Posture And Gait

Front 1

ideal postural alignment in relation to gravitational line?

Back 1

-posterior to apex of coronal suture

-external auditory meatus

-humeral head

-middle of L3 vertebra

-femoral head

-posterior to mid-knee

-anterior to lateral malleolus

-center of gravity 5cm anterior to S2

Front 2

___posture is "statically" unstable?

Back 2

upright posture is "statically" unstable

Front 3

in the upright posture the center of gravity is?

Back 3

as high as possible

Front 4

in the upright posture ___is maximized?

Back 4

potential energy

Front 5

teleceptors?

Back 5

-the distance senses: vision and sound, etc.

-can orient very quickly

Front 6

rotation in the upright posture there is an __?

Back 6

an axis, a midline

Front 7

normal sagittal curves (physiological)?

Back 7

-cervical lordosis: convex anterior

-thoracic kyphosis: convex posterior

-lumbar lordosis: convex anterior

Front 8

usual standing includes small___; standing is "apparently" ___?

Back 8

includes small oscillations; standing is "apparently" static

Front 9

with regards to muscular activity modulates sway, ___adjust movements?

Back 9

"postural" muscles adjust the movements

Front 10

___tend to serve antigravity functions in the upright position?

Back 10

phasic "postural" muscles

Front 11

what are the phasic "postural" muscles? and when are they active?

Back 11

-they are active in the "resting" position

-calves (gastrocnemius soleus)

-neck muscles

-jaw muscles

Front 12

what is the compensatory posture?

Back 12

it is a highly organized homeostatic mechanism working through the entire body unit to maximize function

Front 13

postural compensation takes place in what planes?

Back 13

in all three planes

Front 14

what does the compensatory posture?

Back 14

maintains body balance and eye level

Front 15

how does the postural compensation maintain body balance and eye level?

Back 15

-CNS-- visual and vestibular functions

-spinal compensation involves CNS correlation of: proprioceptive info from muscles and tendons, vestibular info of semicircular canals, visual info

Front 16

__are areas where curves reverse are commonly susceptible to somatic dysfunction?

Back 16

transition zones

Front 17

locations of transition zones?

Back 17

-occiptio-cervical junction

-cervico-thoracic junction

-thoraco-lumbar junction

-lumbo-sacral junction

Front 18

changes in transition zones include?

Back 18

-bony changes to the vertebrae

-changes in the sagittal plane

-muscular and fascial changes

Front 19

besides looking at the transition zones, also look at ___for dysfunction?

Back 19

also look at the apex of the curves

Front 20

in the physiologic curves, compensatory changes in one sagittal plane curve results in?

Back 20

changes to other curves

ex. an increased lumbar lordosis causes an increased thoracic kyphosis and cervical lordosis

Front 21

when is the primary onset for scoliosis?

Back 21

10-15 years old

Front 22

what is scoliosis?

Back 22

an appreciable deviation of a group of vertebrae from the normal straight vertical alignment of the spine

Front 23

scoliosis occurs ___among the genders? however?

Back 23

occurs equally among both genders; however, females are 8 times (800%) more likely to progress to a curve magnitude that requires treatment

Front 24

classification of scoliosis, addressed during routine physical exam?

Back 24

-reversibility

-severity

-cause

-location

Front 25

scoliosis reversibility?

Back 25

-functional scoliotic curve

-structural scoliotic curve

Front 26

functional scoliotic curve?

Back 26

curve reduced with side bending, rotation or forward bending

Front 27

structural scoliotic curve?

Back 27

curve fixed and not reduced with side bending, rotation or forward bending

Front 28

scoliosis severity?

Back 28

-mild: 5-15 degrees

-moderate: 20-45 degrees

-severe: greater than 50 degrees

-cobb angle >50 degrees= high probability of requiring surgical correction

Front 29

cobb angle >50degrees=__?

Back 29

high probability of requiring surgical correction

Front 30

most common cause of scoliosis? percent of scoliotic curves?

Back 30

idiopathic--no known cause

-70 to 90% of all scoliotic curves

-most common

Front 31

causes of scoliosis?

Back 31

-idiopathic

-congenital

-acquired

Front 32

congenital cause of scoliosis?

Back 32

75% of progressive

-2nd most common cause

Front 33

acquired cause of scoliosis?

Back 33

-short leg syndrome

-hip prosthesis

-osteomalicia

-sciatic irritability

-psoas syndrome

-healed leg fracture

Front 34

scoliotic curve is named for?

Back 34

-direction: right or left

-pattern: single, double or junctional

-location: thoracic-single, lumbar-single, thoraco-lumbar double (more common), junctional thoraco-lumbar, junctional cervicothoracic (rare)

Front 35

most common type of scoliosis?

Back 35

double major curve 75d (R thoracic, L lumbar)

Front 36

what does a scoliometer measure?

Back 36

the ATR (angle of trunk rotation or axial trunk rotation)

Front 37

there is a good correlation between scoliometer reading (ATR) and ___?

Back 37

and scoliosis measured using Cobb angle

Front 38

___is different than Cobb Angle?

Back 38

ATR angle

Front 39

5 degree ATR angle requires?

Back 39

radiographic evaluation to determine Cobb Angle (usually correlates to 10-12 degrees Cobb angle) and follow-up screening in 6 months

Front 40

5 degree ATR angle usually correlates to ___Cobb angle?

Back 40

10-12 degrees Cobb Angle

Front 41

7 degrees or greater ATR angle requires?

Back 41

referral to scoliosis specialist (usually correlates to >20 degrees Cobb Angle)

Front 42

a 7 degree or greater ATR angle usually correlates to?

Back 42

to >20 degrees Cobb Angle

Front 43

___should be used for screening only? ___is confirmatory test?

Back 43

scoliometer measurement should be used for screening only; measurement of Cobb Angle is confirmatory test

Front 44

estimates are that a person takes ___gait cycles per year?

Back 44

takes 1/2 to 3 million gait cycles per year

Front 45

with gait, conversely, as the restriction is relieved, ____?

Back 45

the form will move closer to the ideal

Front 46

"structure" adapts with ___? (in gait)

Back 46

adapts with repetition of restriction

Front 47

"gait cycle"= ___=___?

Back 47

"gait cycle"= 1 stride= 2 steps

Front 48

step length=?

Back 48

distance b/w the point of initial contact of one foot and the point of initial contact of the opposite foot

Front 49

cadence=?

Back 49

steps per minute

Front 50

velocity=?

Back 50

cadence X step length (in units of distance per time)

eg: MPH, KPH, etc

Front 51

in normal gait, the right and left step lengths are?

Back 51

are similar

Front 52

width of stride is an average of?

Back 52

2-4 inches

Front 53

length of step=? average?

Back 53

length of step= heel strike of one foot to heel strike of opposite foot

-average= 15inches

Front 54

length of gait cycle (stride)=? average?

Back 54

length of gait cycle (stride)= heel strike of one foot to heel strike of same foot

-average= 30 inches

Front 55

foot angle?

Back 55

20-25 d

Front 56

gait cadence=? normal?

Back 56

cadence= steps/unit of time

normal= 90 to 120 steps per minute

Front 57

reasons for widened base?

Back 57

-decreased sensation on soles of feet

-cerebellar problems

-torn knee cartilage

Front 58

stance phase=___= ___% of gait cycle=___foot and ground relationship?

Back 58

heel strike to toe off= 60% of gait cycle= foot in contact with ground at all times

Front 59

swing phase= ___= ___% of gait cycle= __foot and ground relationship?

Back 59

swing phase=toe off to heel strike= 40% of gait cycle= foot does not contact ground at any time

Front 60

parts of the stance phase?

Back 60

heel strike (HS)

foot flat (FF)

midstance (MST)

heel off (HO)

toe off (TO)

Front 61

heel strike of the stance phase?

Back 61

the heel of the loading extremity "strikes" the ground

Front 62

foot flat of stance phase?

Back 62

the foot fully contacts the ground

Front 63

midstance (MST) of stance phase?

Back 63

body weight passes directly over the supporting extremity

Front 64

heel off of stance phase?

Back 64

heel leaves the ground

Front 65

toe off of stance phase?

Back 65

only toe remains on ground

Front 66

parts of swing phase?

Back 66

acceleration (Acc)

midswing (MSW)

deceleration (Dec)

Front 67

acceleration of swing phase?

Back 67

from tow off until midswing

Front 68

midswing of swing phase?

Back 68

extremity directly below torso

Front 69

deceleration of swing phase?

Back 69

from midswing to heel strike

Front 70

stance phase alternative system?

Back 70

-initial contact=heel strike

-loading response= lower extremity accepts wt of body, pre-tibial muscles contract eccentrically

-midstance= 100% of body wt on lower extremity

-terminal stance= gastrocnemuis and solus at maximum contraction

Front 71

swing phase alternative system?

Back 71

-pre-swing= soleus and gastrocnemius at max contraction (heel strike of opposite foot has occurred and both feet are on ground)

-initial swing= pre-tibial muscles initiate dorsiflexion of foot, knee flexes

-mid-swing= foot clears ground by 1cm, ankle neutral

-terminal swing=ankle neutral, knee extended, ends with heel strike

Front 72

difference between walking and running?

Back 72

walking= heel strike of one foot briefly overlaps the toe off of the opposite foot= a brief period of both feet in contact with ground

running= no double stance phase and there is a period when both feet are off of ground (flying)

Front 73

walking?

Back 73

heel strike of one foot briefly overlaps the toe off of the opposite foot= a brief period of both feet in contact with ground

Front 74

running?

Back 74

no double stance phase and there is a period when both feet are off of the ground

-running is therefore literally jumping or bounding or "flying"

Front 75

___is controlled falling?

Back 75

walking

Front 76

upright posture is a dynamic, ___? (walking)

Back 76

upright posture is a dynamic, unstable ongoing recovery of equilibrium

(center of gravity is highest in upright position)

Front 77

the center of gravity is highest when?

Back 77

in the upright position

Front 78

with regards to walking being controlled falling, there is maximizing __while minimizing__?

Back 78

maximizing motion while minimizing energy

Front 79

with walking, how is there a maximizing motion while minimizing energy?

Back 79

straight line path of center of gravity parallel to ground would require the least energy however the center of gravity moves slightly higher and lower as well as vertically in phases of the gait cycle

Front 80

center of gravity lies___? (when examining gait)

Back 80

lies 5 cm anterior of 2nd sacral vertebra

Front 81

the center of gravity oscillates ____? (when examining gait)

Back 81

oscillates no more than 5cm vertically

Front 82

center of gravity displacement produces? ( in examination in gate)

Back 82

sinusoidal wave

Front 83

collectively, what factors are referred to as "determinants of gait"?

Back 83

-pelvis, knee and ankle are all participants in gait

-pelvic rotation and pelvic tilt are present

-knee flexion and extension

-ankle dorsi-flexion and plantar flexion

Front 84

why does smooth gait require less energy?

Back 84

-more relative starting and stopping consumes fuel--think of city Vs highway driving

-even stride length is more optimal

-rhythmic cadence is more economic

Front 85

__gait requires less energy?

Back 85

smooth gait

Front 86

gait and pelvis mechanism?

Back 86

coordinated movement of: lumbar, sacrum and innominate

Front 87

lateral displacement of pelvis and trunk?

Back 87

-approximately 2cm (1inch) to weight-bearing side during gait

-centers weight over hip

Front 88

pelvis anterior rotation?

Back 88

40d pelvic rotation

-contralateral pelvis as fulcrum

Front 89

ilium rotation is rotation on a __axis?

Back 89

rotation on a transverse axis

Front 90

during ilium rotation, the ilium is rotating __the motion of the leg?

Back 90

opposite the motion of the leg

Front 91

during ilium rotation, what happens at right heel strike? right toe off?

Back 91

right heel strike- the R leg starts posterior motion and the R ilium rotates

right toe off- the R leg moves anteriorly and R ilium rotates posteriorly

Front 92

eccentric contraction?

Back 92

lengthening during contracture (deceleration of forward motion allows gait to be smoother)

pre-tibial muscles lower the forefoot to the ground in a modulated way, immediately following the heel strike

Front 93

concentric contracture?

Back 93

the more familiar shortening during contracture

Front 94

pre-tibial group maximal when?

Back 94

during heel strike

Front 95

quadriceps group maximal when?

Back 95

just after heel strike

Front 96

symmetry of movement in gait analysis?

Back 96

-arm swing

-cadence

-foot motion and abduction

-buttock movement

Front 97

6 determinants of gait?

Back 97

-foot slap or foot drag (muscle weakness)

-inspect shoes for uneven wear

-width of base

-ankle eversion or inversion

-foot abduction or adduction

-assess stability

Front 98

hemiplegic gait?

Back 98

"extensor synergies"

-hip extension and internal rotation

-knee extension

-plantar flexion and foot inversion

Front 99

spastic diplegia?

Back 99

affects "only" the lower extremities

-knee extended

Front 100

compass gait?

Back 100

bipedal gait with movement only at the hip and ankle

Front 101

antalgic gait?

Back 101

counteracting or avoiding pain--limp

Front 102

parkinsonian gait?

Back 102

-small steps, shuffling gait (festinating gait)

-stooped posture

Front 103

gait with weak dorsiflexors of the foot such as L5 radiculopathy or perineal neuropathy?

Back 103

-circumduction of the swing leg

-hip hiking of the swing leg

-swing leg lifted abnormally high (steppage gait)

-seen in motor neuron disease such as polio and in peripheral neuropathy (vaulting on the stance leg)

Front 104

how should cane rest?

Back 104

on the ground with your hand on it and your elbow slightly bent when you are standing up straight

Front 105

a cane should normally be carried in which hand?

Back 105

the opposite hand from your injured leg

Front 106

when should you move cane forward?

Back 106

while injured leg is in swing phase, move the cane forward at the same time

-then, bearing your wt partly on the cane and partly on your injured leg, you will swing the good leg through and take another normal step with it

Front 107

all crutches and canes MUST?

Back 107

have rubber tips

Front 108

proper use of crutches?

Back 108

-crutches placed anteriorly

-pt swings legs forward to crutches

-going down stairs: crutches placed on lower step and legs brought level to crutches

-going up stairs: crutches remain on lower step as good leg is raised to upper step-crutch follow

-single crutch--use same as cane

Front 109

proper use of crutches going up stairs?

Back 109

crutches remain on lower step as good leg is raised to upper step--crutches follow

Front 110

proper use of crutches going down stairs?

Back 110

crutches placed on lower step and legs brought level to crutches

Front 111

how to fit crutches?

Back 111

-adjust length so crutches are 5cm below axilla

-adjust handles so thenar and hypothenar areas can take full wt while elbow is straight