Gait

Question 1

Walking

• A simple yet complicated task:
• Simple – we can do it without having to think about it too much
• Complicated – involves so many structures in the body
  
  • … system = muscles, tendons, bones, joints,
  • … system = sensory, motor, autonomic, proprioception
  • … system = heart, blood vessels
  • Special … = vision, hearing
• Problem(s) with any of the systems / structures can have an effect on our ability to walk

Answer 1

• A simple yet complicated task:
• Simple – we can do it without having to think about it too much
• Complicated – involves so many structures in the body
  
  • Musculoskeletal system = muscles, tendons, bones, joints,
  • Nervous system = sensory, motor, autonomic, proprioception
  • Cardiovascular system = heart, blood vessels
  • Special senses = vision, hearing
• Problem(s) with any of the systems / structures can have an effect on our ability to walk

Question 2

Gait is …

Answer 2

the way a person walks

Question 3

Gait (the way a person walks)

• … … walking / running
• Turning
• … adjustment
  
  • A combination of movements

Answer 3

• Straight line walking / running
• Turning
• Terrain adjustment
  
  • A combination of movements

Question 4

Gait (the way a person walks)

• Straight line walking / running
• …
• Terrain adjustment
  
  • A … of movements

Answer 4

• Straight line walking / running
• Turning
• Terrain adjustment
  
  • A combination of movements

Question 5

Gait Cycle

• The … phase of gait begins when the foot first touches the ground and ends when the same foot leaves the ground (60% of cycle)
• The … phase of gait begins when the foot first leaves the ground and ends when the same foot touches the ground again (40% of cycle)

Answer 5

• The stance phase of gait begins when the foot first touches the ground and ends when the same foot leaves the ground (60% of cycle)
• The swing phase of gait begins when the foot first leaves the ground and ends when the same foot touches the ground again (40% of cycle)

Question 6

Gait Cycle

• The … phase of gait begins when the foot first touches the ground and ends when the same foot leaves the ground (…% of cycle)
• The … phase of gait begins when the foot first leaves the ground and ends when the same foot touches the ground again (…% of cycle)

Answer 6

• The stance phase of gait begins when the foot first touches the ground and ends when the same foot leaves the ground (60% of cycle)
• The swing phase of gait begins when the foot first leaves the ground and ends when the same foot touches the ground again (40% of cycle)

Question 7

Gait Cycle

• The … phase of gait begins when the foot first touches the ground and ends when the same foot leaves the ground (60% of cycle)
• The … phase of gait begins when the foot first leaves the ground and ends when the same foot touches the ground again (40% of cycle)

Answer 7

• The stance phase of gait begins when the foot first touches the ground and ends when the same foot leaves the ground (60% of cycle)
• The swing phase of gait begins when the foot first leaves the ground and ends when the same foot touches the ground again (40% of cycle)

Question 8

Classic gait terms:

Answer 8

Heel strike, foot flat, midtance, heel off, toe off, midwing, heel strike

Question 9

New gait terms:

Answer 9

Initial contact, loading response, mid-stance, terminal stance, preswing, inital swing, mid-swing, terminal swing

Question 10

Division of the Gait cycle

• 1 … = 1 gait cycle
  
  • Stance
    
    • Weight … (Initial contact and Loading response)
    • … … support (Mid stance, Terminal stance, Pre swing)
  • Swing
    
    • Limb … (Pre swing, Initial swing, Mid swing, Terminal swing)

Answer 10

• 1 stride = 1 gait cycle
  
  • Stance
    
    • Weight acceptance (Initial contact and Loading response)
    • Single limb support (Mid stance, Terminal stance, Pre swing)
  • Swing
    
    • Limb advancement (Pre swing, Initial swing, Mid swing, Terminal swing)

Question 11

Division of the Gait cycle

• 1 stride = 1 gait cycle
  
  • Stance
    
    • Weight acceptance (… contact and …. response)
    • Single limb support (… stance, … stance, Pre …)
  • Swing
    
    • Limb advancement (Pre …, Initial swing, Mid swing, Terminal swing)

Answer 11

• 1 stride = 1 gait cycle
  
  • Stance
    
    • Weight acceptance (Initial contact and Loading response)
    • Single limb support (Mid stance, Terminal stance, Pre swing)
  • Swing
    
    • Limb advancement (Pre swing, Initial swing, Mid swing, Terminal swing)

Question 12

Division of the Gait cycle

• 1 stride = 1 gait cycle
  
  • …
    
    • Weight acceptance (Initial … and Loading …)
    • Single limb support (Mid stance, Terminal stance, Pre swing)
  • …
    
    • Limb advancement (Pre swing, Initial swing, Mid swing, Terminal swing)

Answer 12

• 1 stride = 1 gait cycle
  
  • Stance
    
    • Weight acceptance (Initial contact and Loading response)
    • Single limb support (Mid stance, Terminal stance, Pre swing)
  • Swing
    
    • Limb advancement (Pre swing, Initial swing, Mid swing, Terminal swing)

Question 13

Division of the Gait cycle

• 1 stride = 1 gait cycle
  
  • Stance
    
    • … acceptance (Initial contact and Loading response)
    • … limb support (Mid stance, … stance, Pre swing)
  • Swing
    
    • Limb advancement (Pre swing, … swing, … swing, … swing)

Answer 13

• 1 stride = 1 gait cycle
  
  • Stance
    
    • Weight acceptance (Initial contact and Loading response)
    • Single limb support (Mid stance, Terminal stance, Pre swing)
  • Swing
    
    • Limb advancement (Pre swing, Initial swing, Mid swing, Terminal swing)

Question 14

Positions of the joints - Heel Strike vs Foot Flat

• Heel strike:
  
  • Hip …
  • Knee …/…
  • Ankle dorsiflexion/neutral
  • 1st MTPJ dorsiflexion/neutral
• Foot Flat:
  
  • Hip …
  • Knee …
  • Ankle plantarflexion
  • 1st MTPJ neutral

Answer 14

• Heel strike:
  
  • Hip flexion
  • Knee neutral/extension
  • Ankle dorsiflexion/neutral
  • 1st MTPJ dorsiflexion/neutral
• Foot Flat:
  
  • Hip flexion
  • Knee flexion
  • Ankle plantarflexion
  • 1st MTPJ neutral

Question 15

Positions of the joints - Heel Strike vs Foot Flat

• Heel strike:
  
  • Hip flexion
  • Knee neutral/extension
  • Ankle …/…
  • 1st MTPJ …/…
• Foot Flat:
  
  • Hip flexion
  • Knee flexion
  • Ankle …
  • 1st MTPJ …

Answer 15

• Heel strike:
  
  • Hip flexion
  • Knee neutral/extension
  • Ankle dorsiflexion/neutral
  • 1st MTPJ dorsiflexion/neutral
• Foot Flat:
  
  • Hip flexion
  • Knee flexion
  • Ankle plantarflexion
  • 1st MTPJ neutral

Question 16

Muscle activities - Heel Strike vs Foot Flat

• Heel Strike:
  
  • Hip extensors … (eccentric) to control hip flexion via momentum
  • … contracts (isometric) to control hip flexion and knee extension
  • Knee flexors contract (concentric) to start knee flexion
  • Knee extensors contract (eccentric) to control knee flexion
  • Ankle … contract (eccentric) to prevent foot slapping
• Foot Flat:
  
  • Hip extensors contract (concentric) to start hip extension
  • Knee flexors contract (concentric) to keep the knee in flexion
  • Knee extensors contract (eccentric) to control knee flexion
  • … contracts (concentric) to keep the knee in flexion
  • Ankle dorsiflexors contract (eccentric) to prevent foot slapping
  • Ankle plantarflexors contract (concentric) to bring the foot to the ground

Answer 16

• Heel Strike:
  
  • Hip extensors contract (eccentric) to control hip flexion via momentum
  • Gracilis contracts (isometric) to control hip flexion and knee extension
  • Knee flexors contract (concentric) to start knee flexion
  • Knee extensors contract (eccentric) to control knee flexion
  • Ankle dorsiflexors contract (eccentric) to prevent foot slapping
• Foot Flat:
  
  • Hip extensors contract (concentric) to start hip extension
  • Knee flexors contract (concentric) to keep the knee in flexion
  • Knee extensors contract (eccentric) to control knee flexion
  • Gastroc contracts (concentric) to keep the knee in flexion
  • Ankle dorsiflexors contract (eccentric) to prevent foot slapping
  • Ankle plantarflexors contract (concentric) to bring the foot to the ground

Question 17

Muscle activities - Heel Strike vs Foot Flat

• Heel Strike:
  
  • Hip extensors contract (eccentric) to control hip … via momentum
  • Gracilis contracts (isometric) to control hip flexion and knee …
  • Knee flexors contract (concentric) to start knee flexion
  • Knee extensors contract (eccentric) to control knee flexion
  • Ankle dorsiflexors contract (eccentric) to prevent foot …
• Foot Flat:
  
  • Hip extensors contract (concentric) to start hip extension
  • Knee flexors contract (concentric) to keep the knee in flexion
  • Knee extensors contract (eccentric) to control knee flexion
  • Gastroc contracts (concentric) to keep the knee in flexion
  • Ankle dorsiflexors contract (eccentric) to prevent foot …
  • Ankle plantarflexors contract (concentric) to bring the foot to the ground

Answer 17

• Heel Strike:
  
  • Hip extensors contract (eccentric) to control hip flexion via momentum
  • Gracilis contracts (isometric) to control hip flexion and knee extension
  • Knee flexors contract (concentric) to start knee flexion
  • Knee extensors contract (eccentric) to control knee flexion
  • Ankle dorsiflexors contract (eccentric) to prevent foot slapping
• Foot Flat:
  
  • Hip extensors contract (concentric) to start hip extension
  • Knee flexors contract (concentric) to keep the knee in flexion
  • Knee extensors contract (eccentric) to control knee flexion
  • Gastroc contracts (concentric) to keep the knee in flexion
  • Ankle dorsiflexors contract (eccentric) to prevent foot slapping
  • Ankle plantarflexors contract (concentric) to bring the foot to the ground

Question 18

Positions of the joints - Mid Swing vs Terminal Swing

• Mid swing:
  
  • Hip flexion
  • Knee flexion
  • Ankle …
  • 1st MTPJ …
• Terminal swing:
  
  • Hip flexion
  • Knee flexion/neutral
  • Ankle …
  • 1st MTPJ …

Answer 18

• Mid swing:
  
  • Hip flexion
  • Knee flexion
  • Ankle dorsiflexion
  • 1st MTPJ dorsiflexion
• Terminal swing:
  
  • Hip flexion
  • Knee flexion/neutral
  • Ankle dorsiflexion
  • 1st MTPJ dorsiflexion

Question 19

Muscle activities - Mid Swing vs Terminal Swing

• Mid swing:
  
  • Hip … contract (eccentric) to control hip flexion
  • … contracts (concentric) to keep the hip and knee in flexion
  • Knee … contract (concentric) to keep the lower leg off the ground
  • Ankle … contract (concentric) to keep the foot off the ground
• Terminal swing:
  
  • Hip … contract (eccentric) to control hip flexion via momentum
  • … contracts (isometric) to control hip flexion and knee extension
  • Knee … contract (concentric) to bring the knee to extension
  • Ankle … contract (concentric) to keep the foot off the ground

Answer 19

• Mid swing:
  
  • Hip extensors contract (eccentric) to control hip flexion
  • Gracilis contracts (concentric) to keep the hip and knee in flexion
  • Knee flexors contract (concentric) to keep the lower leg off the ground
  • Ankle dorsiflexors contract (concentric) to keep the foot off the ground
• Terminal swing:
  
  • Hip extensors contract (eccentric) to control hip flexion via momentum
  • Gracilis contracts (isometric) to control hip flexion and knee extension
  • Knee extensors contract (concentric) to bring the knee to extension
  • Ankle dorsiflexors contract (concentric) to keep the foot off the ground

Question 20

Muscle activities - Mid Swing vs Terminal Swing

• Mid swing:
  
  • Hip extensors contract (…) to control hip flexion
  • Gracilis contracts (concentric) to keep the hip and knee in flexion
  • Knee flexors contract (concentric) to keep the lower leg off the ground
  • Ankle dorsiflexors contract (concentric) to keep the foot off the ground
• Terminal swing:
  
  • Hip extensors contract (…) to control hip flexion via momentum
  • Gracilis contracts (…) to control hip flexion and knee extension
  • Knee extensors contract (concentric) to bring the knee to extension
  • Ankle dorsiflexors contract (concentric) to keep the foot off the ground

Answer 20

• Mid swing:
  
  • Hip extensors contract (eccentric) to control hip flexion
  • Gracilis contracts (concentric) to keep the hip and knee in flexion
  • Knee flexors contract (concentric) to keep the lower leg off the ground
  • Ankle dorsiflexors contract (concentric) to keep the foot off the ground
• Terminal swing:
  
  • Hip extensors contract (eccentric) to control hip flexion via momentum
  • Gracilis contracts (isometric) to control hip flexion and knee extension
  • Knee extensors contract (concentric) to bring the knee to extension
  • Ankle dorsiflexors contract (concentric) to keep the foot off the ground

Question 21

Positions of the joints - Toe Off vs Initial Swing

• Toe off:
  
  • Hip …
  • Knee …
  • Ankle …flexion
  • 1st MTPJ …flexion
• Initial Swing:
  
  • Hip …/…
  • Knee …
  • Ankle neutral/…flexion
  • 1st MTPJ …flexion/neutral

Answer 21

• Toe off:
  
  • Hip neutral
  • Knee flexion
  • Ankle plantarflexion
  • 1st MTPJ dorsiflexion
• Initial Swing:
  
  • Hip neutral/flexion
  • Knee flexion
  • Ankle neutral/dorsiflexion
  • 1st MTPJ dorsiflexion/neutral

Question 22

Muscle activities - Toe Off vs Initial Swing

• Toe off:
  
  • Hip flexors contract (concentric) to start hip flexion
  • … contracts (concentric) to assist the knee in flexion
  • … contracts (concentric) to bring the knee into flexion
  • Ankle … contract (concentric) to propels the body forward THEN Ankle … contract (concentric) to keep the foot off the ground
• Initial Swing:
  
  • Hip flexors contract (concentric) to keep the hip in flexion
  • … contracts (concentric) to keep the knee in flexion
  • Ankle … contract (concentric) to keep the foot off the ground

Answer 22

• Toe off:
  
  • Hip flexors contract (concentric) to start hip flexion
  • Gracilis contracts (concentric) to assist the knee in flexion
  • Gastroc contracts (concentric) to bring the knee into flexion
  • Ankle plantarflexors contract (concentric) to propels the body forward THEN Ankle dorsiflexors contract (concentric) to keep the foot off the ground
• Initial Swing:
  
  • Hip flexors contract (concentric) to keep the hip in flexion
  • Gracilis contracts (concentric) to keep the knee in flexion
  • Ankle dorsiflexors contract (concentric) to keep the foot off the ground

Question 23

Muscle activities - Toe Off vs Initial Swing

• Toe off:
  
  • Hip flexors contract (concentric) to start hip flexion
  • Gracilis contracts (concentric) to assist the knee in flexion
  • Gastroc contracts (concentric) to bring the knee into flexion
  • Ankle plantarflexors contract (concentric) to … the body forward THEN Ankle dorsiflexors contract (concentric) to keep the foot off the ground
• Initial Swing:
  
  • Hip flexors contract (concentric) to keep the hip in …
  • Gracilis contracts (concentric) to keep the knee in …
  • Ankle dorsiflexors contract (concentric) to keep the foot off the ground

Answer 23

• Toe off:
  
  • Hip flexors contract (concentric) to start hip flexion
  • Gracilis contracts (concentric) to assist the knee in flexion
  • Gastroc contracts (concentric) to bring the knee into flexion
  • Ankle plantarflexors contract (concentric) to propels the body forward THEN Ankle dorsiflexors contract (concentric) to keep the foot off the ground
• Initial Swing:
  
  • Hip flexors contract (concentric) to keep the hip in flexion
  • Gracilis contracts (concentric) to keep the knee in flexion
  • Ankle dorsiflexors contract (concentric) to keep the foot off the ground

Question 24

Gait Terms

• Both feet in contact with ground (together - stance together) - … support
• One foot in contact with ground, one in swing - … support

Answer 24

• Both feet in contact with ground (together - stance together) - double support
• One foot in contact with ground, one in swing - single support

Question 25

_Gait Terms_ * Step Length - length when one foot in heel ... and other foot in heel ... (length between) * Stride length - heel ... from one foot (full ... ... completed) * Step ... - gap between left and right foot * Foot angle - how far foot deviates from imaginary line running through midline of body

Answer 25

* Step Length - length when one foot in heel **strike** and other foot in heel **strike** (length between) * Stride length - heel **strike** from one foot (full **gait** **cycle** completed) * Step **width** - gap between left and right foot * Foot angle - how far foot deviates from imaginary line running through midline of body

Question 26

_BOS & COM_ * BOS = ... of ... - Defined as the area within an outline of all ground contact points * COM = ... of ... - The average position of all the parts of the system, weighted according to their masses

Answer 26

* BOS = **Base** of **Support** - Defined as the area within an outline of all ground contact points * COM = **Centre** of **Mass** - The average position of all the parts of the system, weighted according to their masses

Question 27

_BOS & COM_ * BOS = Base of Support - Defined as the ... within an outline of all ... ... points * COM = Centre of Mass - The ... position of all the parts of the system, weighted according to their ...

Answer 27

* BOS = Base of Support - Defined as the **area** within an outline of all **ground** **contact** points * COM = Centre of Mass - The **average** position of all the parts of the system, weighted according to their **masses**

Question 28

_Walking speed / ability to turn_ * Normal walking speed for patient? * Walking speed can affect ‘how a person walks’ – spatio-..., ... and kinematic changes (Kirtley et al., 1985) * ... walking speed can improve gait ... in young and older adults (Kang & Dingwell, 2008) * Time and number of steps required for turning * Up to 3.1 seconds for non-fallers (Dai et al., 2012) * Less than 3 steps for healthy adults (Gill et al., 1995)

Answer 28

* Normal walking speed for patient? * Walking speed can affect ‘how a person walks’ – spatio-**temporal**, **kinetic** and kinematic changes (Kirtley et al., 1985) * **Reducing** walking speed can improve gait **stability** in young and older adults (Kang & Dingwell, 2008) * Time and number of steps required for turning * Up to 3.1 seconds for non-fallers (Dai et al., 2012) * Less than 3 steps for healthy adults (Gill et al., 1995)

Question 29

_Walking speed / ability to turn_ * Normal walking speed for patient? * Walking speed can affect ‘how a person walks’ – spatio-temporal, kinetic and kinematic changes (Kirtley et al., 1985) * Reducing walking speed can improve gait stability in young and older adults (Kang & Dingwell, 2008) * Time and number of steps required for turning * Up to ... seconds for non-fallers (Dai et al., 2012) * Less than ... steps for healthy adults (Gill et al., 1995)

Answer 29

* Normal walking speed for patient? * Walking speed can affect ‘how a person walks’ – spatio-temporal, kinetic and kinematic changes (Kirtley et al., 1985) * Reducing walking speed can improve gait stability in young and older adults (Kang & Dingwell, 2008) * Time and number of steps required for turning * Up to **3.1** seconds for non-fallers (Dai et al., 2012) * Less than **3** steps for healthy adults (Gill et al., 1995)

Question 30

_Terrain adjustment_ * ... – up & down * ... surfaces * Various surface ...

Answer 30

* **Stairs – up & down** * **Uneven surfaces** * **Various surface properties (e.g. soft/hard, slippery)**

Question 31

_A complete picture of gait analysis_ * If you want to get the complete picture, you need to take into account your patient’s movement routines: * ... ... * ... * ... * Only straight-line walking in clinic is not always sufficient * ? Compensatory mechanisms

Answer 31

* If you want to get the complete picture, you need to take into account your patient’s movement routines: * **Daily walking – to & from work / school?** * **Activities – sports? dance?** * **Surfaces – smooth? uneven? soft? hard?** * Only straight-line walking in clinic is not always sufficient * ? Compensatory mechanisms

Question 32

_Disruptions in gait_ * Musculoskeletal conditions * E.g. ..., Tendinopathy, ... injury * Neurological conditions * E.g. Parkinson’s, Cerebral ..., CVA, ... neuropathy * Others * P.. * Supply of ... (e.g. heart, lungs, blood vessels) * ... issues

Answer 32

* Musculoskeletal conditions * E.g. **Arthritis**, Tendinopathy, **Ligament** injury * Neurological conditions * E.g. Parkinson’s, Cerebral **Palsy**, CVA, **Peripheral** neuropathy * Others * **Pain** * Supply of **energy** (e.g. heart, lungs, blood vessels) * **Behavioural** issues

Question 33

_Disruptions in gait_ * Musculoskeletal conditions * E.g. Arthritis, Tendinopathy, Ligament injury * Neurological conditions * E.g. Parkinson’s, Cerebral Palsy, CVA, Peripheral neuropathy * Others * Pain * Supply of energy (e.g. heart, lungs, blood vessels) * Behavioural issues

Answer 33

* Musculoskeletal conditions * E.g. Arthritis, Tendinopathy, Ligament injury * Neurological conditions * E.g. Parkinson’s, Cerebral Palsy, CVA, Peripheral neuropathy * Others * Pain * Supply of energy (e.g. heart, lungs, blood vessels) * Behavioural issues

Question 34

_Gait Assessment Tools_ * ... screening examination * GAIT ... checklist

Answer 34

* **GALS** screening examination * GAIT **observation** checklist

Question 35

_Case scenario - GAIT_ * A 55 year old lady complains of severe OA in her left knee. She is otherwise ‘healthy’. * How will this affect her gait? How will she compensate for the severe OA in her left knee?

Answer 35

* A 55 year old lady complains of severe OA in her left knee. She is otherwise ‘healthy’. * How will this affect her gait? * **OA knee could be related with pain, reduced functions of the knee joint, reduced muscle strength (e.g. quadriceps, hamstrings), etc.** * **Thus, it likely leads to decreased use of the affected knee or ‘guarding’ effect.** * How will she compensate for the severe OA in her left knee? * **If a joint (in this case – knee) cannot be used properly, compensations could come from the joint proximal (hip) or distal (ankle) to the affected joint OR from the opposite limb OR the overall gait.** * **In the video, the patient spent more time in swing for the left limb (i.e. avoid weight bearing of the left limb) and more time in stance for the right limb. This means the right limb has to take on weight for a longer period of time.**

Question 36

* Other possible compensations for severe OA in knee include ... of the hip, reduced step ... in the same limb, reduced walking ..., etc. * Please note that patients with the same OA knee may not have the same ... mechanism. This depends each individual and other characteristics that they may have.

Answer 36

* Other possible compensations for severe OA in knee include **circumduction** of the hip, reduced step **length** in the same limb, reduced walking **speed**, etc. * Please note that patients with the same OA knee may not have the same **compensatory** mechanism. This depends each individual and other characteristics that they may have.