Gait Assessment Ppt

-series of rhythmical alternating movements of limb and trunk which result in forward progression of the COG

-time interval or sequence of motions occurring between two consecutive initial contacts of the same foot; each cycle lasts for 1-2 seconds.

Occurs when only one is on the ground; 30% of the gait cycle: single leg stance

Both limbs are simultaneously in contact with the ground; 20% of the gait cycle; double leg stance

% increases to more one slowly walks; it becomes shorter as walking speed increases and disappears in running

WALKING- 2 periods of double leg support

RUNNING- with “double float” ( period of time in which neither foot is in contact with the ground)

1. Stance Phase Makes up to 60% of the gait cycle

during normal walking Occurs when the foot is on the ground

and bearing weight

The Los Amigos National rehabilitation Center (RLA) has developed different terminology in which the subdivision have been redefined and named.

1. HEEL STRIKE refers to the instant at which the heel of the leading extremity strikes the ground.

RLA: Initial contact refers to the instant the foot of the leading extremity strikes the ground.

2. FOOT FLAT- occurs immediately after heel strike and is the point at which the foot fully contacts the ground.

RLA: Loading response occurs immediately following initial contact and continues until the contralateral extremity lifts off the ground at the end of the double-support phase.

3. MIDSTANCE- is the point at which the body weight is directly over the supporting lower extremity.

RLA: Midstance begins when the contralateral extremity lifts off the ground and continues to a position in which the body has progressed over and ahead of the supporting extremity.

4. HEEL OFF is the point at which the heel of the reference extremity leaves the ground.

RLA: Terminal stance is the period from the end of midstance to a point just prior to initial contact of the contralateral extremity or following heel off of the reference extremity.

5. TOE OFF is the point at which only the toe of the ipsilateral extremity is in contact with the ground.

RLA: Preswing encompasses the period from just following heel off to toe off.

40% of the walking cycle Occurs when the foot is not bearing

weight and is moving forward.

1. Acceleration begins once the toe of the reference (ipsilateral) extremity leaves the ground.

- 10% of the swing phase

RLA- Initial swing begins at the same point as acceleration continues until maximum knee flexion of the reference (ipsilateral ) extremity occurs.

2. MIDSWING- occurs when the ipsilateral extremity passes directly beneath the body.( 80% of the swing phase)

RLA- Midswing encompasses the period immediately following maximum knee flexion and continues until the tibia is in a vertical position.

3. Decelaration occurs after the midswing when the tibia passes beyond the perpendicular and the knee is extending in preparation for heel strike.

-10% of the swing phase

RLA- Terminal swing includes the period from the point at which the tibia is in the vertical position to a point just prior to initial contact.

TRADITIONAL Heel Strike Heel strike to foot flatFoot flat to midstanceMidstance to heel offToe offToe off to accelarationAccelaration to

midswingMidswing to

deceleration

RLAInitial contact Loading responseMidstanceTerminal stancePreswing Initial swingMidswingTerminal swing

Traditional terminology – refers to points in time

RLA terminology- refers to lengths of time

Weight acceptance period of the stance leg

First 10% of the gait cycle A period of double support or double-

leg stance

Consists of the single support or single leg stance

Accounts for the next 40% of the gait cycle.

Make up the weight-unloading period Accounts for the next 10% of the gait

cycle A period of double support.

1. BASE WIDTH- distance between the two feet

5 to 10 cm (2-4 inches) Wide base- cerebellar or inner ear

problems, diabetes or peripheral neuropathy indicating loss of sensation, tight hip abductors.

2. STEP LENGTH- distance b/2 successive contact points on opposite feet 37.5cm(15inches)

Should be equal for both legs Increased in tall persons, decreased in

children, female at old, with age , fatigue, pain and disease.

3. STRIDE LENGTH- linear distance in the plane of progression between successive points of foot-to –floor contact of the same foot. 75 cm (30 inches)

4. LATERAL PELVIC SHIFT(PELVIC LIST) -Side to side movement of the pelvis

during walking. - 5cm(2inches) - increases if the feet are farther apart

Causes relative adduction of the weight bearing limb, facilitating the adduction of the hip adductors.

Weakness= trendelenburg gait

5. VERTICAL PELVIC SHIFT Keeps the COG from moving up and

down more than 5cm (2 inches) during the normal gait. High point occurs during midstance

and the low point occurs during initial contact.

The head is never higher during normal gait than it is when the person is standing on both feet.

Swing Phase: hip is lower on the swing side and patient must flex the knee and dorsiflex the foot to clear the toe.

6.PELVIC ROTATION Necessary to lessen the angle of the

femur with the floor; lengthens the femur.

Decreases the amplitude if displacement along the path travelled by the COG and hereby increases the COG dip

8 deg pelvic rotation with 4 deg forward on the swing leg and 4 leg posteriorly on the stance leg.

Thorax rotated in the opposite direction to maintain balance.

5cm(2inches) anterior to the 2nd sacral vertebra.

It’s vertical and horizontal displacement is a figure during walking

Sinusoidal

Number of steps per minute. 90-120 steps per minute WALKING SPEED distance covered over

a period of time. slow70m./min Medium 95/min Fast 120m/min

The determinants of gait has two important function namely:1. Lessen the movement of the center of the gravity, therefore reducing the energy expenditure.

- COG is lowest during the period of double support highest and midstance

- COG is lowest during the period of double support highest and midstance.

2. Produce a smooth sinusoidal movement

Pelvic rotation Pelvic tilt Knee flexion in the stance phase Foot and ankle motion- synchronous

motion produces gradual rise/fall of COG

Knee flexion Lateral motion of the pelvis

1. For females ( compared to males) - slower speed with greater

cadence - decreased arm swing - decreased lateral and vertical

head motion - greater lateral and pelvic shift

2. Elderly - slower speed with wider, shorter

steps - decreased arm swing - less pelvic rotation - increased double support

3. When wearing high-heeled shoes - slower speed, same cadence - increased knee flexion during early

stance - rapid movement to lower fore foot on

the floor

1. STRUCTURAL PATHOLOGIC GAITS 1.1 Inequality of leg length One leg is longer with discrepancy>1.5in. -tiptoe at stance of shorter extremity One leg is longer with discrepancy<1.5

in. - dipping of shoulder and dropping of

the pelvis on the affected side.

- apparent elevation of shoulder on swing side.

- exaggerated hip, knee, ankle flexion by contralateral extremity during swing.

1.2 Hip Ankylosis compensatory motion of the lumbar

spine Exaggerated movement of the

opposite hip.

1.3 Knee joint stability sudden knee buckling Abnormal or excessive ROM of the

knee

1.4 Knee Contractures if flexion contracture is less than 30

degrees – there is limping apparent in fast walking

If flexion contracture is greater than 30 degrees- limping even in slow walking

extension contracture – during STANCE have excessive rise of pelvis and center of gravity with lack of shock absorption during heel strike.

---- during SWING have hip circumduction and hip hiking on the affected side or tiptoeing on affected side.

1.5 Limitation of foot and ankle motiona) Equinus - foot drop deformity usually due to

paralysis of the ant. compartment muscles esp. the tibialis anterior

- heelstrike is absent and patient walks with either a toe-heel gait or starts with foot flat.

- when bilateral a steppage gait is observed so that both feet(specifically the ball of each foot)

horse from which it is named; to clear the foot from the ground the patient will do excessive hip and knee flexion.

b.) Calcaneus -type of deformity that occurs in

paralysis of the gastocsoleus - during gait this will present with an

apparent lack weakness of PUSH OFF.

self-protective The result of injury to the pelvis, hip,

knee, ankle, or foot Stance phase on the affected leg-

shorter than non-affected leg( pt. attempts to remove wt. from the aff. Leg as quickly as possible)

Decreased swing phase of the uninvolved leg- shorter step length of the uninvolved side, decreased walking velocity and decreased cadence.

Cerebellar ataxia- gait includes a lurch or stagger, all movements are exaggerated; drunken gait.

Sensory ataxia- feet slap the ground because they cannot be felt; patient watches the feet while walking; resulting gait is irregular, jerky, and weaving

secondary to weak hip extensors Patient thrusts the thorax posteriorly at

initial contact to maintain hip extension of the stance leg

Resulting gait involves a characteristic backward lurch of the trunk.

secondary to weak hip abductors Patient exhibit an excessive lateral list

in which the thorax is thrust laterally to keep the COG over the stance leg

Bilateral weakness- accentuated side to side movement resulting in wobbling gait or chorus girl swing gait.

patient swings the affected leg outward and ahead in a circle (circumduction) or pushes it ahead

Affected upper limb is carried across the trunk for balance

a.ka. neurogenic gait or flaccid gait

Neck, trunk, and knees of the patient are flexed

Shuffling or short rapid steps Arms are held stiffly and do not have

their normal associative movement Patient may lean forward and walk

progressively faster as through unable to stop (festating)

Spastic paralysis of the hip adductor muscle which causes the knees to be drawn together so that the legs can be swung forward only with great effort

Seen in spastic paralegics a.k.a. spastic gait