3. INTRODUCTION
➢ It is the forward propulsion
of the body by the lower
extremity with the
coordinated rotated
movements of the body
segment.
➢ The lower extremity support
and carries the head , trunk
and arm.
4. DEFINITION
▪ Gait is the style , manner , or
pattern of walking.
▪ The walking pattern or style
may differ from individual to
individual .
▪ It depends on the age , sex,
mood, of an individual and
may be due to some
diseases.
5. CENtre of gravity of human
body during gait
➢ The head , neck , upper limb and trunk contributes of 75% of
body weight.
➢ Among this head and upper limb contributes 25% of the total
body weight.
➢ Neck and trunk contributes 50% of the body weight.
➢ And lower extremity contributes 25% of the body weight.
6. Gait cycle
It is the activity which
occurs between the points of
the initial contact of the
same extremity two times.
Gait cycle consists of two
phases.
1. Stance phase
2. Swing phase
7.
8. Stance phase
➢ The activity , which occurs
during the foot having the
contact with the ground.
➢ In normal walking the stance
phase contributes 60% of the
gait cycle
9. Swing phase
➢ The activity , which occurs
during the foot not having
the contact with the ground.
➢ In normal walking the swing
phase contributes 40% of the
gait cycle.
10. STANCE PHASE
Traditional Method RLA
1. Heel strike
2. Foot flat
3. Mid stance
4. Heel – off
5. Toe - off
1. Initial contact
2. Loading response
3. Mid stance
4. Terminal stance
5. Pre swing
11. Traditional Method
1. Heel strike:
Heel of the leading extremity touches the ground.
2. Foot flat:
The foot totally contacts the ground .
3. Mid stance:
This is the stage where the weight is totally transmitted to the
weight bearing lower extremity.
12. 4. Heel – off :
This is the stage at which heel of the stance phase lower extremity
clears the ground after total weight bearing.
5. Toe – off :
The stage at which the toe of the reference lower extremity clears
the ground.
13. RLA Method
1. Initial contact:
Heel of the leading extremity strikes the ground.
2. Loading response:
Starts with the double support after the initial contact and
continues till the contralateral extremity clears the ground.
3. Mid stance:
It begins when the contralateral extremity clears the ground
and end when the body comes in straight line to the
supporting limb.
14. 4. Terminal stance:
Starts from the end of the mid stance to the initial contact
of the contralateral lower extremity.
5. Pre swing:
It is the period of the contralateral lower extremity initial
contact and the reference extremity clears the ground.
16. Traditional Method
1. Acceleration:
It starts immediately from the toe off of the reference lower
extremity to the same extremity comes directly under the
body.
2. Mid stance:
When the swinging lower extremity swings directly beneath
the body.
3. Deceleration:
It starts from the limb which swings beneath the body to the
knee extension and the preparation for the heel strike.
17. RLA Method
1. Initial swing:
It starts from the point of foot clearing from the ground to the
maximum knee flexion of the same extremity.
2. Mid stance:
It starts from the maximum knee flexion to the vertical
position of the tibia.
3. Terminal swing:
It is the period from the tibia vertical position to the
preparation of the initial contact of the heel.
18.
19. Step length:
This is the distance between the heel strike of one lower extremity
to the heel strike of the other extremity.
Stride length:
This is the distance between the heel strike of one lower extremity
to the heel strike of the same lower extremity once again to the
ground.
Step duration:
It is the time taken for completion of one step.
20.
21. Stride length:
It is the time taken for completion of heel strike of one extremity to
the heel strike of the same extremity again.
Cadence:
It is the number of steps taken per minute.
Determination of cadence:
1. Step length
2. Sex
3. Speed of walking
22. Width of BOS:
Linear distance between the mid point of one foot to other foot is
called Width of BOS.
It is about 2-4 inches.
Degree of toe out or foot angle:
The line intersecting the centre of heel and 2nd toe is called as Foot
angle.
In normal walking , foot angle is 7 degrees it may decrease in fast
walking.
24. Determination of gait:
1. Lateral pelvic tilt
2. Knee flexion
3. & 4. Knee , ankle , foot interaction
5. Pelvic forward and backward rotations
6. Physiological valgus of knee
25. Lateral pelvic tilt:
During the mid stance period the COG reaches the peak level.
It helps to reduce the COG level during the mid stance period.
Knee flexion:
If the swinging lower extremity knee remains in extended position
, the COG still more increases in mid stance phase.
Knee , ankle , foot interaction:
The knee , ankle , foot interaction prevent the abrupt hike of the
upward displacement of the COG when the foot passes from the
heel strike to foot flat.
There is sudden dropping of COG , so to maintain this , there are
some changes happening in knee , ankle , foot.
29. Pelvic forward and backward rotations:
The forward rotation starts during the acceleration and ends in
deceleration , during mid swing the pelvis comes to the neutral
position , meanwhile opposite pelvis for backward rotation.
After the mid stance , there will be sudden dropping of COG level.
Forward and backward rotations help to minimize the hyper
reduction of COG .
Physiological valgus of knee:
Generally , during walking forward placing leg will have mild knee
valgus is called Physiological valgus of knee .
But the vertical allignment of limb provides more BOS than the
normally placed limb.
The physiological valgus is helpful to overcome from the reduced
BOS.
30.
31. Causes for locomotion
(gait) impairment:
1. Age
2. Sex
3. Occupation
4. Clothing
5. Assistive devices
6. Body structure
7. Foot wear
8. Psychological state of individual
9. Diseased state
32. Diseased state or pathological gaits:
1. Neurological gait
2. Muscular weakness gait
3. Joint or muscular limitation gait
4. Leg length discrepancy gait
5. Painful gait
33. Neurological gait
Parkinson gait:
The patient adopts the flexed
posture of neck , trunk , hip and
knee due to the rigidity of muscles .
Because of flexed posture , the
COG falls anteriorly.
The patient will have short steps.
Also known as Shuffling gait.
Seen in Parkinson’s disease ,
Wilson’s disease , Cerebral
atherosclerosis.
34. Hemiplegic gait:
The patient rotates hip
sideways during the swing
phase due to the hip flexor
tightness and places the foot in
flattened manner or toe first
before heel strike.
The step are lengthened
towards the affected side
comparatively with the
unaffected side .
This gait is also called as
Circumduction gait.
35. Ataxic gait
Cerebellar Ataxia Sensory Ataxia
There will be lacking of
coordinated movements.
The gait pattern resembles
like drunking gait.
This gait is otherwise called
as Reeling gait.
The patient raises the foot in
air , through forward in
uncertain manner and stamp
on the floor slowly due to
the lack of kinesthetic
sensation.
This gait pattern looks like
Space walk.
37. Scissoring gait
(crossed leg
gait):
The legs are crossing each
other while walking due to the
adductor tightness.
It is seen in Cerebral palsy
and in exaggerated form of
Paraplegia.
38. Muscular weakness gait
GLUTEUS MEDIUS GAIT
Trendelenburg’s gait: Duck walking gait:
One side gluteus medius
paralysis results in
Trendelenburg gait.
Weakness or paralysis of
right side gluteus medius
results in pelvic drop over
the left side while going for
the swing phase.
Both the side paralysis of
gluteus medius results in
Duck walking gait.
The patient bends his trunk
laterally towards the stance
phase.
40. Gluteus maximus gait:
The gluteus maximus causes
posterior pelvic tilting gait and
shifting the COG towards the
stance phase.
So while walking forward and
backward movement of the trunk
occurs is called as ‘rocking horse
gait’.
41. Quadriceps (hand
to knee gait):
This type of gait is possible
typically in the patients with
quadriceps paralysis.
The locking of knee is not possible
during the mid stance is the
quadriceps are paralysed so the
patient himself locks the knee by
placing his hands above the knee.
42. High stepping gait
(foot drop gait):
During heel strike due to foot drop
the toe goes and contact the ground
first , to avoid this the patient flexes
his hip and raises his foot and slap on
the floor forcibly.
In some exception cases , the patient
started walking with the dragging the
toes on the floor without flexing hip
and raising foot called as toe
“dragging gait”.
43. Genu Recurvatum gait:
If the hamstrings paralysis , the
knee goes for hyperextension in the
mid stance while transmitting
weight through the stance leg , the
knee goes for hyper extension due
to lack of counteraction of the
hamstring.
And also during the late stage of
swing phase slowering of the swing
due to the hamstring paralysis and
the knee will snap into extension.
It is commonly seen in polio.
44. Joint or muscular
limitation gait
Toe tip gait:
Foot remains in plantar flexion due
to the contracture of the plantar
flexor or may be due to paralysis of
dorsiflexors so that the patient
walks on the toe tip an the ball of
the metatarsals.
This type of gait can be seen in
some neurological conditions like
DMD and spastic diplegia.
45. Calcaneal gait:
Contracture of dorsiflexor or
paralysis of plantar flexor may
cause the stable dorsiflexed foot.
So while walking there is absence
of foot flat , mid stance , toe off
stages.
Instead of that the patient walks
with heel or the calcaneum.
This type of gait is said to be
“Calcaneal gait”.
46. Hip flexor
contracture gait:
If the hip flexors are contracted
or hip joint is ankylosed the
flexion movement is restricted.
To compensate that the patient
hikes his pelvis and laterally
half circumducts his hip and
propels forward as well as due
to hip flexor contracture , hip
extension is also restricted to
compensate that the patients do
more anterior pelvic tilt and
lordosis to swing the extremity
forwards.
47. Stiff knee gait:
If the knee is stiff the patient
hikes his hip and clears the foot
from the floor and swing
sideways with hip circumduction
of abduction to propel the limb
forward to reach the heel strike .
This type of gait is called as
“Circumduction gait” or “hip
abductor gait”.
48. Leg length
discrepancy gait:
When the leg length difference is
half inch it can be negligible and
it may be compensated by pelvic
tilt while walking.
If the shortening of leg goes up
to one and half inch it can be
adjusted with slight equines
position , meanwhile if the
shortening is more than two inch
– leads to marked pelvic tilt and
equines deformity at the foot.
This type of gait is called as
equines gait.
49. Painful or antalgic
gait:
When the patient has pain over
the joint of the lower extremity to
avoid to stand on the involved
side.
So, the time taken for the stance
phase on the involved side
shortens , and shortened step
length , increased velocity of
steps also can be noticed.
The patient limps while
transmitting weight over the
involved side so it may be called
as limping gait.