CHS 371 Exam 2 - Normal Gait

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CHS 371 Exam 2 - Normal Gait
2013-03-13 15:16:35

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  1. Locomotion
    The act of moving from place to another
  2. Gait
    the manner of walking
  3. Walking
    a smooth, high coordinated, rhythmical, undulating, reciprocal movement by which the body moves step by step in the required direction at the necessary speed
  4. gait cycle
    the period of time from one event (usually initial contact) of one foot to the following occurrence of the same event with the ipsilateral foot

    right foot touches ground then right foot touches ground again.
  5. Stride
    = 1 gait cycle

    is described as the period from the intial contact of a particular lim to the point of initial contact of the same limb and is equivalent to one gait cycle
  6. step
    the period from initial contact of one limb to the initial contact of the contralateral limb. (two steps in each stride/gait cycle
  7. Stance phase
    The period of time when the foot is in contact with the ground
  8. swing phase
    the period of time when the foot is not in contact with the ground.

    where the foot never leaves the ground (foot drag) when all portions of the foot are in forward motion
  9. Double support
    both feet are in contact with the ground

    occurs twice in the gait cycle at the beginning and end of the stance phase
  10. Single support
    only one foot is in contact with the ground

    this is = to the swing phase of the other limb
  11. Initial contact
    the pint in the gait cycle when the foot initially makes contact with the ground.

    beginning of stance phse

    (foot strike)
  12. terminal contact
    when the foot leaves the gorund

    the end of the stance phase/beginning of swing phase (foot off)
  13. Toe off
    when terminal contact is made with the toe
  14. Foot flat
    the point in time in the stance phase when the full foot is in contact with the ground
  15. heel off
    the point in the stance phase when the heel leaves the ground
  16. Step length
    the distance from a point of contact with the ground of one foot to the following occurrence of the same point of contact with the other foot.

    the right step length is the distance from the left heel to the right heel when both feet are in contact with the ground. Measured in meters
  17. step period
    the period of time taken for one step and is measured from an event of one foot to the following occurrence of the same event with the other foot expressed in seconds
  18. stride length
    the distance from initial contact of one foot to the following initial contact of the same foot

    (cycle length meters)
  19. stride period/cycle time
    the period of time from initial contact of one foot to the following initial contact of the same foot (seconds)
  20. velocity
    the rate of change of linear dislacement along the direction of progression measured over one or more strides, expressed in m per second
  21. cadence
    Rate at which a person walks expressed in steps per minute
  22. stance/swing ratio
    the ratio of stance period to the swing period
  23. Walking base
    the side to side distance between the feet which is typically measured from ankle joint center
  24. natural cadence/velocity
    the rate of walking that is voluntarily assumed
  25. Gait
    controlled be the central nervous system

    afferent stimuli -tactile impulses from the sole of the foot

    proprioceptive impulses from the lower limb, trunk and neck
  26. Normal Gait
    The body can stand upright and bear weight evenly on both limbs

    the body can alternate weight on one limb while bringing the other limb forward

    the movements necessary for walking are present and coordinated (trunk and arms)
  27. Stance phase
    constitutes 60% of gait cycle
  28. Swing phase
    constitutes 40%of the gait cycle
  29. Stages of Stance phase
    • initial contact
    • loading response
    • mid-stance
    • terminal stance
    • pre-swing
  30. Initial contact
    double support

    the initial contact of the leading stance foot and the toes of the other foot are both on the ground
  31. Loading response
    weight transferred onto the outstretched limb

    the first period of double support
  32. Mid- stance
    opposite limb leaves the floor until body weight is aligned over forefoot

    body progresses over a single, stable limb
  33. Terminal stance
    the heel is raised as the body moves forward over the stance limb

    body moves ahead of the limb
  34. pre-swing
    second double support stance period

    initial contact of contralateral limb to ipsilateral toe off

    unloading limb occurs as weight is transferred to the contralateral limb
  35. Stages of swing phase
    • Initial swing
    • mid-swing
    • terminal-swing
  36. Swing phase
    non-weightbearing phase of the reference limb

    begins when the foot of the reference limb leaves the ground after foot off, and finishes just prior to initial contact of the same limb
  37. Initial swing
    begins once the foot of the swing limb leaves the ground until the swing limb is directly under the body or at maximum knee flexion
  38. mid-swing
    begins from maximum knee flexion )when the swing limb is under the body) until the swing limb passes the stance limb
  39. terminal swing
    limb moves into the stance phase again

    tibia is in vertical position
  40. Initial contact
    • ankle: neutral
    • knee: flexed
    • hip: flexed
  41. Loading Response
    • ankle:plantarflexed
    • knee: flexed
    • hip: flexed
  42. Mid-stance
    • ankle:dorsiflexed
    • Knee: extended
    • hip:neutral
  43. Terminal stance
    • Ankle: plantarflexed
    • Knee: flexed
    • Hip:extended
  44. Pre swing
    • ankle:plantarflexed
    • knee:flexed
    • hip:neutral
  45. Initial swing
    • ankle:plantarflexed
    • knee:flexed
    • hip:flexed
  46. Mid-swing
    • ankle:dorsiflexed
    • knee:extended
    • hip:flexed
  47. Terminal swing
    • ankle:dorsiflexed
    • knee:extended
    • hip:flexed
  48. Muscle action: initial contact
    ankle: tibialis anterior and toe extensor

    knee: quads contract

    hip: hip extensors
  49. Muscle action: loading response
    ankle: plantarflexion torque

    Knee: eccentric quads

    hip:extensor muscles, gluteus
  50. muscle action: mid-stance
    ankle: soleus and gastrocnemius

    knee:quads, calves

    hip: pelvis, hip abductors
  51. Muscle action: terminal stance
    ankle: calf muscles

    knee: calf muscles

    hip: TFL
  52. muscle action: pre-swing
    ankle: residual plantar flexion

    knee: gracilis

    hip: adductor longus
  53. Muscle action: initial swing
    ankle: pre-tibial muscles

    knee: biceps femoris short head, sartorius and gracilis

    Hip: illiacus, gracilis, and sartorius
  54. muscle action: mid-swing
    ankle: pretibial muscles

    knee: hamstrings

    hip: hamstrings
  55. muscle action: terminal swing
    ankle: pretibial muscles

    knee: quads, hamstrings

    hip: hamstrings, gluteus muscles and TFL
  56. Osseous
    congenital, developmental, metabolic, neoplastic
  57. Neurological
    sensory,motor,spastic, paralytic
  58. muscular soft tissue
    contractures, fibrosis, laxity, metabolic
  59. functional
    lack of coordination, neuromuscular
  60. Factors of Pathological gait
    • pain during movement
    • loss of muscle power
    • increased or fluctuating muscle tone
    • lack of muscle coordination
    • skeletal deformities
    • pregnancy
    • brain injury
    • spinal cord injury
    • peripheral nerve injuries
    • fractures of bones
    • degenerative conditions
  61. Scissoring gait
    a spastic child with marked bilateral adductor spasm at the hips and equinus spasm in the ankle
  62. parkinson's gait
    AKA festinating gait

    increase in cadence,shortened stride, lack of heel strike and toe off, diminished arm swing, hunched over, foot is flat
  63. Cerebellar gait
    coordinating functions of the cerebella are interfered with, so the person walks with a wide base of gait with an unsteady, irregular gait, even if watching feet.
  64. ataxic gait
    Spinal - proprioceptive pathways of the spine or brainstem are interrupted

    • loss of position and motion sense
    • ambulates with a wide base of gait with foot slab at heel contact

    often watch feet as they walk
  65. hip extensor weakness
    AKA gluteus maximus lurch

    individual will throw hip backwards with a lurch using abdominal and paraspinal muscle activation just after heel strike on the affected side

    also seen in dislocated hip and muscular dystrophy
  66. Hip flexor weakness
    major accelerators in swing phase

    results in a limp starting during the stance phase at push off persisting throughout the swing phase of the affected side

    person will demonstrate a trunk lurch backward and toward the unaffected side from push off to midswing
  67. gluteus medius weakness
    AKA tredelenberg gait

    drop of the pelvis more than usual 5* on the unaffected side beginning with initial contact on the affected side and continuing until initial contact on the unaffected side

    lateral excursion occurs on affected side

    may compensate by laterally bending trunk to the affected side
  68. Quadricep weakness
    most apparent during initial contact through the stance phase of gait

    affected knee must be locked in hyperextension at or preceding initial contact by compensatory activity of the gluteus maximus extending femur and soleus which extends the tibia

    repetitive hyperextension of the knee results in stretching of the ligaments and capsule of the knee and resultant recurvatum of the knee during the stance phase
  69. Gastrocnemius weakness
    results in loss of ankle plantarflexion control

    foot off will be delayed and the push off phase will be decreased
  70. ankle dorsiflexion weakness
    AKA drop foot, slap foot, steppage gait

    with mild weakness, the gait abnormality will be noted at heel strike and results in loss of plantarflexion control

    loss of dorsiflexion produces a high knee lift to raise the foot clear off the ground
  71. Over Pronation
    • cause
    • Genetic: excess hip IR or Genu Valgus
    • compromise of the medial longitudinal arch
    • injury/weakness to tibialis posterior muscle
  72. Antalgic gait
    person tries to avoid pain associated with weight-bearing and ambulation

    often quick, short and soft foot steps