Gait Patterns Summary According to Various Sources

Two-point gait: one crutch and opposite extremity move together followed by the opposite crutch and extremity; requires use of two assistive devices (canes or crutches); allows for natural arm and leg motion during gait, good support and stability from two opposing points of contact. Three-point gait: both crutches and involved leg are advanced together, then uninvolved leg is advanced forward; requires use of two assistive devices (crutches or canes) or a walker; indicated for use with involvement of one extremity , e.g. lower extremity fracture. Four-point gait: a slow gait pattern in which one crutch is advanced forward and placed on the floor, followed by advancement of the opposite leg; then the remaining crutch is advanced forward followed by the opposite remaining leg; requires the use of two assistive devices (crutches or canes); provides maximum stability with three points of support while one limb is moving. Swing-to gait: both crutches are advanced forward together; weight is shifted onto hands for support and both legs are then swung forward to meet the crutches; requires the use of two crutches or a walker; indicated for individuals with limited use of both lower extremities and trunk instability. Swing-through gait: both crutches are advanced forward together; weight is shifted onto the hands for support and both legs which are swung forward beyond the point of crutch placement; requires the use of two crutches; both swing-to and swing-through gaits are used for bilateral lower extremity involvement, and trunk instability, e.g. patient with paraplegia, spina bifida. Not as safe as swing-to gait. OSullivan, Susan b., Raymond p. Siegelman. National Physical Therapy Examination Rview and Study Guide. International Educational Resources 2001. p. 234. ___________________________________________________________________________ ___ Two-point gait: This gait pattern is similar to the four-point gait. However, it is less stable because only two points of floor contact are maintained. Thus, use of this gait requires better balance. The two-point pattern more closely simulates normal gait, inasmuch as the opposite lower and upper extremity move together. Two additional, less commonly used crutch gaits are the swing-to and swing-through patterns. These gaits are often used when there is bilateral lower extremity involvement, such as in spinal cord injuries. The swing-to gait involves forward movement of both crutches simultaneously, and the lower extremities swing to the crutches. In the swing-through gait, the crutches are moved forward together, but the lower extremities are swung beyond the crutches. Three-point gait: in this type of gait three points of support contact the floor. It is used when a non-weight-bearing status is required on one lower extremity. Body weight is borne on the crutches instead of on the affected lower extremity. Four-point gait: This pattern provides a slow, stable gait as three points of floor contact are maintained. Weight is borne on both lower extremities and typically is used with bilateral involvement due to poor balance, incoordination, or muscle weakness. In this gait pattern on

crutch is advanced and then the opposite lower extremity is advanced. For example, the left crutch is moved forward, then the right lower extremity, followed by the right crutch and then the left lower extremity. OSullivan, Susan B., Thomas J. Schmitz. Physical Rehabilitation Assessment and Treatment. 4th ed. F. A. Davis Company. 1994. p. 430-431. ___________________________________________________________________________ ___ Two-Point Gait: used to describe a pattern in which a patient uses two crutches or canes. The patient ambulates moving the left crutch forward while simultaneously advancing the right lower extremity and vice-versa. Each step is one point and a complete cycle is two points. Three- point gait: This pattern can be seen with a walker, crutches or canes (two canes). It involves one injured lower extremity that may have decreased weight bearing. The assistive device is advanced followed by the injured lower extremity and then the uninjured lower extremity. The assistive device and each lower extremity are considered separate points. (Three points refers to two assistive devices and one extremity in contact during stance - JM).

Giles, Scott M. , A Guide to Success: Review for Licensure in Physical Therapy. Mainely Physical therapy. 1999. p. 137 ___________________ ________________________________________________________ ___ Ambulating Using One Cane: The gait pattern and sequence when using one standard cane or one quad cane are the same. Positioned in stride, behind and to one side of the patient, the therapist grasps the patients gait belt and shoulder. The patients feet are side by side, with the cane next to the small toe. The cane is advanced first, approximately one stride length ahead. The therapist steps forward with his left, or outside, foot. The patient advances the lower extremity on the side opposite the cane up to the cane. The patient advances the lower extremity on the same side as the cane. The therapist advances his right, or inside, foot as the patient moves here lower extremity. Initially, the patient may only step to the other lower extremity and cane, but should be encouraged to step beyond the other lower extremity and cane. This encourages the patient to develop a more normal rhythm and pattern of gait. The sequence is repeated for continued progression. As the patient improves, she may move the cane and involved lower extremity at the same time, permitting a faster pace of gait. As the patient is able, she uses the can on the involved side, moving the cane and involved lower extremity simultaneously. (So note cane when used singly is considered its own sequence. JM) Ambulating using two caneThree-point gait pattern: to ambulate, both canes and the involved lower extremity are advanced simultaneously and the same amount. The therapist advances his left, or outside, foot, either at the same time or immediately after the canes are

advanced. The patient advances here uninvolved lower extremity beyond the canes. Initially, the patient may step-to here involved lower extremity, rather than step-through. Stepping through is the normal gait pattern, and should be encouraged. The therapist advances his right , or inside, foot as the patient moves here uninvolved lower extremity. The sequence is repeated for continued progression. Duesterhaus Minor, Mary Alice; Scott Duesterhaus Minor. Patient Care Skills. 4th ed. Appleton and Lange. 1999. p. 420-421, 444-445.