Gait, movements that produce locomotion

GAIT

movements that produces locomotion

Gait Cycle or Stride

� A single gait cycle or stride is defined:

� Period when 1 foot contacts the ground to when that

same foot contacts the ground again

� Each stride has 2 phases:

�Stance Phase

� Foot in contact with the ground

�Swing Phase

� Foot NOT in contact with the ground

2

Stance Phase

� Principal events during the stance phase

1.Heel strike

2. Foot-flat (followed by opposite heel-off)

3.Heel-rise (followed by opposite heel strike)

4. Toe-off

3

Principal events during the stance phase:

heel-strike, foot-flat, heel-off, toe-off

4

Activities occur in stance phase

Traditional Method

1. Heel Strike : double support

2. Foot flat : total contact

3. Mid-stance : total weight bearing

4. Heel-off : heel clears the ground

5. Toe-off : toe clears the ground

RLA Method

1. Initial contact : heel strike

2. Loading response : double support

3. Mid-stance : begins when contralateral L/E clears the ground & when the body come straight line to supporting limb

4. Terminal stance : end of mid stance to initial contact of CL L/E

5. Pre-swing : period of clearance from the ground

5

Initial Contact

� Phase 1

� The moment when the

red foot just touches the

floor.

� The heel (calcaneous) is

the first bone of the foot

to touch the ground.

� Meanwhile, the blue leg

is at the end of terminal

stance.

6

Static Positions at Initial Contact

� Shoulder is extended

� Pelvis is rotated left

� Hip is flexed and externally rotated

� Knee is fully extended

� Ankle is dorsiflexed

� Foot is supinated

� Toes are slightly extended

7

Loading Response

� Phase 2

� The double stance period

beginning

� Body wt. is transferred

onto the red leg.

� Phase 2 is important for

shock absorption,

weight-bearing, and

forward progression.

� The blue leg is in the

pre-swing phase. 8

Static Positions at Loading Response

� Shoulder is slightly

extended


� hip is flexed and slightly

externally rotated

� knee is slightly flexed

� ankle is plantar flexing to

neutral

� foot is neutral

� Toes are neutral

9

Mid-stance� Phase 3

� single limb support

interval.

� Begins with the lifting of

the blue foot and

continues until body

weight is aligned over the

red (supporting) foot.

� The red leg advances

over the red foot

� The blue leg is in its mid-

swing phase.10

Static Positions at Midstance

� Shoulder is in neutral

� Pelvis is in neutral rotation

� Hip is in neutral


� Ankle is relatively neutral

� Foot is pronated

� Toes are neutral 11

Terminal Stance

� Phase 4

� Begins when the red heel

rises and continues until

the heel of the blue foot

hits the ground.

� Body weight progresses

beyond the red foot

12

Static Positions at Terminal Stance

� Shoulder is slightly flexed


� Hip is extended and internally rotated


� Ankle is dorsi flexed

� Foot is slightly supinated

� Toes are neutral13

Pre-swing

� Phase 5

� The second double

stance interval in the gait

cycle.

� Begins with the initial

contact of the blue foot

and ends with red toe-

off.

� Transfer of body weight

from ipsilateral to

opposite limb takes

place. 14

Static Positions at Pre-swing� Shoulder is flexed

� Pelvis is rotated right

� Hip is fully extended and internally rotated


� Ankle is plantar flexed

� Foot is fully supinated

� Toes are fully

extended15

Swing phase

� Principal events during the Swing phase

1. Acceleration: ‘Initial swing’

2. Mid swing : swinging limb overtakes the limb in

stance

3. Deceleration: ‘Terminal swing’

16

Activities occur in swing phase

Traditional Method

1. Acceleration : starts

immediately from toe

off

2. Mid stance : swing

directly beneath body

3. Deceleration : knee

extension and prepare

for heel strike

RLA Method

1. Initial swing : max.

knee flexion

2. Mid swing : from max.

knee flxn. to verticl.

Postn. of tibia

3. Terminal swing : from

verticl. Postn. of tibia

to initial contact

17

Initial Swing� Phase 6

� Begins when the red foot

is lifted from the floor

and ends when the red

swinging foot is opposite

the blue stance foot.

� It is during this phase

that a foot drop gait is

most apparent.

� The blue leg is in mid-

stance.

18

Static Positions at Initial Swing

� Shoulder is flexed

� Spine is rotated left

� Pelvis is rotated right

� hip is slightly extended

and internally rotated

� Knee is slightly flexed

� Ankle is fully plantar

flexed

� Foot is supinated

� Toes are slightly flexed

19

Mid-swing

� Phase 7

� Starts at the end of the

initial swing and

continues until the red

swinging limb is in front

of the body

� Advancement of the red

leg

� The blue leg is in late

mid-stance.

20

Static Positions at Mid-swing

� Shoulder is neutral

� Spine is neutral

� Pelvis is neutral

� Hip is neutral

� Knee is flexed 60-90°

� Ankle is plantar flexed to

neutral

� Foot is neutral

� Toes are slightly

extended

21

Terminal Swing

� Phase 8

� Begins at the end of mid-

swing and ends when the

foot touches the floor.

� Limb advancement is

completed at the end of

this phase.

22

Static Positions at Terminal Swing

� Shoulder is extended

� Spine is rotated right


� Hip is flexed and

externally rotated


� Ankle is fully dorsi flexed

� Foot is neutral

� Toes are slightly

extended

23

DISTANCE VARIABLES

� Step length

� Stride length

� Width of walking base

� Degree of toe out

24

Step Length

� Distance between corresponding successive points

of heel contact of the opposite feet

� Rt step length = Lt step length (in normal gait)

25

Stride Length

� Distance between successive points of heel contact

of the same foot

� Double the step length (in normal gait)

26

Walking Base

� Side-to-side distance between the line of the two feet

� Also known as ‘stride width’

� Normal is 3.5 inches

27

Degree of toe out

� Represents the angle of foot placement

� It is the angle formed by each foot’s line of progression and a line intersecting the centre of the heel and the second toe

� Normal angle is 7°for men at free speed walking

28

TEMPORAL VARIABLES� Stance Time : Is the amount of time that elapses during the stance phase of one extremity in a gait cycle

� Single support time : is the amount of time that elapses during the period when only one extremity is on the supporting surface in a gait cycle

� Double support time : is the amount of time that a person spends with both feet on the ground during one gait cycle

� Stride duration : is the amount of time it takes to accomplish one stride

� Step duration : is the amount of time spent during a single step

29

TEMPORAL VARIABLES

� Cadence � Number of steps per unit time� Normal: 100 – 115 steps/min

� Cultural/social variations

� Velocity� Distance covered by the body in unit time

� Usually measured in cm/s

� Instantaneous velocity varies during the gait cycle

� Average velocity (m/min) = step length (m) x cadence (steps/min)

� Comfortable Walking Speed (CWS)� Least energy consumption per unit distance

� Average= 80 m/min (~ 5 km/h , ~ 3 mph)

30

DETERMINANTS OF GAIT

1. Lateral pelvic tilt

2. Knee flexion

3. Knee, ankle, foot interactions

4. Pelvic forward and backward rotation

5. Physiologic valgus of knee

� DGs represents the adjustments made by above components that help to keep movements of body’s COG to minimum.

� They are credited with decreasing the vertical and lateral excursions of the body’s COG and therefore decreasing energy expenditure and making gait more efficient

31

Lateral pelvic tilt

� During mid-stance the COG reaches the peak level & the total body supported by one lower extremity

� The pelvis slopes downwards laterally towards the leg which is in swing phase. i.e. rotation about an anterior-posterior axis

� Only anatomically possible if the swing leg can be shortened sufficiently (principally by knee flexion) to clear the ground.

� Where this is not possible (e.g. through injury), the absence of pelvic tilt and pronounced movements of the upper body are obvious.

32

Knee flexion

� Another DG which helps to reduce the COG during mid-stance

� As the hip joint passes over the foot during the support phase, there is some flexion of the knee.

� This reduces vertical movements at the hip, and therefore of the trunk and head.

33

Knee, ankle, foot interactions

� KAF interaction prevent abrupt hike in COG from heel strike to foot flat

� After heel strike huge upward displacement of COG occurs

� This is reduced by Knee flexion, ankle plantar flexion & foot pronation.

� From mid stance to heel off there is sudden drop in COG

� Ankle plantar flexion, knee extension and foot supination maintain this

34

Pelvic forward and backward rotation

� Forward rotn. occurs in swing phase

� It starts during acceleration and ends in deceleration

� During mid-swing pelvis comes to neutral position

� Forward and backward rotation help to prevent further reduction in COG which started from mid-stance

� During deceleration both lower extremities lengthens

� This prevents in further reduction of COG

35

Physiologic valgus of knee

� Is minimised by having a narrow walking base i.e. feet closer together than are hips.

� Therefore less energy is used moving hip from side to side (less lateral movement needed to balance body over

stance foot)

� Reduced lateral pelvic displacement

36

Efficiency, and energy considerations

• Walking is very energy-

efficient: little ATP is required.

• This is because of various

mechanisms that ensure the

mechanical energy the body has

is passed on from one step to

the next.

• The two forms of mechanical

energy involved are

•kinetic energy (energy due

to movement

•potential energy (energy

due to position)

Economy (J m-1)

37

A conventional pendulum –

energy interconversion

P.E. – Potential energy

K.E. – Kinetic energy

Three points on a pendulum

swing are illustrated.

As the pendulum swings away

from the midpoint, in either

direction, KE is progressively

converted into PE

At the extreme points in the

swing, there is no KE at all and

all the energy is present as PE38

Conventional pendulum action

during the swing phase

� The legs move as conventional pendulums during the swing

phase (with a little assistance from the hip flexors).

� This reduces the amount of muscle energy needed to move

the swinging leg forward

� It also accounts for the “natural” frequency of gait that has

optimal energy efficiency

� Although the legs swing forwards much like pendulums, they

are prevented from swinging backwards by foot strike.

� During the stance phase, the leg can be viewed as an

“inverted pendulum”. This action also involves inter-

conversion of potential and kinetic energy39

An “inverted” pendulum

The pendulum

“bounces”

backwards and

forwards, using

the springs.

40

“Inverted” pendulum action during the stance phase

� During the stance phase, the leg can be viewed as an “inverted

pendulum”.

� The forward momentum of the body gives it the necessary

initial angular velocity of rotation (taking the place of the

“spring” on the previous slide).

� “Inverted” pendulum action also involves inter-conversion of

potential and kinetic energy, but in this case (unlike a

conventional pendulum) KE reaches a minimum at the

midpoint of the motion, and PE is highest at that point.

� When reaching the endpoint of its “inverted swing” the stance

leg does not swing back, as a real inverted pendulum would,

because the foot is taken off the floor, the fulcrum transfers

from the foot to the hip, and the leg swings again as a

conventional pendulum. 41

Positive & negative Work� At a cadence of 105-112 steps/minute

� between heel strike and foot flat

1. a brief burst of positive work (energy generation) occurs as the hip extensors contract concentrically

2. while the knee extensors perform negative work (energy absorption) by acting eccentrically to control knee flexion

� from foot flat through mid-stance

1. Negative work is done by plantar flexors as the leg rotates over the foot during the period of stance

2. Positive work of the knee extensors occurs during this period to extend the knee

� late stance and in early swing

1. Positive work of plantar flexors and hip flexors increase the energy level of the body

� In late swing

1. negative work is performed by the hip extensors as they work eccentrically to decelerate the leg in preparation for initial contact

42

Forces

� The principal forces are:� body weight (BW)

� ground reaction force (GRF)

� muscle force (MF)

� BW and GRF are external forces; so the movement of the centre of mass (CoM) can be predicted from them alone.

� MF must be examined however if we wish to consider either of the following:

� movements of individual limbs or body segments,

� why GRF changes in magnitude and direction during the gait cycle.

43

Vitally important point:

Muscle forces can only influence

the movement of the body as a

whole indirectly, by their effects

on the GRF

44

Walking as a “controlled fall”� One way of beginning to understand the mechanics of walking is to view the movements as a “controlled fall”

� When starting a walk, we lean forward, overbalancing from the equilibrium position.

� This gives the upper part of the body forwards (and downwards) motion

� As the body falls forwards, a leg is extended forwards and halts the fall

� At the same time, the other leg “kicks off” in order to keep the body moving forwards.

� This forward momentum carries the body forward into the next forward fall, i.e. the start of the next step

45

Walking as a controlled fall: forces

involved

� When starting to move, we lean forward (MF)

� As the body starts to fall (BW), a leg is extended

forwards and halts the fall (MF; GRF)

� At the same time, the other leg “kicks off, upwards and

forwards” (MF; GRF) in order to keep the body

moving forwards.

� This forward momentum carries the body forward into

the next forward fall, i.e. the start of the next step

46

Body weight

� Always acts vertically downwards from the CoM

� If its line of action does not pass through a joint, it

will produce a torque about that joint

� The torque will cause rotation at the joint unless it is

opposed by another force (e.g. muscle, or ligament)

� BW contributes to GRF

47

Ground reaction force

� The force that the foot exerts on the floor due to gravity & inertia is opposed by the ground reaction force

� Ground reaction force (RF) may be resolved into horizontal (HF) & vertical (VF) components.

� Understanding joint position & RF leads to understanding of muscle activity during gait

� Forces are typically resolved into:1. Vertical Compression (z)2. Anterior-Posterior Shear (y)3. Medial-Lateral Shear (x)

48

Muscle force

In gait, as in all human movement, muscle activation generates internal joint moments (torques) that: � Contribute to ground reaction force

� Ensure balance

� Increase energy economy

� Allow flexible gait patterns

� Slow down and/or prevent limb movements

Much muscle activity during gait is eccentric or isometric, rather than concentric

49

Center Of Pressure (COP)

� Represents the centroid of foot forces on the floor

� This is an idealization, because pressures are distributed all over

� It is important, because we want to know where the GRF is applied to the body

� When measured by a force plate, it is more correctly called the point of application of the GRF

� Plotting the COP as it moves under the foot:

1. Normal Path: Center of the calcaneus or slightly lateral, curving laterally and then medial (pronation) and ending between the 1st and second toes

2. Variable: Normal individuals can have many COP trajectories, just by changing the footgear

50

Muscles, Joints, and Forces

� Eccentric

� Concentric

� Ground Reaction Force

51

Sagittal Plane Analysis

Initial Contact

� Hip 30° of flexion,

� knee is extended

� ankle is neutral

� GRF

� Ant. to hip, drives the hip into

flexion

� Ant. to knee drives the knee

into extension

� Ankle into plantar flexion

� Hip: hamstrings, gluteus maximus,

and adductor magnus (i to e)

� Knee: quadriceps (c to e)

� Tibiotalar joint: tibialis anterior (e)

� Subtalar joint: anterior and lateral

compartment muscles (e)

52


Loading Response

� Hip extension 25°

� Knee flexion to 20°

� Ankle plantar flexion to 10°

� Contralateral pelvis rotates

anterior

� GRF

� Ant. to hip

� posterior to knee

� posterior to ankle

� Hip : extensors (e),

Abductors (e) limit contralateral

drop to 5°

� Knee : Quadriceps fire (c)

� Ankle :Tibialis anterior (e)

53


Mid Stance

� GRF through hip, knee, and ankle

� Muscular activity terminates

� Hip and knee stability provided by ligamentous restraints

� GRF

� Posterior to hip

� Anterior to knee and ankle

� Gastrosoleus complex fires to initiate knee flexion

� Pelvis continues to rotate, abductors continue to resist pelvic drop

54


Terminal Stance

� No change in GRF

� Free forward fall

� Strong activation of

gastrosoleus complex

55

Sagittal Plane Analysis Pre-Swing

� Hip 20° of hyperextansion

� Knee 30° of flexion

� Ankle 20° of plantarflexion

� Toes 50° of hyper extension

� GRF

posterior to hip, knee

anterior to ankle

� Rapid flexion of knee from rapid

heel rise and unweighting of limb

� Rectus femoris initiates hip flexion

� Adductor longus fires

� Hip : iliopsoas, adductor magnus,

adductor longus

� Knee : Quadriceps

� Ankle :Gastrosoleus complex

� Toes : Ab.hal., FDB, FHB,

Introssei, lumb. 56


Initial Swing

� Hip 0-30° of flexion

� Knee from 30-60° of flexion and extension from 60-30°

� Ankle 20° of plantarflexion to neutral

� Foot clearance is passive due to rapid hip flexion, unless gait is very slow

� In slow gait, tibialis anterior and hamstrings fire to help

� Gait cadence (speed) governed by accelerations of hip flexion during this phase

� Hip flexion

� Rectus femoris

� Iliacus

� Adductor longus

� Gracilis

� Sartorius

� Rest of limb is passive pendulum

57


Mid Swing

� Tibialis anterior fires to

maintain foot position

� Knee extension and hip

flexion continue by inertia

58


Terminal Swing

� Decelerate knee extension

and hip flexion

� Hamstrings

� Gluteus max

� Quads co-contract

� Tibialis anterior maintains

ankle position

59

Frontal Plane Analysis

IC to LR

� Pelvis : forward rotn.

� Hip : med. rotn. of femur

� Knee : increased valgus

� Ankle : increased pronation

� Thorax : Post. postion at

initial contact and begins

moving forward

� Shoulder : extended and

moving forward

� Gracilis, vastus medialis,

semitendinosus, LH of

biceps femoris

� Tibialis post. to control

valgus thrust

60


LR to Mid-stance

� Pelvis : Rt. side rotating backward to reach neutral. Lat. tilt towards the swinging extremity

� Hip : Med. rotn. of femur continues to neutral.

� Knee : Reduction in valgusand tibia begins to rotate laterally

� Ankle-foot : neutral at mid-stance

� Thorax : Rt. side move forward

� Shoulder : Move forward

� Hip abductors are active

� Tibialis post. produce

supination

61


Mid-stance to TS

� Pelvis : Rt. side move Posteriorly

� Hip : Lat. rotn. of femur and adduction

� Knee : lat. rotn. of tibia

� Ankle & foot : supination of subtalar jt. increases

� Thorax : Rt. side move forward

� Shoulder : Rt. shoulder move forward

� Hip : inconsistent adductor activity

� Ankle plantar flexor activity

62

Frontal Plane AnalysisTS to PS

� Pelvis : Lt. side move forward, lat. tilting to swing side ends as double support begins

� Hip : Abduction as wt. shifted to opp. extremity, Lat. rotn. of femur

� Knee : Lat rotn. of tibia

� Foot/Ankle : Wt. shifted to toes. Supination of sub talarjoint

� Thorax : Translation to the left

� Shoulder : Moving forward

� Hip adductors control pelvis

� Plantar flexion

63


IS to MS

� Pelvis : Lat. pelvic tilt to the rt. Right side move forward

� Hip : Lat. rotn to med. rotn.

� Knee : From lat. to med. rotn

� Foot/Ankle : NWBing subtalar joint returns to supination

� Thorax : Rt. side move Posteriorly

� Shoulder : Rt. side move Posteriorly

� Left gluteus medius on pelvis

64


MS to TS

� Pelvis : Rt. side move anteriorly

� Hip : Lat. tilting to the left med. rotn.

� Knee : Med. rotn.

� Ankle/Foot :

� Thorax : Rt. side move posteriorly

� Shoulder : Rt. shoulder move posteriorly

� Right gluteus medius

65

A word on running

� Walking is biomechanically like a pendulum, KE to PE to KE

� Running is biomechanically like a spring

� No double leg stance phase

� Aerial phase or float period

� Ground Reaction Force during stance phase loads spring (quads, achilles)

� Unloading in preparation for aerial phase is passive recoil from tendons and connective tissue and dynamic concentric muscular contraction

66

Running: swing phase

� Muscular rather than pendularmotion at hip.

� Knee flexion, and ankle dorsiflexion, bring CoM of the leg closer to the hip. This reduces moment of inertia and increases angular velocity.

� Knee movements largely passive (i.e not due to muscle activity), and result from transfer of momentum from thigh.

� Depending on the speed of running, initial ground contact may be with heel, whole foot, or ball of foot.

67

Running: support phase

� Hip: slight flexion followed by extension. Gluteus maximusactivity initially eccentric

� Knee: degree of flexion increases with speed; that of extension decreases. Quadriceps active at knee, initially eccentrically

� Ankle : dorsiflexion followed by plantarflexion. Gastrocnemius and soleus active during whole phase, particularly so at the end.

� Stretch shortening/energy

storage activity occurs at all

three joints

68

STAIR GAITStair Ascent� Stance Phase

1. Weight acceptance

2. Pull up

3. Forward continuance

� Swing Phase

1. Foot clearance

2. Foot Placement

� Ascending stairs involves a large amount of positive work that is accomplished by concentric action of the rectus femoris, vastus lateralis, soleus and medial gastrocnemeus

69

STAIR GAITStair Descending� Swing Phase

1. Foot clearance

2. Foot Placement

� Stance Phase

1. Weight acceptance

2. Pull up

3. Forward continuance

� Descending stairs is achieved mostly through eccentric activity of same muscles and involves energy absorption

� The support moments exhibit similar pattern in stair and level gait

� But magnitude is greater in stair gait

70

Sagittal Plane analysis of Stair gait

WA to PU

� Hip : Extension from 60-

30° of flexion

� Knee : Extension from

80-35° of flexion

� Ankle : DF 20-25° of

DF, PF 25-15° of DF

� Hip : Gluteus maximus,

Semitendinosus, Gluteus

medius

� Knee : Vastus Lateralis,

Rectus femoris

� Ankle : Tibialis anterior,

soleus, gastronemius

71


PU to FC

� Hip : extension 30 - 5° of

flexion, flexion 5-20° of

flexion

� Knee : Extension 35-10°

of flexion, flexion 5- 10°

of flexion

� Ankle : PF 15°of DF to

15-10° of PF

� Hip : Gluteus maximus,

gluteus medius,

semitendinosus

� Knee : Vastus lateralis,

rectus femoris

� Ankle : Soleus,

gastronemius, tibialis

anterior

72


Foot clearance through foot placement

� Hip : flexion 10-20° to 40-60° of flexion, extension 40-60° of flexion to 50° of flexion

� Knee : Flexion 10° of flexion to 90-100° of flexion, extension 90-100° of flexion to 85° of flexion

� Ankle : DF 10° of PF to 20°of DF

� Hip : Gluteus medius

� Knee : semitendinosus,

vastus lateralis, rectus femoris

� Ankle : Tibialis anterior

73

FACTORS INFLUENCING GAIT

� Age

� Gender

� Assistive devices

� abnormalities

74


Age� A toddler has a higher COG, wider BOS, decreased single leg support time, a shorter step length , a slower velocity and a higher cadence in comparison to adult

� 3-5 year old showed increase in stride length adjusted to leg length, step length and a faster speed in gait

� From 6-13 years ROM of L/E were almost identical to adults. However linear displacement, velocities and accelerations are larger.

� Elderly demonstrate a decrease in natural walking speed, shorter stride and step length, longer duration of double support periods and smaller swing to support phase ratios

75


Gender

Men Women

�Joint angle increases as speed

increases

�Gait speed faster i.e.. 118-134

cm/s

�Step length larger

� Not much joint angle increase

as compared to men

�Gait speed slower i.e.. 110-129

cm/s

�Step length smaller

�Increased hip flexion and

decreased knee extension during

gait initiation

�Increased knee flexion in pre-

swing

�Increased stride length

�Greater cadence 76


Assistive devices

� Canes are typically been used on the contralateral side to an affected limb to reduce forces acting at the affected limb

� Use of cane on the contralateral side increase the BOS and decrease muscle, GRF forces acting at the affected hip and hip abductor & gluteus maximus activity was reduced to 45%

� Walker gait

77

COMMON GAIT ABNORMALITIES

A. Deformity(Contracture)

B. Muscle Weakness

C. Sensory Loss

D. Pain

E. Impaired Motor Control(Spasticity)

78

Ankle and Foot Gait Deviation

79

Knee Abnormal Gait

80

Knee Abnormal Gait

81

Knee Abnormal Gait

82

Knee Abnormal Gait

83

Hip Abnormal Gait

84

Hip Abnormal Gait

85

Pelvis and Trunk Pathological Gait

86


87


88


89

COMMON TYPES OF ABNORMAL GAITS

� Scissor gait

� Antalgic gait

� Cerebellar ataxia

� Festinating gait

� Pigeon gait

� Propulsive gait

� Steppage gait

� Stomping gait

� Spastic gait

� Myopathic gait

� Magnetic gait

� Trendelenburg gait

90

Scissor gait

� Hypertonia in the legs, hips and pelvis means these areas

become flexed, to various degrees, giving the appearance of

crouching, while tight adductors produce extreme adduction,

presented by knees and thighs hitting or crossing in a scissors-

like movement, while the opposing muscles, the abductors,

become comparatively weak from lack of use. Most common in

patients with spastic cerebral palsy,

usually diplegic and paraplegic varieties. The individual is forced

to walk on tiptoe unless the dorsiflexor muscles are released by

an orthaepedic surgical procedure.

91

Antalgic gait

� Person tries to avoid pain associated with the ambulation. Often quick, short and soft foot steps.

92

Ataxic gait

� Spinal - proprioceptive pathways of the spine or brainstem are interrupted. There is loss of position and motion sense. The person will walk with a wide base of gait with foot slap at heel contact. Often watch feet as they walk.

� Cerebellar - coordinating functions of the cerebella are interfered with, so the person tends to walk with a wide base of gait with an unsteady irregular gait, even if watching feet.

93

Festinating gait

� The patient has difficulty starting, but also has difficulty stopping after starting. This is due to muscle hypertonicity. The patient moves with short, jerky steps.

94

Pigeon gait

� In-toe gait is a very common problem among children and even adults. Fortunately, most in-toeing that is seen in children is a growth and developmental condition and will correct itself without medical or surgical intervention.

95

Propulsive gait

� Disturbance of gait typical of Parkinsonism in which, during walking, steps become faster and faster with progressively shorter steps that pass from a walking to a running pace and may precipitate falling forward.

96

Steppage gait

� A manner of walking in which the advancing foot is lifted high so that the toes clear the ground. Steppage gait is a sign of foot-drop.

97

Stomping gait

� Sensory ataxia presents with an unsteady "stomping" gait with heavy heel strikes, as well as postural instability that is characteristically worsened when the lack of proprioceptive input cannot be compensated by visual input, such as in poorly lit environments.

98

Spastic gait

� An unbalanced muscle action of certain muscle groups leads to deformity. Prime example is "Scissor gait" - adduction and internal rotation of the hips with an equinus of the feet and flexion of the knee.

� the legs are held together and move in a stiff manner, the toes seeming to drag and catch.

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Myopathic gait

� The "waddling" is due to the weakness of the proximal muscles of the pelvic girdle.

� The patient uses circumduction to compensate for gluteal weakness.

� exaggerated alternation of lateral trunk movements with an exaggerated elevation of the hip.

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Magnetic gait

� Normal pressure hydrocephalus (NPH) gait disturbance is often characterized as a "magnetic gait," in which feet appear to be stuck to the walking surface until wrested upward and forward at each step. The gait may mimic a Parkinsonian gait, with short shuffling steps and stooped, forward-leaning posture, but there is no rigidity or tremor. A broad-based gait may be employed by the patient in order to compensate for the ataxia.

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Trendelenburg gait

� The Trendelenburg gait is an abnormal gait caused by

weakness of the abductor muscles of the lower

limb, gluteus medius and gluteus minimus.

� During the stance phase, the weakened abductor

muscles allow the pelvis to tilt down on the opposite

side. To compensate, the trunk lurches to the weakened

side to attempt to maintain a level pelvis throughout the

gait cycle. The pelvis sags on the opposite side of the

lesioned superior gluteal nerve.

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Hemiplegic Gait Demonstration

� The patient has unilateral

weakness and spasticity with

the upper extremity held in

flexion and the lower

extremity in extension. The

foot is in extension so the leg

is "too long" therefore, the

patient will have to

circumduct or swing the leg

around to step forward. This

type of gait is seen with a

UMN lesion.

� This girl has a right

hemiparesis. Note how she

holds her right upper

extremity flexed at the elbow

and the hand with the thumb

tucked under the closed

fingers (this is "cortical

fisting"). There is

circumduction of the right

lower extremity.

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Diplegic Gait Demonstration

� The patient has spasticity in the lower extremities greater than the upper extremities. The hips and knees are flexed and adducted with the ankles extended and internally rotated. When the patient walks both lower extremities are circumducted and the upper extremities are held in a mid or low guard position. This type of gait is usually seen with bilateral periventricular lesions. The legs are more affected than the arms because the corticospinal tract axons that are going to the legs are closest to the ventricles.

� This man has an UMN lesion affecting both lower extremities. He has spasticity and weakness of the legs and uses a walker to steady himself. There is bilateral circumduction of the lower extremities.

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Neuropathic Gait Demonstration

� This type of gait is most often seen in peripheral nerve disease where the distal lower extremity is most affected. Because the foot dorsiflexors are weak, the patient has a high stepping gait in an attempt to avoid dragging the toe on the ground.

� This girl has weakness of the distal right lower extremity so she can't dorsiflex her foot. In order to walk she has to lift her right leg higher then the left to clear the foot and avoid dragging her toes on the ground.

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Myopathic Gait Demonstration

� With muscular diseases, the proximal pelvic girdle muscles are usually the most weak. Because of this the patient will not be able to stabilize the pelvis as they lift their leg to step forward, so the pelvis will tilt toward the non-weight bearing leg which results in a waddle type of gait.

� This young boy has pelvic girdle weakness, which produces a waddling type of gait. Note the lumbar hyperlordosis with the shoulders thrust backwards and the abdomen being protuberant. This posture places the center of gravity behind the hips so the patient doesn't fall forward because of weak back and hip extensors.

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Parkinsonian Gait Demonstration

� This type of gait is seen

with rigidity and

hypokinesia from basal

ganglia disease. The

patient's posture is

stooped forward. Gait

initiation is slow and

steps are small and

shuffling; turning is en

bloc like a statue.

� This man's gait is

bradykinetic and his

steps are smaller then

usual. There is also the

pill-rolling tremor in his

hands. He turns en bloc

and there is decreased

facial expression

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Choreiform Gait Demonstration

� This is a hyperkinetic gait

seen with certain types of

basal ganglia disorders. There

is intrusion of irregular, jerky,

involuntary movements in

both the upper and lower

extremities.

� Note the involuntary,

irregular, jerky movements of

this woman's body and

extremities, especially on the

right side. There are also

choreiform movements of

the face. A lot of her

movements have a writhing,

snake-like quality to them,

which could be called

choreoathetoisis.

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Ataxic Gait Demonstration

� The patient's gait is wide-

based with truncal instability

and irregular lurching steps

which results in lateral

veering and if severe, falling.

This type of gait is seen in

midline cerebellar disease. It

can also be seen with severe

lose of proprioception

(sensory ataxia)

� This woman's gait is wide-

based and unsteady. She has

to use a walker or hold on to

someone in order to maintain

her balance (note how hard

she has to work with the

hand that she's holding on

with in order to maintain her

balance). Her ataxia is even

more apparent when she tries

to turn.

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Gait, movements that produce locomotion

Education

Transcript of Gait, movements that produce locomotion