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What are the main task of the gait cycle?
- - weight acceptance/ limb loading
- - single limb support
- - limb advancement
WHat is the weight accpetance/ limb loading of the gait cycle?
- - most demanding/ hardest task
- - involves transfer of weight, shock absorption and maintenance of forward progression
What is the single limb support component of the gait cycle?
- one limb supports entire body weight andprovide truncal stability
What is the limb advnacement of the gait cycle?
- requires foot clearance and limb swing
What is the closed kinetic chain?
- - stance phase
- - when the limb is weight bearing movement of distal jt influences the position of the proximal joints
What is the open kinetic chain of gait?
- when the limb is non-weight bearing movement of a proixmal jt influences the position of jts distal
What might cause weak DF?
- weak tib ant or spastic PF
Kinetic energy when walking
- - positive energy involves mm to produce the movement and acceleration
- - negative- decelerating
Describe the mm activity when walking
- - mm act over brief periods- should be submaximal torc
- - involved more in deceleration than progression
- - changing the spee of gait alters mm activation patterns- timing and forces of contractions will change. The slower they walk the more energy is required
What are the passive- elastic mechanisms?
- - soft tissue stretch contributes significantly to power bursts
- - reduces the active energy required
- - passive contributions increase with gait speed- due to a great deal of stretch, increaselength of stride
- - hip flexor stretch at terminal stance- 50% passive
- - Ankle PF- 15% thru passive recoil
What are the mm activity during gait?
What happens if you have mm weakness of the lower limb?
What happens if there is a mm contracture of the lower limbs?
What problems will you have if you have mm spasticity of the lower limb?
- Major problem in mm that cross two joints
PF in gait
- - in walk not that important for gait initiation
- - controlled falling- COP is shifted behind COG by decreasing PF activity you increase DF
- - gait initiation takes about 3 steps until steady state is reached. SOmething to think about
What are the principles of gait retraining?
- - max WB thru legs
- - optimize sensory cues
- - max recovery not compensation
- - evidence- training at faster speed = better
- - use the least restrictive assistive devices or no devices
- - start early, maximise intensity and volume
What are the limitations of gait retraining post stroke?
- -requires many therapists
- - we can be injured
- - often limited by therapist endurance
- - takes time
when do we prescribe walking aids and devices?
- - use of aids and assistive devices is controversial in physio
- - does the use help or delay?
- Need to think of:
- - clinical significance
- - differential effects
- - long term effectiveness
- - pt satisfaction with long term use
- - effectiveness compared with other interventions eg treadmill training
What is treadmill training?
- - pt needs to be able to weight bear
- - pt in sling over treadmill
- - improves independence with mobility, gait speed, strength and symmetry
- - increase cardio fitness and decrease energy expendture
- - safe
- -more symmetrical legs stance and weight shift
- - faster walking practice- can increase speed and volume
- - is adjustable
- - therapist can facilitate missing componenets
NEED to make sure pt hasw right gait patterns and treat trunk control, balance and strenght
electromechanical assisted gait training
- - some evidence that with physio could help
- - cost heaps
- - how often should they be use?
What is the lokomat?
- - robotic gait training system using a BWS treadmill
- - by itself it is not the answer
- Limited by:
- - no pelvic rot
- - too passive
- - therapist cannot control sensory cues or facilitate specific mms
Outcome measurement unidimensional
- gait- look at impairement level
outcome measurement multidimensional?
- - function- what pts care about
- - dual tasks
- - community access
- - participation
- Scales include- timed upand go
- - 6 mint walk test
- - ilanoi agility test
- they increase in difficulty
- Independent walking
- - secondary tasks
- - greater cognitive demands
- - upper limb activities
- - envt demands
- - greater physical demands
- then return to work, sport and leisure activities
- - 75% of neurological cases report community mobility essential or very important
- - only 50% of people with stroke regain independent community mobility
- - inability associated with poor satisfaction, QoL and mood disorders
- - gait speed 48m/min and distance of 90m may be predictive- may be able to do community training
What are the components of community mobility?
- - multidimensional
- - no single measure is sufficient
- - no singleintervention will be sufficient
- Associated factors:
- - age and sex- men better
- - strength of affected limbs
- - usual gait speed
- - environmental self efficacy- big thing
- - psychological factors
Real world walking
- - functional needs to involve a turn
- - for indoor activities such as shopping 35-50% of all steps involve a turn
- - 40% of all walking bouts are less than 12 steps- stop/ start
- - 50 steps in a row accounts for 0.7% of total walk bouts
- - 60% of walking lasts <30 sec
Community mobility things to think about?
- - stroke pts use 2x energy to walk than non stroke
- - increased energy requirement for walking in neurological conditions
- - fatigue common symptoms
- - functional implications
- - how long would it take a person to walk 150m from a parking space to the bnak- 2 min normal, stroke 6 min
- stroke pts ned to be fit due to the high energy demands
Cognitive tasks and gait
- - speech prodces more gait interference than memory and visuospinal tasks
- - even when pts are mobility impaired they priortize the cognitive tasks
- - optimal time to introduce dual task training
Points for training people's gait post stroke
- - importance of speed
- - effort of mobilising- up 2x for stroke
- - practice task in its entirety
- - flexible envts
- - cognitive ability
- - ability to self monitor
- - CV fitness
- - use of aids
How strong does someone need to be to run?
at least grade 4
how good does ur balance have to be to run?
dynamic tests needed
what quality of walking do you need before you can run?
best indicator, need stable ankle and knee
You need to understand pts goals and a bench mark for pt
Why is running a high level activity important
- - running extends locomotor ability
- - the bability to take a quick step if required
- - faster transport between places
- - crossing the road before the lights change
- - avoiding dangerous situations
- - to play and care for small children
- - method for promoting fitness and social participation
- - for all these activities you need to increase your speed
Do you have more pelvic rot in running or walking?
what are the ground reaction forces for running?
- - Verticle GRF 3x BW (walking 1x)
- - AP GRF 30% BW (walking 15%)
Centre of gravity when walking and running?
- - walking mid stance- high point
- - running mid stance- low point
What is the role of the 2 jt mm in running?
- - work isometrically
- - transfer energy from one jt to the next therefore reducing metabolic demands
- - are unique in that they often work in opposing actions at adjacent jts
What are the three main events that produce power in running?
- - push off
- - hip extension early in stance
- - hip flexion in late stance
what produces acceleration when running?
- - push off
- - hip flexion in late stance
- - greater proportion of swing phase
- - ball of foot contact
- - calf is primary shock absorber
What is required on a hill?
- - significantly greater jt moments at knee and ankle
- - significantly greater quads activity
uphill what do you need?
- - predominantly concentric
- - maintain gait speed by shorter stride length and greater stride rate
Downhill what do you need?
- predominantly eccentrically
When walking up the stairs what do u need?
- - WB through ball of foot
- - Greater ROM, jt movements and powers
- - almost completely concentric
- - stance phase called pull up
- - no heel strike
When descending stair what do we need to understand?
- - WB through lateral border of ball of foot
- - greater ankle ROM, similar to knee ROM, less hip ROM
- - almost completely eccentric
- - you need more DF to go down- ankle at back
When running backwards
- - slower velocity
- - greater cadence, shorter stride
- - requires significantly greater mm activity, esp quads and gluts
- - shows a greater training effect for mm strength than forward running