GAIT ANALYSIS: KEY SPATIAL AND TEMPORAL VARIABLES

GAIT
MODERATOR :
DR.DHRUBA NARAYAN BORAH
ASSISTANT PROFESSOR
DEPARTMENT OF ORTHOPAEDICs
GMCH, GUWAHATI
PRESENTER :
DR PRITOM SAHA
3RD YEAR PGT DPTT. OF ORTHOPAEDICS
GMCH, GUWAHATI
ULTIMATE GOAL: KEEP OURSELF AND OUR
PATIENTS/CLIENTS MOVING PAIN-FREE
THROUGHOUT OUR/THEIR LIFESPANS!!!

The earliest work on gait was done
by BORELLI in 1682.
The WEBBER brothers in Germany
gave first clear description of GAIT
CYCLE in1836.
In 1940 SCHERB from Switzerland
studied various muscle activity
during different parts of gait cycle,
using treadmill & later by EMG

DEFINITION OF GAIT
Difficult to define “A method of
locomotion involving the use of the
two legs alternately, to provide both
support and propulsion, at least one
foot being in contact with the ground
at all times’

CENTRE OF GRAVITY
 Important in understanding the concept of gait
 Displacements of the CG:
 Both Vertical and Horizontal displacements occur.

 Horizontal displacements (a)
 Alternately to the right and to the left.
 When both are projected on the
coronal plane.
 Vertical Displacement of CG(b)
 Rhythmic up and down movement
 Average 5 cm
 SMOOTH SINUSOIDAL CURVE
 IT DESCRIBES A FIGURE OF 8 IN
AP VIEW.

NEUROLOGICAL CONTROL OF
GAIT
 Motor Cortex
Cerebellum
Extrapyramidal tract
Voluntary modulation of gait.
Eg:Alter in speed,change in
direction.
Controlling Balance
Responsible for most
complex unconscious
pathways

 SPINAL CORD
 GOLGI TENDON
MUSCLE SPINDLE
JOINTS
Reflex Stepping
Movements
Produce neurologic
feedback & serve as
dampening devices for
coordination of gait.

SEQUENCE OF GAIT RELATED PROCESSES:
Automatic process of gait,
which is steady-state stepping
movements associating with
postural reflexes including
coordination accompanied by
appropriate alignment of body
segments and optimal level of
postural muscle tone, is
mediated by the descending
pathways from the brainstem to
the spinal cord. Particularly,
reticulospinal pathways arising
from the lateral part of the
mesopontine tegmentum and
spinal locomotor network
contribute to this process

-The execution of this involves two
components:
ACTIVATION OF THE LOWER
NEURAL CENTRES,
which subsequently establish the
sequence of muscle activation patterns.
2. SENSORY FEEDBACK
from muscles, joints, and other
receptors that modifies the movements.
Locomotor programming in supraspinal centres.
- Converts an idea into a pattern of muscle activity.
-Central locomotor command being transmitted to the brainstem
and spinal cord.

Why Study Normal Gait?
 Loss of the ability to walk can result in
significant health problems
(co-morbidities)
 Pain, injury, paralysis or tissue damage can
alter normal gait and lead to:
further musculoskeletal problems
(compensations)
Cardiovascular and pulmonary problems
(inactivity due to pain)
Psychological problems (depression)

THE MAIN TASK OF GAIT
CYCLE
 (1) Weight acceptance
most demanding task in the gait cycle
 involves the transfer of body weight onto
a limb that has just finished swinging
forward and has an unstable alignment.
Shock absorption and the maintenance of
a forward body progression

 (2) single limb support
One limb must support the entire
weight
Same limb must provide truncal
stability while bodily progression is
continued.
 (3) limb advancement
Requires foot clearance from the floor
The limb swings through three
positions as it travels to its destination
in front of the body.

Gait Cycle or Stride
1
3
 Asingle gait cycleor 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

Activities occur in stance phase
1. Heel Strike:firstcontact(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(double support)
Traditional Method RLAMethod(rancho los amigos)
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
1
4

STANCE PHASE
 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.
1
5
Initial Contact(heel strike):

Static Positions at Initial
CONTACT
 Shoulder is extended
 Pelvis is rotated
 Hip is flexed and externally rotated
 Knee is fully extended
 Ankle is dorsiflexed
 Foot is supinated
 Toes are slightly extended

Loading Response(flat foot):
 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 legis in the
pre-swing phase.
1
7

Static Positions at Loading
RESPONSE
 Shoulder is slightly extended
 hip is flexed and slightly externally
rotated
 knee is slightly flexed
 ankle is plantarflexing to neutral
 foot is neutral
 Toes are neutral

Mid-stance
19
 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 legadvances
over the red foot
 The blue legis in its mid-
swing phase.

Static Positions at Midstance
 Shoulder is in neutral
 Pelvis is in neutral rotation
 Hip is in neutral
 Ankle is relatively neutral
 Foot is pronated

Terminal Stance(heel off):
21
 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

Static Positions at Terminal
STANCE
 Shoulder is slightly flexed
 Hip is extended and internally rotated
 Ankle is plantarflexed
 Foot is slightly supinated

Pre-swing(toe off):
 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 Toe-Off
 Shoulder is flexed
 Hip is fully extended and internally rotated
 Ankle is plantarflexed
 Foot is fully supinated
 Toes are fully extended

SWING PHASE
25
 Principal events during the Swing phase
1. Acceleration: ‘Initial swing’
2. Mid swing :swinginglimb overtakes the limb in stance
3. Deceleration: ‘Terminal swing’

Activities occur in swing phase
26
1. Acceleration : starts
immediately from toe
off
2. Mid stance :swing
directly beneath body
3. Deceleration :knee
extension and prepare
for heel strike
Traditional Method RLAMethod
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

Initial Swing(acceleration):
27
 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.

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 plantarflexed
 Foot is supinated
 Toes are slightly flexed

Mid-swing
29
 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 legis in late
mid-stance.

Static Positions at Midswing
 Shoulder is neutral
 Spine is neutral
 Pelvis is neutral
 Hip is neutral
 Knee is flexed 60-90°
 Ankle is plantarflexed to neutral
 Foot is neutral

Terminal Swing(deceleration):
31
 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.

Static Positions at Terminal Swing
 Shoulder is extended
 Spine is rotated right
 Pelvis is rotated left
 Hip is flexed and externally rotated
 Ankle is fully dorsiflexed
 Foot is neutral

SUMMARY TILL NOW
 STANCE PHASE------------Total is 60%
 Single limb support: only one limb is in contact(40%)
 {flat foot, mid stance, heel off}
 Double limb support: both limb are in contact(20%)
 {heel strike,toe off}
 SWING PHASE------------Total is 40%
 {accerelation,mid swing,decceleration}

DISTANCE VARIABLES
(spatial variables):
35
 Step length
 Stride length
 Width of walking base
 Degree of toe out

STEP LENGTH
36
 Distance between corresponding successive points
of heel contact of the opposite feet
 Rt step length = Lt step length (in normal gait)

STRIDE LENGTH
37
 Distance between successive points of heel contact
of the same foot.
 Double the step length (in normal gait).

WALKING BASE
38
 Side-to-side distance between the line of the two
feet.
 Also known as ‘stride width’.
 Normal is 3.5 inches.

DEGREE OF TOE OUT
39
 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.

TEMPORALVARIABLES
(time variables):
40
 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

41
 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 , ~ 3mph)

DETERMINANTS OF GAIT
42
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.

LATERALPELVIC 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.
43

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.
44

KNEE, ANKLE, FOOT INTERACTIONS
(KAF):
 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
45

PELVIC FORWARDAND
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. 46

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
47

EFFICIENCY, AND ENERGY CONSIDERATIONS:
•Walking is very energy-
efficient: little ATP is required.
48
•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)

Aconventional 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 PE
49

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.
39

An “inverted” pendulum
The pendulum
“bounces”
backwards
and forwards,
using the
springs.
40

“INVERTED” PENDULUM ACTION DURING
THE STANCE PHASE
 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.

POSITIVE & NEGATIVE WORK
HEEL STRIKEAND 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
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

Forces
 The principal forces are:
 body weight (BW)
 ground reaction force (GRF)
 muscle force (MF)
 BWand GRF are external forces; sothemovementof
thecentreofmass(CoM)canbepredictedfromthemalone.
 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.
 Muscle forces can only influence the movement
of the body as a whole indirectly, by their effects
on the GRF

Body weight
 Alwaysacts vertically downwards from the CoM
 If its line of action does not pass through a joint, it
willproduce a torque about that joint
 The torque willcause rotation at the joint unless it is
opposed by another force (e.g. muscle, or ligament)
 BWcontributes toGRF

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)

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

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
58

Aword onrunning
59
 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

Running: swing phase
60
 Muscular rather than pendular
motion 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 largelypassive
(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.

Running: support phase
61
 Hip: slight flexion followed by
extension. Gluteus maximus
activity 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

STAIR GAIT
62
Stair
Ascent
1.
2.
3.
Stance Phase
Weight acceptance
Pull up
Forward continuance
1.
2.
SwingPhase
Foot clearance
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

STAIR GAIT
63
Stair
Descending
1.
2.
1.
2.
3.
SwingPhase
Foot clearance
Foot Placement
Stance Phase
Weight acceptance
Pull up
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

FACTORS INFLUENCING GAIT
 Age
 Gender
 Assistive devices/ WalkingAids
 abnormalities

GAIT IN YOUNG
Main ways in which gait of small
children differs from that of adult are as
follows:
The walking base is wider.
The stride length & speed are lower &
the cycle time shorter(higher cadence).
Small children have no heel strike,initial
contact being made by flat foot.

There is very little stance phase
knee flexion.
The whole leg is externally rotated
during the swing phase.
There is an absence of reciprocal
arm swinging.
The above list will change to adult
pattern by age of 2 to 4yrs.

From 6-13 years range of motion of
lower extrimity were almost
identical to adults. However linear
displacement, velocities and
accelerations are larger.

GAIT IN ELDERLY
The age related changes in gait
takes place in decade from 60 to
70yrs.
There is a decreased stride length,
increased cycle time(decreased
cadence).
Relative increase in duration of
stance phase of gait cycle

 An increase in walking base.
 The speed almost always reduced in elderly people.
 Reduction in total range of hip flexion & extension,a
reduction in swing phase knee flexion & reduced
ankle plantar flexion during the push off.

GENDER:
Men Women
Joint angle increases as speed
increases
Not much joint angle increase as
compared to men
Gait speed faster i.e.. 118-134
cm/s
Gait speed slower i.e.. 110-129
cm/s
 Step length larger  Step length smaller
Increased hip flexion and
decreased knee extension during
gait initiation
Increased knee flexion in pre-
swing
 Increased stride length
 Greater cadence

FACTORS INFLUENCING GAIT
Assistive devices
1.Crutches -3 types
a.Axillary or under arm crutches.
b.Elbow crutches
c.Gutter crutches
2.Walking sticks/canes
3.Walkers

AXILLARY CRUTCHES
 All degree of weight relief possible
 Used when non weight bearing on one limb is indicted.
eg; after a fracture

ELBOW CRUTCHES
 Loftstand crutches
 Less stability than axillary crutches
 Advised for patients bear some weight on both
feet

GUTTER CRUTCHES
 Used in fixed flexion deformity of
elbow,gripping difficulty patients

CANES
 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 decrease muscle,
GRF forces acting at the affected hip and hip
abductor &gluteus maximus activity was reduced to
45%
 It is either straight legged,tripod or quad cane
 Not as stable as elbow crutches
 Lighter and more easily stored
 Placed 15 cm in front and 15 to the side

WALKERS
 For patients who need more support than a cane
provides
 It has four legs with rubber tips and plastic hand
grips
 Many walkers has adjustable legs

WALKING WITH WALKERS
 Move the walker ahead about 15 cm bearing
body weight by both legs
 Then move the right foot while your body
weight being beared by left foot and both arms
 Now move the left foot up to the walker while
body weight beared by right foot and both arms.

DEVICES USED FOR GAIT ANLYSIS
 Instrumented pathways
 Direct motion measurement system
 Electrogoniometer
 Potentiometer devices
 Flexible strain gauges
 Others
 Pressure beneath shoe measurement
 Glass plate examination
 Direct pressure mapping system
 Pedobarograph
 In shoe devices
 Electromyography
 Surface electrodes
 Fine wire electrodes
 Needle electrodes

COMMON GAITABNORMALITIES
A. Muscle Weakness
B. Structural deformities of bone and joint
C. Neurogenic Disorders
D. Miscellaneous

MUSCLE WEAKNESS CAUSING
PATHOLOGICAL GAIT

GLUTEUS MAXIMUS LURCH
It occurs in patient with
paralysis of gluteus maximus
muscle.
Patient with paralysis of
gluteus maximus muscle
hyperextends his trunk
backwards to hip joint when
bearing wt on the affected
side.

TRENDELENBURG GAIT
84
 The Trendelenburg gait isan
abnormal gaitcaused 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 pelvisto tilt down on the
opposite side. To compensate, the
trunk lurches to the weakened side
to attempt to maintain alevelpelvis
throughout the gaitcycle.The
pelvis sagson the opposite side of
the lesioned superior gluteal nerve.

QUADRICEPS GAIT
 Seen in quadriceps weakness
 - Polio, OA knee

 Various stages:
 - Slightly longer stance phase
 - Externally rotated limb
 - Anterior trunk bending
 - Hand knee gait
 - Crawl

MYOPATHIC GAIT
86
 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.

STEPPAGE GAIT
87
 Amanner of
walkingin which
the advancing
foot is lifted
high so that the
toes clear the
ground.
Steppage gait is a
sign of foot-
drop.

CALCANEAL GAIT
 Occurs due to weakness of
gastrocnemius-soleus muscle group
 patient will walk on his heel with a
tendency of rotating the foot owtwards .
 Heel walking

STRUCTURAL DEFORMITIES
CAUSING PATHOLOGICAL GAIT

SHORT LIMB GAIT
Patient lurches on same side and pelvis
drop on opposite side in tredelenberg
gait but in case of short limb gait
patient lurches on same side with
pelvis dropping on the same side.
It typically occurs when the shortening
is more than 4cm.

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

PELVIS AND TRUNK PATHOLOGICAL
GAIT
95

NEUROGENIC DISORDERS
CAUSING PATHOLOGICAL
GAIT

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.

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
willhave to circumduct or swing
the leg around to step forward.
This type of gait is seen with a
UMN lesion.
 This girl has a left
hemiparesis. Note how she
holds her 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 lower
extremity.

SCISSOR GAIT
99
 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 like a scissors.
 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.

ATAXIC GAIT
100
 Spinal - proprioceptive pathways of the
spine or brainstem are interrupted. There
isloss of position and motion sense. The
person willwalk 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 walkwith a wide base of gait
with an unsteady irregular gait, even if
watching feet.

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.

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.

CIRCUMDUCTION
-Usually seen in Hemiplegia.
-Limb is swung around to clear the ground

PIGEON GAIT
 In-toe gait is avery
common problem
among children and
even adults.
Fortunately, most in-
toeing that isseen in
children isa growth
and developmental
condition and will
correct itself without
medical or surgical
intervention.

MAGNETIC GAIT
 Normal pressure
hydrocephalus (NPH) gait
disturbance isoften
characterized as a "magnetic
gait," in which feet appear to be
stuck to the walkingsurface
until wrested upward and
forward at each step. The gait
maymimic a Parkinsonian gait,
with short shuffling steps and
stooped, forward-leaning
posture, but there is no rigidity
or tremor. Abroad-based gait
maybe employed bythe patient
in order to compensate for the
ataxia.

VAULTING GAIT
Stance phase modification
- Goes up on toes of the stance
leg for ground clearance of
affected limb.
Exaggerated vertical movement
of the trunk
Wasteful energy expenditure

TANDEM GAIT
-Walking base close to zero.
-Heel of one foot directly in front
of toes of
other.
-Requires very good balance and
co-ordination
-To test alcohol intoxication.

AMPUTEE GAIT
 Amputation at any level increases energy loss
 Higher level- more loss
 Coupling not truly normal.
 Above knee amputation
 - Control of knee most important
 - Swing phase longer
 Below knee amputation
 - Ankle movements lost
 - Push off lost

TRANSTIBIAL GAIT:
The average gait pattern will vary dependent on the type of prosthesis
used for mobility, however generalisations can be made. The ankle of
the prosthesis has a reduced range of movement compared to the
anatomical ankle. This results in prolonged heel strike and weight
bearing through the heel before flat foot contact, with delayed forefoot
loading.

TRANS FEMORAL GAIT:
A person with a transfemoral amputation has to compensate for the loss of
both the knee and ankle joint. The gait cycle is affected by the quality of
the surgery, the type and alignment of prosthesis, the condition of the
stump and the length of the remaining muscular structure and how well
these are reattached.
The main focus of the gait cycle is to prevent the knee from buckling
during stance phase. A ‘fixed knee’ prosthesis will counteract this issue. A
‘free knee’ will need to remain in extension for longer throughout the
stance phase approx 30-40% to ensure buckling does not occur. This
extension causes prolonged heel strike and the body will move forward
over the prosthetic leg as one unit for stance phase. The hip extensors on
the prosthetic side will work to stabilise the limb in prosthetic weight
bearing.
During swing phase of the prosthetic limb the hip extensors and calf
muscles on the non prosthetic side help to generate force for the non
prosthetic limb to gain swing

CRUTCH GAITS
5 standard crutch gaits are :
1)Four point gate
2) Three point gate
3)Two point gate
4)Swing to gait
5)Swing through gait

FOUR POINT GAIT
1)Provides 3 point of support at all times
2)Safest gait

 3 POINT STEP- THROUGH
 3 POINT STEP TO

MODIFIED 4 POINT AND 2 POINT
GAIT

“DON’T WALK BEHIND ME ,I MAY NOT LEAD
DON’T WALK AHEAD OF ME ,I MAY NOT FOLLOW
WALK NEXT TO ME AND BE MY FRIEND.”
Albert camus

Thank you
Next seminar……
Topic-
Presenter-Dr. Bishal deka
Moderator-
DATE-

GAIT ANALYSIS: KEY SPATIAL AND TEMPORAL VARIABLES

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