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Questions and Answers
What is the primary purpose of gait analysis in neurologic disorders?
What is the normal cadence of walking?
What is the term for the distance between the midline of one foot at mid-stance and the midline of the other foot at mid-stance?
What is the primary factor that influences gait speed at slower speeds?
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What is the term for the manner or style of walking?
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What is the normal speed of walking?
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What is the term for the distance from heel strike of one foot to heel strike of the other foot in one gait cycle?
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What is the significance of slower gait speeds in geriatric patients?
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What type of muscle contraction occurs when the hamstrings contract to flex the knee?
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During the Foot Flat phase, what occurs at the ankle?
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What muscle is responsible for moving the hip from 10° of flexion to extension during Midstance?
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During the Mid Swing phase, what occurs at the ankle?
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Which muscles contract during the Late Swing/Declaration phase to flex the hip?
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During the Heel Off phase, what occurs at the hip?
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What muscle contraction occurs when the quadriceps muscles contract during the Mid Swing phase?
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During the Early Swing phase, what occurs at the knee?
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What is the primary reason for thoroughly investigating gait disorders?
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What is characteristic of an antalgic gait?
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What is associated with cerebellar disturbances?
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What is a common presentation of Parkinsonian gait?
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What is 'festination' in Parkinsonian gait?
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What is the primary goal of categorizing gait disorders?
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What is characteristic of a sensory ataxic gait?
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What is the term for slowness of movement in Parkinsonian gait?
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What percentage of the gait cycle is occupied by the Swing phase?
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During which phase of the gait cycle is the bodyweight borne by both lower extremities?
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What is the range of motion required for normal gait at the ankle during plantarflexion?
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Which muscle is responsible for the extension of the knee during the initial contact phase?
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What is the primary function of the regulation of joint forces and moments during the gait cycle?
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During the initial contact phase, what is the position of the ankle?
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What is the primary purpose of gait analysis?
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During which phase of the gait cycle does the knee flexion begin?
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What is characteristic of the Trendelenburg gait?
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Which gait is associated with footdrop and circumduction of the leg due to paralysis of the anterior tibial and fibular muscles?
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What is a characteristic feature of Diplegic gait?
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What is the primary muscle affected in Trendelenburg gait?
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Which gait is characterized by an exaggerated alternation of lateral trunk movements?
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What is a common feature of Hemiplegic gait?
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Study Notes
Gait Cycle
- The gait cycle includes registration and activation of the gait command within the central nervous system, transmission of the gait systems to the peripheral nervous system, contraction of muscles, generation of several forces, and regulation of joint forces and moments across synovial joints and skeletal segments.
- The gait cycle consists of two main phases: stance phase and swing phase.
Stance Phase
- The stance phase occupies 60% of the gait cycle, during which one leg and foot bear most or all of the body weight.
- The double-support phase occurs during the last 10% of the stance phase, where both feet are in contact with the floor at the same time.
Swing Phase
- The swing phase occupies 40% of the gait cycle, during which the foot is not touching the walking surface and the body weight is borne by the other leg and foot.
- The swing phase consists of initial swing, mid swing, and late swing phases.
Phases of the Gait Cycle
- Initial contact (heel strike): 30° flexion of the hip, full extension of the knee, and ankle movement from dorsiflexion to plantarflexion.
- Loading response (foot flat): body absorbs the impact of the foot by rolling in pronation, hip moves slowly into extension, knee flexes to 15-20°, and ankle plantarflexion increases to 10-15°.
- Midstance: hip moves from flexion to extension, knee reaches maximal flexion and then begins to extend, and ankle becomes supinated and dorsiflexed.
- Terminal stance: heel off, bodyweight is divided over the metatarsal heads, hip hyperextension, knee flexion, and ankle supination and plantarflexion.
- Pre-swing (toe off): hip becomes less extended, knee flexes, plantar flexion of the ankle increases, and the toes leave the ground.
Normal Gait
- Five priorities of normal gait: stability of the weight-bearing foot, clearance of the non-weight-bearing foot, pre-positioning of the foot, adequate step length, and energy conservation.
- Normal speed of walking: 90-120 steps/minute, with a normal cadence of 107 steps/minute and a normal step or stride length of 75 cm.
Abnormal Gait Patterns
- Antalgic gait: a limp adopted to avoid pain on weight-bearing structures, characterized by a very short stance phase.
- Ataxic gait: an unsteady, uncoordinated walk, with a wide base and the feet thrown out, coming down first on the heel and then on the toes with a double tap.
- Parkinsonian gait: characterized by rigidity of joints, reduced arm swing, stooped posture, and flexed knees, with small, shuffling steps.
- Trendelenburg gait: characterized by a listing of the trunk toward the affected side at each step, due to paralysis or weakness of the gluteus medius muscle.
- Hemiplegic gait: characterized by flexion of the elbow, wrist, and hip due to footdrop and circumduction of the leg.
- Steppage gait: characterized by lifting the advancing leg high to clear the ground, due to paralysis of the anterior tibial and fibular muscles.
- Waddling gait: characterized by exaggerated alternation of lateral trunk movements and exaggerated elevation of the hip, seen in muscular dystrophy.
- Diplegic gait (spastic gait): characterized by spasticity in both lower limbs, with contractures of the adductor muscles and plantarflexed ankles, presenting in 'tiptoe' walking.
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Description
Understand the components of the gait cycle, including neural transmission, muscle contraction, and joint forces. Learn what to observe during gait analysis.
