Gait Notes PDF

·  GAIT WHAT IS GAIT ? series of falls done with intention · a to take outside of BOS but catch ourself with a step oppor...

·  GAIT WHAT IS GAIT ? series of falls done with intention · a to take outside of BOS but catch ourself with a step opportunity COM · an (40 % ) and stance (60 % ) a swing · · a double to single support GAIT PHASES TERMINAL STANCE LOADING (LOAD) (TST) IC > - OTO > - HR > - OIC > - TO INITIAL OPPOSITE HEEL OPPOSITE TOE OFF TOE OFF INITIAL CONTACT RISE CONTACT MID-STANCE PRE-SWING (MST) (PSW)  FOLUS ! LOADING PHASE * RIGHT LEG ↑ g · movement from double to single support from · transfering BW rear leg : accepting it into front leg · front leg becomes steady to absorb energy of impacts weight MID-STANCE PHASE O * · longest phase single support · · opposite leg is NEVER in contact with ground COM to travel the that fixed foot L allow body's all way over · : => maintaining a single support phase ! · preparing for the fall opportunity TERMINAL STANCE PHASE FOLUS ! * RIGHT LEG - * & · falling phase? start of catching phase · COM moves forwards (beyond forefoot · we NEED to take a step for the balance upset forwards outside BOS then catch it single support take COM - start - · in ! When · we catch com we are in double support PRE-SWING PHASE & * g ⑧ ! getting ready swing phase · for unload · starting to load the left limbs progressively right limb from right to left (prep to get into single · bring weight support ) !  SWING WHAT IS SWING ? to the fall · Prepare catch ↳ to make forwards swinging limb progress to get it ready to put it into ground is accept BW : keep going pendulum to limb · dual motion advance the swinging ! ↳ legs swing forward through hip flexions knee extension · minimum foot clearance (MFC) catch make avent with ↳ effective swing : effectively ourselves we need to s u re we falling the ! things in way ↑ HASES TERMINAL EARLY SWING STANCE (ESW) (TSW) TO FA > TV > IC > - - - TIBI A INITIAL TOE OFF FOOT CONTACT VERTICAL ADJACENT MID-SWING (MSW)  5 5 - E - ↳ i v E · E = E E ↳ ~ - & ↳ · n 3 · is 5 j *↳ & # F - e = & u↳ · & & - - 3= g n H ~ O = e *  - ⑤ : T - 5 - n E % ↑ 8 # - · W 5 * · 2 ⑧ * E D & # & & ② T & ia 1 g r = F - = g jo = - = J i · & - E · f # H ↳ G & -e 1 I & = - r· E N 7 8 N n F je ? : 5 - # Hi W - - - & * N - N I ↑ * - E - T # & / n1 - - e ⑮ - ↳ - o ⑳ * s F Mt o # - - = = M > - - e ↑ ↑ F = o E E n J ↳ - = · ?? & - - e  I ! LOADING : BECOME STEADY THEN ABSORB : PHASE * R LEG FOCUS ! PURPOSE : · loading is about transferring your weight from L to R INITIAL CONTACT : · hip = flexed & 30% (not locked out) · knee = extended fully · ankle = neutral (90 · angle between foot : leg or slightly dorsiflexed KNEE : knee flexes 150 · at 1C the knee flexion so need knee extensors to resist gravity wants · we ! · gravity is winning since knees are flexing ! · so knee = extensors contracting eccentrically ANkLE : · when heel touches down & KC: ankle is neutral the foot needs to lower to make full contact with floor ↳ this requires plantar flexion ! need ! (tibialis anterior) to resist gravity wants plantarflexion DFs , you · gravity wins so DFs = contract eccentrically · FOOT : · the toot should pronates gravity wants pronation · we need muscles to supinate (invertors tibialis anterior , · muscles that supinate = contract eccentrically MID-STANCE : ABSORB THEN PROPEL : PHASE 2! * R LEG FOCUS ! : LTO R HR ATCH to 2 PHASES : ABSORPTIONS PROPULSION behind the foot beginning mid-stance at · ABSORPTION PHASE-body is of of foot · PROPULSION PHASE= When you crossover threshold : body is over top · when COM is directly above foot= the point that separates the phases HIP : (ie hip extension gluteus : hamstrings) ·. max KNEE : · knee extension passive extension COM · as moves over foot femur forwards tibia pivots over · gravity wants knee extension (so gravity wins : knee flexors · so eccentrically contract) ANKLE : · dorsiflexion , at the end of mid-stance = 10. DF · gravity wants DF so need PFs ! , you gravity wins eccentrically · so PFS contract FOOT : · ABSORPTION : foot will pronate through this · P ro p u l s i o n : past midpoint (COM over foot) ↳ we need foot to become a rigid level , so foot will start to supinate ↳ foot joints lock can push off effectively you so more the ↳ muscles controlling arch to lift a re contracting concentrically wheres in beginning they were contracting eccentrically TERMINAL STANCE : FALL WITH INTENTION : PHASE 3 ! * R LEG FOCUS ! · intentional fall forward double · single support - land in support · propulsive part HIP : · hip reaches peak extension & 20 activation through hip extensors · KNEE : · no longer fully extended · it unlocks : starts to soften ANKLE : heel rises the toes are still in contact with · as ground ↳ forces MTP to into extension go the toe flexors (FHL : FDL are active ↳ eccentric loading of very · ankle PF is a part of propulsion PRE-SWING : FINISH PROPELLING WHILE UNLOADING : PHASE 4 ! * R LEG FOCUS ! to R To WATCH 1 IC : PURPOSE : · loading up the left and unloading the right so the right can get into its swing phase HIP : its direction reversing · out of 20: starts to flex to concentric comes peak extension : a · contraction of hip flexors Cretus femoris , iliosoas sartorious , KNEE : flexed of flexion femur forwards & 30-40 passive as swings · ANKLE : still propelling through PF: will reach about 20 : · PF · concentric contraction of PFs · job is largely done from solens because the knees flexed position puts gastroc in a disadvantage FOOT : · arch is supinated · tibialis posterior is highly active ↳ has dual capacity = lift arch through inversion : its ability to act as a PF !  PHASES ACCELERATE DECELERATE PREP FOR IMPACT SWING : , INITIAL SWING : R To to FA WATCH : - PURPOSE : to get double pendulum going to accelerate the leg forward · the ↳ most motion comes from hip HIP : dominant contraction · flexion is , hip flexors concentrically KNEE : &600 flexing actively · to that movement · we need knee flexors generate ↳ : sartorious (its knee/hip Hexor) hamstrings a ANKLE : · DF to a neutral position the clear grounds ↳ PURPOSE to : when you swing you need not trip or drag toe so we need to make sure there is ground clearance ↳ consider contributions so : of hip flexors , knee flexors : DFs !  : MID-SWING FA to R TV WATCH : - HIP : · continues to flex but approachesend position kNEE : swings into extension · in passive motion ANKLE : · stays in neutral TERMINAL SWING : WATCH : TV to IC = PURPOSE : decelerate limb the swinging · HIP : · reaches peak position of 300 flexion ↳ limited eccentric contration of hip extensors by KNEE : · flexors eccentrically slow down knee extension motion BUT allows knee to full for IC reach extension ANKLE/FOOT : locked in neutral : foot supination · in  COM : ARM SWING , PELVIS COM HIGH --- · · - - - COM Low COM : · vertical trajectory falls rises : slightly · · when foot catches a fall COM = lowest point , ↳ COM reaches peak height when it lines up directly ove r top of foot · COM starts to fall forwards ; down until next foot catches it ARM SWING : forwards backwards ar m swings in opposition · reflects HAT rotation ↳ head , arms trunk all considered together : makes up 43 of BM HAT ROTATION · HAT = head arms : trunk , · lower extremities do all the work when walks HAT just the we is ! passenger PELVIC ROTATION HAT ROTATION I  FOOT DROP GAIT · ankle dorsiflexors (weakness) DF ! ↳ not enough pelvic hike compensation = steppage · 1 STEPPAGE GAIT that feeds DFS · damage to the perennial nerve the ↳ = foot drop gait · increased hip flexion a bit of knee flexion to help get leg through · flat position foot being placed on the ground in a · ↳ the foot doesn't go : heel-> roll into toe through eccentric loading  2 STEPPAGE GAIT · lack of DF · bilateral deficits · toes drag through swing phase ↳ no clearance of the ground ↳ foot PF position hangs in  VAULTING stiff knee; hip · get enough ↳ can't hip/knee flexion limb is functionally long · because : · this happens knee flexors ↳ can't activate the hamstrings as ↳ arthritic knee · happens during the swing phase vertical motion exaggerated · limb ↳ DETOUR : ask the opposite ↳ ask opposite leg to PF which buys some vertical motion (lifts COM higher) to give enough space for limb to swing through with circumduction · partner ↳ DETOUR semicircular path by swing leg taken the : a · start with ER of the hip act ↳ doing so you bring adductors forwards which means they can flexors as hip 3 VAULTING here ! > - vaulting pattern toe ! tippy - ankle limb to · PF through one ankle to allow opposite swing  TRENDELENBURG when happen : · can that feeds ↳ neurological pathology at the superior gluteal nerve the adductors ↳ Osteoarthritic hip ↳ other conditions like : patella femoral syndrome · weakness of hip abductors medius ↳ gluteus · pelvic tilt tilt ↳ abductors manage pelvic in a one leg stance position ↳ pelvis tilts towards the opposite side of limb that you a re standing on · lateral shift of COM ↳ lateral shift the of COM towards stance leg connecting to gait cycle : · ↳ MID-STANCE : ↳ the moment in time where feet a re adjacent and gravity wants pelvis to drop down lateral tilt towards opposite side into abductor mid-stance ↳ glutens medius , weakness : trendelenburg pattern in compensation : · ↳ try to Shift COM through the pelvis/trunk to bring it closer to the hip joint have weak abductors (abductors a re supposed to prevent lateral pelvic tilt) if they shift COM closer to the hip then the abductors don't ↳ if can you have to work as hard  4 TRENDELENBURG L side focus ! · weakness ofL side , abductors of hip · can't stabilize the pelvis towards the ↳ it will drop and tilt right shifts to the left as whole body · a trochanter L side out to the side ! ↳ greater on pops · shows up during mid-stance : is very quick  HEMIPLEGIA ? HEMIPLEGIA GAIT HEMIPARESIS : * hemiparesis : ↳ less severe state = weakness but NOT paralysis muscle tone that influences the posture in the the holds ↳ too much way person ! they move affects the way their body which paralysis or weakness hypertonia · associated with commonly : · (stroke cerebral palsy: TBI) ↳ CNs pathology , extremity : upper · ↳ flexion dominates flexion elbow wrist ↳ hypertonia causing of the , , fingers : forearm will go into pronation : shoulder will adduct ↳ tends to be held close to persons ar m body lower body · : ↳ extension through knee ↳ still knee leg , very extended ↳ foot in PF ! ↳ Functionally long leg  5 SIGNIFICANT HEMIPLEGIC GAIT exercise for > doing an balance/gait ! - stroke post · arm is close to body extended position · leg in ↳ SUBTLE HEMIPLEGIC GAIT · upper extremity is negligable/subtle circumduction · extended : stiff knee leading him into hip/pelvic hike :  PARKINSONIAN GAIT · parkinsons disease : that leads to loss of ↳ degenerative disease the dopamine producing cells in the mid brain neurotransmitter that mood appetites sleep regulates ↳ dopamine = , role in motor control plays ↳ a ↳ tremors stiff movements muscle , shaking , , involuntary contractions balance : difficult = makes gait · stooped shuffling looks hunched don't legs free flowingly ↳ person move limited · extremity motion ↳ limited in lower extremity black of ar m swing ! freezing · they suddenly stepped in glue; couldn't keep going ↳ looks like ↳ happens when there is change/distruption to rhythm of a current gait pattern ↳ EX direction approaching doorways changing : obstacle ! , , navigating an ↳ this they can overcome by listening to another rhythm ↳ EX : a metronome  7 PARKINSONIAN GAIT · OFF PHASE : ↳ shuffling gait ↳ not movement much extremities through ↳ small magnitude ↳ don't arms swing · ON PHASE : with medication ! ↳ moving ar ms ↳ moving freely ↳ ! some freezing but can navigates keep going NOV7 GRE muscular effort force ↳ a reaction to the FBW : you apply to the ground when balancing walking: jumping , ↳ than force due to BW higher ↳ acts at the Cop : COP location changes through stance phase ↳ BW muscular effort GRF = + (both ↳ comes through COPs aims for COM constantly changing) GRF ORIENTATION stance changes through ↳ HGRF IMPACT TRANSIENT ↳ brief initial spike in VGRF as foot makes impact during ↳ MUSCLE IN QUESTION (MIQ) THINK : if GRF is an elastic band what does it want to = do as it passes each joint ? L recruit the muscles that oppose gravity ! you ↳ EX : of NK : what if GRF runs through the centre ? a joint ↳ it ! It stays does nothing neutral ↳ EX : the ankle has no moment arm to cause PF OR DF ! ORTHOTICS  & WHAT IS A PEDORTHIST? the treatment of foot conditions ankles lower · individual who is trained in , extremities requiring fitting , fabricing : pedorthic devices. WHAT IS A CUSTOM ORTHOTIC ? · an insole for a shoe that helps with foot position HOW DO I kNOW IF I NEED AN ORTHOTIC ? 4 factors for assessment determining · · If pt. has mild inefficiencies , no pain? can do everything they to to orthotics ! need less likely give 4 DETERMINING FACTORS : · Pain dog ) ? athlete the · Function (training as olympic or walking · Alignment (of body) · Biomechanics (of movement) ASSESSMENT medial ankle pain ORTHOTIC D · History = tib post ! · Biomechanical assessment Postural · analysis · Functional tests ↳ balance calt raises squat , forward lunge , SL , Gait/ analysis · run HOW IS IT MADE ? Foam plaster scanning 3D · or , · Takes - 4 his MATERIALS DESIGN dependant on condition , activity? Shoes · : person , ↳ to the more specific you make it the more its going help them/the better it works ↳ pain might a come specific instance only = make it for these situations ↳ pain when running= make it for running doesn't of shoes orthotics jump categories · ↳ can't transfer shoe to cleat running soccer OTHER FACTORS · footwear · strength training ↳ orthotics bridge gap between now : When muscles are strong function their enough to on own from it ↳ are not a forever thing can phase away they , you ↳ congenital issues = longer term (ie form) activity specific runners running -> training. · PROSTHETICS PROSTHETICS people with limb loss with artificial limbs providing · catered to the individuals needs : goals. ↳ main cause of amputation = diabetes : peripheral vascular disease LOWER LIMB AMPUTATIONS seen · transtibial is most often ! ASSESSMENT characteristics · objective : strength , limb environment · subjective : prosthetic goals lifestyle , , hobbies , social · stability or ROM · gait analysis (focus on one plane at a time from distal > - proximal · compare to normals and to sound limb PROSTHEIC COMPONENTS · stability = soft ankle cushioned heel (SACH) · ROM = dynamic response PROSTHETIC GAIT takes to use it more energy · needed ↳ more proximal amputation = more energy · favour their sound side reduced extension · hip ↳ hip flexors are short-limited extension ↳ works with physio ↳ they were in a wheelchair prior ! heavy prosthetic limits hip flexion ability · · wider BOS for balance prosthetic knee restrict amount of sleve might knee flexion · over so more compensation with hip flexion · prosthetic side = longer step length (less time spent on prosthetic side) TRANSTIBIAL · Bilateral transtibial ↳ you determine length ? how do ↳ start them short , find out what height was ↳ (the taller the harder to control COM) ↳ wider Bos ↳ knees in valgus ↳ trunk swaying ↳ crouched at knee to down for balance more bring COM TRANSFEMORAL GAIT DEVIATIONS · circumduction ↳ prosthetic swings in laterally curved line ↳ e frontal plane in swing phases I : seen leg locked vaulting · body and foot raises entire ↳ early excessive PF of sound initial-mid ? ↳ a seen : saggital plane in swing long 100 Knee prosthetic for timingion2. oor flex ? p Fi dence con of lack lateral trunk bending · ↳ leans towards the amputated side when prosthesis is in stance phase ↳ seen : frontal plane in stance phase ! weak abductors in socket ? short? too pain prosthetic  gaitway neurophysiology (PD) WHAT AREAS OF BRAIN ARE AFFECTED ? BASAL GANGLIA controls motor associated with PD symptoms · ↳ a) motor/occulomotor circuits habituals directed movements : goal ↳ automatic movements ↳ b) associative circuits : executive functions attention planning ↳ how pre on to do things ↳ c limbic circuit : motivations reward ↳ can cause depression 4 AREAS IN BASAL GANGLA · dorsal striatum : ventral striatum ↳ ) global pallidus ↳ 2) ventral pallidus ↳ 3) subthalamic nucleus ↳ 4) substantia factor !) niagra (biggest ↳ FUNCTION : Neurotransmitter DOPAMINE · dopamine = or NONE · dopamine allows voluntary movements to be done smoothly dopamine tells "stop" "Go" with movement (prevent over/undershooting) · or you freezing ↳ is common · dopamine helps with dual/multitasking ↳ functions cognitive ↳ exerts motor systems an inhibitory influence on a number of 5 MOTOR SYMPTOMS temors symptom · not motor · hypokinesia * dyskinesia is a its medication issue · bradykinesia a · freezing of gait ↳ "go" or "no go" is fired up · falls 5 NOW MOTOR SYMPTOMS · depression · anxiety · lack of motivation · sleep disturbance · fatigue EXAMPLES IN PD GAIT EX : 1 ↳ can't process what to do when they run into a doorway · induces FREEZING because double tasking (open door/walk through ↳ ziegler outcome measure identifies them to · freezing by asking turn in circle EX : 2 ↳ bilateral tremors · treatment focuses on with gait weight , transition , smooth stepping , stride length ↳ this pt struggles heel touch EX : 3 ↳ has towards : freezing one side DBS (dual · treatment waddles) focuses on smooth walking tasking) , weight shifting (penguin ↳ freezing happens when meds wear off or tired  NEUROPLASTICITY ABILITY OF CNS Intensity · ↳ to release the vigorous exercise improves corticomotor excitability dopamine missing ! · complexity ↳ also CNS fired ges up ↳ dual tasks · repitition ↳ repeat until can't get it wrong so it becomes automatic · salience/specific ↳ motivation ↳ tasks are specific : different for individuals ↳ a dancer would want to dance ! · timing ↳ 2-fold have lots of = timing of day when they energy ; when they take medication ON aren't ↳ work with pt when they are so when they are off they as bad EXERCISE WITH PD · PD warrior · PWR ! Moves /done in class) · LSVT BIG steady boxing rock · cycling · ↳ tandem to biking for automatics Smooth movements because you have keep up dancing · ↳ movements for stiffness flowing , rigidity , posture balance · tai chi ↳ balance pole walking · ↳ stride length NEUROACTIVE EXERCISE · high intensity challenging neuroprotective · - · amplitude helps with dopamine · · big movements · clears brain to work more flowing · normally rigidity shuffling stride length · , , active holds slows progression · gets do things independently to get · power to n e u ro system to · open up stance power · * usually they have as long as possible · balance narrow a stance ↳ functional power I speed gains ↳ need power first before for dopamine then faster you move PD CONDITIONING CLASS · use boom whackers feet time ↳ gets ar ms? going a same · use chairs to sit if balance issues · high energy too ! use rings · ↳ feel , hear , see it ↳ helps with smooth movements : amplitude * GET ACTIVE NOW IF FAMILY HISTORY OF PD ! MUSIC QUESTION · rhythm changes brain waves to normalize movements excite/calm to work other things can like bradykinesia · on and rigidity helps with motivation ·