MSK - Gait

Question 1

Define gait

Answer 1

The mechanism by which the body is transported using coordinated movements of the major lower limb joints. It is an energy efficient interaction between musculoskeletal and neurological systems

Question 2

What are the five attributes of normal gait?

Answer 2

• stability in stance
• foot clearance in swing
• pre-positioning for initial contact
• adequate step length
• energy conservation

Question 3

Define gait cycle

Answer 3

The period of time from initial contact to the next initial contact on the same side

Question 4

How much of a normal gait cycle is made up of stance phase and how much is made up of swing phase?

Answer 4

60% is stance phase, 40% is swing phase

Question 5

What are the periods between stance and swing called in the gait cycle of walking?

Answer 5

‘Double support’ - this is where both feet are on the ground simultaneously

Question 6

What is the period between stance and swing called in the gait cycle of running?

Answer 6

‘Double float’, where both feet are off the ground

Question 7

What are the five stages of the stance phase (walking)?

Answer 7

• initial contact (heel strike)
• loading response
• mid-stance (foot flat)
• terminal stance (heel off)
• pre-swing (toe off)

Question 8

What are the three components of the swing phase (walking)?

Answer 8

• initial swing
• mid-swing
• terminal swing

Question 9

Define stride

Answer 9

The distance from initial contact on right foot to the next initial contact on the right foot

Question 10

Define step

Answer 10

Distance from initial contact on the right foot to initial contact on the left foot

Question 11

Define cadence

Answer 11

The number of steps taken per minute

Question 12

What is the difference between kinetics and kinematics?

Answer 12

Kinematics describe motion - joint angles, displacements, velocities, accelerations etc.

Kinetics describe the things that cause motion - forces and moments etc.

Question 13

What can be examined while looking at gait in the sagittal plane?

Answer 13

• pelvic tilt

- flexion/extension of hip, knee and ankle

Question 14

What can be examined while looking at gait in the coronal plane?

Answer 14

• adduction/abduction of the pelvis, hip, knee and ankle

Question 15

What can be examined while looking at the body in the transverse plane?

Answer 15

Rotational position of the body and limbs

Question 16

What are the ‘three rockers’ of ankle kinematics?

Answer 16

• heel rocker: heel is fulcrum as initial contact occurs
• ankle rocker: ankle is fulcrum as centre of gravity shifts
• forefoot rocker: forefoot is fulcrum as heel begins to lift

Question 17

What is the main role of a muscle that is concentric (shortening)?

Answer 17

Acceleration/power generation

Question 18

What is the main role of a muscle that is eccentric (lengthening)?

Answer 18

Deceleration/power absorption

Question 19

What is the role of a muscle that remains isometric during the gait cycle?

Answer 19

Stability

Question 20

How is energy conserved in the gait cycle?

Answer 20

• minimise excursion of centre of gravity
• control momentum
• transfer energy between body segments
• phasic muscle action

Question 21

What is an antalgic gait?

Answer 21

This occurs when there is pain in one leg. There is a short stance phase on the affected leg, and a lack of body weight shift to it. There will be a short swing phase in the unaffected leg, resulting in an uneven gait.

Question 22

When might a hemiplegic gait be observed?

Answer 22

Following hemi-brain injury, eg due to stroke, cerebral palsy or trauma

Question 23

What are the characteristics of a hemiplegic gait?

Answer 23

• flexed upper limb
• extended lower limb
• short step in the unaffected leg
• circumduction of the affected leg

Question 24

When is a diplegic gait seen?

Answer 24

Often in children with cerebral palsy

Question 25

What is the appearance of a diplegic gait?

Answer 25

- 'scissoring' due to tight psoas, adductors, hamstring and calf muscles - ankle is plantar flexed - forefoot makes initial contact

Question 26

When is a high steppage gait often seen?

Answer 26

In sciatica, common perineal nerve palsy, other neuromuscular disorders

Question 27

What are the characteristics of a 'high steppage gait'?

Answer 27

They have 'foot drop' where the toe hangs down, so they have excessive hip flexion on the affected side to avoid tripping over feet. They also have a foot slap as their foot hits the floor

Question 28

What are the characteristics of a Parkinsonian gait?

Answer 28

- Shuffling, short steps - forward flexed (leaning forward) - no arm swing - festinant