterbalances PF movement in IC

A

Pre-tibialis

66
Q

Shock is absorbed while FWD momentum is preserved

A

Loading respones

67
Q

LR - ankle

A

pre-tibial muscles eccentrically control PF
subtalar eversion
1st rocker

68
Q

LR - knee

A

20 deg of flx for shock absorption
quadriceps to control knee flx movement

69
Q

LR - hip

A

maintained in flex (20 deg)
hip ext active to stability

70
Q

LR critical events

A

pre-tibial muscles eccentrical control PF
quads active to control knee flexion movement
hip extensors active to stability

71
Q

LR muscles for hip stability

A

hamstrings and gluteals

72
Q

LR muscles to counterbalance flexion movement

A

quadriceps

73
Q

LR muscles at ankle

A

pre-tibialis to counterbalance PF moment. Calf for stance stability

74
Q

Single limb support

A

midstance
terminal stance

75
Q

Midstance objectives

A

progression over stationary foot
limb and trunk stability

76
Q

terminal stance objective

A

progression of body beyond the supporting foot
limb and trunk stability

77
Q

Body progresses over foot in controlled manner. Contralateral limb provides momentum

A

Midstance

78
Q

Mst - ankle

A

DF controlled eccentrically by gastrocnemius and soleus
ankle 2nd rocker

79
Q

Mst - knee

A

extension

80
Q

Mst - hip

A

neutral

81
Q

Mst critical event

A

DF controlled eccentrically by gastrocnemius and soleus

82
Q

Mst muscles for stance stability

A

quadriceps

83
Q

Mst calf muscle

A

for stance stability and to counterbalance DF movement

84
Q

Tst - ankle

A

Noted by heel rise
forefoot 3rd rocker
decline in gastro/soleus mm activity

85
Q

Tst - knee

A

full ext to maximum step length

86
Q

Tst - hip

A

20 deg of apparent hyperextension for maximum step length

87
Q

Tst critical event

A

Trailing limb

88
Q

Tst calf

A

counterbalance DF movement

89
Q

1st rocker

A

arc of ankle PF right after IC

90
Q

2nd Rocker

A

Tibial progression FWD during midstance

91
Q

3rd rocker

A

forefoot DF as heel rises

92
Q

4th rocker

A

tibia continues to progress fwd as great toe extends

93
Q

Swing limb advancement

A

preswing
initial swing
midswing
terminal stance

94
Q

Pre swing objective

A

position of limb for swing
accelerate progression

95
Q

Psw critical event

A

passive knee flexion 40 deg

96
Q

Psw hip flexors

A

counterbalance extension movement and initate swing

97
Q

Psw calf

A

counterbalance DF movement

98
Q

Psw pre-tibialis

A

foot clearance

99
Q

initial swing objectives

A

foot clearance
advancement of the limb from the trailing limb position

100
Q

Isw critical events

A

Peak knee flexion for toe clearance \15 deg of hip flx

101
Q

Msw critical event

A

ankle neutral to slight DF

102
Q

Tsw Critical event

A

knee extension to neutral

103
Q

Midswing objectives

A

limb advancement
foot clearance

104
Q

terminal swing objectives

A

complete limb advancement

105
Q

Forefoot remains on ground. Knee rapidly while weight is shifted to other limb.

A

Pre-swing

106
Q

Psw - ankle

A

2nd arc of PF (15 deg)
toe rocker
no gastroc/soleus mm activity

107
Q

Psw - knee

A

passive knee flx (40 deg)
Prepares limb for toe clearance

108
Q

Psw - hip

A

10 deg of apparent hyperextension

109
Q
A
110
Q

Isw - ankle

A

nearly neutral for foot clearance

111
Q

Isw - knee

A

peak flexion (60 deg) for toe clearance
Peak mm activity of biceps femoris short head, sartorius, and gracilis

112
Q

Isw - hip

A

15 deg of flex
Peak mm activty of gracilis and sartorius

113
Q

Msw - ankle

A

Neutral to slight DF

114
Q

Msw - knee

A

passive ext caused by the momentum of hip flx

115
Q

Msw - hip

A

peak flx (25 deg)

116
Q

Leg reaches out to achieve step length. Preparation for IC.

A

Terminal swing

117
Q

Tsw - ankle

A

at neutral to prepare for heel strike

118
Q

Tsw - knee

A

extensions to neutral (5 deg flex)
extension controlled eccentrically by the hamstrings
Quads turn on in late Tsw to prepare for weight-bearing

119
Q

Tsw - hip

A

subtle retraction to 20 deg of flx

120
Q

Tsw critical event

A

Knee extension to neutral

121
Q

What are the key muscles for pelvic control

A

hip ext and hip abd

122
Q

Pelvic motion during gait in the sagittal plane

A

neutral pelvis in ~ 10 deg of anterior tilt
Slight increase in anterior pelvic tilt during Tst and Tsw

123
Q

Pelvic motion during gait in frontal plane

A

During WA, 4 deg of contralateral pelvic drop
During Psw, 4 deg of ipsilateral pelvic drop

124
Q

Pelvic motion during gait transverse plane

A

Max pelvic protraction (4°) during TSW and IC
Max pelvic retraction (4°) during TST
Neutral rotation at MSW and MST

125
Q

Average vertical displacement

A

4.2 cm

126
Q

Average lateral displacement

A

4.5 cm to the R and L

127
Q

Trunk during gait

A

Multifidus act bilaterally during IC
Low level activity of rectus abdominis and external obliques

128
Q

The arms provide counterforce to oppose

A

excessive rotation of the body

129
Q

UE

A

Peak flexion (shoulder = 8°) during contralateral initial contact
Flexion is a passive movement
Peak extension (shoulder = 24°) during ipsilateral initial contact
Extension is controlled by posterior deltoid and teres major
Arm swing range (increased extension) increased with increased walking velocity

130
Q

critical joint angles - ankle

A

neutral ankle during swing
20 deg of DF in terminal stance

131
Q

critical joint angle - knee

A

60 deg of flexion in intial swing
20 deg of flexion in loading response
0 in at IC and midstance

132
Q

critical joint angle - hip

A

25 deg of flx in midswing
20 deg of extension in terminal stance

133
Q

Critical muscle activity - ankle

A

anter tib during loading response (eccentric)
anter tib during swing (concentric)
Gastrocnemius active during stance to control knee flexion movement

134
Q

Critical muscle activity - knee

A

No hamstring or quadriceps muscle activity during Msw
Quadriceps active during stance to control knee flexion movement

135
Q

Critical muscle activity - hip

A

hip flexors during swing (concentric)
hip abductors during single limb support to prevent hip drop

136
Q

Faster walking speeds create

A

higher peaks and lower valleys

137
Q

Increase knee adduction moments have been associated with

A

knee OA

138
Q

Goal of gait methods

A

is the individual achieving a functional, comfortable, biomechanically, efficient, and energy efficient gait

139
Q

Gait methods

A

Manual assessment of spatial and temporal parameters
Instrumented Walkways
Three-Dimensional Gait Analysis
Video Analysis
Observational Gait Analysis

140
Q

Outcome measures for manual assessment of spatial and temporal parameters

A

6 MWT
2 MWT
10 meter walk test

141
Q

Physical measurements of manual assessment of spatial and temporal parameters

A

step length, step width, or cadence

142
Q

Advantages of instrumented walkways

A

Easy to use
Less expensive
Portable
Requires minimal set up
Requires minimal space
Generally produces reliable data

143
Q

Limitations of instrumented walkways

A

Generally limited to temporal spatial data acquisition
Limited to number of steps
Artificial environment validity?

144
Q

GAITRite

A

2 ft wide x 12-24 ft length walkway
Numerous client-specific normal databases can be created and compared against
Can use to track a patient’s progress

145
Q

Which gait analysis is the gold standard

A

three-dimensional gait analysis

146
Q

Three-dimensional gait analysis

A

measures temporal spatial parameters, kinematics, and kinetics

147
Q

Advantages of three-dimensional gait analysis

A

Captures joint kinematics and kinetics in all planes
Accurate
Good for complicated gait patterns
Can sync with EMG data

148
Q

Limitations of three-dimensional gait analysis

A

Need large room
Costly
Must have knowledge to process data
Accuracy influenced by body composition and precision of marker placement
Skin artifact

149
Q

Capture rate

A

minimum 60 Hz for walking for faster movements must increase rate

150
Q

detecting gait events

A

foot strikes on force plates
velocity of foot
foot switches

151
Q

Can a EMG distinguish if muscle contraction is concentric, eccentric, or isometric

A

there is no way

152
Q

EMG surface

A

Non-invasive
Good for group and/or surface muscle activity
Should be placed at muscle belly
Good for measuring timing of muscle activity
Signal can be “noisy”
Does not work well with thick layer of subcutaneous fat

153
Q

EMG fine wire

A

Invasive
Good for deep or specific muscle activity
Needles must be sterilized
In CA, need to be certified to perform
Time intensive

154
Q

Plantar Pressures

A

Instrumented insoles place in patient’s shoes
Can not use during barefoot walking
Published “normals”

155
Q

Inertial measurement units

A

Self-contained system that measures linear and angular motion with the use of gyroscopes, magnetometers, and accelerometers

156
Q

Advantages of video gait analysis

A

Measures joint angles
Inexpensive
Simple to use

157
Q

Limitations of video gait analysis

A

Accuracy
Patient consent to video

158
Q

Tips for observational gait analysis

A

Must be familiar with NORMAL gait first!
Start global then get specific
Breakdown into stance and swing and then further into phases
Can list in order of significance or superior  inferior

159
Q

what are the 3 main functional task of gait

A

weight acceptance
single limb support
swing limb advancement

160
Q
A

P & O (4 decks)

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