Stance and Gait
Temporal Characteristics of gait: 1. 2. 3.
1. Velocity 2. Step Duration 3. Cadence
Functional Tasks of Gait: 1. 2. 3.
1. Weight Acceptance 2. Single Limb Support 3. Limb Advancement
Immature Walking is characterized by what 8 things?
1. Wide based gait 2. Stepping initiated at hips with stiff knees 3. IC made with entire foot with marked lateral rotation at the hip. 4. Hips in lateral rotation 5. Short steps; increased cadence 6. Exaggerated periods of double limb support 7. Upper extremities used for balance 8. Lack of pelvic mobility
At normal adult walking speeds, one cycle lasts 1 second and has a length of __.__ meters
1.4
Independent walking starts between ___-___ months
11-15 months
At the end of the loading phase the knee is flexed ____ - ____ degrees
15-20
What joint must achieve a minimum of 55-60 degrees of extension by end of pre-swing?
1st MTP
1st half of swing - muscles act as _______________ 2nd half of swing - muscles act as _______________
1st half- accelerators 2nd half- decelerators
During a gait cycle there are how many periods of double limb support?
2 periods
Vertical displacement in the sagittal plane = __-__cm
2-5cm
Sagittal plane - Knee: At IC there is __-__ degrees of flexion after which further flexion occurs
3-5
What plane is the largest and easiest to track during gait movement?
Sagittal Plane
What occurs at midstance and is the point when the body is most unstable?
Single Limb Support
Gait cycle (Stride): Stance = ____%; Swing = ___%
Stance = 60%; Swing = 40%
What is defined as the amount of time the foot is on the floor?
Step Duration
What is defined as the distance between the initial contact (measured at the midpoint of the heel) of one foot to the initial contact of the opposite foot?
Step Length
What is defined as the horizontal distance between the two feet, measured from the midpoint of one heel to the midpoint of the next heel contact? - typically measures between 2 to 4 inches
Step Width
What strategy is used for very large and rapid changes in center of mass?
Stepping Strategy - Essentially one needs to take a step to regain balance and prevent falling
What is defined as the distance between initial contact of one foot and initial contact of that same foot again?
Stride Length
During what phase does plantarflexion occur to assist advancement?
Terminal Stance
What part of stance? As the body continues its forward movement and the heel lifts off the floor, the stance phase progresses into?
Terminal Stance
The development of mature gait is very dependent on first having normal gait prerequisites, which include?
adequate motor control and CNS maturation (which implies an intact neurologic system), adequate ROM, strength, appropriate bone structure and composition, and intact sensation.
The line of gravity passes either anterior or posterior to joint axis - muscles will be required to maintain what?
an upright posture
The body sways in an anterior-posterior direction as well as side-to-side. This sway occurs primarily at the _______-_______ segment
ankle-foot - as evidenced by low-level alternating contractions in antagonistic ankle muscles, principally the anterior tibialis and soleus.
Muscle activity during gait is characterized by '_________'
bursts
By what age should a mature adult walking pattern be demonstrated?
by age 7
The time when both feet are in stance is called what?
double support *important
During unilateral stance, the pelvis drops 8 degrees on what side?
swing side - since the stance leg adducts
Knee moves towards extension reaching full extension at ?
terminal stance
One gait cycle is what?
the heel of one foot touches the ground to the time it touches the ground again
In the sagittal plane, the COM moves up and down _______ during one gait cycle while it moves once from left to right in the frontal plane.
twice - Two vertical smooth sinusoidal oscillations (mvmt) of COM
Maximum lateral displacement occurs during _________ stance
unilateral
What orthopedic gait challenge results in gait that is characterized by: - Initial contact occurring at mid-foot if full extension is limited - Shortened stride length - Knee does not reach full extension at midstance - COM remains lower throughout gait cycle
Knee Motion Restriction
What functional task of gait includes terminal and prestance phases? - the swing phase requires sufficient clearance of the foot from the floor.
Limb Advancement
What is defined as moving from 1 place to another?
Locomotion - Gait is upright locomotion in the particular manner of moving on foot, which may be a walk, jog, or run.
What part of stance? As the stance phase continues, the body's COM moves directly over the foot
Midstance
What condition results in gait that is characterized by: - Decreased Hip and knee extension - Decreased Dorsiflexion at ankle - Trunk and pelvic motions are diminished - Trunk may be flexed - Increased speed with shortening stride length - Patients have difficulty stopping and changing direction
Parkinson's Disease
Sagittal plane - Ankle and Foot: From terminal stance to swing, ankle moves from a ___________ position to _____________.
Plantarflexed position to dorsiflexion.
Small motions during stance posture are called?
Postural Sway
What is commonly assessed using a 'plumb line'
Posture
What part of stance? Metatarsals on the floor
Preswing
What orthopedic gait challenge results in the knees being placed in full extension as quadriceps may not be strong enough to control knee flexion? - Knee may have tendency to hyperextend
Quadriceps Weakness
Gait cycle is divided into '________' and '________' phases
'Stance' and 'Swing'
The muscles that support upright posture (standing anatomical position) are called '______-__________' muscles
'anti-gravity' -These muscle groups primarily include the neck and back extensors, hip and knee extensors, and to a lesser degree, the neck and trunk flexors and hip abductors and adductors
The hip joint moves through 40° of sagittal motion in a single gait cycle. At initial contact, the hip is flexed at __° to __°. As the stance phase continues, the hip progressively moves into extension, reaching its maximum extension at __° of hyperextension by terminal stance.
- 25° to 30°. - 10°
The knee begins to flex (__-__ degrees) during pre-swing and reaches a maximum of __-__ degrees during mid-swing
- 35-40 degrees during pre-swing - 60-65 degrees during mid-swing
Spatial Characteristics of gait: (1-4)
- Step Length - Stride Length - Step Width - Angle of Progression
Effect of an assistive device = - Upper extremities must do what? - Generally requires more _________ - Greater _________ demands
- hold onto device - no reciprocal arm swing - energy - cognitive
Swing subdivisions: 1. 2. 3.
-Initial Swing -Mid-Swing -Terminal Swing
Normal walking speed - one gait cycle lasts how long?
1 second
What are the 3 Recovery Strategies?
1. Ankle Strategy 2. Hip Strategy 3. Stepping Strategy
Spatial characteristics of gait changes in older adults include: 1. 2.
1. Decreased step and stride length 2. Increased stride width
Temporal characteristics of gait changes in older adults include: 1. 2. 3.
1. Decreased velocity 2. Increased stance time; double limb support 3. Decreased swing time
Kinematic gait changes in older adults include: 1. 2. 3. 4. 5.
1. Decreased vertical movement of COM 2. Decreased arm swing 3. Decreased hip, knee, ankle flexion 4. Increased incidence of foot flat at IC (initial contact) 5. Decreased dynamic stability during stance
Stance subdivisions: 1. 2. 3. 4. 5.
1. Initial contact (IC) 2. Loading Response 3. Midstance 4. Terminal Stance 5. Preswing
Mature Walking is characterized by what 5 things?
1. Stability in stance 2. Sufficient foot clearance in swing 3. Pre-positioning of foot during swing for IC 4. Adequate step length 5. Efficient energy expenditure
What is defined as achieving upright locomotion on foot (walk, run or jog)?
Gait
What is a type of locomotion that is used clinically - with or without assistive device?
Ambulation
What is the angle formed between the line of progression in a straight line and a line that bisects the foot at the heel's midpoint and runs between the second and third toes? - Out-toeing of about 7° is typical in mature adults
Angle of Progression
What is defined as postural control initiated at the ankle? -this is the most common automatic adjustment to anterior-posterior sway.
Ankle Strategy
What is the preferred strategy when challenge is small?
Ankle Strategy
What condition results in gait that is characterized by: - Uneven step length - Step width is irregular - Rhythm is absent - Feet are often lifted too high - Arm swing is frequently absent - Incorrect force generation and overall timing
Ataxia
Most fundamental unit of gait = Heel contact to heel contact of same lower extremity called?
Gait cycle (Stride)
What is defined as the distance covered over a unit of time such as meters per second or miles per hour?
Velocity
What condition results in gait that is characterized by: - Flexor muscles active during swing - Extensor muscles active during stance - Pre-mature and continued stance muscle activity - Co-contraction and co-activity patterns - Decreased velocity - Increased energy expenditure to cover same distance as an unimpaired individual as it takes longer - Asymmetrical between involved and uninvolved sides
CVA and Adult Hemiplegia
What is defined as the number of steps completed per unit of time, usually given in steps per minute?
Cadence
What condition results in gait that is characterized by: - Increased Hip flexion / Adduction / Medial Rotation - Weak Hip extensors / Abductors / Quadriceps and leg muscles - Increased energy cost of ambulation
Cerebral Palsy
Curve is Highest at _______________; Lowest at ______________
Curve is Highest at mid-stance; Lowest at Double limb support
Sagittal plane - Ankle and Foot: What occurs during swing and aids in 'clearing' limb?
Dorsiflexion
T/F: Fewer muscles work during stance vs. swing
False - fewer work during swing vs. stance
T/F: The body is stationary when standing in place
False - the body has postural sway when standing
From ___________ through ____________, the thigh moves into a relatively neutral position
From midstance through terminal stance - The hip abducts about 5° during swing phase to assist in clearing the foot from the floor and returns to neutral as it approaches the end of terminal swing
What orthopedic gait challenge results in gait that is characterized by: - Contralateral (swing side) pelvis drops in frontal plane - Trendelenberg Gait - Compensation occurs by leaning towards affected side - Assistive device (cane) recommended on unaffected
Gluteus Medius Weakness
In Mid-Stance, the tibia moves over the fixed foot into dorsiflexion. Maximum DF (10 degrees) is achieved just prior to ?
Heel Rise
What is defined as control of posture from the hip, pelvis and trunk?
Hip Strategy
What is the preferred strategy when challenge is large and fast or if the support surface is too small to accommodate the ankle forces?
Hip Strategy
What part of stance? The stance phase begins when the foot first makes contact with the ground. The heel is usually the foot section involved , but other parts of the foot may contact the ground first in the presence of some pathologic conditions.
Initial contact (IC)
___________ is a particular form of gait and the most common of human locomotor patterns.
Walking
Gait is performed at a __________ level
subconscious
The line of gravity falls on concavity of spinal curves in sagittal plane - What is required to offset this?
Trunk extensor activity
T/F: In the frontal plane, there is little to no motion of the knee
True
T/F: Posture is the alignment of body segments and is inter-related with movement
True
T/F: when you walk, more than 1,000 muscles synchronize to move more than 200 bones around 100 joints
True
T/F: Maximum lateral and vertical displacements occur at the same time of the gait cycle
True - important
T/F: If one pelvis protracts, the other retracts
True - the pelvis rotates forward or protracts 4 degrees on swing side and likewise 4 degrees of retraction on stance side (8 total)
Humans are bipedal and learn to walk in around the ________ year of life
first
Maximum protraction of the pelvis occurs in what stage of gait?
initial contact
Energy expenditure during gait is?
kept minimal
In the frontal plane the pelvis tilts ________ ~8 degrees on each side
laterally
in the frontal plane the body moves ____________ to maintain COM over BOS
laterally
Maximum knee flexion of the entire gait cycle occurs during __________, with the knee at 60° to 65° of flexion.
midswing
During the swing phase of gait, muscles work to control what?
momentum
During Loading Response the ankle rapidly _____________
plantarflexes
During gait, posterior arm swing motion at the shoulder occurs largely through contraction of what muscle? - there are no major muscle bursts with anterior shoulder motion
posterior deltoid
In the transverse plane, what motion moves the anterior pelvis forward?
protraction
The ankle plantarflexes and dorsiflexes twice during the gait cycle. At the moment of initial contact, the ankle joint is in __________ plane _________
sagittal plane neutral
During the middle 40% of its stance, the lower extremity is in what? - The duration of double support varies inversely with the speed of walking
single limb support
Peak activity occurs during what period of gait?
stance
To maintain a __________ position, the body's relatively high center of gravity (COG) or center of mass (COM) at S2 must remain within its relatively small base of support
standing
