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78 Cards in this Set

  • Front
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stance phase = ___%
60%
swing phase = ____%
40%
double stance time = ____%
22%
What are the subdivisions of Stance? (5)
1. initial contact
2. loading response
3. midstance
4. terminal stance
5. preswing
Tell me about initial contact
The split second in time when foot touches the floor

normally, contact is made w/ heel

the ankle must be NEUTRAL to ensure heel contact

at this specific moment in time you must have:
1. forward rotation of pelvis
2. hip flexion
3. knee extension
4. NEUTRAL ANKLE
Tell me about loading response
immediately after initial contact

you are absorbing impact of loading limb

two important things that must happen:
1. ankle PLANTAR FLEXION (10 degrees)
2. knee flexion (15 degrees)
Tell me about midstance
it is the FIRST period of single limb support

we need DF range to advance tibia and rest of body over the foot

Important things that must happen:
1. lateral hip stability to maintain a level pelvis
2. controlled tibial advancement to get DF (5 degrees)
Tell me about terminal stance
a continuation of SINGLE LIMB support

important things that happen:
1. DF (5-10 degrees)
2. heel rise
3. forward progression over the foot
Tell me about preswing
part of stance phase

period of DOUBLE LIMB support

the limb is unloaded and prepared for foot lift

moment before foot is lifted off the floor

important thing that happens:
1. PASSIVE knee flexion (40 degrees)
what are the subdivisions for swing phase? (3)
1. initial swing
2. mid-swing
3. terminal swing
tell me about initial swing
the purpose is to lift the foot off the floor and CLEAR TOES

important things that happen:
1. knee flexion (60 degrees)
2. hip flexion (15 degrees)

note: no DF mentioned here in ranchos los amigos video
tell me about midswing
limb continues to advance forward

important things that happen:
1. TIBIA achieves a VERTICAL position
2. hip flexion (25 degrees)
3. **DF to NEUTRAL is required to clear the foot during midswing
tell me about terminal swing
step length is created here

important things that happen:
1. **knee is fully EXTENDED
2. ankle is DF to neutral
3. hip flexion
4. forward rotation of pelvis
definition of cadence
steps per unit of time
how do you measure stride length?
distance between back of R heel and back of R heel.

Step w/ R, L, R
measure between R and R
how do you measure step length?
step R, step left

measure between heel of R and heel of L
what are 4 major categories that cause gait deviations?
1. weakness
2. deformity
3. impaired control
4. pain
tell me about weakness and gait deviations
insufficient strength to meet the demands of walking

substitute if weakness alone
tell me about deformity and gait deviations
not enough mobility to attain required posture and ROM

ie a contracture would be a deformity

contractures
1. rigid
2. elastic
tell me about impaired control and gait deviations
sensory loss

motor control
1. spasticity
2. planning
tell me about pain and gait deviations
pain usually causes deformity AND weakness
muscle weakness and gait

what is the function of dorsiflexors?

what happens if they are weak?
Function of DFs during gait

1. keep ankle in DF (neutral) during swing and in terminal swing - if its weak, it LENGTHENS THE LIMB

weak dorsiflexors lengthen the limb.

2. DFs control ankle at Initial contact and Loading response. Ankle is DF to neutral during IC, and ankle is PLANTAR FLEXED (10 degrees) during loading response.

Dorsiflexor muscles (Tib A) control plantar flexion eccentrically

Deviation: foot slap
Compensation: land with foot flat, or on forefoot, so foot doesn't slap.
plantar flexors and gait deviations.

what is the function of PFs during gait? what happens if weak?
Function of plantar flexors during gait

1. control forward progression of Tibia during single leg stance.

when your tibia is going over your foot, the ankle is dorsiflexing. This dorsiflexion of the ankle is controlled eccentrically by the plantar flexors (gastroc/soleus)

if plantar flexors weak, you get
1. loss of hip, knee, and ankle stability
2. PROLONGED midstance

weak plantar flexors cause PROLONGED MIDSTANCE

2. Second purpose of plantar flexors is PROPULSION.
If weak, there is a decrease or absence of push off.
Quads and gait deviations

What is the purpose of quads during gait?

what happens if they are weak?
Function of Quads during gait

1. Maintain KNEE EXTENSION at initial contact (and terminal swing)

if Quads are weak, you get instability after IC

2. Quads provide shock absorbtion. If weak, you have poor shock absorption.

When you make IC, your quads are responsible for keeping your knee straight. If your quads are weak, you can't keep your knee straight. therefore, you lock your knees into extension after IC so your quads don't have to work.
hip extensors and gait deviations

what is the function of the hip extensors during gait?
what happens if weak?
Function of the hip extensors during gait

1. stability of the hip from IC to loading response

2. slow the thigh in TS

if weak, you have poor hip control after IC

remember the boy w/ hand in his pocket. He has lumbar hyperlordosis, shoulders thrust backwards, abdomen sticking out. This posture places COM BEHIND the hips so the Pt. doesn't fall forward b/c of weak back and HIP EXTENSORS
hip abductors and gait

what is the function of hip abductors during gait?

what happens if weak?
function of hip abductors (glut med) during gait

1. control the pelvis during single limb support

if weak - increased pelvic lateral tilt (trendelemburg, hip drop on opposite side of stance leg.)

weak right side, left hip drop.
causes of leg length asymmetry

contracture: flexion vs. extension

bony: long bones, pelvis, spine

functional: pronation, supination, hip weakness
cool
if the swing leg is long, what can you do with the swing leg to clear the foot?
1. circumduction
2. hip hike

or you can vault the stance leg
the stance leg

flexion and pronation will do what?
shorten the limb
stance leg

plantar flexion will do what?
lengthen the limb
Plantar flexion contractures will do what to gait? (4)
1. RAPID FOOT FLAT (b/c can't DF to neutral during IC, so flat foot or forefoot contacts ground first)

2. KNEE EXTENSION - as you advance you tibia forward, you have to get DF. If you have PF contracture, that will put your knee into extension.

3. EARLY HEEL RISE - b/c there is no DF during terminal stance

4. TOE DRAG - b/c no DF to neutral during midswing
DF contractures do what to gait?
1. rapid tibial advancement

2. knee flexion (b/c your ankle is stuck in DF, to get your foot flat on the ground, you have to bend your knee)
knee flexion and hip flexion contractures do what to the limb?
shorten the limb
knee extension contractures do what to the limb?
lengthen the limb
IC
what 3 important things happen? (sagittal plane)
1. heel strike
2. full knee extension
3. hip flexion
Loading response
what 3 things happen?
(sagittal plane)
1. foot achieves foot flat (PF)
2. knee flexion
3. hip flexion for shock absoption
what happens during single leg stance (midstance and terminal stance)
1. shin advance over the foot in a controlled manner
2. heel rises at terminal stance
3. terminal stance = knee extends until heel rise, then after heel rise is knee flexion(pre swing)
4. hip must extend just before heel rise
what happens during preswing?
1. foot plantarflexes and clears the foot

2. the knee FLEXES to clear the foot
what happens during initial swing and mid swing?
1. foot clears the ground
2. knee flexes
3. hip flexes
what happens w/ the knee at terminal swing?
knee extends
what is the definition of GRF?
force of the GROUND on the foot and is equal in magnitude and opposite in direction to the force that the body applies to the floor through the foot.

COP is the point where the forces act.
ray's attempt to explain the "M" shaped curve before reading JSF:

the spike occurs when?
hump occurs when?
valley occurs when?
spike occurs at heel contact (IC)

hump occurs at
1. loading response
2. preswing

valley occurs at midstance.
friction is required to walk normally

anterior spike occurs when?
braking hump occurs when?

acceleration hump occurs when?
anterior spike at heel contact

braking hump in loading response

acceleration hump in preswing
GRF during IC makes the ankle do what?
ankle is DF to neutral before IC.

during IC, GRF makes the ankle plantarflex
what differentiates terminal stance and preswing?
during terminal stance knee is extended

you get passive knee flexion during preswing.
GRF in the frontal plane are ____
highly variable

the COM is usually medial to the foot, so odds are its a lateral force
what is the characteristic pattern of a child w/ diplegia or quadriplegia?
flexion, adduction, and internal rotation at the hips and flexion at the knees

walk w/ bilateral circumduction of LEs
genu recurvatum

wtf is that?
flexed hips, knees extended, ankles plantarflexed
what is a gait cycle aka stride?
spans two successive events of the same limb (R then R)

therefore, if you have 1 stride/sec, then you have 2 steps/sec
how long does the stance phase last?
60%

IC, LR, midstance, terminal stance, preswing
how long does the swing phase last?
40%

initial swing, midswing,terminal swing
what phases are you in Single Limb Support, and for what % of the time?
1. midstance
2. terminal stance

if you are in double support 22% of the time, assuming you are not floating, you are in single limb support 78% of the time.
What stances are you in double limb support?
The stance phases are:
1. IC
2. loading response
3. midstance
4. terminal stance
5. preswing

the only stances w/ single limb support is midstance and terminal stance. Therefore, all the other stances are double limb support. all swing phases are obviously single limb support

double limb support = preswing, IC, loading response
location of GRF at
ankle
knee
hip

and actions caused during

initial contact
GRF is:
behind ankle = PF
front of knee = knee extension
front of hip = hip flexion
location of GRF at
ankle
knee
hip

and actions caused during

Loading response
GRF is
behind ankle = PF
behind knee = knee flexion
front of hip = hip flexion
location of GRF at
ankle
knee
hip

and actions caused during

midstance
GRF is:
front of ankle = DF
front of knee = knee extension
behind hip = hip extension
location of GRF at
ankle
knee
hip

and actions caused during

terminal stance
GRF is:
front of ankle = DF
front of knee = knee extension
behind hip = hip extension
location of GRF at
ankle
knee
hip

and actions caused during]

preswing
GRF is:
front of ankle = DF
behind knee = knee flexion
behind hip = hip extension
how do you measure stride length?
measure from Right IC to Right IC (same as gait cycle)
how do you measure step length?
measure from Right IC to Left IC
angle of toe out approximately ____degrees

toe out ___ as speed increases

it allows for what?
7 degrees

angle toe out decreases as speed increases

allows fro pronation/supination of foot

angle of line from mid-heel to great toe
what is base of support?
distance between heel midpoints of opposite feet (average = 3.5 inches)
what is Center of Pressure?
sum of all GRF to one point on foot in time

starts at posterior-lateral edge of heel and moves in a nearly linear manner toward the midfoot and across the ball to 2nd and 1st toes

Forms a line from lateral side of heel to base of great toe.
Rancho Los Amigos

Initial contact =
Traditional (baxter, you know I don't speak spanish)

Initial contact = heel strike
Rancho Los Amigos

Terminal stance =
Traditional

terminal stance = heel off
Rancho los Amigos

Loading response
Traditional

loading response = foot flat
Rancho los Amigos

Initial swing =
Traditional

initial swing = toe off
Rancho Los Amigos

terminal swing =
Traditional

terminal swing = reach
List 3 forces that control the motion of our joints
1. muscles
2. passive tension (ligaments, joint capsule
3. GRF/gravity
what is the close packed position of the

hip
extension

abduction

internal rotation
what is the open packed position of the hip?
flexion

slight abduction

internal rotation
what is the closed packed position of the knee?
full extension
what is the open packed position of the knee?
knee flexion (25 degrees)
what is the closed packed position of the ankle?
full dorsiflexion

full supination of STJ
what is the open packed position of the ankle?
full plantarflexion

when you sprain your ankle and it swells up, its natural position is in PF
why is muscle power not required at the knee and hip during quiet standing?
b/c the knee and hip are in extension

GRF is in front of the knee = extension
GRF is behind the hip = hip extension

The GRF vector does not lie far from the axes of these joints and does not generate a large torque component (ie there is no large torque that is making the hip flex or knee bend)

however, the GRF is farther in front of your ankle, making it want to DF. therefore, your gastroc/soleus is working in quiet standing.
why is the width of the base of support greater in standing than during gait?
during gait, the pelvis rotates forward on the swing leg side, therefore the width of the base of support is smaller when you walk.
how does the center of gravity shift during gait?
COG lowest during loading response = first hump on M curve

COG highest during midstance = valley of M curve (lowest GRF)

COG lowest again at preswing = second valley of M curve (highest GRF)