Gait AnalysisGait Analysis

Physiotherapy HCSW Training Physiotherapy HCSW Training

20132013

Aims of session Aims of session

�� Outline the main components Outline the main components normal gait gait patternpattern

�� Look at some Look at some abnormal patterns and discuss patterns and discuss how we would describe and document thishow we would describe and document this

�� What can we do to What can we do to improve gait with a patientgait with a patient

�� Discussion around provision and use of Discussion around provision and use of walking aids

� Group work

�� How can we How can we improve our practice as a result of as a result of this training?this training?

Definition of GaitDefinition of Gait

�� Gait Gait –– the manner of walkingthe manner of walking

�� Gait cycle Gait cycle Swing phase and and Stance phase

�� Normal gait double leg support is only for 22% Normal gait double leg support is only for 22% so for almost so for almost 80% of time itof time it’’s only single leg s only single leg supportsupport

�� Swing Swing -- toe leaving ground till heel striketoe leaving ground till heel strike

�� Toe off, initial swing, mid swing, terminal swing, heel Toe off, initial swing, mid swing, terminal swing, heel strikestrike

�� Stance Stance -- heel strike till toe offheel strike till toe off

�� Heel strike / initial contact, midHeel strike / initial contact, mid--stance, toestance, toe--offoff

Gait cycleGait cycle

Requirements for normal gait Requirements for normal gait

pattern pattern

�� MSK structureMSK structure

�� Muscle powerMuscle power

�� Central Nervous System ControlCentral Nervous System Control

�� Gross and fine motor control and regulationGross and fine motor control and regulation

�� Sensory feedbackSensory feedback�� Including peripheral sensory nerves, joint Including peripheral sensory nerves, joint propreoceptionpropreoception, balance centre info, balance centre info

Normal gait is highly efficient but through injury or Normal gait is highly efficient but through injury or illness if any of these systems are affected efficiency illness if any of these systems are affected efficiency will reduce.will reduce.

ParkinsonianParkinsonian GaitGait

�� Caused by damage to the basal ganglia of Caused by damage to the basal ganglia of the brainthe brain

�� Flexed trunk, hips, kneesFlexed trunk, hips, knees

�� Short step lengthShort step length

�� Festinating gait Festinating gait -- increasing speed, increasing speed, shortening shortening stepssteps

Foot Drop GaitFoot Drop Gait

�� High stepping gait High stepping gait -- usually asymmetricalusually asymmetrical

�� Increased hip flexion to compensate for lack of Increased hip flexion to compensate for lack of dorsidorsi--flexion at ankleflexion at ankle

�� Loss of heelLoss of heel--toe patterntoe pattern

�� Can be corrected by fixed / dynamic AFOCan be corrected by fixed / dynamic AFO

�� Normally caused by neurological damageNormally caused by neurological damage�� Central Central ieie. CVA or peripheral . CVA or peripheral ieie. Nerve root . Nerve root compressioncompression

CircumductoryCircumductory GaitGait

�� Hemiplegic patientsHemiplegic patients

�� Increased LL tone and lack of modulation / Increased LL tone and lack of modulation /

activity of opposing muscle groupsactivity of opposing muscle groups

�� Lack of full hip extension in Lack of full hip extension in midstancemidstance

�� Hip take out into abduction to clear foot rather Hip take out into abduction to clear foot rather

than toethan toe--off, hip knee flexion swing phaseoff, hip knee flexion swing phase

Ataxic GaitAtaxic Gait

��Wide base of supportWide base of support

�� Reduction in coReduction in co--ordination of movement ordination of movement

leads to exaggerated movements and leads to exaggerated movements and

balance correctionsbalance corrections

�� Loss of heelLoss of heel-- toe rocker and propulsiontoe rocker and propulsion

Common deficits of gait patternCommon deficits of gait pattern

�� Unable to lift feet off groundUnable to lift feet off ground

�� Toe catching Toe catching

�� Poor balance when steppingPoor balance when stepping

�� Knees and hips flexed when walkingKnees and hips flexed when walking

�� Shuffling gaitShuffling gait

What terms can we use to What terms can we use to

document gait? document gait? �� Step heightStep height

�� Step lengthStep length

�� Step symmetryStep symmetry

�� Path deviationPath deviation

�� Posture / joint position Posture / joint position

�� Number of steps over distanceNumber of steps over distance

�� Time over distanceTime over distance

�� Amount of support / correction requiredAmount of support / correction required

�� Walking aid usedWalking aid used

�� Distance walkedDistance walked

�� Limiting factorLimiting factor

Gait rehab Gait rehab -- preparationpreparation

�� Relevant PMHRelevant PMH

�� Why are they needing physiotherapy?Why are they needing physiotherapy?

�� Are they well enough to participate in session?Are they well enough to participate in session?

�� How did they perform in previous sessions?How did they perform in previous sessions?

�� Factors affecting mobility?Factors affecting mobility?

�� Risk assessment Risk assessment

How can we improve Gait?How can we improve Gait?

�� Fix the cause of the problem!Fix the cause of the problem!

�� Strengthen / increase ROM thru exercise Strengthen / increase ROM thru exercise

�� Verbal prompts focusing on component that Verbal prompts focusing on component that

needs improvedneeds improved

�� Practice, practice, practicePractice, practice, practice

�� Graded exposure / activity Graded exposure / activity

Walking aidsWalking aids

�� Provided to increase base of support and allow Provided to increase base of support and allow weight bearing to be transferred from lower weight bearing to be transferred from lower limbs to upper limbslimbs to upper limbs

�� Chosen according to patient strength, balance or Chosen according to patient strength, balance or weight bearing status.weight bearing status.

�� Variety of aids used in GG and CVariety of aids used in GG and C

�� Know weight limits or where to find themKnow weight limits or where to find them

�� Issue paperworkIssue paperwork

Group sessionGroup session

��What challenges do you face when asked What challenges do you face when asked to improve someoneto improve someone’’s gait?s gait?

�� Are there outcome measures that you Are there outcome measures that you currently use / previously used / would like currently use / previously used / would like to use?to use?

�� Are there any changes you could make to Are there any changes you could make to your practice / your teams practice after your practice / your teams practice after this session?this session?

What are the main learning What are the main learning

points from this discussion?points from this discussion?�� Outline the main components normal gait patternOutline the main components normal gait pattern

�� Look at some abnormal patterns and discuss how we would Look at some abnormal patterns and discuss how we would describe and document thisdescribe and document this

�� What we can do to improve gaitWhat we can do to improve gait

�� Discussion around provision and use of walking aidsDiscussion around provision and use of walking aids

�� Questions?Questions?

�� Thank youThank you