Gait & Gait Aids Associate professor shereen algergawy Rheumatology and rehabilitation department.
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Transcript of Gait & Gait Aids Associate professor shereen algergawy Rheumatology and rehabilitation department.
![Page 1: Gait & Gait Aids Associate professor shereen algergawy Rheumatology and rehabilitation department.](https://reader035.fdocuments.in/reader035/viewer/2022062803/56649c885503460f9494144c/html5/thumbnails/1.jpg)
Gait & Gait Aids
Associate professor shereen algergawy
Rheumatology and rehabilitation department
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Normal Gait & Abnormal GaitNormal Gait & Abnormal 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 (> 4 inch) Hip-abduction contracture Instability due to fear, proprioceptive
deficit, cerebellar problem Perineal pain Genu valgum
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Narrow base (< 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 s
tep
trend to fall forward and to i
ncrease speed (festination)
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Hemiplegic gait
Abnormal arm swing : adduction wit
h flexion at shoulder ,elbow ,wrist an
d fingers
extensor synergy of lower limb: leg
extension ,adduction and hip IR ,kne
e extension ,ankle and foot plantarfl
exion 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 -> 3-point gait
Bilateral partial weight bearing or incoordination/ataxia -> 2 or 4-point gait
Bilateral weakness of lower extremities eg paraplegia -> 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 -> required 18-36% more energy per unit distance than normal
NWB required 41-61%more 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 -> 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