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DefinitionDefinition
Human gait is bipedal, biphasic,Human gait is bipedal, biphasic,
forward propulsion of centre of gravity,forward propulsion of centre of gravity,in which there is alternate sinuousin which there is alternate sinuous
movement of different segments of themovement of different segments of the
body, with least expenditure of energy.body, with least expenditure of energy.
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WHY???!!WHY???!!
DiagnosisDiagnosis
Plan TreatmentPlan Treatment
Results of treatmentResults of treatmentComparison of different modalities ofComparison of different modalities of
treatmenttreatment
Orthosis and prosthesis manufacturingOrthosis and prosthesis manufacturingand to render scientific basis to newer andand to render scientific basis to newer and
innovative productsinnovative products
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Normal Gait Pre-requisitesNormal Gait Pre-requisites
EquilibriumEquilibrium-ability to assume upright-ability to assume upright
posture and maintain balance.posture and maintain balance.LocomotionLocomotion-ability to initiate and maintain-ability to initiate and maintain
rhythmic stepping.rhythmic stepping.Muskuloskeletal integrity-Muskuloskeletal integrity-normal bonenormal bone
joint and muscle function.joint and muscle function.Neurological control-Neurological control-visual ,auditoryvisual ,auditory
vestibular and sensory motor inputvestibular and sensory motor input
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GAIT CYCLEGAIT CYCLE
A single gait cycle or stride is defined:A single gait cycle or stride is defined:Period when ONE foot contacts the ground toPeriod when ONE foot contacts the ground to
when that same foot contacts the groundwhen that same foot contacts the ground
againagainEach stride has 2 phases:Each stride has 2 phases:Stance PhaseStance Phase -60% of the gait cycle-60% of the gait cycle
Foot in contact with the groundFoot in contact with the groundSwing PhaseSwing Phase -40% of the gait cycle-40% of the gait cycle
Foot NOT in contact with the groundFoot NOT in contact with the ground
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STANCE PHASESTANCE PHASE
When the foot is in contact with the groundWhen the foot is in contact with the ground
Stance phase has 5 parts:Stance phase has 5 parts:
1.Initial Contact1.Initial Contact (Heel Strike)(Heel Strike)2.Loading Response2.Loading Response (Foot Flat)(Foot Flat)
3.Midstance3.Midstance
4.Terminalstance4.Terminalstance(heel off + push off)(heel off + push off)5.Pre-Swing5.Pre-Swing(toe off)(toe off)
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SWING PHASESWING PHASE
When foot is NOT contacting the groundWhen foot is NOT contacting the ground
Limb advancement phaseLimb advancement phase3 parts of swing phase:3 parts of swing phase:
-Initial swing-Initial swing
-Midswing-Midswing
-Terminal swing-Terminal swing
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GAIT PARAMETERSGAIT PARAMETERS
(CADENCE PARAMETERS)(CADENCE PARAMETERS)
Step lengthStep length distance between two feet duringdistance between two feet duringdouble limb support, it is measured from the heeldouble limb support, it is measured from the heelof one foot to heel of contralateral footof one foot to heel of contralateral foot
Stride lengthStride length -distance one limb travels during-distance one limb travels during
the stance and swing phase, it is measured fromthe stance and swing phase, it is measured fromthe point of foot contact at the beginning ofthe point of foot contact at the beginning ofstance phase to the point of contact by the samestance phase to the point of contact by the samefoot at the end of swing phasefoot at the end of swing phase
Step timeStep time amount of time used to completeamount of time used to completeone step lengthone step length CadenceCadence number of steps taken per minutenumber of steps taken per minuteWalking velocityWalking velocity -distance traveled per minute-distance traveled per minute
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Murray et al. determined parameters ofMurray et al. determined parameters of
gait in nondisabled men.gait in nondisabled men.
Mean duration of the gait cycle -Mean duration of the gait cycle -
1.031.03
secondsseconds..
The steps per minute - 117 (90-120 steps)The steps per minute - 117 (90-120 steps)
Average comfortable walking speed wasAverage comfortable walking speed was2.8 miles per hour.2.8 miles per hour.
Average stride length -Average stride length - 70-82 cm70-82 cm
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LAW OF PHYSICS:LAW OF PHYSICS:
Centre of gravity of body mass should fallCentre of gravity of body mass should fall
within its base of support to retain itswithin its base of support to retain its
stabilitystability
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Smoothness of gait:Smoothness of gait:
Stance leg must support the centre ofStance leg must support the centre of
gravity and provide active extension ofgravity and provide active extension of
hip and knee to help the swing leg tohip and knee to help the swing leg to
clear the groundclear the ground
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Study of human locomotionStudy of human locomotion
Walking consists of a series of gaitWalking consists of a series of gait
cyclescyclesA single gait cycle is known as a STRIDEA single gait cycle is known as a STRIDE
GAIT ANALYSISGAIT ANALYSIS
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CLINICAL GAIT ANALYSISCLINICAL GAIT ANALYSIS
OBSERVATIONAL GAIT ANALYSISOBSERVATIONAL GAIT ANALYSIS
3D GAIT ANALYSIS3D GAIT ANALYSIS
OBSERVATIONAL GAIT ANALYSISOBSERVATIONAL GAIT ANALYSIS
Pt should be viewed from the front, side,Pt should be viewed from the front, side,and behindand behind
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3D GAIT ANALYSIS3D GAIT ANALYSIS
Kinematics -movementKinematics -movement Kinetics -forces related to movementsKinetics -forces related to movements
Ground reaction forces (GRF)Ground reaction forces (GRF) Moment or torque - a turning force that results inMoment or torque - a turning force that results in
angular change of position of a segment/jointangular change of position of a segment/joint Power - a function of joint angular velocity andPower - a function of joint angular velocity and
joint moment; rate of doing workjoint moment; rate of doing work Electromyography (EMG) -recording ofElectromyography (EMG) -recording of
myoelectrical activitymyoelectrical activity
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KINEMATICSKINEMATICS
Denotes the motion observed andDenotes the motion observed and
measured at pelvis, hip, knee, ankle andmeasured at pelvis, hip, knee, ankle and
footfoot
Done in three planesDone in three planes
-sagittal plane-hip flexion ,extension-sagittal plane-hip flexion ,extension
-coronal plane-hip abduction,adduction-coronal plane-hip abduction,adduction-transverse plane-rotation hip,tibia,feet-transverse plane-rotation hip,tibia,feet
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MUSCLES ACTING DURINGMUSCLES ACTING DURING
WALKINGWALKING
Concentric contraction- - muscle shortens onConcentric contraction- - muscle shortens on
stimulation, generates power and acceleratesstimulation, generates power and accelerates
body forward.body forward.-gastrosoleus contracts to lift the-gastrosoleus contracts to lift the
heel off the groundheel off the ground
-iliopsoas contracts flexing the hip-iliopsoas contracts flexing the hipand pulling the stance phase limband pulling the stance phase limb
off the groundoff the ground
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MUSCLES ACTING DURINGMUSCLES ACTING DURING
WALKINGWALKING Eccentric contraction- muscle lengthens onEccentric contraction- muscle lengthens on
stimulation, slows down and stabilises jointstimulation, slows down and stabilises jointmotionmotion
-tibialis anterior-contracts at initial-tibialis anterior-contracts at initial
contact ,firing during plantar flexioncontact ,firing during plantar flexionas the foot is lowered to ground,as the foot is lowered to ground,
so the foot is gently lowered to groundso the foot is gently lowered to ground
-gastrosoleus-contracts eccentrically-gastrosoleus-contracts eccentrically
through the stance phase controlling thethrough the stance phase controlling the
rate of dorsiflexion of anklerate of dorsiflexion of ankle
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SAGITTAL PLANESAGITTAL PLANE
Pelvis is tilted 15 degrees, minimal motion of thePelvis is tilted 15 degrees, minimal motion of theanterior tilt as each leg is advanced forward.anterior tilt as each leg is advanced forward.
Hamstrings tight: More posterior tiltHamstrings tight: More posterior tilt Knee: More complex patternKnee: More complex pattern Deviations: Hyperextension in stance phase ifDeviations: Hyperextension in stance phase if
the heel cord is tight, flexion in stance due tothe heel cord is tight, flexion in stance due tohamstring tightness, inability to flex the knee inhamstring tightness, inability to flex the knee inswing phase due to inappropriate rectus femorisswing phase due to inappropriate rectus femoris
action, quadriceps gaitaction, quadriceps gaitAnkle: First Rocker, Second Rocker, ThirdAnkle: First Rocker, Second Rocker, Third
RockerRocker
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CORONAL PLANECORONAL PLANE
Pelvic ObliquityPelvic Obliquity
Each hemipelvis rises slightly during swingEach hemipelvis rises slightly during swing
phase to augment the ability to advancephase to augment the ability to advance
the swing limb, this is associated with athe swing limb, this is associated with a
contralateral hemipelvis fall.contralateral hemipelvis fall.
Adducts during stance phase.Adducts during stance phase.
Accentuated in CP.Accentuated in CP.
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TRANSVERSE PLANETRANSVERSE PLANE
Pelvis and hips rotate minimally duringPelvis and hips rotate minimally during
gait, Tibiae are mildly externally rotated.gait, Tibiae are mildly externally rotated.
FOOT PROGRESSION ANGLE: AngleFOOT PROGRESSION ANGLE: Angle
the foot makes with the path the subject isthe foot makes with the path the subject is
walking.walking.
Normally: 10-15 degreesNormally: 10-15 degrees
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PATHOLOGICAL GAITSPATHOLOGICAL GAITS
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GAITS IN CPGAITS IN CP True EquinusTrue Equinus -distal spasticity (Gastrosoleus spasticity)-distal spasticity (Gastrosoleus spasticity)
Equinus Genu recurvatumEquinus Genu recurvatum
Jump GaitJump Gait
Spasticity of hamstrings and hip flexors, equinus + hip and knee inSpasticity of hamstrings and hip flexors, equinus + hip and knee inflexion + ant. pelvic tilt + exaggerated lumbar lordosis + knee stiffflexion + ant. pelvic tilt + exaggerated lumbar lordosis + knee stiff
Crouch gaitCrouch gait Excessive dorsiflexion or calcaneus at ankle +Excessive dorsiflexion or calcaneus at ankle +excessive flexion at knee and hip + ant. pelvic tiltexcessive flexion at knee and hip + ant. pelvic tilt
May be Iatrogenic due to isolated lengthening of TA (w/o correctingMay be Iatrogenic due to isolated lengthening of TA (w/o correctinghamstring & iliopsoas spasm)hamstring & iliopsoas spasm)
Scissoring gaitScissoring gait
Adductor musculature spasm, Flexion + int. rotation deformityAdductor musculature spasm, Flexion + int. rotation deformity
Can bring the swing limb up to the stance limbCan bring the swing limb up to the stance limb
Cadence parameters are grossly decreasedCadence parameters are grossly decreased
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CROUCH GAITSCISSORING GAIT
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TRENDELENBERG GAITTRENDELENBERG GAIT
Functional weakening of abductorFunctional weakening of abductor
mechanismmechanism
Standing on affected side pelvisStanding on affected side pelvis
drop to normal sidedrop to normal side
To compensate patient lurches to affectedTo compensate patient lurches to affected
sideside
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GAIT IN BILATERAL HIPGAIT IN BILATERAL HIP
DISEASESDISEASES
Waddling gaitWaddling gait
Bilateral trendelenbergBilateral trendelenberg
CDHCDH
COXA VARACOXA VARA
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SHORT LIMB GAITSHORT LIMB GAIT
Shift to same sideShift to same side
Pelvis tilt downward with dipPelvis tilt downward with dip
Equal period on each sideEqual period on each sideSupinate foot or toe walkSupinate foot or toe walk
Flex knee and hip on normal sideFlex knee and hip on normal side
Raise pelvis on normal side in swingRaise pelvis on normal side in swingphase hip hiking to clear groundphase hip hiking to clear ground
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GLUTEUS MAXIMUS GAITGLUTEUS MAXIMUS GAIT
GL. MAXIMUS - Terminal swing-GL. MAXIMUS - Terminal swing-
opposite side gluteus maximus locksopposite side gluteus maximus locks
hip in extension on wt bearing sidehip in extension on wt bearing side
Weakness - pelvis thrust forward andWeakness - pelvis thrust forward and
trunk backward shift COG backwards -trunk backward shift COG backwards -
increased lordosisincreased lordosis
Patient lurches back &forth over thePatient lurches back &forth over the
hipships
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CALCANEAL GAITCALCANEAL GAIT
Gastrosoleus contracts eccentricallyGastrosoleus contracts eccentrically
throughout the second rocker, hencethroughout the second rocker, hence
controlling excessive dorsiflexion.controlling excessive dorsiflexion.
Weakness of gastrosoleusWeakness of gastrosoleus
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STIFF HIP GAITSTIFF HIP GAIT
No flexion of hip during walkingNo flexion of hip during walking
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QUADRICEPS GAITQUADRICEPS GAIT
Weakness of QuadricepsWeakness of Quadriceps
PoliomyelitisPoliomyelitis
Hand to Knee GaitHand to Knee Gait
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STEPPAGE GAITSTEPPAGE GAIT
Foot dropFoot drop
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Other Pathological GaitsOther Pathological Gaits
CEREBELLAR ATAXIA: WIDE BASED REELING GAIT (DRUNKENCEREBELLAR ATAXIA: WIDE BASED REELING GAIT (DRUNKENSOLDIERS GAIT)SOLDIERS GAIT)
HEMIPARETIC : CIRCUMDUCTION GAITHEMIPARETIC : CIRCUMDUCTION GAIT PARKINSONISM: FESTINENT GAITPARKINSONISM: FESTINENT GAIT MARCHE A PETIT PAS: DEMENTIA / FRONTAL LOBEMARCHE A PETIT PAS: DEMENTIA / FRONTAL LOBE
SYNDROMESSYNDROMES MYOPATHIC GAIT: EXAGGERATED HIP MOVEMENTSMYOPATHIC GAIT: EXAGGERATED HIP MOVEMENTS MULTIPLE SCLEROSIS/ VIT B 12 DEFICIENCY:MULTIPLE SCLEROSIS/ VIT B 12 DEFICIENCY:
CORTICOSPINAL + PROPRIOCEPTION : SPASTICITY + ATAXIA :CORTICOSPINAL + PROPRIOCEPTION : SPASTICITY + ATAXIA :JIGGLING/ BOBBLY GAITJIGGLING/ BOBBLY GAIT
HYPERKINETIC GAIT : CHOREA (GROTESQUE DANCING ANDHYPERKINETIC GAIT : CHOREA (GROTESQUE DANCING AND
PRANCING)PRANCING) CAUTIOUS SENILE GAIT: VELOCITY DECREASES, STEPSCAUTIOUS SENILE GAIT: VELOCITY DECREASES, STEPS
SHORTEN AND BASE WIDENSSHORTEN AND BASE WIDENS MAGNETIC GAIT (GAIT APRAXIA)MAGNETIC GAIT (GAIT APRAXIA)
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Thank YouThank You
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