GAIT ASSESSMENT

By: Brina Kitts

Gait AnalysisThere are two acceptable ways to analyze gait pattern:A. Los Ranchos Amigos:o Initial contacto Loading responseo Midstanceo Terminal stanceo Preswingo Initial swingo Midswingo Terminal swing

B. Standard (Classic):o Heel strikeo Foot flato Midstanceo Heel offo Toe offo Midswingo Heel strike

Gait Pattern DeviationsThere are many different musculoskeletal causes for deviation within a gait

pattern:

Hip PathologyKnee pathologyFoot and ankle pathologyLeg length discrepancyPain

Affects of gait due to hip pathologies:

◦ Arthritis- An arthritic hip has reduced range of movement during swing phase which causes an exaggeration of movement in the opposite limb that is known as ‘hip hiking’

◦ Excessive hip flexion- alters gait pattern most commonly due to: Hip flexion contractures, IT band contractures, Hip flexor spasticity, Compensation for excessive knee flexion and ankle DF, Hip pain, Compensation for excess ankle plantar flexion in mid swing

◦ Hip abductor weakness- will cause the hip to drop towards the side of the leg swinging forward. This is also known as Trendelenburg gait.

◦ Hip adductor contracture- during swing phase the leg crosses mid-line due to the weak adductor muscles, this is known as ‘scissor gait’

◦ Weak hip extensors- will cause a person to take a smaller step to lessen the hip flexion required for initial contact, resulting in a lesser force of contraction required from the extensors

◦ Hip flexor weakness- results in a smaller step length due to the weakness of the muscle to create the forward motion. Gait will likely be slower and may result in decreased floor clearance of the toes and create a drag

Affects of gait due to knee pathologies:

oWeak quadriceps- weakness of these muscles causes the hip extensors to compensate by bringing the limb back into a more extended position, reducing the amount of flexion at the knee during stance phase. Instead heel strike will occur earlier, increasing the ankle of plantar flexion at the ankle, preventing the forward movement of the tibia, to help stabilize the knee joint

oSevere quadriceps weakness- instability will present in hyperextension during the initial contact to stance phase. The knee joint will ‘snap’ back into hyperextension as the body weight moves forward over the limb

oKnee flexion contraction- knee is restricted in extension, meaning heel strike is limited and step length reduced. To compensate the person is likely to ‘toe walk’ during stance phase

Affects of gait due to ankle pathologies:

◦ Ankle dorsiflexion weakness- results in a lack of heel strike and decreased floor clearance

◦ Calf tightening or contractures- will cause reduced heel strike due to restricted dorsiflexion. The compensated gait result will be ‘toe walking’ on stance phase, reduced step length and excessive knee and hip flexion during swing phase to ensure floor clearance

Leg Length Discrepancy◦ Leg length discrepancy can be as a

result of an asymmetrical pelvic, tibia, or femur length or for other reasons, such as a scoliosis or contractures.

◦ The gait pattern will present as a pelvic dip to the shortened side during stance phase with possible ‘toe walking’ on that limb.

◦ The opposite leg is likely to increase its knee and hip flexion to reduce its length

Antalgic GaitKnee pain-presents with decreased

weight bearing on the affected sideAnkle pain- may present with a

reduced stride length and decreased weight bearing on the affected limb

Hip pain- results in reduced stance phase on that side

Common Neurological Causes of Pathological Gait

◦ Hemiplegic gait◦ Diplegic gait◦ Parkinsonian gait◦ Ataxic gait◦ Myopathic gait◦ Neuropathic gait

Hemiplegic Gait◦ often seen as a result of a

stroke

Diplegic Gait◦ Spasticity is normally associated with both lower limbs

Parkinsonian Gait ◦ often seen in Parkinson’s disease or associated with conditions which cause

Parkinson’s

Ataxic Gait◦ seen as uncoordinated steps with a wide base of support and swaying foot

placement

Myopathic Gait◦ Due to weakness of hip muscles- if it is bilateral the presentation will be a

‘waddling gait’, unilaterally will present as a Trendelenburg Gait

Neuropathic Gait◦ High stepping gait to gain floor clearance often due to foot drop

Common Tests for Gait Assessment

◦ 6 Minute Walk Test - measures the distance an individual is able to walk over a total of six minutes on a hard, flat surface. The goal is for the individual to walk as far as possible in six minutes. Patient is allowed to self-pace and rest as needed as they navigate back and forth along a marked walkway

◦ Tinetti-Test – assesses the gait and balance in older adults. It is therefore also called: performance-oriented mobility assessment. Good indicator of fall-risk assessment

Tinetti Test

Common Tests for Gait Assessment (cont.)

Timed Get Up and Go (TUG)- the patient is to wear their regular footwear and can use a walking aid if needed. Begin by having the patient sit back in a standard armchair and identify a line 3 meters or 10 feet away on the floor.Instructions to the patient:◦ When I say “Go,” I want you to:◦ 1. Stand up from the chair◦ 2. Walk to the line on the floor at your normal pace◦ 3. Turn◦ 4. Walk back to the chair at your normal pace◦ 5. Sit down again

That concludes this in-service on gait assessment!

Thank You!!