1 Gaits Not Gates Carla Wilhite, OTR/L Sherril York. Ph.D. Oklahoma AgrAbility

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Gaits Not GatesGaits Not Gates

Carla Wilhite, OTR/LCarla Wilhite, OTR/L

Sherril York. Ph.D.Sherril York. Ph.D.

Oklahoma AgrAbilityOklahoma AgrAbility

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Goals & ObjectivesGoals & Objectives

Describe normal gait phases and Describe normal gait phases and componentscomponents

Practice observational analysisPractice observational analysis Determine mechanical consequences of Determine mechanical consequences of

abnormal gaitabnormal gait Suggest justification documentation Suggest justification documentation

examplesexamples Present recommendations for improving Present recommendations for improving

work performancework performance

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What is Normal Gait?What is Normal Gait?

A series of losing and regaining balance A series of losing and regaining balance resulting in forward motionresulting in forward motion

Normal pattern assumes variety of formsNormal pattern assumes variety of forms Disruptions in sequence of actions result Disruptions in sequence of actions result

in anatomical or mechanical deviationsin anatomical or mechanical deviations Some differences due to body type, Some differences due to body type,

gender, pathology, or galactic origingender, pathology, or galactic origin

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Click on link below to see Alien song moviehttp://home.quicknet.nl/qn/prive/sc.deering/MoviePages/Alien.html

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Gait CycleGait Cycle

Cycle extends from time heel contacts Cycle extends from time heel contacts ground until same heel contacts ground ground until same heel contacts ground againagain

Consists of two phasesConsists of two phases StanceStance SwingSwing

Consists of periods of single limb support Consists of periods of single limb support and double limb supportand double limb support

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Phases of Gait CyclePhases of Gait Cycle

Stance phase–60% of cycleStance phase–60% of cycle Initial contact/loadingInitial contact/loading Midstance Midstance Terminal stance Terminal stance Preswing Preswing

Swing phase–40% of cycleSwing phase–40% of cycle Initial swing Initial swing Midswing Midswing Terminal swing Terminal swing

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Phases of WalkingPhases of Walking

Taken from Soderberg, G. (1986). Kinesiology:Application to Pathological Motion

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Phases of Gait CyclePhases of Gait Cycle

Taken from Pribut, S. (2004). Gait Biomechanics.

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Weight ShiftWeight Shift

Weight shifts from Weight shifts from slightly lateral in the slightly lateral in the heel at heel strikeheel at heel strike

Moves forward Moves forward between 1st and 2nd between 1st and 2nd long bone of footlong bone of foot

Exits through the Exits through the great toe at toe offgreat toe at toe off

Taken from Pribut, S. (2004). Gait Biomechanics.

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Anatomy of a WalkAnatomy of a Walk

Walking is a cyclic Walking is a cyclic movement movement

Head position should Head position should remain relatively levelremain relatively level

Arms and legs move Arms and legs move in opposition in opposition

Pelvis, and shoulders, Pelvis, and shoulders, rotate forward-back rotate forward-back and up-down around and up-down around spinespine

Taken from Classic Walk Tutorial http://www.rubberbug.com/tutorials.htm

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Feet and LegsFeet and Legs Heel strike as weight Heel strike as weight

shifts to forward footshifts to forward foot Double limb supportDouble limb support

ArmsArms Move in opposition to Move in opposition to

legslegs

Taken from Anatomy of Walking Tutorial http://www.rubberbug.com/walking.htm

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Feet and LegsFeet and Legs Weight is transferred Weight is transferred

to forward foot, knee to forward foot, knee flexes to absorb shockflexes to absorb shock

Toe-off of back foot Toe-off of back foot occursoccurs

Single limb supportSingle limb support ArmsArms

Move in reciprocal Move in reciprocal motion to legsmotion to legs Taken from Anatomy of Walking Tutorial

http://www.rubberbug.com/walking.htm

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Feet and LegsFeet and Legs Forward knee extends Forward knee extends

and lifts bodyand lifts body Weight on foot rolls Weight on foot rolls

from outside to insidefrom outside to inside Back leg begins swing Back leg begins swing

forwardforward ArmsArms

Move in reciprocal Move in reciprocal motion to legs motion to legs Taken from Anatomy of Walking Tutorial

http://www.rubberbug.com/walking.htm

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Feet and LegsFeet and Legs Free leg has now Free leg has now

moved forward in moved forward in prep. for heel strikeprep. for heel strike

Weighted leg is Weighted leg is beginning propulsion beginning propulsion to toe-offto toe-off

ArmsArms Arms move like Arms move like

pendulums in pendulums in opposition to legsopposition to legs


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Feet and LegsFeet and Legs Free leg now is Free leg now is

weighted at heel strikeweighted at heel strike Double limb supportDouble limb support

ArmsArms Opposite to leg Opposite to leg

movementmovement


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Anatomy of a WalkAnatomy of a Walk With legs apart, the pelvis With legs apart, the pelvis

and shoulders rotate in and shoulders rotate in opposite directions opposite directions around the spinearound the spine

As one leg moves past As one leg moves past the other, the pelvis and the other, the pelvis and shoulders move vertically shoulders move vertically in opposite directionsin opposite directions

As the legs part, the As the legs part, the pelvis and shoulders pelvis and shoulders again rotate in oppositionagain rotate in opposition


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““Normal” Gait LabNormal” Gait Lab

Gain familiarity with gait sequenceGain familiarity with gait sequence

Demonstration of typical gait patternsDemonstration of typical gait patterns

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Normal Gait SequenceNormal Gait Sequence

Click on link below to view normal gait

Downloaded from McGill Medical Gait Disorders site

http://sprojects.mmi.mcgill.ca/gait/normal/movie2.asp

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Gait DeviationsGait Deviations

Common Causes of Gait Deviations:Common Causes of Gait Deviations: Pain or discomfort during weight-bearing or Pain or discomfort during weight-bearing or

movementmovement Muscle WeaknessMuscle Weakness Limitations of joint movementLimitations of joint movement In-coordination of MovementIn-coordination of Movement Changes in bone or soft tissue (including Changes in bone or soft tissue (including

amputations)amputations)

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Pain or Discomfort: CluesPain or Discomfort: Clues Report of pain and locationReport of pain and location May spend less time in weight-bearing phaseMay spend less time in weight-bearing phase GrimacingGrimacing

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Muscle Weakness: CluesMuscle Weakness: Clues Broadened base of supportBroadened base of support Shorter stepsShorter steps Diminished arm swingDiminished arm swing Difficulty with balanceDifficulty with balance Extensive weakness: inability to ambulateExtensive weakness: inability to ambulate

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Limitation of joint movement: CluesLimitation of joint movement: Clues Arthritis pathologyArthritis pathology Surgical procedures (instrumentation)Surgical procedures (instrumentation) Disuse of a body partDisuse of a body part

(Can confirm joint limitation through (Can confirm joint limitation through measurement and gait analysis)measurement and gait analysis)

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In-coordination: CluesIn-coordination: Clues SpasticitySpasticity HemiparesisHemiparesis Hypertonia: Cannot selectively activate Hypertonia: Cannot selectively activate

muscle: see total flexion or total extension muscle: see total flexion or total extension patterns when moving limbspatterns when moving limbs

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Changes in bone or soft tissue: CluesChanges in bone or soft tissue: Clues Bone shortening after fractureBone shortening after fracture Congenital malformationsCongenital malformations Scar tissueScar tissue

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Bottom Line: Anything that is not “normal” Bottom Line: Anything that is not “normal” gait (i.e. forward progression) is a gait gait (i.e. forward progression) is a gait deviation.deviation.

Vs. “Functional” gaitVs. “Functional” gait

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Pathology at Specific JointsPathology at Specific Joints

ToesToes ExtendedExtended ClawedClawed

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Pathology at specific jointsPathology at specific joints

Ankle and FootAnkle and Foot Forefoot contactForefoot contact Foot-flat contactFoot-flat contact Foot slapFoot slap Inversion/eversionInversion/eversion DragDrag No heel offNo heel off

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Pathology at Specific JointsPathology at Specific Joints KneeKnee

Limited flexion Limited flexion Hyper or hypo Hyper or hypo

extensionextension Varus/valgusVarus/valgus WobblingWobbling Extension thrustExtension thrust

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HipHip Circumduction (multiple components)Circumduction (multiple components) Limits in flexion or extensionLimits in flexion or extension Problems with rotationProblems with rotation Problems with adduction or abductionProblems with adduction or abduction

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PelvisPelvis HikingHiking Posterior or anterior tiltPosterior or anterior tilt DroppingDropping Rotation problemsRotation problems

TrunkTrunk Back or forward leanBack or forward lean Lateral leanLateral lean

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Pathology at Specific JointsPathology at Specific Joints ArmsArms

Decreased or absent Decreased or absent arm swingarm swing

Head and neckHead and neck KyphosisKyphosis Head forward postureHead forward posture

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Lab: Walking ExperiencesLab: Walking Experiences

Place one foot directly in front of the otherPlace one foot directly in front of the other Walk with a wide base of supportWalk with a wide base of support Walk with toes pointed outWalk with toes pointed out Walk with toes pointed inWalk with toes pointed in Take a shorter than normal strideTake a shorter than normal stride Walk with both arms beside bodyWalk with both arms beside body

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Popcorn and MoviesPopcorn and Movies

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HemiplegiaHemiplegia

Click on link below to see Hemiplegic gait


http://sprojects.mmi.mcgill.ca/gait/hemiplegic/hemimovie.asp

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Drop FootDrop Foot

Click on link below to see Drop foot gait


http://sprojects.mmi.mcgill.ca/gait/footdrop/footmove.asp

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Parkinson’sParkinson’s

Click on link below to see Parkinson’s gait


http://sprojects.mmi.mcgill.ca/gait/parkinson/movie1.asp

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LimpLimp

QuickTime™ and aYUV420 codec decompressor

are needed to see this picture.

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Writing your observationsWriting your observations

Describing what you see.Describing what you see. What’s the functional problem? (Not DX)What’s the functional problem? (Not DX) What’s the impact of the problem?What’s the impact of the problem? What’s the recommendation (s)?What’s the recommendation (s)?

Estimate the “costs”Estimate the “costs” Energy expenditure=fatigueEnergy expenditure=fatigue Orthopaedic costs= mechanical wear and tearOrthopaedic costs= mechanical wear and tear Functional costs= Walking safety/stability/mobilityFunctional costs= Walking safety/stability/mobility

Refer for professional analysis (PT)Refer for professional analysis (PT)

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Describing what you seeDescribing what you see

“ “ Mr. Jones was observed walking today across Mr. Jones was observed walking today across a level dirt and gravel surface between his home a level dirt and gravel surface between his home and workshop. I observed the following and workshop. I observed the following difficulties as he was walking” :difficulties as he was walking” : Mr. Jones was using a quad cane to ambulate.Mr. Jones was using a quad cane to ambulate. He was walking with a wide base of support.He was walking with a wide base of support. While advancing his right leg while, his right forefoot While advancing his right leg while, his right forefoot

was striking the ground and he was circumducting his was striking the ground and he was circumducting his leg.leg.

He has a decreased step length and he walks very He has a decreased step length and he walks very slowly. slowly.

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Estimating the Costs…Estimating the Costs…

““Because Mr. Jones has difficulty in Because Mr. Jones has difficulty in walking from his home to the workshop, he walking from his home to the workshop, he becomes more fatigued (energy cost), he becomes more fatigued (energy cost), he appears to be placing more weight over appears to be placing more weight over his left leg to compensate for right sided his left leg to compensate for right sided weakness (wear and tear), and he has weakness (wear and tear), and he has problems maintaining his balance while problems maintaining his balance while walking to reach his workplace (functional walking to reach his workplace (functional cost).”cost).”

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ReferralReferral

“ “ Mr. Jones should be referred to a Mr. Jones should be referred to a physical therapist for a professional physical therapist for a professional analysis of his gait to determine if…analysis of his gait to determine if… He is using the appropriate assistive device.He is using the appropriate assistive device. He needs further remediation/improvement in He needs further remediation/improvement in

his gait.his gait. To improve his balance and mobility for To improve his balance and mobility for

functional activities.functional activities. To determine the need for orthotic devices.To determine the need for orthotic devices.

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Recommendations and Recommendations and JustificationJustification

““Mr. Jones may need a powered mobility Mr. Jones may need a powered mobility device to enable him to get to his farm device to enable him to get to his farm work spaces to:work spaces to: PreventPrevent physical fatigue. physical fatigue. EnableEnable him to have increased mobility in him to have increased mobility in

getting to his work locations.getting to his work locations. PreventPrevent secondary injury from additional secondary injury from additional

biomechanical stress on his non-affected limb.biomechanical stress on his non-affected limb. Keep him Keep him safersafer when moving from his home to when moving from his home to

the worksite.the worksite.

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Farm gait contextsFarm gait contexts

Gait is dynamic. How does it change if:Gait is dynamic. How does it change if: On uneven terrain?On uneven terrain? Carrying a bucket?Carrying a bucket? Walking with a feed sack on one shoulder?Walking with a feed sack on one shoulder? Slippery surfaces?Slippery surfaces?

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AdaptationsAdaptations

Personal assistive Personal assistive devicedevice

Farm mobility deviceFarm mobility device Community mobilityCommunity mobility

Documents

1 Gaits Not Gates Carla Wilhite, OTR/L Sherril York. Ph.D. Oklahoma AgrAbility