Abnormal gait by SURYA LIKHITA-VAPMS COLLEGE OF PHYSIOTHERAPY
- 1. BY- R. SURYA LIKHITA ROLL NO. 42 BPT 2nd YEAR
- 2. 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
- 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
- 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.
- 15. Swing phase Traditional Method RLA 1. Acceleration 2. Mid stance 3. Deceleration 1. Initial swing 2. Mid stance 3. Terminal swing
- 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.
- 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.
- 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.
- 23. Foot angle
- 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.
- 27. Knee flexion
- 28. Knee , ankle , foot interaction
- 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.
- 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.
- 36. Ataxic gait Cerebellar Ataxia Sensory Ataxia
- 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.
- 39. Gluteus medius gait Trendelenberg Gait Duck Walking Gait
- 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.