You are on page 1of 110
Mark David S. Basco, PTRP Faculty Department of Physical Therapy College of Allied Medical Professions University

Mark David S. Basco, PTRP Faculty Department of Physical Therapy College of Allied Medical Professions

University of the Philippines Manila

At the end of the session, you should be able to:  Explain the importance of

At the end of the session, you should be able to:

Explain the importance of studying gait in PT and OT

Identify fundamental requirements of normal gait

Define the phases and sub-phases of gait and tasks accomplished by these

At the end of the session, you should be able to:  Describe gait in terms

At the end of the session, you should be able to:

Describe gait in terms of kinematic and kinetic variables

Explain the “determinants” of gait Describe changes in aging Describe effects of common pathological conditions on gait

 Appreciation of our own locomotor ability  Knowledge of gait is important in understanding human

Appreciation of our own locomotor ability

Knowledge of gait is important in understanding human function

Knowledge of gait can aid in identifying abnormalities and, thus, care needs of patients in PT and OT

 Equilibrium and Locomotion  Others ◦ Intact musculoskeletal system ◦ Normal muscle tone ◦ Intact

Equilibrium and Locomotion

Others

Intact musculoskeletal system Normal muscle tone Intact sensory system

 Equilibrium and Locomotion  Others ◦ Intact musculoskeletal system ◦ Normal muscle tone ◦ Intact
 Tasks accomplished by gait  Gait cycle: ◦ Phases ◦ Sub-phases  Time and distance

Tasks accomplished by gait Gait cycle:

Phases Sub-phases

Time and distance parameters of gait Relationships among gait variables

Tasks accomplished by gait  Weight acceptance  Single limb support  Limb advancement

Tasks accomplished by gait Weight acceptance Single limb support Limb advancement

Tasks accomplished by gait  Weight acceptance  Single limb support  Limb advancement
Gait cycle phases  Gait cycle, stride, step  Stance ◦ Single limb support (SLS) ◦

Gait cycle phases Gait cycle, stride, step Stance

Single limb support (SLS) Double limb support (DLS)

Swing

Gait cycle sub-phases (STANCE)  Initial contact  Loading response  Midstance  Terminal stance 

Gait cycle sub-phases (STANCE) Initial contact Loading response Midstance Terminal stance Preswing

Gait cycle sub-phases (STANCE)  Initial contact  Loading response  Midstance  Terminal stance 
 Initial contact

Initial contact

 Initial contact
 Loading response

Loading response

 Loading response
 Midstance

Midstance

 Midstance
 Terminal stance

Terminal stance

 Terminal stance
 Preswing

Preswing

 Preswing
Gait cycle sub-phases (SWING)  Initial swing  Midswing  Terminal swing

Gait cycle sub-phases (SWING) Initial swing Midswing Terminal swing

Gait cycle sub-phases (SWING)  Initial swing  Midswing  Terminal swing
 Initial swing

Initial swing

 Initial swing
 Midswing

Midswing

 Midswing
 Terminal swing

Terminal swing

 Terminal swing
 Traditional terminology ◦ Heel strike (HS) ◦ Foot flat (FF) ◦ Midstance (MSt) ◦ Heel

Traditional terminology

Heel strike (HS) Foot flat (FF) Midstance (MSt) Heel off (HO) Toe off (TO)

 Traditional terminology ◦ Acceleration (Acc) ◦ Midswing (MSw) ◦ Deceleration (Dec)

Traditional terminology

Acceleration (Acc) Midswing (MSw) Deceleration (Dec)

Time and distance gait variables  Stride length and stride time  Step length and step

Time and distance gait variables Stride length and stride time Step length and step time Stance time and swing time SLS time and DLS time Base / step width

Time and distance gait variables  Foot angle  Gait velocity: free, fast, slow  Cadence

Time and distance gait variables Foot angle Gait velocity: free, fast, slow Cadence Period of “double float”

Relationships among some variables  Gait velocity and cadence  Gait velocity and step length 

Relationships among some variables Gait velocity and cadence Gait velocity and step length Gait velocity and SLS time Gait velocity and DLS time

The equivalent of heel strike in the Rancho Los Amigos terminogy is: A. Initial contact B.

The equivalent of heel strike in the Rancho Los Amigos terminogy is:

A. Initial contact

B. Loading response

C. Preswing

D. Initial swing

This sub-phase of stance occurs from the time the contralateral foot gets into contact with the

This sub-phase of stance occurs from the time the contralateral foot gets into contact with the ground until the reference foot lifts off the ground:

A. Terminal stance

B. Preswing

C. Loading response

D. None of the above

With an increase in gait velocity, the following will increase logically, EXCEPT: A. Cadence B. Step

With an increase in gait velocity, the following will increase logically, EXCEPT:

A. Cadence

B. Step length

C. DLS time

D. None of the above

 Description of joint motions that occur during gait  Ideally, description should encompass all three

Description of joint motions that occur during gait

Ideally, description should encompass all three planes of motion

Often, sagittal motions are described (simplistically)

 HS – FF  FF – MSt  MSt – HO  HO – TO

HS – FF

FF – MSt

MSt – HO

HO – TO

0 – 15 deg p/flex

15 deg p/flex –

  • 10 deg d/flex

10 – 15 deg d/flex

15 deg d/flex –

  • 20 deg p/flex

O’ Sullivan, S.B., & Schmitz, T.J. (2001). Physical rehabilitation:

Assessment & treatment. Philadelphia; F.A. Davis.

 Acc – MSw  MSw – Dec d/flex - neutral neutral O’ Sullivan, S.B., &

Acc – MSw

MSw – Dec

d/flex - neutral

neutral

O’ Sullivan, S.B., & Schmitz, T.J. (2001). Physical rehabilitation:

Assessment & treatment. Philadelphia; F.A. Davis.

 HS – FF  FF – MSt  MSt – HO  HO – TO

HS – FF

FF – MSt

MSt – HO

HO – TO

0 – 15 deg flex

15 deg flex – 5 deg flex

5 deg flex - neutral

0 – 40 deg flex

O’ Sullivan, S.B., & Schmitz, T.J. (2001). Physical rehabilitation:

Assessment & treatment. Philadelphia; F.A. Davis.

 Acc – MSw 40 – 60 flex  MSw 60 deg flex – 30 deg

Acc – MSw

40 – 60 flex

MSw

60 deg flex – 30 deg flex

Dec

30 deg flex - neutral

O’ Sullivan, S.B., & Schmitz, T.J. (2001). Physical rehabilitation:

Assessment & treatment. Philadelphia; F.A. Davis.

 HS – FF  FF – MSt  MSt – HO-TO  Acc - MSw

HS – FF

FF – MSt

MSt – HO-TO

Acc - MSw

MSw – Dec

30 deg flex

30 – 5 deg flex

5 deg flex - 10 deg ext

20 – 30 deg flex

30 deg flex

O’ Sullivan, S.B., & Schmitz, T.J. (2001). Physical rehabilitation:

Assessment & treatment. Philadelphia; F.A. Davis.

At the moment of HS, the ankle is normally in this many degrees of dorsiflexion: A.

At the moment of HS, the ankle is normally in this many degrees of dorsiflexion:

A. 20

B. 10

C. 5

D. None of the above

Using traditional terminology, the highest amount of knee flexion during normal (comfortable) gait is observed in:

Using traditional terminology, the highest amount of knee flexion during normal (comfortable) gait is observed in:

A. Toe off

B. Acceleration

C. Midswing

D. Deceleration

Normally, the hip must extend to at least this many degrees during HO – TO to

Normally, the hip must extend to at least this many degrees during HO – TO to aid limb advancement:

A. 10

B. 20

C. 30

 Ground reaction forces  Electromyographic activity

Ground reaction forces

Electromyographic activity

Ankle dorsiflexors  Just after initial contact  Swing phase

Ankle dorsiflexors Just after initial contact

Swing phase

Ankle plantarflexors  Loading response  Preswing

Ankle plantarflexors Loading response

Preswing

Knee extensors  Loading response  Preswing (slight) ◦ Rectus femoris

Knee extensors Loading response

Preswing (slight)

Rectus femoris

Knee flexors  Terminal swing to initial contact  Initial swing

Knee flexors Terminal swing to initial contact

Initial swing

Hip extensors  Terminal swing to initial contact

Hip extensors Terminal swing to initial contact

Hip flexors  Initial swing

Hip flexors Initial swing

Hip abductors  Loading response through midstance

Hip abductors Loading response through midstance

Hip adductors  Preswing ; Initial swing

Hip adductors Preswing ; Initial swing

Back extensors  At initial contact (both sides)

Back extensors At initial contact (both sides)

Peak activity of the knee extensors occur in: A. Loading response B. Midstance C. Terminal stance

Peak activity of the knee extensors occur in:

A. Loading response

B. Midstance

C. Terminal stance

D. Preswing

At initial contact, the erector spinae on both sides are active to check: A. Trunk flexion

At initial contact, the erector spinae on both sides are active to check:

A. Trunk flexion

B. Trunk lateral flexion

C. Hip flexion

D. None of the above

Intuitively, peak activity of the ankle plantarflexors should occur in: A. Initial contact B. Loading response

Intuitively, peak activity of the ankle plantarflexors should occur in:

A. Initial contact

B. Loading response

C. Terminal stance

D. Preswing

 Reduce maximum COM height of the body during midstance  Increase minimum COM height of

Reduce maximum COM height of the body during midstance

Increase minimum COM height of the body at heel-strike and toe-off

 Pelvic rotation  Pelvic obliquity or “list”  Knee flexion in the stance phase 

Pelvic rotation Pelvic obliquity or “list” Knee flexion in the stance phase Ankle rockers Transverse rotation Genu valgum

Pelvic rotation
Pelvic rotation

Pelvic rotation

Pelvic obliquity or “list”
Pelvic obliquity or “list”

Pelvic obliquity or “list”

Knee flexion in the stance phase
Knee flexion in the stance phase

Knee flexion in the stance phase

Ankle rockers
Ankle rockers

Ankle rockers

Ankle rockers
Ankle rockers

Ankle rockers

Transverse rotation (1)
Transverse rotation (1)

Transverse rotation (1)

Transverse rotation (2)
Transverse rotation (2)

Transverse rotation (2)

Genu valgum
Genu valgum

Genu valgum

 Gender; age  Sensory conditions  Demands / purpose of the task  Environmental constraints

Gender; age Sensory conditions Demands / purpose of the task Environmental constraints Mood / psychological state

Dimensions of mobility (Patla & Shumway-Cook 1999)
Dimensions of mobility (Patla & Shumway-Cook 1999)

Dimensions of mobility (Patla & Shumway-Cook

1999)

Post-OTPT102 exam: which one represents you?

Post-OTPT102 exam: which one represents you?

 Physiological decline of multiple systems in the body  Effects of chronic conditions  Effects

Physiological decline of multiple systems in the body

Effects of chronic conditions

Effects of acute conditions

Common observable changes*  Decreased: ◦ GAIT velocity ◦ STEP length ◦ Arm swing ◦ PELVIC

Common observable changes* Decreased:

GAIT velocity STEP length Arm swing PELVIC rotation ANKLE motions

Common observable changes*  Increased: ◦ Cadence ◦ DLS time ◦ Postural sway

Common observable changes* Increased:

Cadence DLS time Postural sway

The COM of the body normally translates a total of ____ cm in the coronal plane:

The COM of the body normally translates a

total of

____

cm in the coronal plane:

A. 2

B. 4

C. 6

D. None of the above

Gait changes observed in aging is / are considered to be primarily a function of: A.

Gait changes observed in aging is / are considered to be primarily a function of:

A. Acute health conditions

  • B. Chronic health conditions

C. Normal decline of physiological functions

  • D. All of the above

Common causes of abnormal gait  Pain  Muscle weakness  Soft tissue or contracture 

Common causes of abnormal gait Pain Muscle weakness Soft tissue or contracture Abnormal muscle tone

Common causes of abnormal gait  Lower limb length discrepancy  Impaired proprioception / kinesthesia 

Common causes of abnormal gait Lower limb length discrepancy Impaired proprioception / kinesthesia Impaired balance or motor control

Some patterns of abnormal gait  Antalgic gait  Equinus gait  Stiff knee gait 

Some patterns of abnormal gait Antalgic gait Equinus gait Stiff knee gait Waddling gait

Some patterns of abnormal gait  Hemiplegic gait  Parkinsonian gait  Scissors gait  Ataxic

Some patterns of abnormal gait Hemiplegic gait Parkinsonian gait Scissors gait Ataxic gait

This abnormal gait pattern typically results when there is generalized muscle weakness in one side of

This abnormal gait pattern typically results when there is generalized muscle weakness in one side of the body:

A. Antalgic

B. Hemiplegic

C. Equinus

D. None of the above

In an antalgic gait pattern, the following would be expected to decrease, EXCEPT: A. SLS time

In an antalgic gait pattern, the following would be expected to decrease, EXCEPT:

A. SLS time – affected limb

B. DLS time

C. Preswing – affected limb

D. None of the above

Generalized reflex hyperactivity of the lower limb muscles, the hip adductors in particular, often result in

Generalized reflex hyperactivity of the lower limb muscles, the hip adductors in particular, often result in this abnormal gait pattern:

A. Equinus

B. Parkinsonian

C. Ataxic

D. None of the above

EACH GROUP must bring:  Kinesiology attire  2 – 3 ink markers  Masking tape

EACH GROUP must bring:

Kinesiology attire 2 – 3 ink markers Masking tape Measuring tape Stopwatch 1m x 6m walkway Pair of sunglasses Piece of wood Small pebble

I would like to acknowledge

Prof. EJ Gorgon, MPhysio, PTRP for the powerpoint slides used in this presentation.

I would like to acknowledge Prof. EJ Gorgon, MPhysio, PTRP for the powerpoint slides used in

Gait is a complicated subject to learn and study. It is strongly encouraged that you do extra reading. For references that you could use, do not hesitate to seek consult.

The depth and quality of learning that you would get from this college does not entirely

The depth and quality of learning that you would get from this college does not entirely depend on the faculty and the instructional materials used ...

Most of it depends...

On the passion that you put into learning and your perseverance to rise up against the challenges and difficulties you would encounter.