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GAIT

Objectives
To define different terms that describes the normal gait To know the different gait deviations To know the gait cycle To know the normal parameters of gait

Intro
Walking is the simple act of falling forward and catching oneself One foot is always in contact with the ground In a cycle:
There are 2 periods of single leg support 2 period of double leg support

In running:
There is a period of time during which neither foot is in contact with the ground. double float

Definition
Gait Cycle is the time interval or sequence of motions occurring between 2 consecutive initial contact of the same foot. Phases of gait cycle
Stance phase 60% of the cycle Swing phase 40% of the cycle

Parameters
Base Width
Distance bet. 2 feet 5-10cm If wider base; there may be pathology that result in poor balance

Step Length
Distance bet. successive contact points on opposite feet approx. 72cm/28 in. varies with age, sex and height

Parameters
Stride Length
Distance in the plane bet. Successive points of footto-foot contact of same foot approx. 144cm/56 in. Decreases with age, pain, disease and fatigue

Cadence
Women has higher cadence than men 90-120steps/min

Gait Speed
approx. 1.4m/sec

Parameters
Center of Gravity
5cm ant. to S2 Higher in men than women

Lateral Pelvic Shift


Side-to-side movement of pelvis during walking 2.5-5 cm/1-2 in.

Parameters
Vertical pelvic Shift
Keeps the COG from moving up and down more than 5cm during normal gait

Pelvic Rotation
Necessary to lessen the angle of femur with the floor

Normal Patterns of Gait

Stance Phase
Traditional: Rancho Los Amigos:

Heel Strike Foot Flat Midstance Heel off Toe off

Initial Contact
Loading Response

Midstance Terminal Stance Preswing

Stance Phase
Heel Strike
Beginning of stance phase when the heel contacts the ground

Initial Contact
The beginning of the stance phase when the heel or another part of the foot contacts the ground

Stance Phase
Foot Flat
Immediately after HS, when sole of foot contacts the floor

Loading Respone
The portion of the first double support period of the stance phase from the initial contact until the contralateral extremity leaves the ground

Stance Phase
Midstance
Point at which the body passes over the reference extremity

Midstance
The portion of the single limb support stance phase that begins when the contralateral extremity leaves the ground & ends when the body is directed over the supporting limb

Stance Phase
Heel Off
Point following midstance, heel of the reference extremity leaves the ground

Terminal stance
the last portion of the single limb support stance phase that begins with heel rise and continues until contralateral extremity contacts the ground

Stance Phase
Toe Off
Only toe of the reference extremity is in contact with the ground

Pre-swing
The portion of stance that begins the second double support period from the initial contact of the contralateral extremity to lift off the reference extremity

Swing Phase
Traditional: Acceleration Midswing Deceleration Rancho Los Amigos Intial swing Midswing Terminal Swing

Swing phase
Acceleration
Portion of beginning swing from the moment the toe of reference extremity leaves the ground to the point when the reference extremity is directly under the body

Initial swing
The portion of swing from the point when the reference extremity leaves the ground to maximum knee flexion of the same extremity

Swing Phase
Midswing
Portion of the swing phase when reference extremity passes directly below the body. Midswing extends from the end of acceleration to the beginning of decceleration

Midswing
Portion of the swing phase from maximum knee flexion of the reference extremity to a vertical tibial position

Swing Phase
Deceleration
Swing portion of the swing phase when the reference extremity is decelerating in preparation for heel strike

Terminal Swing
The portion of the swing phase from a vertical position of the tibia of the reference extremity to just prior to initial contact

Gait Assessment

The types of gait assessment in use today can be classified under as Kinematic and Kinetic. Kinematic gait assessment is used to describe movement patterns without regard for the forces involved in producing the movement. A kinetic gait assessment consists of a description of movement of the body as a whole or body segments in relation to each other during gait.

Actions of Muscles of the LE


Erector spinae: extensors of the back Gluteus maximus: extension of hip Gluteus medius: adductor Iliopsoas: hipflexion Adductor magnus: adduction of the thigh Qudriceps femoris: extension of knee Hamstrings: flexion of knee

Gastrocnemius: plantarflexion of the foot Tibialis ant, extensor hallucis longus, extensor digitorum longus: dorsiflexion of the foot Tibialis posterior, flexor hallucis longus, flexor digitorum longus: planterflex and invert Peroneals: eversion of the foot

Gait Assessment Stance Phase


PHASE OF GAIT HIP

Kinematic
KNEE ANKLE FOOT

HEEL STRIKE

20-40 , slight add. and LR

Full / before HS, ing @ HS

Moving to PF

Supination at HS

FOOT FLAT

Hip/, add. and MR Neutral to /; pelvis PPT 10-15 Hip /, abd and LR

20/

PFDF

Pronation

MIDSTANCE

15/

3 DF

Neutral

HEEL OFF

4/

15 DFPF

Supination

TOE OFF

10/, abd. and LR Full /40

20 PF

Supination

Gait Assessment
PHASE OF GAIT
HEEL STRIKE

Kinetic
HIP KNEE
Quads-eccentric

ANKLE AND FOOT


TA, EDL, EHL-eccentric

G.Max, Hams and Erector SpinaeEccentric G.Max, Hams Erector Spinaeconcentric Iliopsoas-eccentric G. Med-reverse contraction stab on opposite pelvis Iliopsoas-continue activity Adductor Magnusconcentric to stab pelvis Iliopsoas-continue activity

FOOT FLAT

Quads-concentric

DFors- TP, FHL, FDL-eccentric

MIDSTANCE

Quads- Gastrocs-eccentric

Gastrocsoleus and Peroneals-eccentric

HEEL OFF

Gastrocs-concentric to Gastrocsoleus and begin knee Peroneals-concentric Gastrocsoleus and Peronealspeakinactive

TOE OFF

Quads-eccentric

Gait Assessment Swing Phase


PHASE OF GAIT Acceleration to Midswing Midswing to Deceleration HIP

Kinematic
KNEE ANKLE AND FOOT

0-15 30 30-60 to neutral

20 DF and slight pronation Neutral and slight supination

30-40

Near full /

Kinetic
PHASE OF GAIT HIP Hip orsconcentric Contralat. G.Medconcentric KNEE ANKLE AND FOOT

Acceleration to Midswing

Hams-concentric DFors-concentric

Midswing to Deceleration

QuadsG. Max-eccentric concentric Hams-eccentric

DFors-isometrically

Anterior View
Note

Observation
lateral pelvic tilt Sideways swaying of the trunk Rotation of pelvis: horizontal plane Trunk and UE: opposite direction Reciprocal arm swaying

Movements of hip, knee, ankle and foot


Hip: rotation, abduction, and adduction Knee: flexion and extension Ankle and foot: DF and P; toe in toe out; supination pronation

Bowing of femur or tibia: genu varum/genu valgum Medial or lat. rot. of hips femur or tibia: toe in/toe out Position of the feet: Ficks Angle Abd. or circumduction of the swing leg Atrophy of mm of ant thigh and leg Base width * Best view used to examine the weight loading period

Observation
Lateral View
Rotation of the shoulder, thorax as well as reciprocal arm swing Spinal posture, pelvic rotation movement of jts. of LE
Flex-ext. of hip and knee DF and PF of ankle

Step length, stride length and cadence

Observation
Posterior View
Same as ant. view Heel rise BOS Weight unloading period Lateral movement of the spine, musculature of the back, buttocks, post thigh and calf

EXAMINATION
Force Platforms Electromyography High-speed video motion system

ABNORMAL GAIT

Three reasons why gait deviations can occur:


Pathology or injury in the specific joint. They may occur as compensations for injury or pathology in other joints on the same or ipsilateral side. And finally, they may occur as compensations for injury or pathology on the opposite or contralateral limb.

Antalgic (Painful) gait


Self-protective; result of injury to the pelvis, hip, knee, ankle or foot. The stance phase on the affected leg is shorter than that on the unaffected leg, because the patient attempts to remove weight from the affected leg as quickly as possible.

Arthrogenic (Stiff Hip or Knee) Gait


Results from stiffness, laxity or deformity, and it may be painful or pain free.

Ataxic Gait
The patient has poor sensation or lacks muscle coordination. There is a tendency toward poor balance and a broad base. The gait of a person with cerebellar ataxia includes a lurch or stagger, and all movements are exaggerated. The feet of an individual with sensory ataxia slap the ground because they cannot be felt.

CONTRACTURE GAITS
Hip flexion contracture results in: - increased lumbar lordosis - extension of the trunk combined with knee flexion to get the foot on the ground. Knee flexion contracture: - patient demonstrates excessive ankle dorsiflexion from the late swing phase to early stance phase on the uninvolved leg and early heel rise on the involved side in terminal stance. Plantarflexion contracture at ankle results in: - knee hyperextension, forward blending of the trunk with hip flexion.

Equinus Gait (Toe Walking)


This childhood gait is seen with talipes equinovarus(club foot), CP and limb-length discrepancy. The weight-bearing phase on the affected limb is decreased, and a limp is present.

Gluteus Maximus Gait


Primary hip extensor, is weak. Patient thrusts the thorax posteriorly at initial contact (heel strike) to maintain hip extension of the stance leg. The resulting gait involves a characteristic backward lurch of the trunk.

Gluteus Medius (Trendelenburg's) Gait


Hip abductor muscles together with the gluteus minimus, are weak. Patient exhibits an excessive lateral list in which the thorax is thrust laterally to keep the COG over the stance leg. If there is a bilateral weakness of the gluteus medius muscles, the gait shows accentuated side-to-side movement, resulting in a wobbling gait.

Hemiplegic or Hemiparetic Gait


The patient with hemiplegic gait swings the paraplegic leg outward and ahead in a circle(circumduction) or pushes it ahead. Sometimes referred to as a neurogenic or flaccid gait.

Parkinsonian Gait
Basal ganglia affected Neck, trunk and knees are flexed. The gait is characterized by shuffling.

Plantar Flexor Gait


If the plantarflexors are unable to perform their function, ankle and knee stability are greatly affected. Loss of the plantar flexors results in decrease or absence of push-off. The stance phase is less, and there is a shorter step length on the unaffected side.

Psoatic Limp
Patient demostrates a difficulty in swingthrough, and the limp may be accompanied by exaggerated trunk and pelvic movement. The limp may be caused by weakness or reflex inhibitionof the psoas major muscle. Classic manifestations of this limp: - lateral rotation, flexion and adduction of the hip.

Quadriceps Avoidance Gait


The patient compensates in the trunk and lower leg if the quads have been affected.

Scissors Gait
It is the result of spastic paralysis of the hip adductor muscles, which causes the knees to be drawn together so that the legs can be swung forward only with great effort. May be referred to as spastic gait.

Short Leg Gait


The patient may demonstrate lateral shift to the affected side if one leg is shorter than the other, and the pelvis tilts down on the affected side. May also be termed painless osteogenic gait.

Steppage or Drop Foot Gait


Patient has weak or paralyzed dorsiflexor muscles, resulting a drop foot. At initial contact, the foot slaps on the ground because of loss of control of the dorsiflexor muscles, their peripheral nerve supply, or the nerve roots supplying the muscles.

Reference
Orthopedic Physical Assessment
David J. Magee

Physical Rehabilitation
Susan B. O Sullivan

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