Gait Asessment

7/29/2019 Gait Asessment

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GAIT


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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


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Intro

Walking is the simple act of falling forwardand 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


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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


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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


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Parameters

Stride Length

Distance in the plane bet. Successive points of foot-to-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


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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.


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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


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Normal Patterns ofGait


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Stance Phase

Traditional:

Heel Strike

Foot Flat

Midstance

Heel off

Toe off

Rancho Los Amigos:

Initial Contact

Loading ResponseMidstance

Terminal Stance

Preswing


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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


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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 thecontralateral extremity leaves the ground


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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 leavesthe ground & ends when the body is directed overthe supporting limb


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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


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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 ofthe contralateral extremity to lift off the

reference extremity


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Swing Phase

Traditional:

Acceleration

Midswing

Deceleration

Rancho Los Amigos

Intial swing

Midswing

Terminal Swing


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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 isdirectly under the body

Initial swing

The portion of swing from the point when thereference extremity leaves the ground to

maximum knee flexion of the same extremity


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Swing Phase

Midswing Portion of the swing phase when reference

extremity passes directly below the body.

Midswing extends from the end of accelerationto the beginning of decceleration

Midswing

Portion of the swing phase from maximum knee

flexion of the reference extremity to a vertical

tibial position


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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 verticalposition of the tibia of the reference extremity to

just prior to initial contact


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Gait Assessment


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The types of gait assessment in use today can

be classified under as Kinematic and Kinetic.Kinematic gaitassessment is used to describe

movement patterns without regard for the

forces involved in producing the movement.A kinetic gaitassessment consists of a

description of movement of the body as a

whole or body segments in relation to each

other during gait.


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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


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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


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Gait Assessment

Stance Phase KinematicPHASE OF

GAITHIP KNEE ANKLE FOOT

HEEL STRIKE20-40, slight

add. and LR

Full / before HS,

ing @ HSMoving to PF

Supination at

HS

FOOT FLATHip/, add. and

MR20/ PFDF Pronation

MIDSTANCENeutral to /;

pelvis PPT15/ 3 DF Neutral

HEEL OFF10-15 Hip /, abd

and LR4/ 15 DFPF Supination

TOE OFF 10/, abd. and LR Full /4020 PF

Supination


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Gait Assessment Kinetic

PHASE OF GAIT HIP KNEE ANKLE AND FOOT

HEEL STRIKE

G.Max, Hams and

Erector Spinae-Eccentric

Quads-eccentric TA, EDL, EHL-eccentric

FOOT FLAT

G.Max, Hams

Erector Spinae-

concentric

Quads-concentricDFors-

TP, FHL, FDL-eccentric

MIDSTANCE

Iliopsoas-eccentric

G. Med-reverse

contraction stab on

opposite pelvis

Quads-

Gastrocs-eccentric

Gastrocsoleus and

Peroneals-eccentric

HEEL OFFIliopsoas-continue

activity

Gastrocs-concentric to

begin knee

Gastrocsoleus and

Peroneals-concentric

TOE OFF

Adductor Magnus-

concentric to stab

pelvis

Iliopsoas-continue

activity

Quads-eccentric

Gastrocsoleus and

Peroneals-

peakinactive


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Gait Assessment


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Gait Assessment

Swing Phase Kinematic


Acceleration to

Midswing

0-15 30

to neutral30-60 20 DF and slight pronation

Midswing to

Deceleration 30-40 Near full /

Neutral and slight

supination


Acceleration toMidswing

Hip ors-

concentric

Contralat.

G.Med-

concentric

Hams-concentric DFors-concentric

Midswing to

Deceleration

G. Max-eccentric

Quads-

concentric

Hams-eccentric

DFors-isometrically

Kinetic


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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, knee, ankle and foot

Hip: rotation, abduction, and adduction Knee: flexion and extension

Ankle and foot: DF and P; toe in toe out; supinationpronation


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Bowing of femur or tibia: genu varum/genuvalgum

Medial or lat. rot. of hips femur or tibia: toein/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 loadingperiod


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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

Step length, stride length and cadence


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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


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EXAMINATION

Force Platforms

Electromyography

High-speed video motion system


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ABNORMAL GAIT


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Pathology or injury in the specific joint.

They may occur as compensations for injury or

pathology in other joints on the same oripsilateral side.

And finally, they may occur as compensations

for injury or pathology on the opposite or

contralateral limb.

Three reasons why gait deviations can

occur:


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Self-protective; result of injury to the pelvis, hip,

knee, ankle or foot.

The stance phase on the affected leg is shorter than

that on the unaffected leg, because the patientattempts to remove weight from the affected leg as

quickly as possible.

Antalgic (Painful) gait


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Results from stiffness, laxity or deformity, and it

may be painful or pain free.

Arthrogenic (Stiff Hip or Knee) Gait


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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.

Ataxic Gait


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Hip flexion contracture results in:

- increased lumbar lordosis

- extension of the trunk combined with kneeflexion to get the foot on the ground.

Knee flexion contracture:

- patient demonstrates excessive ankledorsiflexion from the late swing phase to earlystance 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 thetrunk with hip flexion.

CONTRACTURE GAITS


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This childhood gait is seen with talipes

equinovarus(club foot), CP and limb-length

discrepancy.

The weight-bearing phase on the affected

limb is decreased, and a limp is present.

Equinus Gait (Toe Walking)


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Primary hip extensor, 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

l di ( d l b ' )


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Hip abductor muscles together with thegluteus minimus, are weak.

Patient exhibits an excessive lateral list in

which the thorax is thrust laterally to keepthe COG over the stance leg.

If there is a bilateral weakness of the gluteusmedius muscles, the gait shows accentuatedside-to-side movement, resulting in awobbling gait.

Gluteus Medius (Trendelenburg's)

Gait


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The patient with hemiplegic gait swings the

paraplegic leg outward and ahead in a

circle(circumduction) or pushes it ahead.

Sometimes referred to as a neurogenic or

flaccid gait.

Hemiplegic or Hemiparetic Gait


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Basal ganglia affected

Neck, trunk and knees are flexed.

The gait is characterized by shuffling.

Parkinsonian Gait


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If the plantarflexors are unable to perform

their function, ankle and knee stability are

greatly affected.

Loss of the plantar flexors results in decrease

or absence of push-off.

The stance phase is less, and there is a

shorter step length on the unaffected side.

Plantar Flexor Gait


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Patient demostrates a difficulty in swing-

through, 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.

Psoatic Limp


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The patient compensates in the trunk and

lower leg if the quads have been affected.

Quadriceps Avoidance Gait


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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.

Scissors Gait


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The patient may demonstrate lateral shift to

the affected side if one leg is shorter than the

other, and the pelvis tilts down on the

affected side.

May also be termed painless osteogenic gait.

Short Leg Gait


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Patient has weak or paralyzed dorsiflexor

muscles, resulting a drop foot.

At initial contact, the foot slaps on the

ground because of loss of control of the

dorsiflexor muscles, their peripheral nerve

supply, or the nerve roots supplying the

muscles.

Steppage or Drop Foot Gait


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Reference

Orthopedic Physical Assessment David J. Magee

Physical Rehabilitation

Susan B. O Sullivan


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THANK YOU

Documents

Gait Asessment