ClinKinesExam2

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kdarnell
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70715
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ClinKinesExam2
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2011-03-12 22:06:48
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  1. What is required for normal gait?
    intact nervous system, muscular system, skeletal system
  2. individual gait characteristics affected by?
    genetics

    environment

    non-verbal communication

    culture/ethnicity

    emotional state
  3. Reference foot: Initial contact

    non-reference foot=?
    preswing
  4. reference foot loading response

    non-reference foot=?
    preswing
  5. reference foot- midstance

    non-reference foot=?
    initial and midswing
  6. reference foot-terminal stance

    non-reference foot=?
    terminal swing
  7. reference foot-preswing

    non-reference foot=?
    initial contact--->loading response
  8. reference foot-initial swing

    non-reference foot=?
    midstance
  9. reference foot-midswing

    non-reference foot=?
    midstance
  10. reference foot-terminal swing

    non-reference foot=?
    terminal stance
  11. stride length =?
    distance from 1 heel strike to the next heel strike of the same foot.

    1 full gait cycle

    4 feet
  12. stance phase=?
    when foot contacts surface until it leaves surface

    60% of gait cycle
  13. initial contact =?
    moment foot contacts ground
  14. loading response=?
    weight transfered onto outstretched limb

    1st period of double limb support

    most demanding task-need shock absorber
  15. midstance=?
    body progresses over a single stable limb

    single limb stance
  16. initial contact--->midstance
    restraining period

    action of putting on brakes to slow the body down from swing
  17. terminal stance
    body moves ahead of the limb and weight is transferred onto the forefoot

    begins with heel rise and continues until opposite LE contacts the ground
  18. preswing (toe-off)
    unloading of the limb occurs as weight is transferred to the opposite limb

    double support
  19. swing phase=?
    moment toe leaves ground the ground and ends just before the heel makes contact with the ground

    40% of gait cycle
  20. inital swing=?
    thigh advances as the foot comes up off the floor

    from the time the foot leaves the floor until maximum knee flexion of the reference limb
  21. initial swing--->mid swing
    acceleration

    advances the leg; toe leaves the ground until directly under the body
  22. mid-swing=?
    thigh continues to advance as the knee begins to extend; the foot clears the floor
  23. terminal swing=?
    knee extends, limb prepares to contact the ground for IC

    deceleration
  24. midswing-->terminal swing
    deceleration
  25. double limb stance
    20% of gait cycle

    heel of 1 foot and toe of other foot touch ground

    decreases with increased speed

    does not exist in running
  26. step width=?
    midline of 1 heel to midline of other heel

    about 2-4 inches (8cm)
  27. step length=?
    IC of 1 foot to IC of opposite foot

    1/2 of gait cycle

    2 feet
  28. stride time=?
    amount of time 1 LE spends completing a gait cycle (swing and stance)

    1-2 seconds per gait cycle
  29. cadence=?
    number of steps/minute

    normal = 100-115
  30. speed=?
    normal person's walking speed

    2.25-5 mph or 80 m/min
  31. velocity=?
    measure of distance over time
  32. norma toe out
    about 7-10d
  33. qualitative kinematic analysis
    movement without regard to forces involved in producing movement
  34. kinetic gait analysis
    assessment and analysis of the forces that act on the body or body parts during gait

    for every external torque force body responds with internal torque force (muscle contraction, ligament resistance)
  35. Newton's 3rd law of
    every action has an equal and opposite reaction

    ground force reactions= force from ground that strikes back once contact made
  36. COG displacement in normal walking
    sinusoidal curve

    • total vertical displacement 2 inches
    • -(summit)occurs midstance on 1 leg, mid swing on other leg
    • -(valley) occurs at double limb stance in IC one 1 side and pre-swing on other

    total horizontal displacement 2 inches
  37. what are the 6 determinants of gait?
    • 1. lateral displacement of the pelvis (shift over)
    • 2.lateral pelvic tilt
    • 3.pelvic rotation
    • 4.knee flexion in stance (keeps COG f/ getting high)
    • 5. knee mechanisms
    • 6.foot mechanisms
  38. Pelvic motions in gait?
    normal lateral tilt ~ 2-4 inches

    high point is during midstance low point during initial contact

    normal pelvic rotation ~ 8 inches
  39. Factors that control lateral COG displacement (4)
    • 1. pelvic rotations
    • 2.medial femoral angulation
    • 3.knee genu valgus
    • 4.inertia
  40. factors that prevent COG from rising (2)`
    • 1. lateral pelvic tilt
    • 2.knee flexion and ankle PF in stance
  41. factors that prevent COG from falling (1)
    IC with knee extended (knee/foot mechanisms) horizontal pelvic rotation, terminal stance heel rise
  42. opposite pelvic drop (lateral pelvic tilt)
    ~ 4 d of pelvic drop

    downward tilt of pelvis toward swing side

    decelerated by hip abductors on the opposite leg
  43. collision at heel strike creates negative work...how do you compensate?
    by positive work: muscular effort to keep from forward progression
  44. good push off just prior to IC of swing leg can increase/decrease negative work of the collision?
    decrease
  45. Energy costs: answer by increase/decrease
    narrow step widths
    longer steps
    faster steps
    decrease

    increase

    increase
  46. in early stance, the foot needs to act as a _______?
    shock absorber
  47. in preswing the foot needs to act as ______?
    push off lever
  48. decreased sensation =?
    greater step width

    increased energy expenditure
  49. when in gait cycle are the major muscles groups active?
    beginning and end of stance and swing
  50. muscles the initiate movement are stretched beyond resting length first due to momentum....?
    hip flexors (lift and bring forward)
  51. much of the muscle activity in gait is eccentric to decelerate motion or resist the force
    DF (control)
  52. GFRF in IC-->LR
    posterior to ankle which creates a PF moment = eccentric
  53. DF in midstance-->terminal stance
    inactive
  54. DF in preswing-->midswing-->terminal swing
    concentric

    helps to clear foot from hitting ground
  55. calf muscles in gait
    not active in IC-->LR
  56. GFRF in late LR-->Midstance-->terminal stance-->Psw
    anterior to ankle= DF moment
  57. calf muscles in late LR-->to midstance=
    eccentric---restrains forward movement
  58. calf muscles in terminal stance-->preswing
    concentric= need push off
  59. quads in IC-->LR
    controls knee flexion

    eccentric
  60. GFRF in knee during IC-->LR
    posterior= flexion moment
  61. quads in LR--> midstance
    knee extension

    concentric contraction
  62. quads in midstance-->terminal stance
    silent/inactive

    begin contracting again in last half of swing

    =concentric

    to prepare for IC and stablilize
  63. hamstrings in IC-->LR
    help prevent increased hip flexion stabilize for extension

    eccentric
  64. GFRF in hip during IC-LR
    anterior to hip joint

    creates flexion moment
  65. hamstrings in midstance
    inactive
  66. when are hamstrings active in gait
    toward end of swing phase

    decelerate forward swing of leg

    in MSw-->TSw-->LR=eccentric
  67. glute max in gait
    most active during IC and immediately after LR

    controls hip flexion=eccentric
  68. GFRF in hip
    anterior

    creates flexion moment
  69. glute max inactive during?
    midstance and rest of stance phase
  70. hip flexors are silent in?
    ic-midstance

    midswing-terminal swing

    stance phase
  71. hip flexors are active when?
    just before preswing-->midswing

    short burst of activity in initial swing to mid swing

    concentric contraction
  72. hip abductors are active when?
    midstance

    IC-->midstance

    eccentric contraction
  73. GFRF falls medial to hip jt =?
    adduction moment
  74. hip abductors contribution in gait?
    control lateral pelvic tilt on swing side
  75. hip abductors are also active with what other muscles?
    glute max and quads
  76. erector spinae in gait
    stabilize trunk in LR
  77. Abs in gait
    internal and external obliques active throughout gait cycle at low level
  78. posterior deltoid
    decelerate arm during foward arm swing and initiate backward swing
  79. @ IC what type of moment is at the ankle
    PF
  80. what muscles are active at the ankle?
    DF=eccentric
  81. what is the moment at the knee at IC-->LR
    flexion
  82. what muscles are active at the knee?
    quads=eccentric
  83. what is the moment at the hip during IC-->LR
    flexion
  84. what muscle are active at the hip?
    glute max, hamstrings=eccentric
  85. Muscles active in IC
    quads, hamstrings, DF
  86. muscles active in LR
    quads, glute max
  87. muscles active in midstance
    quads, soleus, gastoc
  88. muscles active in terminal stance
    soleus, gastoc
  89. muscles active in pre-swing
    adductor longus, rectus femoris
  90. muscles active in initial swing
    hip flexors, DF
  91. muscles active in mid swing
    hip flexors, DF
  92. muscles active in terminal swing
    hamstrings, quads, DF
  93. Effects of DF weakness/poor timing?

    1-deviation w/o compensation results in IC--LR ____

    2- with compensation in IC _____

    3- deviation w/o compensation in swing _____

    4-with compensation in swing ______
    1- foot drop

    2-flat foot or toe contact

    3-foot drop/toe dragging

    4-steppage gait (may circumduct, hip hike, vault walk)
  94. other anomalies during IC

    1-toes contact first =?

    2-flat foot contact=?
    1- PF contracture, antalgic heel

    2-fixed DF
  95. PF muscle weakness/poor timing

    1-IC--Tst=?

    2-Tst--Psw=?
    1-excessive DF, uncontrolled tibial advance compensation-step to gait

    • 2-decreased opposite step
    • compensation-whole foot lifted off ground
  96. why do some people drop their pelvis on the affected side at the last moment of stance? (midstance--terminal stance)
    don't have PF to push you up and forward-fall off the flat foot

    have rapid uncontrolled movement of the tibia over the foot
  97. quads:

    1-with weakness/poor timing--


    2-swing--
    1-excessive knee flexion or trunk lean forward with strong PF-causes knee to hyperext (can use hand to extend knee)

    2-mid swing--terminal swing--inad terminal knee extension
  98. why does a person with quad weakness exhibit knee hyperextension?
    knee hyperext and hip extension the GFRV is anterior to the knee and posterior to the hip stabilizing these joints

    == hang on ligaments
  99. hamstrings:

    1-with weakness/poor timing

    2-deviations
    • 1-affects swing phase most
    • -decreases the ability to slow the forward swing of the leg

    • 2-rapid/uncontrolled knee extension/hip flexion
    • -lands with a harsh heel
  100. phase most affected by glute max weakness/poor timing
    early stance phase
  101. deviations of glute max (3)
    1-backward throwing of trunk and pelvis just after IC on affected side with knee hyperext (no hip flexion moment)

    2-forward protrusion of the affected hip due to trunk motion--increased hip flexion and anterior pelvic tilt

    3-tightly extended/hyperextended knee in midstance resulting in elevation of the hip during full weight bearing
  102. hip flexors:

    1-with weakness/poor timing

    2-deviations
    1-swing phase most affected

    2-circumduct/hip hike

    • -backward throwing of the trunk and pelvis as a unit followed by pelvic flexion
    • -whole deviation last from terminal stance/preswing to midswing
  103. Biomechanics of normal hip:
    center of mass is _____to hip

    causes a ______moment at the hip joint

    pelvis on swing side is pulled _____

    resisted by action of the _____ and _____ on stance side

    hip joint acts as a (1st, 2nd, 3rd) class lever?
    1-medial

    2-rotary

    3-down

    4-glute med, glute min

    5-1st class lever
  104. hip abductors:

    weakness/poor timing
    phase affected most is stance
  105. deviations of hip abductors
    --uncompensated glute med gait
    increased lateral pelvic tilt on unaffected side, IC of affected side

    -IC of unaffected side- lateral protrusion of affected hip sliding of entire trunk/pelvis toward affected side

    often results in steppage gait
  106. deviation of the hip abductors
    --compensated glute med gait
    -dropping of pelvis on unaffected side, IC of affected side--

    -medial devation of affected hip instead of a protrusion

    -lateral flexion over affected hip with dipping of the shoulder on same side

    decreased steppage gait
  107. biomechanics of uncompensated glute med gait:
    -glute med is unable to overcome the force (resistance) of body weight being pulled down by gravity

    -what happens? during what phase?

    -hip _____is increased on ______side (stance side)

    -hip will appear more protrude and weak during _____
    -pelvis drops during swing phase

    -adduction .....affected side

    -stance
  108. biomechanics of compensated glute med gait:
    -COG is moved ___ (medial to lateral) to compensate and decrease pain

    -______in resistance lever means glut med and min do not have to work as hard to hold pelvis up and pelvis wont drop

    decreased glute med force + decreased body weigh force = _______resultant force on hip jt

    lateral trunk flexion over _____

    -movement of the entire pelvis _______

    -decreased/increased stance phase time on involved/affected stance side
    -closer

    -reduction

    -decreased

    -affected side

    -laterally

    -decreased stance phase time
  109. Unilateral stance biomechanics
    gravity and tension of adductors creates a rotary force between femoral head and acetabulum that is greater than body weight
  110. implications for using a cane during ambulation:
    decreases:
    force need to stabilize pelvis by weak hip abductors

    rotary movements at hip

    pain
  111. what does the cane do during gait?
    upward force which raises the hip during swing phase--opposes downward force of bodyweight which decreases hip abductors work on stance side

    changes hip from 1st class lever to 2nd class lever
  112. key points of gait:
    -more weight on cane =

    -countertorque by _____ decreases need for abductors

    -both affect the body weight from pulling the pelvis __

    -___________ by placing weight on cane

    = _______compressive forces on hip and results in ______ pain
    less force required by abductors

    lats

    down

    decreasing force of body weight

    less compressive forces

    decreased pain
  113. other possible causes of gait deviations besides muscle weakness?
    decreased ROM

    excessive ROM

    pain

    abnormal tone

    contractures
  114. knee surgeries...how does it impact gait?
    decreased stance, force, compensated glut med gait
  115. Genu valgus

    stressed/stretched structures

    compressed stuctures
    stressed structures-medial

    compressed-lateral
  116. genu varus

    stressed/stretched structures

    compressed structures
    stressed-lateral

    compressed-medial
  117. genu recurvatum (hyperextension)

    structure stressed/stretched

    structures compressed
    stressed-posterior capsule, muscles/ligs, poor position of patella

    compressed- anterior structures, hamstrings?
  118. what happens with a knee flexion contracture greater than 20d?
    decreased stance time

    decreased knee movement

    possible compensated glut med gait
  119. when the knee is restricted near full extension what happens?
    leg length discrepancy

    increased energy expenditure

    decreased walking speed
  120. gait resulting from pain = antalgic
    -occurs during stance phase

    -step length on non affected side decreased

    -decreased walking velocity and cadence

    -dampening of IC and terminal stance/preswing

    -exhibit compensated glut med gait
  121. foot pain results in.....
    dampen terminal stance--preswing

    -flat foot gait

    -pick up foot as a unit
  122. heel pain results in.....
    dampen IC or avoidance

    pain in IC--terminal stance

    decreased stance time

    possibly compensated glut med gait
  123. leg length discrepancy can result in.....
    vaulting

    circumduction

    hip hiking

    steppage gait

    abducted gait
  124. vaulting

    definition and deviation
    definition-excessive vertical displacement of the body on stance leg to compensate for longer limb

    deviation-increased PF during late stance of shorter leg head bobs up and down
  125. circumduction

    definition and deviation
    longer leg abducts during swing phase only but will come back to midline for stance phase
  126. hip hiking
    pt will shorten longer leg in swing by hiking hip up with quadratus lumborum, erector spinae, abs

    -can also be done to compensate hip flexor weakness or extensor spasticity in the swing leg
  127. steppage gait

    definition/deviation

    purpose/cause
    definition/deviation-excessive hip and knee flexion during swing phase

    purpose/cause-compensates for DF weakness

    can also be seen in hamstring weakness of swing phase when hamstrings can't decelerate leg
  128. abducted gait

    def/deviation

    reasons for use
    def/deviation-continuous abduction of long LE in all phases of gait

    wide base gait

    • reasons-leg length discrepancy
    • -increased stability
    • ITB or hip abductor shortness
    • -neuro dysfunction
  129. functional ambulation
    includes use of aids, transfers, distances to cross street or to get from 1 part of house to another, safe, secure

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