Gait Quiz 1

Front 1

What are the 8 phases of gait?

Back 1

Initial Contact
Loading Response
Midstance
Terminal stance
Pre swing
Initial Swing
Mid Swing
Terminal Swing

Front 2

What motions define Initial Contact?

Back 2

foot hits ground (usually heel first)

Front 3

What is the functional goal of initial contact?

Back 3

Functional Tasks:
decelerate
shock absorption
stability
maintain forward progression

Front 4

What motions define Loading Response?

Back 4

From Initial contact to toe-off of opposite foot
Ends with foot flat, slight knee flexion, opposite foot about to lift off

(goes with pre-swing of other leg)

Front 5

What is the functional goal of loading response?

Back 5

accept weight

Front 6

Critical events of loading response

Back 6

1. Heel rocker - controlled plantar flexion
2. slight knee flexion
3. hip stability with upright trunk

Front 7

What motions define midstance?

Back 7

From opposite leg behind body (toe-off) to in front with tibia vertical

Front 8

functional goals of midstance

Back 8

maintain single limb stability
forward progression (w/o stability, sacrifice forward progression - step-to gait pattern)
body weight behind to on top to just in front
COM in front of foot
Make stance limb tall/long

Front 9

Critical events of midstance

Back 9

1. "ankle rocker" - controlled tibial advancement
2. Knee extension - limb tall
3. hip extension to 0-5 degrees

Front 10

Motions that define terminal stance

Back 10

From opposite tibia vertical in front to heel rise on stance limb

Front 11

Functional goals of terminal stance

Back 11

load C.O.M. and make it go past toes
Momentum -> central pattern generator

Front 12

Critical events of terminal stance

Back 12

1. Controlled heel rise - "forefoot rocker"
2. "trailing limb" - terminal hip extension ~20 degrees ext.

Swing phase problems are due to not getting terminal stance

Front 13

What motions define pre-swing?

Back 13

End of heel rise (TS) to toe-off of that foot
Double-limb support
Start with opposite foot contact

Front 14

Functional goals of pre-swing

Back 14

shift weight to other leg (transfer)

Front 15

Critical Events of pre-swing

Back 15

1. Toe Rocker - roll off big toe - 60 degrees MTP extension
2. Passive plantar flexion - 20 degrees
3. passive knee flexion - 40
4. hip flexion to 0 degrees

Front 16

Motions that define initial swing

Back 16

from toe off 'till limb parallel w/ COM over foot (if you put that foot down, it would be next to the other foot)

Front 17

Functional goal of initial swing

Back 17

foot off ground
make limb short
COM over foot

Front 18

Critical events of initial swing

Back 18

1. Knee flexion to 60
2. initiate dorsiflexion
3. Hip flexion to 5-10 degrees

Front 19

Motions that define mid swing

Back 19

from balanced COM (above foot) till tibia vertical

Front 20

Functional goals of mid-swing

Back 20

clear foot (don't trip)
Keep limb short
COM in front

Front 21

Critical events of mid-swing

Back 21

1. 0 degrees dorsiflexion
2. Hip flexion to 25 degrees
3. Knee extends to 25 degrees flexion

Front 22

Motions that define Terminal Swing

Back 22

From tibia vertical to just before heel hits

Front 23

Functional goals of terminal swing

Back 23

COM in front and long step length
Prepare for safe landing

Front 24

Critical events of Terminal Stance

Back 24

1. Hip stays (where... in flexion?)
2. Knee extends to 0-5 degrees flexion
3. Ankle stays neutral

Front 25

Why is gait designed the way it is?

Back 25

To minimize displacement of body - be efficient (not much vertical)
Gait deviation shifts amount of motion (>5 cm and 4 cm)
Minimize side-to-side displacement
- narrow stride width

Front 26

What phases are in weight acceptance?

Back 26

initial contact and loading response

Front 27

What phases are in single limb support?

Back 27

midstance and terminal stance

Front 28

What phases are in swing limb advancement?

Back 28

Pre-swing (part of stance phase), initial swing, midswing, and terminal swing

Front 29

Which phases are double-limb support?

Back 29

IC, LR, and PS

Front 30

During PSw on L, what happens on R?

Back 30

IC and LR

Front 31

During MSt on L, what happens on R?

Back 31

ISw, MSw

Front 32

During TSt on L, what happens on R?

Back 32

TSw

Front 33

What is the order of "rockers"?

Back 33

Heel rocker (IC and LR), Ankle rocker (MSt), Forefoot rocker (TSt), Toe-rocker (PSw)

Front 34

What are the two things patients come to PT with?
How does exam go for gait issues?

Back 34

Patient comes in with symptom (pain -> cause of pain) or function (can't do things - multiple impairments across many regions of body) problem
Exam -> diagnose patient pain (what part of gait cycle hurts?)
-> gait = reason for pain? mechanics
-> w/ diagnosis, use as hypothesis for impairments to test
Observe
AROM
PROM
MMT
ST
Palp
Observe functional activities (gait, etc) - use that to figure out other tests

Front 35

Quantitative aspects of gait

Back 35

speed
distance
lvl of assistance
duration
stride length
type of device, shoes...

Front 36

Qualitative aspects of gait

Back 36

observational motion analysis
- change in motion in real time (observing gait is trained skill!)
- observe -> identify deviations
- Hypothesize causes
- Test

Front 37

Concept 1: Movement and posture are goal oriented
therefore, the goal of walking is to:

Back 37

1. A -> B usually most efficient way to transport
2. Adapt to different surfaces/conditions
3. Continuous stepping
4. Maintain balance = safe
5. Efficiency = physical and mental

Front 38

Concept 2: At each moment in time you observe a person, every posture adopted or movement produced depends upon three interacting variables:

Back 38

the task (e.g. runway, get away)
the environment (e.g. ice)
and the individual body systems and functions of the person
(individual strength, ROM, balance, visual, motor control, sensation)

Front 39

Clinical significance of concept 2: we have 3 diff ways to change the movements produced by our patients. We can...

Back 39

We can change the goal of the task, change the environment, and we can treat the body of the person

Front 40

Concept 3: Optimal gait can be determined behaviorally
Behavioral: gait is ideal or optimal - as opposed to normal - when:

Back 40

1. Effective
2. Efficient
3. Not harmful
4. Adaptive
5. Reliable/consistent

Front 41

Concept 4: optimal gait can be determined biomechanically vs. the GRF/LOG
Observational motion analysis of functional skills: knowledge base required
What do you need to know about movements in order to analyze them?

Back 41

1. Biomechanical goal/functional tasks that must be accomplished during the different phases of the motion to perform the functional skill - e.g. weight acceptance
2. Critical events/elements and deviations - specific kinematics/joint movements observed at specific time points or phases of the motion ("normal")
Significance: has to happen during phase to achieve functional task in safe and efficient manner
deviation is not safe and efficient
3. Body structure and functions

Front 42

Concept 5: what if my gait is not ideal? when is a gait deviation a problem

Back 42

I didn't take notes on that
The simple answer: (when it significantly messes up one of those aspects?)
Behaviorally:
Biomechanically:

Front 43

Stride length =

Back 43

initial contact to ipsilateral initial contact

Front 44

Step length =

Back 44

contra-lateral IC to ipsilateral IC

Front 45

Temporal variables of gait

Back 45

DLS time: IC right to TO left and vice versa
SLS time: TO opposite to IC opposite
Velocity: distance/time
Cadence: steps/minute

Front 46

Spatial variables of gait

Back 46

Stride length: IC -> ipsi IC
Step length: Contra IC -> ipsi IC
Width of BOS: distance between center of both heels

Front 47

Functional tasks: goals of gait

Back 47

3 "jobs"
weight acceptance
single limb support
swing limb advancement

Front 48

At what point in gait do you expend most energy?

Back 48

picking leg up - concentric muscle action
the way down is more eccentric
build potential energy at highest point

Front 49

Determinants of gait (? phrasing?)
5 small motions - mostly to minimize up and down

Back 49

Chart shows A - walking without reduction of COM displacement
B - adding horizontal plane pelvic rotation (trunk has counter rotation - longer step)
C - Adding sagittal plane ankle rotation - rockers
D. Adding stance phase knee flexion - not totally straight
E. Adding frontal plane pelvic rotation - decreases amount of up and down, tall on stance leg while other hip drops

All these factors decrease vertical COM displacement

Physiologic genu valgus helps reduce side-to-side (narrower width)

Front 50

Heel rocker
During which phase of gait does it occur?
What functional task of gait is met during each rocker?
What is the other limb doing at the same time?

Back 50

Loading response
Accept weight
Other limb is in pre-swing

Front 51

Which kinematic strategies reduce the downward displacement of the CoM?

Back 51

Transverse plane rotation of the pelvis
Sagittal plane ankle rotation

Front 52

Which kinematic strategies reduce the upward displacement of the CoM?

Back 52

Stance phase Knee flexion
Frontal plane pelvic rotation/tilt

Front 53

Which kinematic strategies reduce the side-to-side displacement of the CoM?

Back 53

frontal plane hip rotation (step width)
her slides say Physiologic genu valgus (feet narrower than hips)

Front 54

#5 Physiologic genu valgus

Back 54

#5 Physiologic genu valgus—Physiological genu valgus is a structural feature of the human knee joint that limits lateral movement in the body's center of gravity during the gait cycle. Because of this knee alignment, the feet are closer together which minimizes the width of base of support and the distance the weight must shift laterally in single limb support.

Without this valgus—or with a wider base of support—there is a greater lateral translation of the COM.

Front 55

#4: Foot Ankle knee interactions—

Back 55

#4: Foot Ankle knee interactions—at initial contact dorsiflexion with knee extension in terminal swing lengthens the leg minimize the drop, plantar flexion with knee flexion in preswing minimize limb length change.

Front 56

#3 Knee flexion in stance—

Back 56

#3 Knee flexion in stance—Midstance knee flexion prevents an excessive rise in the body's COG during that period of the gait cycle.

Front 57

#2 Pelvic tilting during swing phase

Back 57

#2 Pelvic tilting during swing phase—Lateral pelvic tilting (dropping on the unsupported side) during midstance prevents an excessive rise in the body's center of gravity.
If the pelvis does not drop on the swing limb then the COM is higher during midstance.

Front 58

#1: Pelvis rotation with hip rotation—

Back 58

#1: Pelvis rotation with hip rotation—Forward rotation of the pelvis on the swing side prevents an excessive drop in the body's center of gravity during periods of double limb support.

Front 59

During double limb support, when the center of gravity is at its lowest point, joint angles at the ankle and knee in both lower extremities are such that

Back 59

During double limb support, when the center of gravity is at its lowest point, joint angles at the ankle and knee in both lower extremities are such that their effective lengths are maximized (C below). Additionally, the pelvis is rotated forward on the side where the limb is in loading response, and backward on the limb which is in preswing (B below). This functional lengthening of the limbs minimizes the vertical drop in the center of gravity.

Front 60

During midstance and midswing, when the center of gravity is highest, the stance limb's hip, knee, and ankle are all

Back 60

During midstance and midswing, when the center of gravity is highest, the stance limb's hip, knee, and ankle are all flexed 5 degrees (D below). In addition, the pelvis is tilted downward laterally toward the swing limb (E below). This minimizes the center of gravity's upward excursion, keeping it lower than if the individual were standing erect.

Front 61

Noteworthy is the fact that the body's CoM is never

Back 61

Noteworthy is the fact that the body's CoM is never directly located over the body's base of support during single-limb support (see Figure 15-13, B). This fact illustrates the relative imbalance of the body during gait, especially during single-limb support, when the foot must be positioned just slightly lateral to the vertical projection of the body's CoM to control its side-to-side movement. Proper location of the foot by hip motion in the frontal plane (i.e., hip abduction and adduction) is crucial considering the limited ability of the muscles of the subtalar joint to control the side-to-side motion of the CoM

Front 62

In the vertical direction, the CoM oscillates up and down to describe...
total displacement?

Back 62

In the vertical direction, the CoM oscillates up and down to describe two full sine waves per gait cycle (see Figure 15-13, A). This movement of the CoM is best understood by looking at the individual from the side.
Minimum height of the CoM occurs at the midpoint of both periods of double-limb support (5% and 55% of the gait cycle) in the middle of LR for the right and then for the left limb when the foot is flat on the ground..
Maximum height of the CoM occurs at the midpoint of both periods of single-limb support (30% and 80% of the gait cycle) or the middle of midstance for the right and then the left.
A total vertical displacement of approximately 5 cm is noted at the average walking speed in the adult male.

Front 63

In the side-to-side direction: During ambulation the CoM is also alternately shifted...
total displacement?

Back 63

In the side-to-side direction: During ambulation the CoM is also alternately shifted from the right to the left lower extremity, creating a single side-to-side (right-to-left) sinusoidal pattern per gait cycle (see Figure 15-13, B).
Minimum side-to-side position of the COM occurs at midpoint of both double limb support period (5% and 55%) which is in the middle of LR for each limb when the foot is flat on the ground.
Maximum position of the CoM to the right occurs at the midpoint of the stance phase on the right lower extremity (30% of the gait cycle), and maximum position of the CoM to the left occurs at the midpoint of the stance phase on the left lower extremity (80% of the gait cycle).
A total side-to-side displacement of approximately 4 cm occurs during normal ambulation.
The amount of displacement increases when the individual has a wider base of support during gait (i.e., walking with the feet wider apart) and decreases with a narrower base of support (i.e., walking with the