Clinical Skills Exam 2

8 Phases of the Gait Cycle

Initial contact

Loading response

Midstance

Terminal stance

Pre-swing

Initial swing

Mid-swing

Terminal swing

Start and end of initial contact

Start - heel strike

End - heel strike

Start and end of loading response

Start - initial contact

End - Opposite foot lift

Start and end of mid stance

Start - Opposite foot lift

End - body alignment over single leg tibia

Start and end of terminal stance

Start - heel rise

End - Opposite heel contact

Start and end of pre-swing

Start - opposite heel contact

End - toe-off

Start and end of initial swing

Start - toe-off

End - when swinging leg is opposite of stance foot

Start and end of mid-swing

Start - when swinging leg is opposite of stance foot

End - swinging tibia is vertical

Start and end of terminal swing

Start - when tibia is vertical

End - heel strike

Important hip muscles during initial contact/loading response

Concentric hip extension

Concentric hip abduction

Important knee muscles during loading response

Eccentric quadriceps contraction

Important ankle muscles during loading response

Eccentric dorsiflexor contraction (foot lowering) THEN concentric dorsiflexor activity (bring tibia over ankle)

Important ankle muscles during terminal stance

Eccentric plantarflexion contraction

Important hip muscles during mid-swing/terminal swing

Eccentric hamstring contraction

Important ankle muscles during mid-swing

Concentric dorsiflexor contraction

Important knee muscles during terminal swing

Isometric quadriceps and hamstrings contraction

ROM needed in hip for normal gait

10-0-30

ROM needed in knee for normal gait

0-60

ROM needed in ankle for normal gait

10 DF - 20 PF

Heel rocker start/end

Start - Heel contact

End - Toes come down

Ankle rocker start/end

Start - toes come down

End - heel comes up

Tibia is moving over forward over toes

Forefoot rocker start/end

Start - Heel comes up

End - toes come up

Stride length

Linear distance from one heel IC to the same heel IC

Step length

Linear distance from one heel IC to the other heel IC

Step width

Distance from lateral heel of one foot to lateral heel of other foot

Normal step width

9.8 cm ± 2.8 cm (3-4 inches)

Normal cadence

117 steps/min

Physiological walker

Walks at home or in PT

Household walker

Walks >150 feet

Community walker

Walks >1000 feet

Normal walking/crossing street gait speed

1.2 m/s

Community ambulator

0.8 m/s

Fall risk gait speed

<1.0 m/s

List AD options from most to least stability (9)

Parallel bars → Pick up walker → Rolling walker

Bilat axillary crutches → Bilat forearm crutches → Bilat canes

Hemi walker → Quad cane → single point cane

NWM (Non-weight bearing)

0% - foot and toes do not touch the ground

TTWB (toe-touch weight bearing) / TDWB (touch-down weight bearing)

10-20% - foot may rest on floor, but extremity is not bearing wieght. Toes may touch the ground for balance assistance only

PWB (partial weight bearing)

20%-50% of BW - often prescribed as a percentage of patient’s bosy weight

WBAT (weight bearing as tolerated)

50%-100% - limited only by patient’s tolerance

FWB (full weight bearing)

100% - no limitation

Two point gait pattern AD options

1 or 2 canes, 1 or 2 crutches, hemi-walker

Two point gait pattern definition

AD+contralateral LE contact floor at the same time

Three point gait pattern definition

Both ADs + WB-restricted LE contact floor at the same time

Four point gait pattern definition

L AD → R LE → R AD → L LE …

Four point gait pattern is ___ stable and ___ mobile than two point gait pattern

___ point gait pattern is more stable and less mobile than ___ point gait pattern