Bishop Gait Spring 2009

Front 1

stance phase = ___%

Back 1

60%

Front 2

swing phase = ____%

Back 2

40%

Front 3

double stance time = ____%

Back 3

22%

Front 4

What are the subdivisions of Stance? (5)

Back 4

1. initial contact
2. loading response
3. midstance
4. terminal stance
5. preswing

Front 5

Tell me about initial contact

Back 5

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

Front 6

Tell me about loading response

Back 6

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)

Front 7

Tell me about midstance

Back 7

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)

Front 8

Tell me about terminal stance

Back 8

a continuation of SINGLE LIMB support

important things that happen:
1. DF (5-10 degrees)
2. heel rise
3. forward progression over the foot

Front 9

Tell me about preswing

Back 9

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)

Front 10

what are the subdivisions for swing phase? (3)

Back 10

1. initial swing
2. mid-swing
3. terminal swing

Front 11

tell me about initial swing

Back 11

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

Front 12

tell me about midswing

Back 12

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

Front 13

tell me about terminal swing

Back 13

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

Front 14

definition of cadence

Back 14

steps per unit of time

Front 15

how do you measure stride length?

Back 15

distance between back of R heel and back of R heel.

Step w/ R, L, R
measure between R and R

Front 16

how do you measure step length?

Back 16

step R, step left

measure between heel of R and heel of L

Front 17

what are 4 major categories that cause gait deviations?

Back 17

1. weakness
2. deformity
3. impaired control
4. pain

Front 18

tell me about weakness and gait deviations

Back 18

insufficient strength to meet the demands of walking

substitute if weakness alone

Front 19

tell me about deformity and gait deviations

Back 19

not enough mobility to attain required posture and ROM

ie a contracture would be a deformity

contractures
1. rigid
2. elastic

Front 20

tell me about impaired control and gait deviations

Back 20

sensory loss

motor control
1. spasticity
2. planning

Front 21

tell me about pain and gait deviations

Back 21

pain usually causes deformity AND weakness

Front 22

muscle weakness and gait

what is the function of dorsiflexors?

what happens if they are weak?

Back 22

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.

Front 23

plantar flexors and gait deviations.

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

Back 23

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.

Front 24

Quads and gait deviations

What is the purpose of quads during gait?

what happens if they are weak?

Back 24

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.

Front 25

hip extensors and gait deviations

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

Back 25

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

Front 26

hip abductors and gait

what is the function of hip abductors during gait?

what happens if weak?

Back 26

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.

Front 27

causes of leg length asymmetry

contracture: flexion vs. extension

bony: long bones, pelvis, spine

functional: pronation, supination, hip weakness

Back 27

cool

Front 28

if the swing leg is long, what can you do with the swing leg to clear the foot?

Back 28

1. circumduction
2. hip hike

or you can vault the stance leg

Front 29

the stance leg

flexion and pronation will do what?

Back 29

shorten the limb

Front 30

stance leg

plantar flexion will do what?

Back 30

lengthen the limb

Front 31

Plantar flexion contractures will do what to gait? (4)

Back 31

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

Front 32

DF contractures do what to gait?

Back 32

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)

Front 33

knee flexion and hip flexion contractures do what to the limb?

Back 33

shorten the limb

Front 34

knee extension contractures do what to the limb?

Back 34

lengthen the limb

Front 35

IC
what 3 important things happen? (sagittal plane)

Back 35

1. heel strike
2. full knee extension
3. hip flexion

Front 36

Loading response
what 3 things happen?
(sagittal plane)

Back 36

1. foot achieves foot flat (PF)
2. knee flexion
3. hip flexion for shock absoption

Front 37

what happens during single leg stance (midstance and terminal stance)

Back 37

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

Front 38

what happens during preswing?

Back 38

1. foot plantarflexes and clears the foot

2. the knee FLEXES to clear the foot

Front 39

what happens during initial swing and mid swing?

Back 39

1. foot clears the ground
2. knee flexes
3. hip flexes

Front 40

what happens w/ the knee at terminal swing?

Back 40

knee extends

Front 41

what is the definition of GRF?

Back 41

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.

Front 42

ray's attempt to explain the "M" shaped curve before reading JSF:

the spike occurs when?
hump occurs when?
valley occurs when?

Back 42

spike occurs at heel contact (IC)

hump occurs at
1. loading response
2. preswing

valley occurs at midstance.

Front 43

friction is required to walk normally

anterior spike occurs when?
braking hump occurs when?

acceleration hump occurs when?

Back 43

anterior spike at heel contact

braking hump in loading response

acceleration hump in preswing

Front 44

GRF during IC makes the ankle do what?

Back 44

ankle is DF to neutral before IC.

during IC, GRF makes the ankle plantarflex

Front 45

what differentiates terminal stance and preswing?

Back 45

during terminal stance knee is extended

you get passive knee flexion during preswing.

Front 46

GRF in the frontal plane are ____

Back 46

highly variable

the COM is usually medial to the foot, so odds are its a lateral force

Front 47

what is the characteristic pattern of a child w/ diplegia or quadriplegia?

Back 47

flexion, adduction, and internal rotation at the hips and flexion at the knees

walk w/ bilateral circumduction of LEs

Front 48

genu recurvatum

wtf is that?

Back 48

flexed hips, knees extended, ankles plantarflexed

Front 49

what is a gait cycle aka stride?

Back 49

spans two successive events of the same limb (R then R)

therefore, if you have 1 stride/sec, then you have 2 steps/sec

Front 50

how long does the stance phase last?

Back 50

60%

IC, LR, midstance, terminal stance, preswing

Front 51

how long does the swing phase last?

Back 51

40%

initial swing, midswing,terminal swing

Front 52

what phases are you in Single Limb Support, and for what % of the time?

Back 52

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.

Front 53

What stances are you in double limb support?

Back 53

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

Front 54

location of GRF at
ankle
knee
hip

and actions caused during

initial contact

Back 54

GRF is:
behind ankle = PF
front of knee = knee extension
front of hip = hip flexion

Front 55

location of GRF at
ankle
knee
hip

and actions caused during

Loading response

Back 55

GRF is
behind ankle = PF
behind knee = knee flexion
front of hip = hip flexion

Front 56

location of GRF at
ankle
knee
hip

and actions caused during

midstance

Back 56

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

Front 57

location of GRF at
ankle
knee
hip

and actions caused during

terminal stance

Back 57

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

Front 58

location of GRF at
ankle
knee
hip

and actions caused during]

preswing

Back 58

GRF is:
front of ankle = DF
behind knee = knee flexion
behind hip = hip extension

Front 59

how do you measure stride length?

Back 59

measure from Right IC to Right IC (same as gait cycle)

Front 60

how do you measure step length?

Back 60

measure from Right IC to Left IC

Front 61

angle of toe out approximately ____degrees

toe out ___ as speed increases

it allows for what?

Back 61

7 degrees

angle toe out decreases as speed increases

allows fro pronation/supination of foot

angle of line from mid-heel to great toe

Front 62

what is base of support?

Back 62

distance between heel midpoints of opposite feet (average = 3.5 inches)

Front 63

what is Center of Pressure?

Back 63

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.

Front 64

Rancho Los Amigos

Initial contact =

Back 64

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

Initial contact = heel strike

Front 65

Rancho Los Amigos

Terminal stance =

Back 65

Traditional

terminal stance = heel off

Front 66

Rancho los Amigos

Loading response

Back 66

Traditional

loading response = foot flat

Front 67

Rancho los Amigos

Initial swing =

Back 67

Traditional

initial swing = toe off

Front 68

Rancho Los Amigos

terminal swing =

Back 68

Traditional

terminal swing = reach

Front 69

List 3 forces that control the motion of our joints

Back 69

1. muscles
2. passive tension (ligaments, joint capsule
3. GRF/gravity

Front 70

what is the close packed position of the

hip

Back 70

extension

abduction

internal rotation

Front 71

what is the open packed position of the hip?

Back 71

flexion

slight abduction

internal rotation

Front 72

what is the closed packed position of the knee?

Back 72

full extension

Front 73

what is the open packed position of the knee?

Back 73

knee flexion (25 degrees)

Front 74

what is the closed packed position of the ankle?

Back 74

full dorsiflexion

full supination of STJ

Front 75

what is the open packed position of the ankle?

Back 75

full plantarflexion

when you sprain your ankle and it swells up, its natural position is in PF

Front 76

why is muscle power not required at the knee and hip during quiet standing?

Back 76

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.

Front 77

why is the width of the base of support greater in standing than during gait?

Back 77

during gait, the pelvis rotates forward on the swing leg side, therefore the width of the base of support is smaller when you walk.

Front 78

how does the center of gravity shift during gait?

Back 78

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)