GAIT

Canent, Adrian Jeremy D.

Kuizon, Danielle P.
Rosario, Eleiza Marie M.
San Pedro, Merry Grace C.
FEU NRMF
Objectives
• To define different terms that describes the
normal gait
• To know the different gait deviations
• To know the gait cycle
• To know the normal parameters of gait
• To be a certified “BOBATHIAN”
Intro
• Walking is the simple act of falling forward
and catching oneself
• One foot is always in contact with the ground
• In a cycle:
– There are 2 periods of single leg support
– 2 period of double leg support
• In running:
– There is a period of time during which neither
foot is in contact with the ground. “double float”
Definition
• Gait Cycle – is the time interval or sequence
of motions occurring between 2 consecutive
initial contact of the same foot.

• Phases of gait cycle

– Stance phase – 60% of the cycle
– Swing phase – 40% of the cycle
Parameters
• Base Width
– Distance bet. 2 feet
– 5-10cm
– If wider base; there may be pathology that result
in poor balance
• Step Length
– Distance bet. successive contact points on
opposite feet
– approx. 72cm/28 in.
– varies with age, sex and height
Parameters
• Stride Length
– Distance in the plane bet. Successive points of foot-
to-foot contact of same foot
– approx. 144cm/56 in.
– Decreases with age, pain, disease and fatigue
• Cadence
– Women has higher cadence than men
– 90-120steps/min
• Gait Speed
– approx. 1.4m/sec
Parameters
• Center of Gravity
– 5cm ant. to S2
– Higher in men than women

• Lateral Pelvic Shift

– Side-to-side movement of pelvis during walking
– 2.5-5 cm/1-2 in.
Parameters
• Vertical pelvic Shift
– Keeps the COG from moving up and down more
than 5cm during normal gait

• Pelvic Rotation
– Necessary to lessen the angle of femur with the
floor
Normal Patterns of
Gait
Stance Phase
Traditional: Rancho Los Amigos:
– Heel Strike – Initial Contact
– Foot Flat – Loading Response
– Midstance – Midstance
– Heel off – Terminal Stance
– Toe off – Preswing
Stance Phase
• Heel Strike
– Beginning of stance phase when the heel
contacts the ground

• Initial Contact
– The beginning of the stance phase when the heel
or another part of the foot contacts the ground
Stance Phase
• Foot Flat
– Immediately after HS, when sole of foot contacts
the floor

• Loading Respone
– The portion of the first double support period of
the stance phase from the initial contact until the
contralateral extremity leaves the ground
Stance Phase

• Midstance
– Point at which the body passes over the reference
extremity

• Midstance
– The portion of the single limb support stance phase
that begins when the contralateral extremity leaves
the ground & ends when the body is directed over
the supporting limb
Stance Phase
• Heel Off
– Point following midstance, heel of the reference
extremity leaves the ground

• Terminal stance
– the last portion of the single limb support stance
phase that begins with heel rise and continues
until contralateral extremity contacts the ground
Stance Phase

• Toe Off
– Only toe of the reference extremity is in contact
with the ground
• Pre-swing
– The portion of stance that begins the second
double support period from the initial contact of
the contralateral extremity to lift off the
reference extremity
Swing Phase
Traditional: Rancho Los Amigos
• Acceleration • Intial swing

• Midswing • Midswing

• Deceleration • Terminal Swing

Swing phase
• Acceleration
– Portion of beginning swing from the moment the
toe of reference extremity leaves the ground to
the point when the reference extremity is
directly under the body
• Initial swing
– The portion of swing from the point when the
reference extremity leaves the ground to
maximum knee flexion of the same extremity
Swing Phase
• Midswing
– Portion of the swing phase when reference
extremity passes directly below the body.
Midswing extends from the end of acceleration
to the beginning of decceleration
• Midswing
– Portion of the swing phase from maximum knee
flexion of the reference extremity to a vertical
tibial position
Swing Phase
• Deceleration
– Swing portion of the swing phase when the
reference extremity is decelerating in
preparation for heel strike

• Terminal Swing
– The portion of the swing phase from a vertical
position of the tibia of the reference extremity to
just prior to initial contact
Gait Assessment
• The types of gait assessment in use today can
be classified under as Kinematic and Kinetic.
Kinematic gait assessment is used to
describe movement patterns without regard
for the forces involved in producing the
movement. A kinetic gait assessment
consists of a description of movement of the
body as a whole or body segments in relation
to each other during gait.
 Actions of Muscles of the LE
• Erector spinae: extensors of the back
• Gluteus maximus: extension of hip
• Gluteus medius: adductor
• Iliopsoas: hipflexion
• Adductor magnus: adduction of the thigh
• Qudriceps femoris: extension of knee
• Hamstrings: flexion of knee
• Gastrocnemius: plantarflexion of the foot
• Tibialis ant, extensor hallucis longus,
extensor digitorum longus: dorsiflexion of
the foot
• Tibialis posterior, flexor hallucis longus,
flexor digitorum longus: planterflex and
invert
• Peroneals: eversion of the foot
Gait Assessment
Stance Phase Kinematic
Gait Assessment Kinetic
Gait Assessment
Swing Phase Kinematic

Kinetic
Observation
• Anterior View
– Note
• lateral pelvic tilt
• Sideways swaying of the trunk
• Rotation of pelvis: horizontal plane
• Trunk and UE: opposite direction
• Reciprocal arm swaying
– Movements of hip, knee, ankle and foot
• Hip: rotation, abduction, and adduction
• Knee: flexion and extension
• Ankle and foot: DF and P; toe in toe out; supination
pronation
– Bowing of femur or tibia: genu varum/genu
valgum
– Medial or lat. rot. of hips femur or tibia: toe
in/toe out
– Position of the feet: Fick’s Angle
– Abd. or circumduction of the swing leg
– Atrophy of mm of ant thigh and leg
– Base width
* Best view used to examine the weight loading
period
Observation
• Lateral View
– Rotation of the shoulder, thorax as well as
reciprocal arm swing
– Spinal posture, pelvic rotation
– movement of jts. of LE
• Flex-ext. of hip and knee
• DF and PF of ankle
– Step length, stride length and cadence
Observation
• Posterior View
– Same as ant. view
– Heel rise
– BOS
– Weight unloading period
– Lateral movement of the spine, musculature of
the back, buttocks, post thigh and calf
 EXAMINATION
• Force Platforms
• Electromyography
• High-speed video motion system
ABNORMAL GAIT
Three reasons why gait deviations can
occur:
• Pathology or injury in the specific joint.
• They may occur as compensations for injury or
pathology in other joints on the same or
ipsilateral side.
• And finally, they may occur as compensations
for injury or pathology on the opposite or
contralateral limb.
Antalgic (Painful) gait
• Self-protective; result of injury to the pelvis, hip,
knee, ankle or foot.
• The stance phase on the affected leg is shorter than
that on the unaffected leg, because the patient
attempts to remove weight from the affected leg as
quickly as possible.
Arthrogenic (Stiff Hip or Knee) Gait
• Results from stiffness, laxity or deformity, and it
may be painful or pain free.
Ataxic Gait
• The patient has poor sensation or lacks muscle
coordination.
• There is a tendency toward poor balance and a
broad base.
• The gait of a person with cerebellar ataxia includes
a lurch or stagger, and all movements are
exaggerated.
• The feet of an individual with sensory ataxia slap
the ground because they cannot be felt.
 CONTRACTURE GAITS
• Hip flexion contracture results in:
- increased lumbar lordosis
- extension of the trunk combined with knee
flexion to get the foot on the ground.
• Knee flexion contracture:
- patient demonstrates excessive ankle
dorsiflexion from the late swing phase to early
stance phase on the uninvolved leg and early
heel rise on the involved side in terminal stance.
• Plantarflexion contracture at ankle results in:
- knee hyperextension, forward blending of the
trunk with hip flexion.
 Equinus Gait (Toe Walking)
• This childhood gait is seen with talipes
equinovarus(club foot), CP and limb-length
discrepancy.
• The weight-bearing phase on the affected
limb is decreased, and a limp is present.
 Gluteus Maximus Gait
• Primary hip extensor, is weak.
• Patient thrusts the thorax posteriorly at
initial contact (heel strike) to maintain hip
extension of the stance leg.
• The resulting gait involves a characteristic
backward lurch of the trunk.
 Gluteus Medius (Trendelenburg's)
Gait
• Hip abductor muscles together with the
gluteus minimus, are weak.
• Patient exhibits an excessive lateral list in
which the thorax is thrust laterally to keep
the COG over the stance leg.
• If there is a bilateral weakness of the gluteus
medius muscles, the gait shows accentuated
side-to-side movement, resulting in a
wobbling gait.
 Hemiplegic or Hemiparetic Gait
• The patient with hemiplegic gait swings the
paraplegic leg outward and ahead in a
circle(circumduction) or pushes it ahead.
• Sometimes referred to as a neurogenic or
flaccid gait.
 Parkinsonian Gait
• Basal ganglia affected
• Neck, trunk and knees are flexed.
• The gait is characterized by shuffling.
 Plantar Flexor Gait
• If the plantarflexors are unable to perform
their function, ankle and knee stability are
greatly affected.
• Loss of the plantar flexors results in decrease
or absence of push-off.
• The stance phase is less, and there is a
shorter step length on the unaffected side.
 Psoatic Limp
• Patient demostrates a difficulty in swing-
through, and the limp may be accompanied
by exaggerated trunk and pelvic movement.
• The limp may be caused by weakness or
reflex inhibitionof the psoas major muscle.
• Classic manifestations of this limp:
- lateral rotation, flexion and adduction of
the hip.
 Quadriceps Avoidance Gait
• The patient compensates in the trunk and
lower leg if the quads have been affected.
 Scissors Gait
• It is the result of spastic paralysis of the hip
adductor muscles, which causes the knees to
be drawn together so that the legs can be
swung forward only with great effort.
• May be referred to as spastic gait.
 Short Leg Gait
• The patient may demonstrate lateral shift to
the affected side if one leg is shorter than the
other, and the pelvis tilts down on the
affected side.
• May also be termed painless osteogenic gait.
 Steppage or Drop Foot Gait
• Patient has weak or paralyzed dorsiflexor
muscles, resulting a drop foot.
• At initial contact, the foot slaps on the
ground because of loss of control of the
dorsiflexor muscles, their peripheral nerve
supply, or the nerve roots supplying the
muscles.
Reference
• Orthopedic Physical Assessment
– David J. Magee
• Physical Rehabilitation
– Susan B. O’ Sullivan
TAPOS NA!!!!