Definition

Human gait is bipedal, biphasic, forward propulsion of centre of gravity, in which there is alternate sinuous movement of different segments of the body, with least expenditure of energy.

WHY???!!
Diagnosis Plan

Treatment Results of treatment Comparison of different modalities of treatment Orthosis and prosthesis manufacturing and to render scientific basis to newer and innovative products

Normal Gait Pre-requisites

Equilibrium-ability

to assume upright posture and maintain balance. Locomotion-ability to initiate and maintain rhythmic stepping. Muskuloskeletal integrity-normal bone joint and muscle function. Neurological control-visual ,auditory vestibular and sensory motor input

GAIT CYCLE
A

single gait cycle or stride is defined:

Period

when ONE foot contacts the ground to when that same foot contacts the ground again Each stride has 2 phases:
Stance Phase -60% of the gait cycle
Foot

in contact with the ground NOT in contact with the ground

Swing Phase -40% of the gait cycle

Foot

STANCE PHASE
When the foot is in contact with the ground Stance phase has 5 parts: 1.Initial Contact (Heel Strike) 2.Loading Response (Foot Flat) 3.Midstance 4.Terminalstance(heel off + push off) 5.Pre-Swing(toe off)

SWING PHASE
When foot is NOT contacting the ground
Limb

advancement phase 3 parts of swing phase: -Initial swing -Midswing -Terminal swing

GAIT PARAMETERS (CADENCE PARAMETERS)

Step

length distance between two feet during double limb support, it is measured from the heel of one foot to heel of contralateral foot Stride length -distance one limb travels during the stance and swing phase, it is measured from the point of foot contact at the beginning of stance phase to the point of contact by the same foot at the end of swing phase Step time amount of time used to complete one step length Cadence number of steps taken per minute Walking velocity -distance traveled per minute

 Murray

et al. determined parameters of gait in nondisabled men. Mean duration of the gait cycle - 1.03 seconds. The steps per minute - 117 (90-120 steps) Average comfortable walking speed was 2.8 miles per hour. Average stride length - 70-82 cm

CENTRE OF MASS
Center

of mass (COM) is located just anterior to the second sacral vertebra COM deviates from the straight line in vertical and lateral sinusoidal displacements.

LAW OF PHYSICS:
Centre

of gravity of body mass should fall within its base of support to retain its stability

Smoothness of gait: Stance leg must support the centre of gravity and provide active extension of hip and knee to help the swing leg to clear the ground

DETERMINANTS OF GAIT
1953, Saunders, Inman & Eberhart Pelvic rotation Pelvic tilt Stance phase knee flexion Foot and ankle motion Knee Motion Lateral displacement of pelvis

GAIT ANALYSIS
Study

of human locomotion Walking consists of a series of gait cycles

A

single gait cycle is known as a STRIDE

CLINICAL GAIT ANALYSIS

OBSERVATIONAL

GAIT ANALYSIS 3D GAIT ANALYSIS

OBSERVATIONAL

GAIT ANALYSIS Pt should be viewed from the front, side, and behind

WHAT TO LOOK FOR

The head position. Shoulders Amount of arm swing The trunk The pelvis The hip The knee The ankle The foot Pain Cadence parameters

3D GAIT ANALYSIS
Kinematics

-movement Kinetics -forces related to movements Ground reaction forces (GRF) Moment or torque - a turning force that results in angular change of position of a segment/joint Power - a function of joint angular velocity and joint moment; rate of doing work Electromyography (EMG) -recording of myoelectrical activity

KINEMATICS
Denotes

the motion observed and measured at pelvis, hip, knee, ankle and foot Done in three planes -sagittal plane-hip flexion ,extension -coronal plane-hip abduction,adduction -transverse plane-rotation hip,tibia,feet

MUSCLES ACTING DURING WALKING

Concentric

contraction- - muscle shortens on stimulation, generates power and accelerates body forward. -gastrosoleus contracts to lift the heel off the ground -iliopsoas contracts flexing the hip and pulling the stance phase limb off the ground

MUSCLES ACTING DURING WALKING

Eccentric

contraction- muscle lengthens on stimulation, slows down and stabilises joint motion -tibialis anterior-contracts at initial contact ,firing during plantar flexion as the foot is lowered to ground, so the foot is gently lowered to ground -gastrosoleus-contracts eccentrically through the stance phase controlling the rate of dorsiflexion of ankle

SAGITTAL PLANE
Pelvis

is tilted 15 degrees, minimal motion of the anterior tilt as each leg is advanced forward. Hamstrings tight: More posterior tilt Knee: More complex pattern Deviations: Hyperextension in stance phase if the heel cord is tight, flexion in stance due to hamstring tightness, inability to flex the knee in swing phase due to inappropriate rectus femoris action, quadriceps gait Ankle: First Rocker, Second Rocker, Third Rocker

CORONAL PLANE
Pelvic

Obliquity Each hemipelvis rises slightly during swing phase to augment the ability to advance the swing limb, this is associated with a contralateral hemipelvis fall. Adducts during stance phase. Accentuated in CP.

TRANSVERSE PLANE
Pelvis

and hips rotate minimally during gait, Tibiae are mildly externally rotated.

FOOT

PROGRESSION ANGLE: Angle the foot makes with the path the subject is walking. Normally: 10-15 degrees

PATHOLOGICAL GAITS

GAITS IN CP

True Equinus -distal spasticity (Gastrosoleus spasticity) Equinus Genu recurvatum Jump Gait Spasticity of hamstrings and hip flexors, equinus + hip and knee in flexion + ant. pelvic tilt + exaggerated lumbar lordosis + knee stiff Crouch gait Excessive dorsiflexion or calcaneus at ankle + excessive flexion at knee and hip + ant. pelvic tilt May be Iatrogenic due to isolated lengthening of TA (w/o correcting hamstring & iliopsoas spasm) Scissoring gait Adductor musculature spasm, Flexion + int. rotation deformity Can bring the swing limb up to the stance limb Cadence parameters are grossly decreased

CROUCH GAIT

SCISSORING GAIT

ANTALGIC GAIT
Pain

in lower limb ,back, hip pain Lurch to affected side No gluteal weakness Short stepping Asymmetrical step length Step length on affected side less Unaffected limb is brought forward more quickly than normal in swing phase Duration of stance phase increased on normal side

TRENDELENBERG GAIT
Functional

weakening of abductor mechanism Standing on affected side pelvis drop to normal side To compensate patient lurches to affected side

GAIT IN BILATERAL HIP DISEASES

Waddling

gait Bilateral trendelenberg CDH COXA VARA

SHORT LIMB GAIT

Shift

to same side Pelvis tilt downward with dip Equal period on each side Supinate foot or toe walk Flex knee and hip on normal side Raise pelvis on normal side in swing phase hip hiking to clear ground

GLUTEUS MAXIMUS GAIT

GL.

MAXIMUS - Terminal swingopposite side gluteus maximus locks hip in extension on wt bearing side Weakness - pelvis thrust forward and trunk backward shift COG backwards increased lordosis Patient lurches back &forth over the hips

CALCANEAL GAIT
Gastrosoleus contracts eccentrically throughout the second rocker, hence controlling excessive dorsiflexion. Weakness of gastrosoleus

STIFF HIP GAIT

No

flexion of hip during walking

QUADRICEPS GAIT
Weakness

of Quadriceps Poliomyelitis Hand to Knee Gait

STEPPAGE GAIT
Foot

drop

Other Pathological Gaits

CEREBELLAR ATAXIA: WIDE BASED REELING GAIT (DRUNKEN SOLDIERS GAIT) HEMIPARETIC : CIRCUMDUCTION GAIT PARKINSONISM: FESTINENT GAIT MARCHE A PETIT PAS: DEMENTIA / FRONTAL LOBE SYNDROMES MYOPATHIC GAIT: EXAGGERATED HIP MOVEMENTS MULTIPLE SCLEROSIS/ VIT B 12 DEFICIENCY: CORTICOSPINAL + PROPRIOCEPTION : SPASTICITY + ATAXIA : JIGGLING/ BOBBLY GAIT HYPERKINETIC GAIT : CHOREA (GROTESQUE DANCING AND PRANCING) CAUTIOUS SENILE GAIT: VELOCITY DECREASES, STEPS SHORTEN AND BASE WIDENS MAGNETIC GAIT (GAIT APRAXIA)

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