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Chapter 21 & 22 Posture and Gait
Terms in this set (71)
Position of body parts in relation to each other
What is "sway back"
Increase lumbar lordosis
What is "flat back"
Decrease lumbar lordosis
Any lateral curve of the spine is a pathological condition known as what?
True or false: An increase in lumbar curve also presents a decrease in thoracic curve?
An increase in lumbar curve also presents an increase in thoracic curve
What is the primary curve? Which ones are classified as primary curves?
Anteriorly concave curve
Thoracic and sacral
What is the secondary curve? Which ones are classified as secondary curves?
Anteriorly convex curves
Cervical and lumbar
What 2 things need to occur in order for the pelvis to be considered in a neutral position?
1. ASIS and PSIS are level
2. ASIS and pubic symphysis are in the same plane
Does the lumbar curve increase or decrease with an anterior pelvic tilt? A posterior pelvic tilt?
What muscles are responsible for controlling a lateral tilt and brining it back to neutral?
Lateral trunk flexors and hip abductors
Define antigravity muscles. What are the primary muscles responsible for resisting gravity?
Muscle contractions responsible for maintaining static and dynamic upright posture
Hip and knee extensors & trunk and neck extensors
What other muscle groups are also important to maintaining upright posture?
- Neck and trunk flexors
- Hip abductors and adductors
- Ankle pronators and supinators
Define postural sway? What are the primary muscles responsible for controlling postural sway?
Anterior-posterior motion of the body
Ankle PF and DF also displacement of COG and BOS
Weighted string from ceiling used to assess posture
How do you assess posture from a lateral view?
- Anterior to the lateral malleoli
- Posterior to patella
- Through greater trochanter
- Through lumbar bodies
- Through acromion process
- Through earlobe
How do you assess posture from an anterior view?
- Head level
- Shoulders level
- Midline of sternum
- ASIS's level
- Legs slightly apart
- Knees level
- Normal arches
- Feet slightly outward
How do you assess posture form a posterior view?
- Head level
- Shoulders level
- Hips level
- Legs slightly apart
- Knees level
- Feet slightly apart
What position applies the most amount of pressure on intervertebral discs? The least?
The process of components of walking
Activity that occurs between the time one foot touches the floor and the time the same foot touches the floor again
The distance traveled during the gait cycle
Basically 1/2 of a stride
The distance between heel strike of one feel and the heel strike of the other foot
The number of steps taken per minute
What are the 2 stances of the gait cycle?
1. Stance phase
2. Swing phase
Begins with the heel strike of one foot and ends when that foot leaves the ground
Accounts for about 60* of the gait cycle
Begins as soon as the foot leaves the floor and ends when the heel of the same foot touches the floor again
Accounts for about 40* of the gait cycle
What 3 tasks need to be accomplished during the phases of the gait cycle?
1. Weight acceptance
2. Single leg support
3. Leg advancement
Occurs at the very beginning of stance phase when the foot touches the ground and the body begins to shift onto that leg
Single leg support
As the body weight shifts completely onto the stance leg so that the opposite leg can swing forward
Occurs during swing phase
True or false: The gait cycle has 2 periods of double support and only 1 period of single support
It has 2 of each
When both feet are in contact with the ground at the same time
Each period takes up 10* of the gait cycle
A time during which neither foot is in contact with the ground (does not occur walking)
When only one foot is in contact with the ground
Each period takes up about 40* of the gait cycle
What is the difference between traditional terminology and Rancho Los Amigos terminology?
Traditional terms refer to points in time (key points within the gait cycle), whereas RLA terms refer to periods of time (reflects the moving or dynamic nature of gait)
What are the 5 components of the stance phase?
1. Heel strike
2. Foot flat
4. Heel off
What are the 3 components of the swing phase?
COG goes up and down about 2 inches (being highest at mid stance and lowest at heel strike)
think chalk board scenario in book
COG goes side to side about 2 inches (greatest during single support phase at midstance)
Width of walking base
Ranges from 2-4 inches
What is a lateral pelvic tilt also known as?
What are some characteristics of a young child's gait?
- Walk with a wider walking base
- Cadence is faster
- Stride length is shorter
- Initial contact with the floor is with a flat foot
- Knees remain mostly extended during stance phase
- Little or no reciprocal arm swing
What are some characteristics of an older adults gait?
- Tend to walk slower
- Spend more time in stance phase
- Longer periods of double support
- Take shorter step
- Vertical displacement is less
- Walk with a wider base
- Greater horizontal displacement
- Decrease toe to floor clearance
Glute max gait
"Rocking horse gait"
Trunk shift posteriorly at heel strike, extreme backward-forward movement of trunk
Glute med gait/Trendelenburg gait
Shifts the trunk over the affected side during stance phase
- May lean the body forward over quads at the early part of stance phase
- Using hip extensors and ankle plantar flexors in a closed- chain action to pull the knee into extension at heel strike
1. Knee will go into excessive hyperextension during stance phase
2. Knee will snap into extension during swing phase
When there is no ankle DF resulting in the toes to strike first
Weak ankle dorsiflexors may not be able to support the body weight after heel strike and will thus move toward foot flat
Foot falls into plantar flexion due to weak dorsiflexors during the swing phase
Knee is lifter higher as a result of a dropped foot
Triceps surae group
"Sore foot limp"
(gastroc and soleous are weak) there is no heel rise at push off resulting in a shortened step length on the unaffected side
Commonly seen with muscular and other dystrophies
Stands with shoulder behind hips, in order to swing the leg forward the entire side of the body must swing forward. Leg and arm swing together
Hip flexor contracture
Involved hip is unable to go into hip extension and hip hyperextension during the mid stance and push off phases
Hip is flexed and the person's trunk leans forward as if bowling
Increased motion of the lumbar spine and pelvis can greatly compensate for hip motion
Knee flexion contracture
Excessive DF during mid stance and an early heel rise during push-off, shortened step length of the unaffected side
Knee fusion/vaulting gait
Lower leg will be at a fixed length
- Rise up on toes of uninvolved leg
- Hip hike involved side
- Swing leg out to side
Leg begins near midline at push off, swing out to side during swing phase, then returns to midline for heel strike
Leg remains in an abducted position throughout gait cycle
Triceps surae contracture
- Limited DF or extreme extension of the knee
- Early heel rise will occur at push off
- Knee will be lifted higher during swing phase
- Toes will land first during heel strike
- Loss of ankle pronation and supination
- Shortened stride length
- Limited DF and PF
- Difficulty walking on uneven surfaces
- Hip goes into extension, adduction, and medial rotation
- No reciprocal arm swing
- Step length tends to be lengthened on involved side and shortened on uninvolved side
- Extension synergy in involved LE
- Flexion synergy in involved UE
Parkinsonian gait/festinating gait
- Tremors and demonstrates diminished movement
- Posture of the LE and trunk tend to be flexed
- Elbows are flexed with little to no reciprocal arm swing
- Stride length is diminished
- Walks with weight mostly forward on toes
- Has difficulty stopping
Unsupported leg swings against or across the stance leg
Bilateral LE involvement commonly seen in spastic diplegia and cerebral palsy
- Excessive flexion, adduction, and medial rotation at the hips and flexion at the knees
- Ankles are PF
- Pelvis maintains an anterior pelvic tilt
- Arm swing is exaggerated to compensate
If there is pain in the LEs what do people have a tendency of doing?
Shorten the stance phase
- Gait for compensating pain in the LEs
- Shorten, often abducted stance phase on the involved side results in a rapid and shortened step length on the uninvolved side
- Reciprocal arm swing shortens as the step length is shortened
How do you compensate for minimal leg length discrepancy?
Drop the pelvis on the shorter (affected) leg side or leaning over the shorter leg
Only works for a discrepancy up to 3 inches
How do you compensate of moderate leg length discrepancy?
- 3-5 inches
- Shorten the uninvolved leg or make the involved leg functionally longer
- Walks on the ball of the involved side
How do you compensate for severe leg length discrepancy?
- More than 5 inches
- Drop pelvis
- Walk on balls of feet
- Flex knee on uninvolved side during entire cycle
- Stance phase would begin with flat foot
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