Gait

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Gait Gait Aids
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Normal Gait Abnormal Gait
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Gait

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Why we should know Normal Gait
If we have sound knowledge of the
characteristics of normal gait
We can accurately detect interprete
deviations from the normal gait pattern
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60
40
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60
40
20-25
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Stride width 5-10cm
Cadence 70-130 step/min
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Abnormal gait

• Stance phase
• Antalgic
• Lateral trunk bending
• Anterior trunk bending
• Posterior trunk bending
• Lordosis
• Hyperextended knee
• Excessive knee flexion
• Excessive Genu Valgum or Varum

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• Inadequate Dorsi-flexion control
• Insufficient Push-off
• Abnormal walking base
• Internal or external limb rotation
• Excessive medial or lateral foot contact
• Vaulting

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• Swing phase
• Circumduction
• Hip hiking
• Internal or external limb rotation
• Inadequate Dorsiflexion control
• Abnormal walking base

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Antalgic gait

• Pain in stance phase knee, hip, foot pain

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Lateral trunk bending

• Hip abductor weakness
• Hip dislocation, coxa vara, slipped capital
  femoral epiphysis
• Hip pain
• Perineal pressure
• Involved limb relatively shorter
• Compensation for abducted gait

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Trendelenberg gait

• Gluteus Medius Gait

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Anterior Trunk Bending

• Quadriceps weakness combined with weakness of
  gluteus maximus, gastrocnemius, or both

Pushing backward with the hand / lateral rotation
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Posterior Trunk Bending

• Gluteus Maximus (Lurch) Gait
• Hip-extensor weakness
• Knee ankylosis, spasticity or orthotic knee lock
• Hip-extensor spasticity

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Hyperextended knee

• Quadriceps weakness
• Capsular ligament laxity
• Quadriceps spasticity
• Plantar-flexion contracture or spasticity
• Compensation for contralateral limb shortening
  (hip-flexion or knee-flexion contracture)

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Excessive knee flexion

• Knee-flexion or hip-flexion contracture
• Knee-flexor spasticity
• Uncompensated quadriceps weakness
• Ankle ankylosis, pes calcaneus
• Plantar-flexor weakness
• Involved limb relatively longer

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Steppage gait

• Ankle dorsiflexor weakness compensate by
  exaggerated hip and knee flexion

Foot drop / dragging
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Slap foot

• Ankle dorsiflexor weakness early stance phase

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Insufficient Push-Off

• Flat foot gait
• Plantar-flexor weakness
• Rupture of the Archilles tendon or the triceps
  surae
• Metatarsal pain, hallux rigidus

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Internal or External Limb Rotation

• Internal rotation
• Biceps femoris weakness
• spasticity
• External rotation
• Quadriceps weakness
• Inner hamstring weakness
• Spasticity

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Abnormal walking base

• Wide Base (gt 4 inch)
• Hip-abduction contracture
• Instability due to fear, proprioceptive deficit,
  cerebellar problem
• Perineal pain
• Genu valgum

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• Narrow base (lt 2 inch)
• Spasticity
• Genu varum

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Vaulting

• Swing-phase limb is relatively longer

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Hip hiking

• Increased ipsilateral length
• hip -flexor or dorsiflexor weakness
• hip, knee, ankle ankylosis or spasticity
• insufficient hip or knee flexion
• Contralateral shortness

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Circumduction

• Spasticity
• Hip flexor weakness
• Hamstring paralysis
• Knee or ankle ankylosis / orthotic knee lock
• Dorsiflexor weakness
• Plantar-flexion contracture

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Scissoring gait

• In spastic CP with spasticity of adductor m.

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Crouched Gait

• Excessive flexion of hip and knee due to
  spasticity, muscle tightness or contracture
• Spastic CP

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Parkinsonian gait

• Trunk ,head ,neck forward and knee flexed
• wide base ,small shuffling step
• trend to fall forward and to increase speed
  (festination)

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Hemiplegic gait

• Abnormal arm swing adduction with flexion at
  shoulder ,elbow ,wrist and fingers
• extensor synergy of lower limb leg extension
  ,adduction and hip IR ,knee extension ,ankle and
  foot plantarflexion and inversion.

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Gait aids
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Purpose of gait aids

• Increase area of support, maintain center of
  gravity over support area
• Redistribute weight-bearing area

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Requirements

• ROM, muscle strength and endurance, coordination,
  trunk balance, sensory perception, mental status
• Amount of weight-bearing permitted on lower limb

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Requirements

• Shoulder depressor latissimus dorsi, lower
  trapezius, pectoralis minor
• Shoulder adductor pectoralis major
• Shoulder flexor, extensor and abductor deltoid
• Elbow extensor triceps
• Wrist extensor ECR, ECU
• Finger flexor FDS, FDP, FPL, FPB

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Crutches

• Body weight transmission with bilateral axillary
  crutches 80 of BW, nonaxillary crutches
  40-50 of BW
• Good strength of upper limbs usually required
  more weight bearing and propulsion

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• Unilateral non/partial weight bearing eg
  fracture, amputee -gt 3-point gait
• Bilateral partial weight bearing or
  incoordination/ataxia -gt 2 or 4-point gait
• Bilateral weakness of lower extremities eg
  paraplegia -gt swing-to or through gait

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• Non-axillary crutches
• Lofstrand/forearm crutches
• Platform crutch
• Wooden forearm orthosis (Kenny stick)
• Triceps weakness orthoses (arm orthoses) eg Warm
  Spring, Everett, Canadian crutch

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Axillary crutches

• Crutch length measure anterior axillary fold to
  point 6 inches anterolaterally from foot or to
  heel plus 1-2 inches
• Hand piece elbow flexed 30 degree, wrist max
  extension, finger fist
• 2-3 FB from apex of axilla
• Compressive radial neuropathies

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Lofstrand/forearm crutches

• Single aluminum tubular adjustable shaft,
  handpiece, forearm piece 2 inches below elbow,
  forearm cuff anterior opening (hinge)
• Elbow flexion 20 degree
• Can release hand without loosing crutch
• Requires great skill, good strength of UEs, trunk
  balance

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Platform crutch

• Painful wrist and hand condition or elbow
  contractures, or weak hand grip
• Platform, velcro strap
• Elbow flexed 90 degrees

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Crutch Gaits

• Point gait stability, slow
• Swing gait more energy, fast

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Four-point gait

• Good stability - at least 3 point contact ground
• Ataxia or incoordination
• Slowest, difficulty

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Three-point gait/alternating two-point gait

• Non-weight-bearing gait for lower limb fracture
  or amputation
• 3-point PWB gait -gt required 18-36 more energy
  per unit distance than normal
• NWB required 41-61more energy per unit distance
  than normal

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Two-point gait

• Faster than 4-point gait but less stability
• Decrease both lower limbs weight-bearing

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Swing-through gait

• Fastest gait, requires functional abdominal
  muscles
• Required increase of 41-61 in net energy cost (
  3-point NWB)

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Swing-to gait

• Both crutches -gt both lower limbs almost to
  crutch level

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Canes

• Body weight transmission for unilateral cane
  opposite affected side is 20-25
• Gluteus medius weakness, or pathological at knee
  or ankle

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• Cane eliminate necessary gluteus medius force and
  reduces compressional force on hip

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Measure tip of cane to level of greater
trochanter, elbow flexed 20-30 degree
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Walker/Walkerette

• Wider and more stable base of support, but slow
  gait (interfere smooth reciprocal gait)
• For patients requiring maximum assistance with
  balance, uncoordinated

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• Add wheels to front legs for who lack
  coordination or power in upper limbs

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• Front of walker 12 inches in front of patient
• Shoulder relaxed and elbow flexed 20 degree
• Three-point gait