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Gait/Posture Exam

Stack for my Gait and Posture Exam October 2010

Ideal static posture, describe through which points of the body a plumb line should pass in a lateral view – starting from lateral malleolus ? -anterior to lateral malleolus -anterior to midline of knee joint -through greater trochanter -through sacral promontory -mid way through trunk- bodies of lumbar spine -Through shoulderjoint -Through bodies of cervical spine -Through hole of ear
What factors can change your static posture away from the ideal. Give specific examples and the specific effect it may have on one’s posture. -Congenital abnormalities of musc.syst. -poor muscle strength -muscle imbalance -damage to bony structures -damage to cennective tissue -biomechanics -changes of line of gravity (pregnancy, footwear, behaviours etc.)
Factors changing static posture: Congenital abnormalities of the musculoskeletal system scoliosis, abnormal posture because of the curve of the spine
Factors changing static posture: Poor muscle strength no training to improve muscle strength, atrophy, muscle get weak, change in posture
Factors changing static posture: Muscle imbalance imbalances between upper and lower body, also between right and left site, can cause change in posture- scoliosis, rounded back-hyper kyphosis
Factors changing static posture: Damage to bony structures fracture of a bone, can cause change of posture because of atrophy and disalignmend of bones
Factors changing static posture: Damage to connective tissue including ligaments, cartilage Sprains and strains of the muscle can shorten the muscle that can cause posture changes
Factors changing static posture: Biomechanics biomechanics means moving freely and preventing injuries, muscle balances, flexibility of muscles and free movement of nerve structures
Signs of a Flat back ? Head forward, Cervical spine slightly extended, Upper thoracic increased flexion with lower part straight, lumbar spine flexed, posterior tilt, hip joints extended, knee joints extended, ankle joints sl plantar flexion
Signs of a Sway back ? Short: Hamstring, Upper fibres of internal obliques, low back muscle fibres strong but not short; weak: one joint hip flexors, External oblique, upper back extensor, neck flexor
Signs of Scoliosis ? Lateral curves caused by: muscle imbalance or leg length and defect or congenital boney anomaly in vertebral column
Signs of a Lordosis ? Natural lordosis is the curve in lumbar spine, when curve is extreme it is called hyper lordotic curve, short: low back erector spinae, hip flexors; weak: abs especially external obliques, hip extensors
Signs of a Kyphosis ? Abnormal Kyphotic curve in upper back is called hyper kyphosis. Short: upper and lateral fibres of internal oblique, shoulder adductors, pec minor and intercostals; weak: thoracic spine extensors, middle traps and lower traps.
What are the 3 major body systems control our balance ? Vestibular system, Vision, Proprioceptive System
What is the vestibular system ? located in your inner ear. Sensitive in changes to head position and movement direction. Consist of three semicircular canals. Structure: thousands of tiny hair cells that generate and relay balance signals to the brain.
What are the functions of your eyes ? Your eyes see both your position in space and movement. Communication between vestibular system and movement of the eyes – vestibular ocular reflex. Vestibular system works to control eye position and movement so when head moves eyes stays fixed.
What are the function of your proprioceptive system ? Proprioceptive(feeling): Your proprioceptive system uses special pressure sensors in your muscles, tendons and joints to sense gravity and joint position. Most of your proprioceptive sensors are in your feet and leg joints.
What happens when one ore more of these systems ever fail ? it can impose enormous changes on your lifestyle.
Define normal gait ! Normal gait is a series of rhythmical and alternating movements of the trunk and limbs which result in the forward progression of the centre of gravity. It is a series of controlled falls.
What are the functions/tasks of the gait cycle ? Functions and tasks are: bear weight, provide a means for locomotion and maintain equilibrium
What are the 4 stance phases ? heel contact, mid stance, active propulsion and passive propulsion
How does the active propulsion start ? heel contact of left foot and ends with toe off of right foot
How does the mid stance phase start ? toe off left foot and ends with heel lift of right foot
How does the heel conatct phase start ? heel contact right foot and ends with toe off left foot
How does the passive propulsion start ? heel contact of left foot end with toe off of right foot
What are the two phases of the swing pahse and what does it mean ? Acceleration the swinging limb catches up to and passes the torso and Deceleration forward movement of the limb is slowed down to position the foot for heel strike
What is step length ? rt step length = lf step length (distance of heel contact opposite foot)
What is Stride length ? Double the step length (distance of heel contact same foot)
Explain Walking base ! Side to side distance between the line of the two feet also known as stride width
What is Cadence (Gleichschritt) ? Number of steps per unit (100-115 steps a minute)
Velocity, what are the aspects ? Average velocity is step length x cadence, it is the distance covered by the body in unit time
What is comfortable walking speed ? Least energy consumption per unit distance
What is single support and double support in gait ? One foot is in contact with ground in single support and in double support both feet are in contact with the ground
What happens when walking speed increases ? Stance phase will decrease # swing phase will increase # double support will decrease
What are the changes in the gait cycle when ones starts running ? Ration between stance and swing reverses, double support disappears and double swing develops
What does stand CG for ? Centre of Gravity
What is the average vertical displacement of CG during gait cycle ? Rhythmic up & down movement, highest point midstance, lowest point double support, average displacement 5 cm, path: extremely smooth sinusoidal curve
What is the average lateral displacement of CG during gait cycle ? Rhythmic side to side, lateral limits midstance, average displacement 5 cm, path: extremely smooth sinusoidal curve
What are the 6 determents or optimisations to minimise excursion of the CG in vertical and lateral planes ? 1 Pelvic rotation # 2 Pelvic tilt # 3 Knee flexion in stance # 4 Ankle mechanism # 5 Foot mechanism # 6 Lateral displacement
Explain pelvic rotation ! forward rotation of the pelvis in horizontal plane reduces angle of hip flexion and extension and enables a slightly longer step length
Explain Pelvic tilt ! 5* dip of swinging side (hip adduction) reduces the height of the apex of the curve of CG
Explain Knee flexion in stance ! Approx 20* dip, shortens leg in middle of stance phase, reduces the height of the apex of the curve of CG
Explain Ankle mechanism ! Lengthens the leg at heel contact, smoothens the curve of CG and reduces lowering CG
Explain foot mechanism ! Lengthens the leg at toe off as ankle moves from dorsi flexion to plantar flexion, smoothens the curve of CG
Explain Lateral displacement ! The normally narrow width of the walking base minimizes the lateral displacement of CG, reduces muscular energy consumption due to reduced lateral acceleration & deceleration
What muscles are invert and evert the foot to allow movement across uneven surfaces ? Tibialis anterior = inversion of foot and dorsi flexion of ankle # Peroneus longus and Peroneus brevis are evert and abduct the foot, also weak plantar flexion of foot
Which muscles enables foot clear the floor as it swings through ? it is dependent on ankle and hip position. The ankle dorsi flexes to neutral and the hip attacks 30* flexion. Knee flexion decreases to 30*. Tibialis anterior dorsi flexes the foot also the long extensors dorsi flexes the foot for toe clearance.
Explain Antalgic gait ! a limp adopted so as to avoid pain on weight-bearing structures, characterized by a very short stance phase. Conditions associated with an Antalgic gait are Trauma, Osteoarthritis and Pelvic girdle pain.
What is meant by lateral bending and what may cause it ? Lateral trunk bending is caused by weakness of the abductor muscles, gluteus medius and gluteus maximus muscles. During the stance phase the weakened abductor muscle allow the pelvis to tilt down on the opposite side.
What do you do to compensate lateral trunk bending ? To compensate the trunk lurches to the weakened side to attempt to maintain a level pelvis throughout the gait cycle.
How can you have a leg dicrepancy and how do people overcome them ? It will have a longer swing phase than stance phase. The 4 common compensations are circumduction, hip hiking, steppage and vaulting (can happen due stroke)
What can cause a increased walking base ? Common causes for an increased walking base are deformities e.g. abducted hip or valgus knees., which causes feet to be wider apart than usual. It also causes instability and therefore fear of falling. e.g. cerebellar ataxia
Consequences and cuase of inadequate dorsi flexion ?! In stance it will result in foot slap, in swing it will result in toe drag. Causes are due to a stroke which can cause muscle weakness -> weak tibialis anterior and spastic plantar flexion. Consequences are functional leg length discrepancy.
Excessive knee extension, explain ! Loss of normal Knee flexion during stance phase. Knee may go in hyperextension. Common causes are quadriceps weakness (mid stance), quadriceps spasticity (mid stance), knee flexor weakness (end stance).
What is cerebellar ataxia ? sudden onset of uncoordinated muscle movement, may affect from the neck to hip area of the body, or the arms and legs. The body may move side to side or back to front while sitting, before quickly moving to an upright position.
What are the symptoms of cerebellar ataxia ? Common symptoms are sudden movement, walking problems, uncoordinated eye movements, and clumsy speech pattern.
How would you walk when you have cerebellar ataxia ? Walking movement would be shaky and unstable also less accurate trying to reach destination, poor balance.
Could drinking alohol affect walking when haveing cerebellar ataxia ? Yes it could because it impairs ones vision ability to calculate how far away a step, person or object is. It can cause nerve damage e.g. peripheral neuropathy -> which causes inability to carry information from the brain to the spinal cord.
What is vestibular ataxia ? Vestibular ataxia is a loss of balance with preservation of strength. If unilateral, the abnormality is asymmetrical; if bilateral, it is symmetrical.
What happen when having vestibular ataxia ? In vestibular ataxia, the signals from the inner ear are unable to reach the brainstem and cerebellum. A patient with vestibular ataxia often experiences vertigo i.e. a feeling that either the patient or his surroundings are spinning.
What are some causes of vestibular ataxia ? . Some common causes include inflammation of the inner ear or vestibular nerve that carries signals, trauma, lack of blood supply and some drugs that affect the inner ear.
What is causes foot drop ? Inability in moving the ankle / toes into dorsi flexion. In walking, the leg has to be lifted higher than normal. Foot drop is usually caused by nerve damage. Damage to fibular/peroneal nerve will lead to inability for the leg to dorsi flex the foot.
Created by: locke
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