PEMERIKSAAN GAIT,

LOCOMOTION, AND BALANCE

 DEFINISI
 Gait (Pola jalan)
– cara seseorang berjalan
– Dikarakteristikkan oleh ritme, irama, langkah, jarak
langkah, dan kecepatan

 Locomotion (pindah tempat)

– Kemampuan untuk bergerak dari satu tempat ke tempat
lain

 Balance (keseimbangan)
– Kemampuan untuk mempertahankan tubuh dalam
keseimbangan dengan gravitasi secara statik dan
dinamik
 TUJUAN PEMERIKSAAN
 Mengetahui adanya gangguan,
keterbatasan, dan ketidakmampuan
berjalan, berpindah, dan keseimbangan
 Menentukan apakah perlu menggunakan
alat bantu, ortotik, prostetik.
 INDIKASI KLINIS

 Penyakit, gangguan, atau kondisi pada sistem :

– Kardiovaskuler, respirasi, muskuloskeletal, neuromuskular
 Impairment
– Sirkulasi (klaudikasio intermitten)
– Integritas dan mobilitas sendi (nyeri gerak hip)
– Fungsi motor (pola gerak abnormal)
– Kinerja otot (penurunan kekuatan dan ketahanan otot)
– ROM (lGS tak normal saat jalan)
 Keterbatasan fungsi dalam kemampuan membentuk aksi,
kerja, dan aktivitas yang meliputi :
– Pemelihaaan diri (ketidakmampuan berpakaian krn
ketidaknormalan keseimbangan duduk)
– Pengelolaan rumah tangga (ketidakmampuan melakukan aktivitas
berkebun krn menurunnya kekuatan otot)
– dsb
 Indikasi ….

 Disability (ketidakmampuan atau

keterbatasan kmampuan untuk membentuk
aksi, tugas, atau aktivitas sesuai dengan
aturan dalam konteks sosial budaya
individu
 Faktor resiko
– Meningkatnya resiko jatuh
 KEbutuhan kesehatan, wellness, dan
kebugaran
 OBSERVASI GAIT
 Berjalan adalah berpindahnya tubuh
dari satu titik, ketitik berikutnya
dengan cara menggunakan kedua tungkai
(bipedal : posisi tubuh selalu tegak
selama proses berlangsung). Pola
repetisi daripada penumpuan berat
badan dari satu tungkai ketungkai yang
lain dengan heel – toe striding adalah
fenomena yang membedakan manusia
dengan hominids yang lebih primitif
( Napier, 1967).
 Walking is a series of gait cycles
– A single gait cycle is known as a STRIDE
 TUJUAN
 untuk mengetahui ketidaknormalan gait
yang disebabkan kelemahan otot,
keterbatasan mobilitas sendi, nyeri,
atau ganggan kontrol motoris akibat lesi
sistem saraf
 Analisa : dengan camera video dan
videotape
 Syarat Jalan Normal
4 kriteria utama yang penting saat berjalan.
– Equilibrium
 kemampuan untuk mengambil sikap tegak
dan menjaga keseimbangan.
– Locomotion
 kemampuan untuk memulai dan
mempertahankan langkah ritmis
 Syarat Jalan Normal

– Musculoskeletal Integrity
 fungsi tulang, sendi, dan otot normal
– Neurological Control,
 harus menerima dan mengirim impuls
yang memberi tahu tubuh bagaimana
dan kapan harus bergerak. (visual,
vestibular, auditory, sensorimotor
input)
 Siklus berjalan :
 Satu cycle, dimulai dari
heel strike, sampai tungkai
yang sama mulai heel
strike berikutnya.
 Interval antara dua steps
bisa dihitung jarak dan
waktunya.
A Single Gait Cycle or Stride
 SIKLUS GAIT NORMAL
Stance phase (40%) Swing Phase (60%)

Racho Konvensinal Racho Konvensional

Initial contact Heel strike Initial swing Acceleration

Loading Foot flat Mid-swing Mid-Swing

response
Mid-stance Mid-stance Terminal Deceleration
swing
Terminal Heel off
stance
Pre swing Toe off
 Komponent Gait Normal :

 1). Tumpuan Berat Badan.

 2). Support 1 Tungkai.
 3). Kemajuan Tungkai.
 Stance.
 Initial Contact.
 Loading Response (LR).
 Mid Stance (MSt).
 Terminal Stance (TSt).
 Swing
 Pre-swing (PSw).
 Initial Swing (Isw)
 Midswing (MSw)
 Terminal Swing (TSw)
 Stride length :
 Adalah jarak antara dua jejak kaki, pada
kaki yang sama.
 Pada orang dewasa pria jaraknya
antara 140 – 156,5 cm.
 Stride duration :

 Adalah waktu yang dibutuhkan untuk

jarak tersebut ( stride length ).
 Step length :
 Adalah jarak antara dua jejak
kaki , baik dari kanan kekiri atau
sebaliknya.
 Jarak rata2nya adalah 68 – 78cm.
 Step duration :
 Adalah waktu yang dibutuhkan
dari heel strike kaki yang satu ke
heel strike kaki yang lain.
 Cadence :
 Adalah jumlah steps permenit.
 Dimana nilai rata2nya adalah 112
– 116 permenit.
 Stance Phase of Gait
 Saat kaki hanya bersentuhan
dengan tanah
 Propulsion phase
 Stance phase has 5 parts:
– Initial Contact (Heel Strike)
(1)
– Loading Response (Foot Flat)
(2)
– Midstance (2)
– Terminal Stance (3)
– Toe Off (Pre-Swing) (4)
(Missing Loading Response in
picture)
 Gerakan saat Stance Phase
 Shoulder flexes
 Pelvis rotates right (transverse plane)
 Spine rotates left
 Hip extends, IRs
 Knee flexes, extends
 Ankle plantarflexes, dorsiflexes, plantarflexes
 Foot pronates, supinates
 Toes flex, extend, flex
 Initial Contact

 Phase 1
 The moment when the
red foot just touches the
floor.
 The heel (calcaneous) is
the first bone of the foot
to touch the ground.
 Meanwhile, the blue leg
is at the end of terminal
stance.
 Static Positions at Initial Contact

 FREEZE FRAME POSITIONS

 Shoulder is extended
 Pelvis is rotated left
 Hip is flexed and externally rotated
 Knee is fully extended
 Ankle is dorsiflexed
 Foot is supinated
 Toes are slightly extended
 Loading Response
 Phase 2
 The double stance period
beginning
 Body weight is transfered onto
the red leg.
 Phase 2 is important for shock
absorption, weight-bearing, and
forward progression.
 The blue leg is in the pre-swing
phase.
 Static Positions at Loading
Response

 Shoulder is slightly extended

 Pelvis is rotated left
 hip is flexed and slightly externally rotated
 knee is slightly flexed
 ankle is plantarflexing to neutral
 foot is neutral
 Toes are neutral
 Midstance

 Phase 3
 single limb support interval.
 Begins with the lifting of the
blue foot and continues until
body weight is aligned over the
red (supporting) foot.
 The red leg advances over the
red foot The blue leg is in its
mid-swing phase.
 Static Positions at Midstance

 Shoulder is in neutral
 Pelvis is in neutral rotation
 Hip is in neutral
 Knee is fully extended
 Ankle is relatively neutral
 Foot is pronated
 Toes are neutral
 Terminal Stance

 Phase 4
 Begins when the red
heel rises and continues
until the heel of the
blue foot hits the
ground.
 Body weight progresses
beyond the red foot
 Static Positions at Terminal Stance

 Shoulder is slightly flexed

 Pelvis is rotated left
 Hip is extended and internally rotated
 Knee is fully extended
 Ankle is dorsiflexed
 Foot is slightly supinated
 Toes are neutral
 Toe-Off

 Phase 5
 The second double stance
interval in the gait cycle.
 Begins with the initial
contact of the blue foot
and ends with red toe-off.
 Transfer of body weight
from ipsilateral to
opposite limb takes place.
 Static Positions at Toe-Off

 Shoulder is flexed
 Pelvis is rotated right
 Hip is fully extended and internally rotated
 Knee is fully extended
 Ankle is plantarflexed
 Foot is fully supinated
 Toes are fully extended
 Stance Phase Characteristics

 During a single stride, there are 2 periods of

double limb support (both feet on ground):
– Loading response (right) & Toe Off (left)
– Loading response (left) & Toe Off (right)
Gait Progression
 Swing Phase

 When foot is NOT contacting the ground,

it is swinging!
 Limb advancement phase
 3 parts of swing phase:
 Initial swing
 Midswing
 Terminal swing
 Motions during Swing Phase

 Shoulder extends
 Spine rotates right
 Pelvis rotates left (passive)
 Hip flexes, ERs
 Knee flexes, then extends
 Ankle dorsiflexes
 Foot supination (inversion)
 Toes extend
 Initial Swing

 Phase 6
 Begins when the red foot is
lifted from the floor and
ends when the red swinging
foot is opposite the blue
stance foot.
 It is during this phase that a
footdrop gait is most
apparent.
 The blue leg is in mid-stance.
 Static Positions at Initial Swing

 Shoulder is flexed
 Spine is rotated left
 Pelvis is rotated right
 hip is slightly extended and internally rotated
 Knee is slightly flexed
 Ankle is fully plantarflexed
 Foot is supinated
 Toes are slightly flexed
 Midswing

 Phase 7
 Starts at the end of the
initial swing and continues
until the red swinging limb
is in front of the body
 Advancement of the red
leg
 The blue leg is in late mid-
stance.
 Static Positions at Midswing

 Shoulder is neutral
 Spine is neutral
 Pelvis is neutral
 Hip is neutral
 Knee is flexed 60-90°
 Ankle is plantarflexed to neutral
 Foot is neutral
 Toes are slightly extended
 Terminal Swing

 Phase 8
 Begins at the end of
midswing and ends when
the foot touches the
floor.
 Limb advancement is
completed at the end of
this phase.
 Static Positions at Terminal Swing

 Shoulder is extended
 Spine is rotated right
 Pelvis is rotated left
 Hip is flexed and externally rotated
 Knee is fully extended
 Ankle is fully dorsiflexed
 Foot is neutral
 Toes are slightly extended
 Gait Pathologies
 Deviations from “normal” gait pattern
 Result from
– Pain
– Injury (ROM restrictions)
– Surgery (ROM restrictions)
– Weakness
– Balance deficits
 Consider all “normal” components of stance
and swing phase of a gait cycle or stride
 Compare right and left sides when observing a
person’s gait pattern
 Antalgic Gait

 Painful leg gait

 Decreased stance time on painful leg
 Increased swing time on painful leg
 Decreased swing time on non-painful leg
 Increased stance time on non-painful leg
 Trendelenburg Gait

 Gluteus medius mengalami kelemahan saat

berjalan
 Lateral trunk beban lebih ke arah sisi yg
lemah
 Maintain body’s COG over weak side during
stance phase
 Mempertahankan COG disisi yg lemah saat
berdiri
 Flexed Knee Gait

 Flexed knees
 Flexed trunk posture
 No arm swing
 No initial contact
 No Toe-off
 No hip extension
 Short step
 Shortened stride
 COG stays within BOS
 Common in elderly with fear of falling
Flexed Gait Posture
Common Gait Posture in Elderly People
 Pemeriksaan Fungsi Jalan
 Gait Cycle (inked-Foot Print)
 Gait cycle measurement modified
 Parameter pengukuran analisa pola jalan
 Table 1.
 Gait Speed Reference Values
 Study Age of Participants
 Oberg et al,2 1993
Habitual Gait Speed (m/s) Fast Gait Speed (m/s)
Men Women Men Women
 20–29 1.227 1.241 1.626 1.693
 30–39 1.316 1.285 1.768 1.721
 40–49 1.328 1.247 1.717 1.667
 50–59 1.252 1.105 1.640 1.471
 60–69 1.277 1.157 1.639 1.555
 70–79 1.182 1.113 1.586 1.418
 Bohannon,3 1997
 20–29 1.393 0.153 1.407 0.175 2.533 0.291 2.467 0.253
 30–39 1.458 0.094 1.415 0.127 2.456 0.315 2.342 0.344
 40–49 1.462 0.164 1.391 0.158 2.462 0.363 2.123 0.275
 50–59 1.393 0.229 1.395 0.151 2.069 0.448 2.010 0.258
 60–69 1.359 0.205 1.296 0.213 1.933 0.364 1.774 0.254
 70–79 1.330 0.196 1.272 0.211 2.079 0.363 1.749 0.281