Gait-Abnormal Gait by surya likhita

GAIT
R. SURYA LIKHITA
BPT 2nd YEAR
VAPMS COLLEGE OF PHYSIOTHERAPY

CONTENTS
1. Introduction
2. Definition
3. COG of human body during
gait
4. Gait cycle
5. Determinants of gait
6. Causes for gait impairment
7. Pathological gaits

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.

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.

CENter 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.

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

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
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.

The traditional method and Rancho Los Angious
[RLA] medical center , California , defines activities ,
which occur during the stance phase and swing
phase. Activities , which occur during stance phase
and swing phase are:
STANCE PHASE:
 Traditional Method
1. Heel strike
2. Foot flat
3. Mid stance
4. Heel – off
5. Toe - off
RLA
1. Initial contact
2. Loading response
3. Mid stance
4. Terminal stance
5. Pre swing

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.

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.

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
contra-lateral extremity clears the ground.
3. Mid stance:
It begins when the contra-lateral extremity
clears the ground and end when the body
comes in straight line to the supporting
limb.

4. Terminal stance:
Starts from the end of the mid stance to the
initial contact of the contra-lateral lower
extremity.
5. Pre swing:
It is the period of the contra-lateral lower
extremity initial contact and the reference
extremity clears the ground.

Swing phase
Traditional Method RLA
1. Acceleration
2. Mid stance
3. Deceleration
1. Initial swing
2. Mid stance
3. Terminal swing

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.

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.

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.

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

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.

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

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.

Knee , ankle , foot interaction

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.

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

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

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.

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.

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.

Ataxic gait
Cerebellar Ataxia Sensory Ataxia

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.

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.

GLUTEUS MEDIUS GAIT
Trendelenberg Gait Duck Walking Gait

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‟.

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.

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”.

GENU RECURVATUM GAIT:
If the hamstrings paralysis ,
the knee goes for hyper
extension 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.

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 dorsi-flexors
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.

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”.

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.

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”.

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.

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.

Gait-Abnormal Gait by surya likhita

Gait-Abnormal Gait by surya likhita

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