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
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
Stance Phase
Traditional: Rancho Los Amigos:
Initial Contact
Loading Response
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.
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
Kinematic
KNEE ANKLE FOOT
HEEL STRIKE
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
20 PF
Supination
Gait Assessment
PHASE OF GAIT
HEEL STRIKE
Kinetic
HIP KNEE
Quads-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
MIDSTANCE
Quads- Gastrocs-eccentric
HEEL OFF
TOE OFF
Quads-eccentric
Kinematic
KNEE ANKLE AND FOOT
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
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
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
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
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.
Parkinsonian Gait
Basal ganglia affected Neck, trunk and knees are flexed. The gait is characterized by shuffling.
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.
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.
Reference
Orthopedic Physical Assessment
David J. Magee
Physical Rehabilitation
Susan B. O Sullivan
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