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Canent, Adrian Jeremy D. Kuizon, Danielle P. Rosario, Eleiza Marie M. San Pedro, Merry Grace C. FEU NRMF
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 To be a certified BOBATHIAN
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
± There is a period of time during which neither foot is in contact with the ground. double float
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
± varies with age. there may be pathology that result in poor balance Step Length ± Distance bet. sex and height . successive contact points on opposite feet ± approx. 72cm/28 in.Parameters Base Width ± Distance bet. 2 feet ± 5-10cm ± If wider base.
Parameters Stride Length ± Distance in the plane bet. ± Decreases with age. 144cm/56 in. Successive points of footto-foot contact of same foot ± approx. 1.4m/sec . disease and fatigue Cadence ± Women has higher cadence than men ± 90-120steps/min Gait Speed ± approx. pain.
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 Rancho Los Amigos Intial swing Midswing Deceleration 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 .
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. Kinematic gait assessment is used to describe movement patterns without regard for the forces involved in producing the movement. . The types of gait assessment in use today can be classified under as Kinematic and Kinetic.
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 .
flexor digitorum longus: planterflex and invert Peroneals: eversion of the foot . flexor hallucis longus. Gastrocnemius: plantarflexion of the foot Tibialis ant. extensor digitorum longus: dorsiflexion of the foot Tibialis posterior. extensor hallucis longus.
add. abd and LR 20° / PF DF Pronation MIDSTANCE 15° / 3° DF Neutral HEEL OFF 4° / 15° DF PF 20° PF Supination TOE OFF 10°/.Gait Assessment Stance Phase PHASE OF GAIT HIP Kinematic KNEE ANKLE FOOT HEEL STRIKE 20-40° ». and LR Full / 40° Supination . and MR Neutral to /. slight add. and LR Full / before HS. pelvis PPT 10-15° Hip /. abd. ing @ HS Moving to PF Supination at HS FOOT FLAT Hip /.
FDL-eccentric MIDSTANCE QuadsGastrocs-eccentric Gastrocsoleus and Peroneals-eccentric HEEL OFF Gastrocs-concentric to Gastrocsoleus and begin knee Peroneals-concentric TOE OFF Quads-eccentric Gastrocsoleus and Peronealspeak inactive . 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 DF orsTP.Gait Assessment PHASE OF GAIT HEEL STRIKE Kinetic HIP KNEE Quads-eccentric ANKLE AND FOOT TA. FHL. EDL.Max. EHL-eccentric G.
Gait Assessment Swing Phase PHASE OF GAIT Acceleration to Midswing Midswing to Deceleration HIP Kinematic KNEE ANKLE AND FOOT 0-15° 30° to neutral 30-40° 30-60° Near full / 20° DF and slight pronation Neutral and slight supination Kinetic PHASE OF GAIT HIP Hip orsconcentric Contralat. G.Medconcentric KNEE ANKLE AND FOOT Acceleration to Midswing Hams-concentric DF ors-concentric Midswing to Deceleration QuadsG. Max-eccentric concentric Hams-eccentric DF ors-isometrically .
Observation Anterior View ± Note lateral pelvic tilt Sideways swaying of the trunk Rotation of pelvis: horizontal plane Trunk and UE: opposite direction Reciprocal arm swaying ± Movements of hip. abduction. supination pronation . toe in toe out. and adduction Knee: flexion and extension Ankle and foot: DF and P. knee. ankle and foot Hip: rotation.
of hips femur or tibia: toe in/toe out ± Position of the feet: Fick s Angle ± Abd. rot.± Bowing of femur or tibia: genu varum/genu valgum ± Medial or lat. 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 .
stride length and cadence . of hip and knee DF and PF of ankle ± Step length. pelvic rotation ± movement of jts. thorax as well as reciprocal arm swing ± Spinal posture. of LE Flex-ext.Observation Lateral View ± Rotation of the shoulder.
Observation Posterior View ± Same as ant. post thigh and calf . buttocks. view ± Heel rise ± BOS ± Weight unloading period ± Lateral movement of the spine. musculature of the back.
EXAMINATION Force Platforms Electromyography High-speed video motion system .
ABNORMAL GAIT .
And finally. . They may occur as compensations for injury or pathology in other joints on the same or ipsilateral side. they may occur as compensations for injury or pathology on the opposite or contralateral limb.Three reasons why gait deviations can occur: Pathology or injury in the specific joint.
ankle or foot. knee. because the patient attempts to remove weight from the affected leg as quickly as possible. .Antalgic (Painful) gait Self-protective. result of injury to the pelvis. hip. The stance phase on the affected leg is shorter than that on the unaffected leg.
. and it may be painful or pain free.Arthrogenic (Stiff Hip or Knee) Gait Results from stiffness. laxity or deformity.
Ataxic Gait The patient has poor sensation or lacks muscle coordination. and all movements are exaggerated. There is a tendency toward poor balance and a broad base. The feet of an individual with sensory ataxia slap the ground because they cannot be felt. . The gait of a person with cerebellar ataxia includes a lurch or stagger.
Knee flexion contracture: .knee hyperextension.CONTRACTURE GAITS Hip flexion contracture results in: .extension of the trunk combined with knee flexion to get the foot on the ground. . forward blending of the trunk with hip flexion.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: .increased lumbar lordosis .
CP and limb-length discrepancy.Equinus Gait (Toe Walking) This childhood gait is seen with talipes equinovarus(club foot). . and a limp is present. The weight-bearing phase on the affected limb is decreased.
. 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 Maximus Gait Primary hip extensor.
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. are weak. resulting in a wobbling gait.Gluteus Medius (Trendelenburg's) Gait Hip abductor muscles together with the gluteus minimus. . the gait shows accentuated side-to-side movement.
. Sometimes referred to as a neurogenic or flaccid 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.
The gait is characterized by shuffling. trunk and knees are flexed. .Parkinsonian Gait Basal ganglia affected Neck.
Loss of the plantar flexors results in decrease or absence of push-off.Plantar Flexor Gait If the plantarflexors are unable to perform their function. . and there is a shorter step length on the unaffected side. The stance phase is less. ankle and knee stability are greatly affected.
Classic manifestations of this limp: . flexion and adduction of the hip.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.lateral rotation. .
.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. May be referred to as spastic gait. . which causes the knees to be drawn together so that the legs can be swung forward only with great effort.
Short Leg Gait The patient may demonstrate lateral shift to the affected side if one leg is shorter than the other. . May also be termed painless osteogenic gait. and the pelvis tilts down on the affected side.
the foot slaps on the ground because of loss of control of the dorsiflexor muscles. resulting a drop foot. . or the nerve roots supplying the muscles.Steppage or Drop Foot Gait Patient has weak or paralyzed dorsiflexor muscles. At initial contact. their peripheral nerve supply.
O Sullivan .Reference Orthopedic Physical Assessment ± David J. Magee Physical Rehabilitation ± Susan B.
TAPOS NA!!!! .
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