K Class 11TG Gait Assessment

8/10/2019 K Class 11TG Gait Assessment

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Kinesiology





Manner of walkingRhythmic andalternatingmovement of thelegs along withthe trunk and thearms, which

results in thepropulsion of thebody mass.



An automaticfunctioncoordinated byinnate (presentfrom birth) andlearned reflexes.Unique to everyperson so can varygreatly



Muscles worktogether to producemovement but inlarge portions ofthe gait cycle, thereis little or nomuscle action inmost of the muscle

groups showing theenergy efficientnature of walking.



Gait cycle (GC):◦ The period in which a complete sequence of

events takes place & divided into 2 phasesStance phase: heel strike, midstance & toe

offSwing phase

◦ The cyclic pattern of muscles and joints of thebody when walking

Begins when one heel strikes the groundEnds when that same leg does heel strikeagain





Double stance ordouble supportThe point in the

gait cycle at whichboth feet aretouching theground





Stride :◦ One cycle of the gait cycle◦ Consists of two steps:

(1) a left step(2) a right step◦ Stride length ranges from 28-30 inchesStep :◦ Each step makes up 50% of the gait cycle◦ Step length is about 15 inches





Cadence :◦ Steps per minute◦ Average cadence: 90-120 steps per

minuteVelocity :◦ Speed of walking◦ Average walking speed: about 3.1 miles

per hour (mph)



Forefoot: includes 5metatarsals & 14phalangesMidfoot:◦ Includes 5 of 7 tarsal

bones (navicular,cuboid, & 3cuneiforms).

◦ The midfoot meetsforefoot at the 5

tarsometatarsal(TMT) joints.Hindfoot: includestalus & calcaneu s



In the foot, acombination ofeversion &abductionmovements takingplace in the tarsal &metatarsal joints

Results in loweringmedial edge of foot& longitudinal arch



In the foot, it ismovements thatraise medial edge

of the foot & oflongitudinal arch



Over-pronation: occurswhen there is too muchroll on the inside of thefoot, which distributesthe weight and shock of

impact more heavily onthe inside of the foot andstretches the softtissues.Under-pronation : occurswhen more weight isabsorbed by the outsideof the foot







Two major abilities essential towalking:◦ Equilibrium - ability to assume an

upright posture & maintain balance.◦ Locomotion - ability to initiate &

maintain rhythmic stepping.

Maintaining stability duringlocomotion is essential.





In humans, gait is primarily determined by thepelvis, upper leg (thigh), lower leg & the foot.

The upper body components including thetrunk, head, & arms are used in locomotion toprovide momentum & counterbalance.The whole arm is used as a counterbalance &for momentum & moves opposite the legmovement.Pattern is linked by the contralateral reflex arcmechanism.



Head Begins Forward Movement:To begin forward movement, we relax themuscles at the back of the neck.The head moves forward which increases itsweight.Because of its weight, this movement takesthe whole body forward.

Our bodies help us move forward, not byrequiring increased force, but by using the

head to initiate forward movement.“Lead all movements with your head’ is abiomechanically correct statement.



When standing and when walking, ourcenter of gravity (COG) is located in ourpelvis at the upper sacral region anterior toS2.

Our head is balanced on the top of ourspine & the COG for the head is in front ofthe ear by the cheek.The pivot point for movement of the head isbehind the COG, the posterior occipital &cervical muscles exert force to hold up thehead.





In the early stance phase, nearly 60%of the body weight is loaded onto theipsilateral leg.

This abrupt impact is absorbed ateach of the leg joints.



The self-selected walking pace ofan normal adult is thatindividual’s most efficient way ofwalking.









Peripheral receptors in our joints & musclesdetect changes in muscle length & force, joint position, & weight-bearing status ofthe legs.Righting reflexes involving the eyes & ears,together with tonic neck flexes, maintain anupward, level, & forward head position,while ocular/pelvic reflexes balance thehead & pelvis position.

Pressure receptors on the soles of the feetrelay postural information about weightdistribution.



If you are standing & begin to walk by liftingyour right foot off the floor, signal of the lossof balance begins the reflex process, allowingthe right leg and the left arm to swing forward(flexing) & the left leg & right arm to keep thebody steady (extending).Flexion & extension of the hip joints causesome rotation of the lumbar spine, & to keepthe head facing forward & the eyes level, thelumbar & cervical spine rotate in the oppositedirection.



Reciprocal movementsof the arms & legsoccur with the rightarm flexing at theshoulder jointsimultaneously withthe flexion at the lefthip joint.Normally the shoulderjoint starts to flex orextend slightly beforethe same movement inthe elbow joint.



The rhythmicalternating movementsof the legs which resultin the forwardmovement of the body.

As the body movesforward, one legprovides support while

the other leg isbrought forward inpreparation for its roleas the support leg.

The activity that occursbetween heel strike ofone leg ( reference leg)and the next heelstrike of that same leg.

2 Phases of Gait Cycle:◦ Stance Phase- 60◦ Swing Phase – 40





Definition: Landmarks:

When the leg underconsideration is incontact with thefloor

Heel-strike /InitialcontactFoot-flat/LoadingresponseMidstanceHeel-offToe-off



The moment theperson’s heelstrikes the groundBegins the stance

phase & ends theswing phaseHip flexed withknee & ankle in

neutral .





The moment thatthe entire plantarsurface of foot is incontact with theground or whenfoot is flat on theground

Hip flexed withknee & ankle flexed





Midpoint of stance phase& is when the weight ofthe body is directly overthe legWhen the greatertrochanter is directly overthe middle of the footHip, knee & ankle inneutral (or slightly

flexed)When the COG reachesits highest point in theGait Cycle.





The moment theheel leaves thegroundHip extended, kneein neutral, andankle planterflexed.





The moment that theperson’s toes push off& leave the groundEnds the stance phase

& begins the swingphaseHip in neutral withknee flexed & ankleplantar flexedAlso called Pre-swing







When the foot isnot in contactwith the floorBegins at toe-offEnds at heel-strikeAccompanied byan arm swing

Components:

Acceleration or

Early swingMidswingDeceleration orLate swing



Contralateral arm & legare moving in the samedirection in the sagittalplane

As each shouldergirdle advances, thepelvis & lower limb ofthe ipsilateral side trailbehind



Hip flexed,knee flexedand ankleplantar flexed



Hip flexed,knee flexedand ankleneutral



Hip flexed withknee and anklein neutral



Increasing the walking speedincreases the speed of the arm swingWith increased speed, the length of

time in stance phase decreasesFES p. 419 In slow walking, the lengthof time in double stance increases



In running, a higher proportion of the cycle isswing phase because the foot is in contactwith the ground for a shorter period.Because of this, there is no double stancephase, and there is a point when neither footis in contact with the ground (flight phase).As speed increases, stance phase becomesshorter and shorter with an increasedtendency for in-toeing.





FES p. 473 Gluteus maximus & minimuslose their effectiveness & walking loses itseasy spring and becomes more labored.Elderly people tend to have decreasedmuscle bulk, strength, & flexibility, as wellas some loss of hearing and vision.The major changes in gait are an overall

reduction in velocity & a reduction instep/stride length.



The elderly, when increasing their walking speed,tend to take more steps instead of increasing theirstride length.The elderly tend to have more problems in

situations that require speed (such as in crossingstreets), agility (such as walking on unevensurfaces), or in the dark.There is reduced arm swing, decreased rotation ofthe pelvis, & a more flat foot approach to both heelstrike & push off.





Box 10-2 Kinetic Chain Protocol: Gait (Part 2)FES p. 423 & FTM p. 400

Muscles concentrically contract to createthe motion needed during gait cycleMuscles eccentrically contract todecelerate or slow the momentum of the

gait cycleMuscles isometrically contract tostabilize & prevent motion of a body part





FES pp. 471-473



Iliopsoas , sartorius& rectus femoris.Iliopsoas initiateswalking.Some sourcesinclude TFL &pectineus

2 roles in gait cycle



First Role Second Role

Primary role :Concentricallycontracts to createforward swing oflower leg duringearly aspect ofswing phase

Contracteccentrically toslow extension ofthigh that isoccurring justbefore toe-off ofstance phase



Hamstrings &gluteusmaximus2 roles in gaitcycle




Contract eccentrically :To slow the forwardswinging leg at thelate aspect of theswing phase

To slow down theflexion of the thighoccurring during theswing phase

Isometrically contractsforcefully on heel-strikeof stance phase:

To stabilize pelvis fromanteriorly tilting at hip

joint

To prevent pelvis &upper body from beingthrown forwardbecause of momentumwhen leg’s forwardmotion is stopped bystriking the ground



Gluteus medius &minimus, TFL &sartoriusTheir action is onpelvis rather than

thighMajor function is tocontract, creating adepressing force onthe pelvis during the

stance phase.



Major function is tocontract, creating adepressing force ofon the pelvis duringthe stance phaseParticularly active inthe first half of thestance phase, fromheel-strike to

midstance.

Stabilize pelvis &prevent it from fallingtoward the swing-legside because when thebody is in single-legsupport , the center ofweight of the body isnot balanced over thesupport limb but over

thin air.



Thigh adductorgroup2 roles in gaitcycle




Contract at heel-strikeThis contraction mayaid the hip jointextensors’ stabilizationof the pelvis as theforce of hitting theground travels upthrough the leg.

Contract again justafter toe-off whichlikely aids in theflexion of the hip



TFL & anteriorfibers of gluteusmedius & minimusActive during thestance phase

The medial rotatorsperform their reverseaction of ipsilateralrotation of the pelvis atthe hip joint whichpulls the entire pelvisforward & helpsadvance the swing-legforward



Gluteus maximus,posterior fibers ofgluteus medius &minimus & the 6

deep lateralrotators of thethighActive during the

stance phase

Believed to beimportant incontrolling the hipjoint medial

rotators actionTheir contralateralrotation of thepelvis controls the

ipsilateral rotationof the medialrotator muscles



FES pp. 473-479



Quadricepsfemoris group 2 roles in gaitcycle



Contract concentricallyat the end of swingphase to extend leg atknee & reach out withthe leg in preparation

of heel-strikeContract morepowerfully during thefirst half of the stancephase from heel-striketo midstance:

(1st) Eccentrically contract& slow knee flexion thatoccurs early in stance phase

just after heel-strike(2nd) Concentricallycontract to extend knee aswe approach midstance.When stepping off curb,quads do a eccentriccontraction to resist pull ofgravity to prevent us fromfalling .



Hamstringsandgastrocnemius3 roles in gait



Contract eccentrically to decelerateknee extension just before heel-strikeContract just after heel-strike which

may stabilize the knee in the earlystage of the stance phase.Contract during the swing phase to

keep the foot from dragging on theground.



FES pp. 479-481The movements at the ankle are relativelysmall but they are essential for shockabsorption & progression.



Anteriorcompartmentmuscles – tibialisanterior, extensor

digitorum longus,extensor hallucislongus, & peroneustertius2 roles in gait



Contract eccentrically to slow plantarflexion of the foot during stance phasebetween heel-strike and foot-flat whichallows the foot to be lowered to the ground

in a controlled & graceful manner as thebody weight transfers over to the stancelimb.Contract concentrically during the swing

phase to prevent the toes from scrappingon the ground as the swing leg is broughtforward.



Gastrocnemius& soleus2 roles in gait



Eccentrically contract during most of thestance phase to decelerate dorsiflexion.Because the foot is fixed to the floor, theforce of plantar flexion slows the forwardmotion of the leg toward the ankle. Withoutthis, the leg would collapse anteriorly at theankle.Contract concentrically more forcefully atheel-off during the late stage of the stancephase to help push the foot off the floor.



Also called the talocalcaneal jointwhich is between talus andcalcaneus.



Tibialis posterior,tibialis anterior,flexor digitorumlongus, flexorhallucis longus, &the intrinsicmuscles of the foot2 roles in gait



Contract eccentrically during stancephase from heel-strike to foot-flat toslow pronation of the Subtalar joint.During this phase of the GC, pronation isa passive process caused by the bodyweight moving over the arch of the foot.Then contract concentrically between

foot-flat & toe-off to supinate the foot.



Peroneus longus &brevisActive during the laterstance phase, fromfoot-flat to toe-off.

Believed to co-contractalong with thesupinators to helpstabilize the foot &make it more rigid as itreadies to push off theground for propulsion.





Moves in a side-lying figure eightpatternHealthy SI joint provides stability & mobility for the figure 8 movementpattern.If SI joint is not functioning properly,the entire gait is disrupted.

A healthy SI joint provides a rockingmovement of the pelvis.







Ankles rotate in an arc around theheel at heel-strike & around a centerin the forefoot at push-off.

Maximum dorsiflexion is at the end ofthe stance phaseMaximum plantar flexion is at the endof push-off or toe-off.Ankle is neutral at heel-strike.



FTM pp. 383-4Proficiency Exercise10-5 pp. 385-395



Efficient movement pattern:◦ If left leg extended for heel strike, right

arm is extended◦ Activation of flexors of both the arm and

leg & inhibition of the extensors.◦ Strength imbalances common in this gait

pattern.

If a muscle contracts too strongly, itoverpowers the antagonist group.



If the flexors of the left leg are activated, the flexor& adductor muscles of right arm should activate,facilitate, & coordinate with the flexors & adductorsof the left leg.The right arm muscles should test strong & the

flexors & adductors of right leg & left arm shouldtest weak & inhibited.Inhibited left hip flexors would indicate right armflexors inhibited too.Similarly, if the right leg adductors are activated,the left arm adductors should test strong & theabductors of the left leg & right arm should testweak.



FTM pp. 370-372 & 408-9Proficiency Exercise 10-3 p. 372Figure 3-17 Assessment RecordingForm pp. 108-9



Finding problems in gait can be the key toidentifying the cause of pain in the feet,ankles, legs, knees, hips, back or neck.Gait analysis/assessment can help determineunderlying problems such as:◦ Bone deformities◦ Movement restrictions◦ Muscle weakness◦ Nerve dysfunction◦ Skeletal or joint misalignments◦ Complications from spasticity or contracture◦ Complications from arthritis





Observe client standing (static testing) &walking (dynamic testing).Client is observed in the standing positionto evaluate posture as well as bone & softtissue symmetry.Focus is placed on evaluating the foot &ankle during standing to assess differencesin between rear foot & forefoot.



Observe client walking from front, back &sides while walking barefooted or wearingsocks as well as wearing normal walkingshoes.

The therapist observes the following:◦ Joint range of motion◦ Speed◦

Quality of gait◦ Synchrony of all arm & leg joints



1. Head and trunk vertical,shoulders level2. Arms swing freelyopposite leg swing

3. Step length and timingeven

4. Entire body oscillatesvertically

5. Entire body movesrhythmically

6. Heel strike: foot at rightangle to leg

7. Knee extended, notlocked

8. Weight shifts forward instance phase

9. Push-off: foot stronglyplantar flexed

10. During leg swing, footeasily clears floor

11.Heel contacts floor first12. Weight rolls to theoutside of the arch

13. Arch flattens slightly inresponse to weight load

14. Weight shifts to ball offoot



FTM p. 370Figure 10-8Toe should point

directly forwardwith each step.A= proper

B = improper



FTM p. 402 Fig. 10-20

Look for areas thatmove inefficiently.Pain causestightening & altersnormal relaxed flow.Look forcompensation &shifting movementpatterns.



Let’s Walk



Generally done inGait Laboratorieswhere videographyis used to recordthe client’s gait andjoint movementsPressure/forceplates andelectromyographyprovide additionalinformation.





To reduce pain, patientsavoid putting weight onthe affected sideCharacterized by adecrease in the stancephase on the affectedside.A person moves off theaffected foot as quicklyas possible to avoid pain.The person has a limpinggait to avoid pain.



An unsteady,uncoordinated walkwith a broad base ofsupport and the feetthrown outward

Found in alcoholintoxication, neuro-pathy such as indiabetes, long-termalcoholism, & some

stroke victims



Loss of the ability to carry out familiar,purposeful movements in the absence ofparalysis or other motor or sensoryimpairment

Typically the person can stand, but hasdifficulty initiating gait, is very unsteady,takes small irregular steps, and their feetappear frozen to the floorCan be found in dementia



Characterized by astooped posture, loss ofarm swing, shuffling,small steps, & festinationAn ataxic gait ischaracterized byimbalance, & usually abroad couching stance incompensation



Foot hangs with the toespointing down, causing thetoes to scrape the groundwhile walkingFound in Guillain-BarreSyndrome (FES p. 131),Multiple Sclerosis (FES p.

617), damage to theperoneal nerve, & herniatedlumbar disk.Feet & toes are liftedthrough hip & knee flexionto excessive heights

Usually secondary todorsiflexors weakness. Thefoot will slap at initialcontact due to decreasedcontrol.



Weakness in thegluteus medius &minimus musclesThe individual’sopposite hip sags onweight bearingbecause the hipabductors cannotmaintain properalignment.Has excessive lateral

trunk flexion & weightshifting over the stanceleg.



• Structure of foot• Muscle imbalance•

Arthritis



Morton’s Toe: second toe is longer than bigtoeBone spurs, bunions, deformities of big toe &flat feet

Too-rigid foot:◦ Foot does not pronate enough or it may stay in

pronation past midstance◦ Impact forces are not absorbed through the gait so

the shock is sent up the kinetic chain.



Morton’s Toe Bone Spur



Peroneus longus & Tibialis anterior:◦ Oppose each other & insert on same 2 bones.◦ Actions balance the transverse arch.◦ If one shortens, changes how the foot walks

in the gait pattern.◦ A tight tibialis anterior pulls on medial side of

the foot & strains the everters.◦ A tight peroneus longus pulls on lateral side

of foot & strains the inverters.



Gastrocnemius & soleus:High heels are blamed for contractedgastrocnemius and soleus muscles andperpetual plantar flexion.These women will only be able to walk ontheir toes & the plantar flexors will not beable to lengthen.

These legs muscles have adapted to thisrepetitive position and, if not stretched,will permanently shorten their fibers.



A common muscleweakness that causesdysfunction in gait aswell as low back pain.When Gluteus medius isweak, a person will showa lurch to the side ashe/she attempts tocounteract the imbalancecaused by the weakness.The lurch can be minimalor extreme, dependingon the severity of theweakness.



Joint pain, limited ROM of a joint, or jointdeformity associated with arthritis can causean abnormal gait.With arthritis people begin to take smaller

steps, limp or alter their gait to compensatefor painful or damaged joints.

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K Class 11TG Gait Assessment