Gait Exam II

At IC and LR, what is ROM at the hip and pelvis?

hip at 30 deg flexion, pelvis in 10 APT

Thigh position during IC and LR?

20 deg flexion

Torque demand and muscle activity at hip during IC

TD - flexion (BW is in front of hip)
MA - hip extensors (gluts, hams)

Functional significance of hip at IC

limb positioning for ipsilateral step length

Location of GRF relative to hip during IC and LR

anterior

ROM at hip during LR

30 flexion

TD and MA at hip during LR? What type of contraction at hip?

TD in flexion
MA extensors isometric

functional significance of hip during loading response

hip stability and trunk position for posture

What structures resist hip external (extension) torque when just BW is posterior to hip?

hip flexors and hip ant capsule

ROM at hip start and end of midstance, and due to what?? How does thigh look?

start at 30, ends at 10 flexion due to APT, as thigh looks vertical (0 deg)

Torque demand hip at mid stance? Where is GRF relative to hip?

switches to extension by end, moves posterior to joint

functional significance of hip during mid stance

progression of head, arms, trunk (passenger unit)/stability of hip via passive forces

muscle activity during mid stance at hip

extensor activity diminishes

ROM at start and end terminal stance

10 deg flexion to 10 deg extension

torque demand and muscle activity at hip during terminal stance

TD into extension
MA from TFL to restrain hip extension

functional significance of terminal stance at the hip?

hip stability and forward progression - trailing limb posture

ROM at start and end of pre-swing,

starts at 10 ext, ends at 0 (thigh in 10 deg ext)

torque demand in pre-swing at hip?

extension decreases

MA during hip pre swing? What other muscle in some people

add longus concentric, rectus femoris

functional significance of the hip during preswing?

hip/knee flexion preserve forward momentum

ROM during initial swing at hip start and end

start neutral end 25 flexion

Torque demand and muscle activity during initial swing at hip?

negligble torque
MA from concentric hip flexors

ROM at start and end mid swing at hip

25 flexion to 35 flexion

What is the external flexion torque during mid swing at hip caused by?

tibial advancement interaction torque from rapid knee extension

Muscle activity during mid swing at hip?

hamstrings control hip flexion and knee extension eccentrically

ROM from start and end terminal swing at hip?

start 35 flexed, end 30 flex

Torque demand and muscle activity during terminal swing at hip?

torque demand 0
MA has hamstrings (deceleration), hip extensors, and hip abductors preparing for initial contact

How does ROM start and end 0-20% gait cycle in frontal plane at hip?

starts neutral, adducts to 5

TD and MA frontal plane hip during 0-20%?

TD into adduction
MA from abductors eccentric

How does non-WB side pelvis change from 0-20% gait cycle?

drops due to adduction

What is the functional significance of the frontal plane movement in 0-20% of the gait cycle?

stability in WA/SLS

Start and end ROM frontal plane hip from 20-60%

starts 5 adduction, ends 5 abduction

Elevation of contralateral pelvis in frontal plane happens during which percentage

20-60%

Muscle activity during 20-50% versus 50-60% of gait cycle at hip during frontal plane? What is this important for? Is there any external torque?

20-50% ipsilateral hip abductors concentric
50-60% ipsilateral hip adductors and contralateral abductors eccentrically

This is important for weight shifting to the opposite limb

External adduction torque

start and end ROM at hip 60-100% gait cycle at hip frontal plane?

start 5 abduction then back to neutral

torque demand and MA during intitial swing and terminal swing 60-100% gait cycle at hip frontal plane

TD negligible
MA - initial swing hip flexors and adductors, terminal swing abductors

Weakness of abductors might see what compensation?

trunk lean to weak side (compensated trendelenburg)/contralateral pelvic drop (trendelenburg)

What is pelvis and femur ROM (0-20%) in the transverse plane of the gait cycle? What is the net hip joint in?

pelvis 5 degrees forward rotation
femur medially rotated
net MR

torque demand in transverse plane 0-20% at hip? muscle activity?

into more medial rotation
muscle activity lateral rotators eccentric

What is the functional significance of 0-20 deg in the transverse plane?

shock absorption and limb stability

Functional significance of the lateral rotation at the hip during 20-60% cycle?

contralateral step length

ROM at pelvis and femur from 20-60% gait transverse plane? What is net hip in?

pelvis 5 degrees backward rotations
femur slight LR
net MR

TD/MA during 20-60% gait in transverse plane

TD into LR
MA from MR

Percentage of gait in the transverse plane for contralateral limb advancement and trailing limb posture

20-60%

ROM at pelvis and femur transverse plane at hip from 60-100% and net hip

pelvis forward rotate to 5 degrees forward rotation (10 total)
femur MR
net in LR until terminal swing

TD and MA from 60-100% transverse plane at hip

TD negligible
MA - hip flexors and adductors

If hip ROM is limited to under 30 deg. what stages are affected?

IC, LR, start mid stance, midswing, terminal swing

During gait cycle, how does the trunk move relative to the pelvis? What is total excursion? what is this important for?

moves opposite the pelvis, 7 degrees total, important for energy efficiency

Erector spinae fires during what percentages? Corresponds with what periods?

0-20, 40-70, 90-100
Corresponds with weight acceptance

Rectus abdominis fires during what percentages? Corresponds with what periods?

20 and 70% short bursts for early single limb support

Total sagittal plane motion from UE during gait? Shoulder and elbow?

60 deg total
shoulder 35 deg
elbow 25 deg

Position of shoulder and elbow of reference limb during IC?

25 extension shoulder, 20 flexion elbow

Position of shoulder and elbow of reference limb during 50% (end of terminal stance)?

10 shoulder flexion, 45 elbow flexion

What muscles continuously firing to support scapula as arm moving?

upper trap, supraspinatus

Muscles responsible for moving the arm during 40-100%? What type of contraction?

middle and posterior delt - concentric

Only need concentric muscle activity from UEs during when?

extension

What is the functional significance of the UE during the entire gait cycle? (3)

minimize trunk rotation, scapular/humeral support, and UE extension

Hip flexion angle changes from 30 to 10 deg flexion during

midstance

During terminal stance at the hip, the GRF produces an external torque in what direction?

extension

In frontal plane from 20-50%, name active hip muscle group and type of contraction?

abductors; concentric

At the end of terminal stance, the ipsilateral shoulder is in what position?

10 deg flexion

From 0-20% of transverse plane, the pelvis of the reference limb is in what position?

forward position

5 causes of pathologic gait categories

functional joint deformity, muscle weakness, sensory loss, pain, impaired motor control

Difference between major and minor deviations of gait?

major impacts mechanics of walking
minor does not affect accomplishing task

Examples of functional joint deformity? (3)

tightness or shortness (muscle length), edema, hypertonicity

Examples of muscle weakness deviations?

muscle injury, peripheral nerve injury

Examples of impaired motor control deviations

UMN lesion, habitual movement pattern

Short plantar flexor muscles would fall under what category of deviation?

functional joint deformity

List reasons for forefoot contact compensations and foot-flat contact compensations during initial contact

forefoot contact due to heel pain or short leg compensation

foot-flat contact compensating for quad weakness or excess knee flexion

Name a functional joint deformity cause and muscle weakness cause for forefoot/flat-foot contact?

functional joint deformity - PF contracture
muscle weakness - DF strength decreased

During LR at the ankle, normally there is what ROM?

rapid 5 PF

Phase of foot slap? Audible?

loading response, ye

Foot slap has what effect on heel rocker and shock absorption?

disrupts heel rocker, decreases shock absorption

Cause of foot slap?

decreased pretibial strength

Unilateral foot slap could indicate a nerve root pathology. What nerve root relates to the pretibial muscles?

L4-5

Phases in which excess plantar-flexion can occur?

all except pre-swing

What is the functional significance of excessive plantar flexion?

-Disrupts all foot rockers
-Impaired foot clearance/limb advancement during swing

Phases in which DFs are active?

IC, LR, all swings

Excess PF could be a compensation for what muscle weaknesses? (2)

quads, DF

Pt may demonstrate excess PF in what phases due to weak quads?

LR and Mid-stance

If someone has decreased pretibial strength, when would they show excess PF?

IC, LR, swings

when are the PFs active at the ankle

midstance, terminal stance

If someone had decreased proprioception, when would they show excess PF?

during stance phases, (especially IC)

Why might someone show excess PF during loading response?

to achieve more stability

During what phases would someone show excess DF?

all stance phases

Excess DF can disrupt the heel rocker, especially in combination with what deviation?

foot flat contact

During SLS, excess DF can impact what rockers?

ankle and forefoot rockers

During SLS, excess DF would require (more/less) quad activity to maintain stability?

more

What deviation might you see if someone wanted to lower a contralateral limb to ground during SLS?

excess DF and hip/knee flexion

Could see excess DF in single limb support due to what? (3)

decreased gastrocsoleus strength, hip or knee flexion contracture, intentional to lower opposite limb to ground

Bouncy gait?

premature heel off

Phases that premature heel off could affect?

initial contact, loading response, mid stance

Impact of premature heel off on loading of forefoot and BOS?

increased loading on forefoot, decreased BOS

What compensation modification might you see if contralateral limb is too long?

premature heel off

If there was excess knee flexion, during what phase might the heel come up early?

during mid stance before terminal stance

If heel does not strike during IC, what most likely happens?

forefoot/foot flat contact

No or delayed heel off can affect what phases?

terminal stance, pre-swing

No/delayed heel off has what effect on contralateral step length? Why?

decreased, no trailing limb posture

no/delayed heel off can have what impact at the knee?

limits knee flexion interaction torque because PF is not occurring

No/delayed heel off could be because of decreased ___ strength or pain in the ________

PF; forefoot