GAIT Flashcards

Stride - the activity that occurs between the time one foot touches the floor and the time the same foot touches the floor again.

The distance traveled during the gait cycle.

1/2 a stride.

The distance between the heel strike of one foot and the heel strike of the other foot.

The speed of the steps. respective to speed - increase speed - increase step length and vice versa.

Walking speed - is the number of steps taken per minute. Can vary greatly. Slow - around 70 steps per minute. Fast - as many as 130 steps per minute. Racewalkers - more.

Stance Phase and Swing phase.

The activity that occurs when the foot is in contact with the ground. Begins with the heel strike of one foot and ends when that foot leaves the ground.

60%

Occurs when the foot is not in contact with the ground. It begins as soon as the foot leaves the floor and ends when the heel of the same foot touches the floor again.

40%

Weight acceptance, single leg support, and leg advancement.

Occurs at the very beginning of stance phase when the foot touches the ground and the body weight begins to shift onto that leg.

Occurs after weight acceptance - as the body weight shifts completely onto the stance leg so that the opposite leg can swing forward.

During the swing phase.

When both feet are in contact with the ground at the same time. Occurs as one leg is beginning it's stance phase and the other leg is ending it's stance phase. Takes up about 10% of total gait cycle.

a time during which neither foot is in contact with the ground - does not occur in walking (does in running. Biggest different besides speed between running and walking!)

Occurs when only one foot is in contact with the ground. Takes up about 40% of the gait cycle.

The gait Laboratory at Rancho Los Amigos Medical Center .

Traditional - points in time
RLA - periods in time.

Trad - heel contacts the ground
RLA term - initial contact- same

Trad - plantar surface of the foot in contact with the ground
RLA - term - loading response
Beginning: just after initial contact when body weight is being transferred onto leg and entire foot makes contact with the ground.
Ending: opposite foot leaves the ground

Trad - point at which the body passes over the weight-bearing leg

RLA - term - midstance
Beginning: opposite foot leaves the ground
Ending: body is directly over the weight bearing limb.

Trad - Heel leaves the ground, while ball of the foot and toes remain in contact with the ground.

RLA term - terminal stance
Beginning: As the heel of weight bearing leg rises Ending: initial contact of the opposite foot: the body has moved in front of the weight-bearing leg.

Trad - Toes leave the ground, ending stance phase
RLA term - preswing
Beginning: initial contact and weight shifted onto the opposite leg Ending: just before toes of weight bearing leg leave the ground.

Trad - the swing leg begins to move forward -

RLA term - initial swing
Beginning: the toes leave the ground
Ending: the swing foot is opposite the
weight bearing foot, and the knee is in
maximum flexion.

Trad - the swing (non-weight bearing) leg is directly under the body

RLA -term - midswing Beginning: the swing foot is opposite the weight-bearing foot
Ending: the swing leg has moved in front of the body and the tibia is in a vertical position

Trad - the leg is slowing down in preperation for heel strike

RLA -term - terminal swing Beginning: the tibia is in a vertical position
Ending: just prior to initial contact

1 - heel strike 2 - foot flat 3 - midstance 4 - heel-off 5 - toe-off - sometimes it's 4 phases and heel-off/toe off are considered push off.

heel strike

when the entire foot is in contact with the ground - occurs shortly after heel strike.
Comparable to RLA - loading response.

Heel strike - Foot flat - midstance - heel off
toe off
Initial cont. loading rep midstance terminal stance preswing

Activity - stance phase begins - task of weight acceptance begins - double leg support begins - body at lowest point in cycle.
Key points to observe - head and trunk are upright throughout cycle, ankle dorsiflexed to neutral, knee extended, hip flexed, leg in front of body, pelvis rotated forward-ipsilateral side - ipsilateral arm back, contralateral arm forward.

Activity - weight shift onto stance leg continues - double leg support ends
Key points to observe - angle plantar flexes putting foot on ground, knee partially flexed, absorbing shock, hip moving into extension, body catching up with leg, ipsilateral arm swinging forward

Activity - body at highest point in cycles, single leg supports begins
Key points to observe - ankle slight dorsiflexed, knee and hip continue extending, body passes over right foot, pelvis in neutral position, both arms parallel with body

Activity - body moves ahead of foot, single leg support ends
Key points to observe - ankle slightly dorsiflexed, then begins plantar flexion, knee extending, then beginning slight flexion, hip hyperextending, body ahead of stance leg, pelvis rotating back - ipsilateral side, ipsilateral arm swinging forward.

Activity - task of leg advancement begins, double leg support begins and ends
Key points to observe - ankle plantar flexed, knee and hip are flexing, lateral pelvic tilt on right side, ipsilateral arm forward

Activity - swing phase (non-weight bearing) begins, single leg support begins on contralateral side
Key points to observe- ankle beginning to dorsiflex, knee and hip continue flexing, leg is behind body but moving forward, pelvis beginning to rotate forward, ipsilateral arm swinging backward.

Activity - leg shortens to clear floor, single leg support on contralateral side continues
Key points to observe - ankle dorsiflexed, knee at maximum flexion and begins to extend, hip at maximum flexion, leg passing under and moving in front of body, pelvis in neutral position, arms parallel with body and moving in opposite directions

Activity - leg advancement task ends, single support ends
Key points to observe - ankle continuing in dorsiflexion, knee extended, hip flexed, leg ahead of body, pelvis rotated forward-ipsilateral side, ipsilateral arm back, contralateral arm forward.

That horizontal chalk line that shows variations in your height with gait. Highest at midstance and lowest at heel strike. Typically 2 inches of variation.

center of gravity as the body weight shifts from side to side. greatest during the single leg support phase at midstance. The distance a body must shift horizontally onto one foot so that the other foot can swing forward. typically 2 inches of variation.

2 to 4 inches - this is called the width of walking base.

Erector spinae group (same side - non-weight bearing) and hip abductors (opposite side - weight bearing).

Age
Younger - wider base, faster cadence and shorter stride length, flat footed, knees remain mostly extended during stance phase. short/choppy steps in a faster time frame. little or no arm swing.
Older - security and fear play a role as well as loss of muscle mass, being less active and often poorer hearing and vision. slower, more time in stance phase, longer periods of double support, vertical displacement is less. wider base, greater horizontal displacement.

Muscular weakness/paralysis
Joint/muscle range-of-motion (ROM) limitation
Neurological involvement
Pain
Leg length discrepancy

Shifting the center of gravity over, or toward the part that is involved. This reduces torque on the joint, lessening the muscle strength required.

The trunk shifts posteriorly at heel strike (initial contact) Rocking Horse Gait - because of the extreme backward-forward movement of the trunk.

The individual shifts the trunk over the affected side during stance phase. The body leans over the left (weak hip abductor on left side) during the legs stance phase, and the right side of the pelvis drops when the right leg leaves the ground and begins the swing phase. Referred to as Trendelburg gait.

The individual may lean the body forward over the quadriceps muscles at the early part of stance phase, as weight is being shifted onto the stance leg.

During stance phase, the knee will go into excessive hyperextension, sometimes referred to as genu recurvatum gait. Knee snaps into extension.

Determines how the individual will compensate. If there is insufficient strength to move the ankle into DF at the beginning of stance phase, the foot will land with a fairly flat foot. If no DF the toes will strike first, which is commonly referred to as equinus gait. They also may not be able to support the body weight after heel strike and will thus move toward flat foot (loading response) as they eccentrically contract. The result is foot slap.

When the muscles are unable to DF the ankle, gravity will cause the foot to fall into plantar flexion when it is off the ground. As a result the knee will need to lift higher for the dropped foot to clear the floor and steppage gait will result.

When the gastrocnemius and soleus are weak - unable to rise the heel up at push-off (terminal stance), resulting in a shortened step length on the unaffected side. Referred to as a sore foot limp. Very pronounced when walking up an incline.

Commonly seen in muscular and other types of dystrophies, because there is diffuse weakness of many muscle groups. Increased lumbar lordosis, pelvic instability and trendelenburg gait. Little or no reciprocal pelvis and trunk rotation occur. Entire body swings.

The hip is unable to go into hip extension and hyperextension during the midstance and push-off phases (terminal stance). To compensate the person will commonly assume the salutation of greeting position in which the hip is flexed and the persons trunk leans forward as if bowing.

Increased motion of the lumbar spine and pelvis can greatly compensate for hip motion. Decreased lordosis and anterior pelvic tilt will allow the leg to swing forward whereas an increased lordosis and anterior pelvic tilt will swing the leg posteriorly. This is sometimes referred to as bell-clapper gait.

Excessive dorsiflexion during midstance and an early heel rise during push-off (terminal stance).

The lower leg will be at a fixed length. That length will depend on the position of the joint. If the knee is in extension, the leg will be unable to shorten during swing phase. The person will compensate by rising up on the toes of the uninvolved leg in a vaulting gait. They will hike the hip of the involved side, swing the leg out to the side or do some variation of all three methods.

The leg begins near the midline at push-off (terminal stance), swings out to the side during swing phase, then returns to the midline for heel strike.

If the leg remains in the abucted state throughout the gait cycle.

When the toes land first during heel strike (initial contact)

Called triple arthrodesis - because fusion of the subtalor joint and the two articulations making up the transtarsal joint. Results in loss of ankle pronation and supination. PF and DF remain but are limited. Stride length is shortened. Difficulty walking on uneven ground, because the ability to supinate or pronate is lost.

Spasticity

Flaccidity

Common in CVA patients - ankle is varus. Hip goes into extension, adduction and medial rotation. Knee is in extension, though often unstable. The ankle demonstrates a drop foot with ankle plantar flexion and inversion (equinovarus) which is present during swing and stance phases. No reciprical arm swing - upper extremity in flexion synergy.

Result of cerebellar involvement - lack of coordination leads to jerky uneven movements. Balance tends to be poor, and the person walks with a wide base of support (abducted gait). Person has difficulty walking in a straight line and tends to stagger. Reciprocal arm motion also appears to be jerky and uneven. All movements appear exaggerated.

One has tremors, demonstrates diminished movement. LE and trunk tend to be flexed. The elbows partially flexed and there is little or no reciprical arm swing. Stride length is diminished and the forward heel does not swing beyond the rear foot. Person walks with a shuffling gait, with the feet flat and weight mostly forward on the toes. Difficulty initiating movements. Starts slowly and increases in speed. Has difficulty stopping. Feet trying to catch up with the forward leaning trunk. Called Fentinating Gait.

Result of spacticity in the hip adductors. Most evident during the swing phase, when the unsupported leg swings against or across the stance leg. Walking base is narrowed. Trunk may lean over the stance leg as the swing phase leg attempts to swing past it.

Bilateral lower extremity involvement seen in the spastic diplegia associated with cerebral palsy. Often great variation in the gait from what is considered "typical." There is excessive flexion, adduction, and medial rotation at the hips and flexion at the knees. Ankles are plantar flexed. Pelvis maintains and anterior pelvic tilt, and there is an increased lumbar lordosis. To compensate, the reciprocal arm swing and horizontal displacement are exaggerated.

Lessen the stance phase. If it hurts, don't stand on it. Gait is referred to as Antalgic Gait. Lean over painful area - to shorten torque and lessen weight.

Heel lifts can be inserted for up to 3 inches of variance. Person walks on the ball of the shorter leg. Called Equinus gait. Loss of heel strike (initial contact) and foot flat (loading response). May flex knee on longer side.

Both have the same components and sequence of events. Walking has a period of double support while running does not. Running has a period of nonsupport that walking does not have.

Traditional terminology refers to single points in a time frame, whereas RLA terminology refers to periods within a time frame.

Stance phase

Double support - between heel-off and toe-off of one foot and heel strike and foot flat on the opposite foot.

During mid-stance of the stance phase.

Swing phase

Step length lengthens and cadence increases.

Walk with feet farther apart to widen their base of support.

Heel strike of stance phase and midswing of swing phase.

Push-off stance phase (toe-off)

Controlled falling - and catching in a controlled manner.

The swinging leg

Longitudinal

Perpendicular (to line of progression)The distance between the right HS and the next left HS.

The speed of gait. 120 steps/min = 60 strides/min.

When cadence decreases - stride length increases. Little quick steps.
When cadence increases - stride length decreases.

10% double support -> 40% single support -> 10% double support -> 40% swing phase. - looking at one foot here!

1st - Heel Strike (The instant the heel touches the ground to begin stance phase)
2nd - Foot Flat (The point in which the entire foot makes contact with the ground)
3rd - Mid-stance (The point during the stance phase when the entire body weight is directly over the stance limb)
4th - Heel-off (The point in which the heel of the stance limb leaves the ground)
5th - Toe-off (The point in which only the toe of the stance limb remains on the ground)
6th - Acceleration (Begins when toe off is complete and the reference limb swings until positioned directly under the body)
7th - Mid-Swing (The point when the swing limb is directly under the body)
8th - Deceleration (Begins directly after mid-swing as the swing limb begins to extend and ends just prior to heel strike)