Movement analysis of gait

In normal gait, during the pre-swing phase the knee flexes to 40 degrees, this is achieved by:

• activation of rectus femoris and sartorius during pre-swing

• activation of iliopsoas during terminal stance

• activation of semimembranosus during pre-swing

• none of the above

none of the above - the knee flexes passively

Phase 5: Pre-swing (aka toe off)

• the second double stance interval in the gait cycle

• ground contact by the blue leg causes the red leg to increase ankle plantar flexion, increase knee flexion, and decrease hip extension

• hip: 10 deg hyperextension - adductors

• knee: 40 deg flexion - no MM activity

• ankle: 15 deg pf - no MM activity of PF - toe rocker)

What is a possible cause of increased plantar flexion seen during stance phase?

• excessive knee flexion

• weak df

• hip flexion contracture

• weak hip abd

• hip flexion contracture - DF only active in loading - tight hip flexors = torso flexes, hips stay back, knee extends, ankle pf

Three functional tasks of normal gait

• weight acceptance

• single leg stance

• limb advancement

weight acceptance

• initial contact (IC) and loading response (LR)

• shock absorption, forward progression and stability

single leg stance

• midST, terminal stance

• forward progress & stability

limb advancement

• PSw, ISw, MSw, TSw (all swing phases)

• foot clearance and limb advancement

gait deviations

aspects of gait that are not normal

gait parameters

parts of gait we can measure

Ranchos Los Amigos observation gait analysis

• compare to norm

• perform segmentally

• ID major deviations during swing and stance phase (use RLA form)

• comment on overall gait parameters (speed, step length, path deviation)

• add variations to bring out deviations

• hypothesize what impairments may be causing these deviations (atypical movements)

Plantar flexion weakness - stance phase

• extensor thrust in MSt to TST (usually chronic)

• excessive df (crouched: knee flex) (acute) - knee buckling

Extensor thrust

snapping knee back to genu recurvatum

Quadriceps weakness - stance phase

• hyperextension of the knee early in stance (IC or LR)

• not very common - quads are first to come back after stroke

hip extensor weakness - stance phase

• excessive hip flexion at IC, LR, beginning of midstance

hip abductor weakness - stance phase

• trendelenburg/reverse trendelenburg

dorsiflexion weakness - stance phase

• foot flat contact or foot slap in LR (beginning of stance)

anterior tib weakness - swing phase

• poor clearance - steppage gait

knee flexor weakness - swing phase

difficulty at initial swing

knee extensor weakness - swing phase

doesn’t achieve full extension at TSwing

hip flexor weakness - swing phase

poor swing and limb clearance

absent or decreased HS in stance limb

impairments:

• PROM restriction or spastic pf

• weak df

• sensory dysfunction

excessive df in stance limb

• weak pf

• comes with increased knee flex

• hamstring contracture

excessive pf in stance limb

• PROM restriction, spastic, weak pf

• hip flex contracture

• weak quads (early)

• spastic quads

knee hyperextension (thrust) in stance limb

• PROM restriction, spastic, weak pf - midstance

• quad weakness - loading

• hip flex contracture

knee wobble in stance limb

• weak pf

• quad weakness

• sensory dysfunction

Impaired motor control

• lack of selective control

• alterations in tone

Lack of selective control

• co-activation

• emergence of primitive synergy patterns

  • mass flexion or extension patterns (stage 3 motor recovery)

Alterations in tone

hypotonicity or hypertonicity

you observe an extensor thrust (recurvatum) of the knee that occurs during midstance. A possible cause would be?

• hamstring weakness

• PF weakness

• quadriceps weakness

• all of the above

PF weakness - calf muscles don’t fire, so the tibia snaps back

causes of gait deviations during WA and SLS

excessive knee hyperextension or extension thrust

• recurvatum

• pf spasticity

• pf contracture (PROM restriction)

• weak (poor motor control) of PF if occurring at MSt

• weak quads if occurring early in cycle

• hip flexion contracture

• quadriceps hypertonicity

• impaired proprioception at knee

terminal stance places the __________ at any joint during the gait cycle

greatest muscle demand

terminal stance - calf muscle activity _____ and allows _______

peaks, the heel to rise (stops the tibia from going forward)

terminal stance - tibia and ankle become ______ and _______

a rigid lever, push knee into flexion

terminal stance - where stance and _____ are linked

swing

if terminal stance does not happen correctly, neither will ______

pre swing

Forward trunk lean during WA or SLS - causes

• intentional to reduce demand on quadriceps

• necessary to progress over an excessively pf ankle

• use of assistive devices

• limited trunk ext ROM (spinal stenosis)

• weak hip extensors

• hip flexion contracture (restored PROM)

• to substitute visual input for impaired proprioception

• abdominal pain

movement analysis of task

slide 19