GAIT Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS 2009.

GAIT

Margo Prim Haynes, PT, DPT, MA, PCSMary Rose Franjoine, PT, DPT, MS, PCS

2009

2009 Margo Prim Haynes & Mary Rose Franjoine

Overview

Definitions Video of typical gait Developmental changes Gait cycle Ground reaction force vectors Atypical gait Lab

Learning Objectives

At the conclusion of this lecture the learner will:1. Describe the characteristics of early gait.2. Describe the key developmental factors that influence the

development and refinement of gait.3 . Identify and describe the characteristics of typical gait

differentiating components of stance phase from swing phase.

4. Visually identify key components of typical gait. 5. Describe the impact of ground reaction forces on the

stance limb. 6. Discriminate typical from atypical components of gait. 7. Design intervention strategies to address key impairments

that contribute to an atypical gait pattern.

Margo Prim Haynes & Mary Rose Franjoine


An Early Walker

Video Clip


Characteristics of Early Gait BOS wider than hips,

therefore hindfoot pronation (eversion) results

Contact with floor occurs with foot flat Heel to toe gait develops

by 2 yrs/ process complete by 3.5 yrs

Uneven step length


Characteristics of Early Gait

Hyperextension of knees throughout stance phase

Greater ant.-post. pelvic movement

Less lateral (pelvic tilting ) & rotational pelvic movement


Characteristics of Early Gait Greater hip & knee flexion

with abduction & external rotation of hip and tibia during swing phase


Characteristics of Early Gait

Upper Extremities (UE) in high, medium, then low guard with improved trunk balance

Reciprocal arm swing developing at 18 months


Kinematic Changes between 1 - 7 Years of Age

↑ duration of single limb stance (esp. to 2.5 yrs) ↑ walking velocity (esp. to 3.5 yrs) ↓ cadence and its variability ↑ step length (esp. to 2.5 yrs) Ratio of body width to stride width: ↑s rapidly

until 2.5 yrs, more slowly to 3.5 yrs, then plateaus


Indicators of Mature Gait

Greater % time in single limb stance with increased limb length and stability

Increased velocity Decreased cadence Greater step length Decreased base of support


Gait

Video


60% of cycle 40% of cycle

Perry 1992


Gait Cycle

Typical walking has 50-60 steps taken per minute

Two phases Stance phase Swing phase


Stance Phase

Heel contact (weight acceptance) to toe off 60% of gait cycle


Swing Phase

Toe off to before heel strike 40% of gait cycle


Quiet Standing

Slow shifting of body weight between limbs due to cardiac dynamics & lack of absolute proprioception Feet generally parallel COG slightly anterior to the ankle joint

Tendency for trunk to move forward & plantarflexors (pf) must hold to stand in place

To move, pf must “let go” (very difficult for children to do with CP as they rely on extension to stay up)


Functional Phases of Gait

Stance Phase (60%) Initial contact Loading response Single limb stance

Midstance Terminal stance

Pre-swing=toe off

Swing Phase (40%) Pre-swing Initial swing Midswing Terminal swing


Initial Contact

The instant at which foot touches floor Ankle locked in supination

Adduction, inversion, and plantarflexion


Loading Response

Begins immediately after heel contact (heel strike) & continues until other foot is lifted for swing (foot flat) Ankle unlocked in pronation

(abduction, eversion, and dorsiflexion

Double Stance Deceleration


Single Limb Stance

Period of time when opposite limb is going through swing phase

Foot/ankle moves to locked position of supination preparing the foot and ankle for push off.


Weight bearing Surface of Foot

At heel contact, weight is lateral to the midline of the heel

Weight moves forward in a straight line towards head of third metatarsal

Then weight shifts medially to allow push off from first metatarsal head when initial swing begins


Weight Bearing Surface of foot


Pre-Swing

Begins with initial contact of opposite limb and ends with ipsilateral toe-off


Initial Swing

Begins with lift of the foot from the floor and ends when swinging foot is opposite the stance foot


Midswing

Begins when swing limb is opposite stance limb and ends when swinging limb is forward and tibia is vertical


Terminal Swing

Begins with vertical tibia and ends when foot contacts (strikes) the floor


Sinusoidal Pattern

Limb motion during walking is based on maintaining a symmetric and low amplitude displacement of the center of gravity (COG) in the lateral and vertical directions. Initial Contact Double limb support Midstance

2009 Margo Prim Haynes & Mary Rose Franjoine Perry, 1992

Sinusoidal Pattern


Sinusoidal Pattern

COG: Lowest during initial contact Central and low during double limb support Highest and most lateral in midstance Moves 4 cm medial-lateral shift, 2 cm

vertical shift


Ground Reaction Force Vectors(GRFV)

Determines the stability or instability by relating alignment of GRFV to the joint centers

Ankle gains stability with 5° dorsiflexion Three forces (body vectors)

Falling body weight Ligamentous tension Body vector as passive stability when the joints

are hyperextended


Body vector as passive stability when the joints are hyperextended

Joints are locked by bodyweight vector on one sideand ligamentous tensionon the other.

← iliofemoral ligament

Posterior oblique ligament →

Perry 1992

This explains the posture of the child with hypotonicity


Perry 1992

Ground Force Reaction Vector

Initial contact to loading


Muscle Activation

Perry 1992


Critical Events for:

Initial contact is heel first contact


Critical Events for:

Loading response is hip stability, controlled knee flexion, and plantarflexion


b


Perry 1992


b

Muscle Activation

(muscles are more balanced, therefore less hard work)

Perry 1992


Critical Events is:

Controlled tibial advancement to create a forward fall position.


c


Perry 1992


c

Muscle Activation

Perry 1992


Critical Events is to have

Ankle locked in dorsiflexion with heel rise; trailing limb

Ankle mobility(This is where the children with

plantarflexion contractures have problems)


Gait Analysis

Observation Pedograph Motion analysis Dynamic electromyography Force plate recordings Energy cost measurement


Five Determinants of Gait1. Lateral pelvic movement (gluteus medius

prevents positive Trendelenberg)2. Rotational pelvic movement (one side moves

forward of the other side to minimize vertical shift of the COG, allows for stride length)

3. Knee flexion(allow for limb length adjustment)4. Knee/ankle/foot interactions (minimizes the

vertical shift of the COG) 5. Physiologic valgus (narrows BOS)


Five Determinants of Gait

1. Lateral pelvic movement (gluteus medius prevents positive Trendelenberg)

2. Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length)

3. Knee flexion(allow for limb length adjustment)

4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG)

5. Physiologic valgus (narrows BOS)


Five Determinants of Gait1. Lateral pelvic movement (gluteus medius prevents positive

Trendelenberg)


3. Knee flexion(allow for limb length adjustment)4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG) 5. Physiologic valgus (narrows BOS)


Five Determinants of Gait

1. Lateral pelvic movement (gluteus medius prevents positive Trendelenberg)


3. Knee flexion(allow for limb length adjustment)

4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG)5. Physiologic valgus (narrows BOS)



Trendelenberg)2. Rotational pelvic movement (one side moves forward of the other side

to minimize vertical shift of the COG, allows for stride length)3. Knee flexion(allow for limb length adjustment)

4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG)




Trendelenberg)2. Rotational pelvic movement (one side moves forward of the other side

to minimize vertical shift of the COG, allows for stride length)3. Knee flexion(allow for limb length adjustment)4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG)



Bibliography Perry J: Gait Analysis Normal and Pathological

Function, NJ: SLACK Inc. 1992 Shumway-Cook & Woollacott: Motor Control Theory

and Practical Applications, Baltimore: Williams & Wilkins, 1995

Sutherland D: Gait Disorders in Childhood and Adolescence, Baltimore: Williams & Wilkins, 1984

Weber & Weber: Mechanics of the Human Walking Apparatus, Berlin: Springer-Verlag, 1992


Original Template designed by: Margo Prim Haynes, PT, DPT, MA, PCS Jane Styer Acevedo, PT

GAIT Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS 2009.

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Transcript of GAIT Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS 2009.