detail description of gait, abnormal gait and walking aid.

1. Human locomotion or Gait may be
described as a translatory progression of the
body as a whole- produced by coordinated,
rotatory movements of body.
The alternating movements of the lower
extremities essentially support and carry
along the HAT.
HAT-
Head,Arm,Trunk

2.  Head, arms and trunk constitutes 75% of the total
body weight with the head & arms contributing
25% of the total body weight & trunk contributing
50%.
 Walking is probably the most comprehensively
studied of all human movements.
FUNDAMENTAL PURPOSES :
“WINTER” proposed the following five main tasks for walking
gait :

3.  Maintenance of support of the "HAT” that is
preventing collapse of the lower limb.
 Maintenance of upright posture & balance of the
body.
 Control of the foot trajectory to achieve safe ground
clearance and balance of the body.
 Generation of mechanical energy to maintain the
present forward velocity.
 Absorption of mechanical energy for shock
absorption and stability.

4. RLA (Rancho Los Amigos) identified three main
tasks in walking :
Weight acceptance (WA)
 Single limb support (SLS)
 Swing limb advancement (SLA)
How ever the body moves only because energy
is generated by means of concentric contraction
of muscle group.

5. During one gait cycle each extremity passes
Through two major phases :
 Stance phase : when some part of the foot is in
contact with the floor-which makes up about 60% of
the gait cycle.
 Swing phase : when the foot is not in contact with
the floor-which makes remaining 40%.
There are two periods of Double support
occurring between the time one limb makes
initial contact & the other one leaves the floor
at toe off.

6. GAIT CYCLE
RIGHT STANCE RIGHT SWING
Left stance Left swing Left stance
Double
support
Right single limb support Double
support
Left single limb
support
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

7. % Gait Cycle 0% 10% 20% 30% 40% 50% 60%
Tradi
tiona
l
E
Initial Foot Heel Toe
Contact(0%) flat(7%) off(40%) off(60%)
Heel strike Mid stance Push off
RLA
E
Loading
response Mid stance Terminal stance Preswing
P
Initial Toe Initial Initial
Contact Off(L) Midstance con(L) con
(0%) (10%) (30%) (50%) (60%)
% Gait Cycle 0% 10% 20% 30% 40% 50% 60%

8. Traditional
Early swing
60-65%
Mid swing
75-87%
Late swing
85-100%
RLA Initial swing
60-73%
Mid swing
73-87%
Terminal swing
87-100%

9.  Heel strike :Refers to the instant at which the heel of the
leading extremity strikes the ground.
 Foot flat : in normal gait occurs after the initial contact-7%
 Mid stance: is the point at which the body weight is directly
over the supporting lower extremity-30%
 Heel-off : is the point at which the heel leaves the ground-
40%
 Toe-off : is the point at which the toe leaves the ground-60%

10.  Heel strike (T)
 Loading response orWA (RLA)-11%
 Mid stance phase (T)-7%
 Mid stance phase (RLA)-11%
&
 Terminal stance (RLA) 30%
 Push-off phase (T)-begins with heel-off (40%) & ends with
toe-off (60%)
 Pre-swing (RLA)-is the last 10% of stance phase and begins
with initial contact of the contra-lateral foot (50%) & ends
with toe-off (60%)

14. Swing Phase :
 Acceleration or early swing (T): begins once the toe leaves
the ground and continues until mid swing.
 Initial swing (RLA) : begins when the toe leaves the ground
and continues until maximum knee flexion.
 Mid swing (T): occurs approximately when the extremity
passes directly beneath the body.
 Mid swing (RLA): the period from maximum knee flexion
until the tibia is in a vertical position.
 Deceleration (T) or late swing: occurs after mid swing-
preparation for heel strike.
 Terminal swing (RLA) : point just before the heel strike.

15. Gait-Terminology:
Time and distance are two basic parameters of motion and measurements of these
variables provide a basic description of GAIT.
 Temporal variables : Include the following
 Stance time
 Single limb & double support time
 Swing time
 Stride & step time
 Cadence
 speed
 The distance variables : Include the following
 Stride length
 Step length
 Width
 Degree of toe-out

16. Temporal variables & distance variables :
 Stance time : is the amount of time that elapses during the
stance phase of one extremity in a gait cycle.
 Single limb or single-support time : is the amount of time
that elapses during the period when only one extremity is
one the supporting surface in a gait cycle.
 Double support time : is the amount of time spent with both
feet on the ground during one gait cycle. The percentage of
time spent in double support may be increased in elderly
persons and those with balance disorders.The percentage
of time (D.S) decreases if speed of walking increases.

17.  Stride length : is the linear distance between two successive
events that are accomplished by the same lower extremity
during gait. In general, stride length is determined by
measuring the linear distance from the point of one heel
strike of one lower extremity to the point of the next heel
strike of the same extremity.
 Stride duration : refers to the amount of time it takes to
accomplish one stride. Stride duration and gait cycle
duration are synonymous.
One stride, for a normal adult, lasts approximately one
second.

18.  Step length : is the linear distance between
two successive points of contact of opposite
extremities.
It is usually measured from the heel strike of
one extremity to the heel strike of the
opposite extremity.
 Step duration : refers to the amount of time
spent during a single step. Measurement
usually is expressed as seconds per step.

19.  Cadence : is the number of steps taken by a person per unit
of time. Cadence may be measured as the number of steps
per second or per minute, but the latter is more common.
Cadence = number of steps / time
The shorter step length will result in an increased cadence at
any given velocity. Lamoreaux found that when person
walks with a cadence between 80 & 120 steps per minute
cadence and stride length had a linear relationship.
As a person walks with increased cadence, the duration of
the double-support period decreases.

20.  Cadence for adult men (normal) = 110 steps per minute.
 Cadence for adult women (normal) = 116 steps per minute.
 Walking velocity : is the linear forward motion of the body,
which can be measured in meters (m) or cm / sec, m / minute,
miles / hour
Scientific literature favours meters per second. But this
not frequently included, more correct term is-
Walking speed .

21.  Walking speed : should be used if direction is not reported.
In instrumented gait analyses, walking velocity is used.
Walking velocity (m / sec) = distance walked (m) / time (sec)
 Step width : may be found by measuring the linear distance
between the midpoint of the heel of one foot and the same
point on the other foot.
Step width has been found to increases in elderly persons
and small children.

23.  Antalgic Gait : A protective gait pattern
where the involved step length is decreased
in order to avoid weight bearing on the
involved side usually secondary to pain.
 Ataxic Gait : A gait pattern characterized by
staggering and unsteadiness. There is usually
a wide base of support and movements are
exaggerated.

24. Festinating Gait : A gait pattern where a
patient walks on toes as though pushed. It
starts slowly, increases, and may continue until
the patient grasps an object in order to stop.
Hemiplegic Gait : A gait pattern in which
patient abduct the paralyzed limb, swing it
around, and bring it forward so the foot comes
to the ground in front of them.

25. Trendelenberg gait: caused by weakness of
the abductor muscles of the lower limb,
gluteus medius and gluteus minimus.
Scissoring gait : In spastic CP with spasticity of
adductor muscle.

26. Hip hiking:
 Increased ipsilateral length:
▪ hip -flexor or dorsiflexor weakness
▪ hip, knee, ankle ankylosis or spasticity
▪ insufficient hip or knee flexion
 Contralateral shortness

28.  Increase area of support, maintain center of
gravity over support area.
 Redistribute weight-bearing area.

29.  ROM, muscle strength and endurance,
coordination, trunk balance, sensory
perception, mental status.
 Amount of weight-bearing permitted on
lower limb.

30.  Shoulder depressor – latissimus dorsi, lower
trapezius, pectoralis minor
 Shoulder adductor – pectoralis major
 Shoulder flexor, extensor and abductor –
deltoid
 Elbow extensor – triceps
 Wrist extensor – ECR, ECU
 Finger flexor – FDS, FDP, FPL, FPB

31.  Body weight transmission with bilateral axillary
crutches = 80% of BW, nonaxillary crutches = 40-
50% of BW
 Good strength of upper limbs usually required –
more weight bearing and propulsion
 Unilateral non/partial weight bearing eg fracture,
amputee -> 3-point gait
 Bilateral partial weight bearing or
incoordination/ataxia -> 2 or 4-point gait
 Bilateral weakness of lower extremities eg
paraplegia -> swing-to or through gait

33.  Crutch length : measure anterior axillary fold
to point 5 inches anterolaterally from foot or
to plus 1-2 inches heel.
 Hand piece : elbow flexed 30 degree, wrist
max extension, finger fist
 Compressive radial neuropathies.

35.  Single aluminum tubular adjustable shaft,
handpiece, forearm piece 2 inches below
elbow, forearm cuff anterior opening (hinge)
 Elbow flexion 20 degree
 Can release hand without loosing crutch
 Requires great skill, good strength of UEs,
trunk balance

37.  Painful wrist and hand condition or elbow
contractures, or weak hand grip
 Platform, velcro strap
 Elbow flexed 90 degrees

38.  Point gait – stability, slow
 Swing gait – more energy, fast

40.  Good stability - at least 3 point contact
ground
 Ataxia or incoordination
 Slowest, difficulty

42.  Non-weight-bearing gait for lower limb
fracture or amputation
 3-point PWB gait -> required 18-36% more
energy per unit distance than normal
 NWB required 41-61%more energy per unit
distance than normal

44.  Faster than 4-point gait but less stability
 Decrease both lower limbs weight-bearing

46.  Fastest gait, requires functional abdominal
muscles
 Required increase of 41-61% in net energy
cost (= 3-point NWB)

48.  Both crutches -> both lower limbs almost to
crutch level

50.  Body weight transmission for unilateral cane
opposite affected side is 20-25%
 Gluteus medius weakness, or pathological at
knee or ankle.
 Cane eliminate necessary gluteus medius
force and reduces compressional force on hip
 Measure tip of cane to level of greater
trochanter, elbow flexed 20-30 degree

53.  Wider and more stable base of support, but
slow gait (interfere smooth reciprocal gait)
 For patients requiring maximum assistance
with balance, uncoordinated
 Add wheels to front legs for who lack
coordination or power in upper limbs
 Front of walker 12 inches in front of patient
 Shoulder relaxed and elbow flexed 20 degree
 Three-point gait

54.  Gait analysis is used to assess and treat
individuals with condition affecting their
ability of walking. Gait analysis uncovers
precisely how our body is moving and
prescription for appropriate assistive devices.

55. Thank
you