POAT Midterm Exam
Initial Contact / Heel Strike - answer Begins the moment the foot touches the ground
and is the 1st phase of double support, the heel rocker is initiated
Hip flexion, quad and hamstring activation for knee stability, ankle DF to control foot
contact with ground
Loading Response - answer The body absorbs the impact of the weight being
transferred onto the outstretched limb through controlled knee flexion and the heel
rocker action
Hip extension, knee flexion for shock absorption, and ankle PF to control tibial
advancement
Midstance - answer The body begins to move from force absorption at impact to force
propulsion forward
Hip moves from flexion to extension, the knee reaches maximal flexion and then begins
to extend in single limb stance, ankle DF
Terminal Stance - answer Begins when the heel leaves the floor. In this phase, the body
weight is divided over the metatarsal heads (toe rocker)
Hip hyperextends then goes into flexion, slight knee flexion, ankle PF
Pre-swing / Toe off - answerToes are still in contact, hip becomes less extended, 2nd
phase of double-limb support occurs as weight is rapidly transferred to the contralateral
limb
Hip extension decreases, knee flexion, ankle PF increases
Initial Swing - answerHip extends then flexes, knee flexes, ankle ends in a neutral
position as the limb moves from the trailing limb position and the foot clears the floor
Hip extension then flexion, knee flexion, ankle PF to neutral position
Midswing - answerLimb advancement and foot clearance continue to be important in
this phase
Hip flexes, knee flexes then extends, ankle DF
,Terminal Swing - answerDeceleration of swing limb and preparation for stance phase
occur
Hip flexion, knee maximally extends in a locked position, ankle in a neutral position
Determinants of Functional Gait - answer1. Stance phase stability
2. Clearance in swing phase
3. Swing phase pre-positioning
4. adequate step length
5. energy conservation
Stance Phase Stability - answerMust be stable to respond to the GRF as the patient
moves through stance phase
Clearance in swing phase - answerTo minimize risk of stumbling
influence by the maintenance of a level pelvis to relatively shorten the length of the
swinging limb. This is achieved by stance limb abductor muscle, and the hip, knee
flexors, and ankle flexors
Swing phase pre-positioning - answerFoot must be positioned for effective initial contact
and loading response
Adequate step length - answerSufficient ROM and motor control of the limb is essential
to ensure normal step length
Energy conservation - answerImpacted by timing, muscle performance, coordination,
balance, and postural control of the gait cycle
First Rocker - answerHeel rocker
The transition from swing into early stance, controlled lowering of the forefoot occurs,
with a fulcrum at the heel.
anterior muscles on lower leg control this movement (eccentric)
Second Rocker - answerAnkle Rocker
Controlled forward progression of the tibia over the foot occurs, with motions at the
talocrural joint of the ankle
Tibia is brought "up and over" the talus rotating around the ankle joint, intrinsic foot
muscles maintain the medial longitudinal arch
anterior tibial translation
, Third Rocker - answerToe Rocker
Transition from stance toward swing occurs as the heel rises, with dorsiflexion pf the
metatarsophalangeal
Ankle PF in toe-off with the heel rising to initiate swing phase
Resultant gait deviations - answerImpairment directly causes this pattern to occur
Example- Plantarflexion hypertonia, PF contraction leading to toe drag and limited heel
strike
Compensatory gait deviations - answerPattern that is created during gait because of the
result of the impairment
Example- Hip hike, circumduction &/or contralateral vaulting to create enough space for
the involved limb to advance during swing phase
Knee Buckling- treatment intervention - answerDF must be limited and PF must be
improved (through exercises and/ot orthoses)
Knee hyperextension- treatment intervention - answerPF must be limited, and DF must
be improved (through exercises and/or orthoses)
Toe or foot drag- treatment intervention - answerPF must be limited
The patient DOES NOT always need medial/lateral stability when experiencing toe/foot
drag
treatment intervention- Stance phase stability - answerIncrease hip and knee extension
strength, core stability, upright posture, greater stability from assistive device
Treatment Intervention- Clearance in swing phase - answerIncrease hip/knee flexion
and ankle DF, upright posture, contralateral stance phase stability, core stability
Treatment Intervention- Swing phase pre-positioning - answerCoordination and
kinesthesia exercises
Treatment Intervention- Adequate step length - answerContralateral stance phase
stability, coordination and kinesthesia exercises, stretch tight muscles
Treatment Intervention- Energy Conservation - answerSelf-pacing techniques, rest
breaks, speed of movement, AD used
Phases of Rehabilitation: Acute Care - answerInitial management and protective healing
Approximately 1-3 weeks after injury or amputation
Initial Contact / Heel Strike - answer Begins the moment the foot touches the ground
and is the 1st phase of double support, the heel rocker is initiated
Hip flexion, quad and hamstring activation for knee stability, ankle DF to control foot
contact with ground
Loading Response - answer The body absorbs the impact of the weight being
transferred onto the outstretched limb through controlled knee flexion and the heel
rocker action
Hip extension, knee flexion for shock absorption, and ankle PF to control tibial
advancement
Midstance - answer The body begins to move from force absorption at impact to force
propulsion forward
Hip moves from flexion to extension, the knee reaches maximal flexion and then begins
to extend in single limb stance, ankle DF
Terminal Stance - answer Begins when the heel leaves the floor. In this phase, the body
weight is divided over the metatarsal heads (toe rocker)
Hip hyperextends then goes into flexion, slight knee flexion, ankle PF
Pre-swing / Toe off - answerToes are still in contact, hip becomes less extended, 2nd
phase of double-limb support occurs as weight is rapidly transferred to the contralateral
limb
Hip extension decreases, knee flexion, ankle PF increases
Initial Swing - answerHip extends then flexes, knee flexes, ankle ends in a neutral
position as the limb moves from the trailing limb position and the foot clears the floor
Hip extension then flexion, knee flexion, ankle PF to neutral position
Midswing - answerLimb advancement and foot clearance continue to be important in
this phase
Hip flexes, knee flexes then extends, ankle DF
,Terminal Swing - answerDeceleration of swing limb and preparation for stance phase
occur
Hip flexion, knee maximally extends in a locked position, ankle in a neutral position
Determinants of Functional Gait - answer1. Stance phase stability
2. Clearance in swing phase
3. Swing phase pre-positioning
4. adequate step length
5. energy conservation
Stance Phase Stability - answerMust be stable to respond to the GRF as the patient
moves through stance phase
Clearance in swing phase - answerTo minimize risk of stumbling
influence by the maintenance of a level pelvis to relatively shorten the length of the
swinging limb. This is achieved by stance limb abductor muscle, and the hip, knee
flexors, and ankle flexors
Swing phase pre-positioning - answerFoot must be positioned for effective initial contact
and loading response
Adequate step length - answerSufficient ROM and motor control of the limb is essential
to ensure normal step length
Energy conservation - answerImpacted by timing, muscle performance, coordination,
balance, and postural control of the gait cycle
First Rocker - answerHeel rocker
The transition from swing into early stance, controlled lowering of the forefoot occurs,
with a fulcrum at the heel.
anterior muscles on lower leg control this movement (eccentric)
Second Rocker - answerAnkle Rocker
Controlled forward progression of the tibia over the foot occurs, with motions at the
talocrural joint of the ankle
Tibia is brought "up and over" the talus rotating around the ankle joint, intrinsic foot
muscles maintain the medial longitudinal arch
anterior tibial translation
, Third Rocker - answerToe Rocker
Transition from stance toward swing occurs as the heel rises, with dorsiflexion pf the
metatarsophalangeal
Ankle PF in toe-off with the heel rising to initiate swing phase
Resultant gait deviations - answerImpairment directly causes this pattern to occur
Example- Plantarflexion hypertonia, PF contraction leading to toe drag and limited heel
strike
Compensatory gait deviations - answerPattern that is created during gait because of the
result of the impairment
Example- Hip hike, circumduction &/or contralateral vaulting to create enough space for
the involved limb to advance during swing phase
Knee Buckling- treatment intervention - answerDF must be limited and PF must be
improved (through exercises and/ot orthoses)
Knee hyperextension- treatment intervention - answerPF must be limited, and DF must
be improved (through exercises and/or orthoses)
Toe or foot drag- treatment intervention - answerPF must be limited
The patient DOES NOT always need medial/lateral stability when experiencing toe/foot
drag
treatment intervention- Stance phase stability - answerIncrease hip and knee extension
strength, core stability, upright posture, greater stability from assistive device
Treatment Intervention- Clearance in swing phase - answerIncrease hip/knee flexion
and ankle DF, upright posture, contralateral stance phase stability, core stability
Treatment Intervention- Swing phase pre-positioning - answerCoordination and
kinesthesia exercises
Treatment Intervention- Adequate step length - answerContralateral stance phase
stability, coordination and kinesthesia exercises, stretch tight muscles
Treatment Intervention- Energy Conservation - answerSelf-pacing techniques, rest
breaks, speed of movement, AD used
Phases of Rehabilitation: Acute Care - answerInitial management and protective healing
Approximately 1-3 weeks after injury or amputation
