Gait refers to the manner of walking or moving on foot. There are four essential criteria for normal gait: equilibrium, locomotion, musculoskeletal integrity, and neurological control. The gait cycle describes the sequence of foot movements from initial heel contact to the next contact of the same heel. Abnormal gaits can be caused by pain, weakness, tightness, loss of balance, or range of motion issues. Specific abnormal gaits include hemiplegic, diplegic, neuropathic, sensory, myopathic, choreiform, parkinsonian, and age-related gaits. Doctors evaluate gait through physical exam, performance tests, and imaging to diagnose underlying causes and prognosis depends on the medical condition.

1. GAIT & ITS
ABNORMALITY
Presentation by:
Dr Indrajeet P. Shah
Dr Amit A. Bhasme

2. DEFINITION
GAIT
 a manner of walking or moving on foot
 a sequence of foot movements (as a walk, trot, pace, or
canter) by which a horse or a dog moves forward
 a manner or rate of movement or progress <the
leisurely gait of summer>

3. ESSENTIALS OF GAIT
There are four major criteria essential to walking.
 Equilibrium:
The ability to assume an upright posture and maintain
balance.
 Locomotion:
The ability to initiate and maintain rhythmic stepping
 Musculoskeletal Integrity:
Normal bone, joint, and muscle function
 Neurological Control:
Must receive and send messages telling the body how and
when to move.
(visual, vestibular, auditory, sensori-motor input)
 Forces for gait:
Muscular force.
Gravitational force.
Forces of momentum.
Floor reaction force.

4. GAIT CYCLE
 The gait cycle is used to describe the complex
activity of walking, or our gait pattern. This cycle
describes the motions from initial placement of the
supporting heel on the ground to when the same
heel contacts the ground for a second time.

5.  The stance period consists of the first five
phases: initial contact, loading response, mid-
stance and terminal stance.

6. WHAT CAUSES PEOPLE TO HAVE A BAD GAIT?
 Gait and balance problems can be a result of
pain, muscle weakness, muscle tightness or
spasticity, loss of balance, or poor posture.
Other causes include limited range of motion,
numbness (sensory deficit), and fatigue. Muscle
weakness can occur in one leg or both, and
make walking difficult

7. HEMIPLEGIC GAIT
 The patient stands with unilateral
weakness on the affected side, arm is
held immoblie and close to the side,
with elbow, wrist and interphalangeal
joints flexed. Leg on same side is in
extension with plantar flexion of the foot
and toes.
 When walking, the patient will hold his
or her arm to one side and drags his or
her affected leg in a semicircle
(circumduction) due to weakness of
distal muscles (foot drop) and extensor
hypertonia in lower limb.
 This is most commonly seen in stroke.

8. DIPLEGIC GAIT (SCISSORS GAIT)
 Patients have involvement on both sides with
spasticity in lower extremities worse than upper
extremities.
 The patient walks with an abnormally narrow base,
dragging both legs and scraping the toes.
 This gait is seen in bilateral periventricular lesions,
such as those seen in cerebral palsy.
 There is also characteristic extreme tightness of hip
adductors which can cause legs to cross the
midline referred to as a scissors gait.

10. NEUROPATHIC GAIT
(STEPPAGE GAIT)
 Seen in patients with foot drop (weakness of foot
dorsiflexion), the cause of this gait is due to an attempt
to lift the leg high enough during walking so that the
foot does not drag on the floor.
 These patients either drag their feet or left them high,
with knees flexed, and bring them down with a slap
onto the floor, thus apperaing to be walking up stairs.
They are unable to walk on their heels.
 Unilateral, causes include peroneal nerve palsy and L5
radiculopathy.
 Bilateral, causes include amyotrophic lateral sclerosis,
Charcot-Marie-Tooth disease and other peripheral
neuropathies including those associated with
uncontrolled diabetes.

12. SENSORY GAIT
 As our feet touch the ground, we receive propioreceptive
information to tell us their location.
 The sensory ataxic gait occurs when there is loss of this
propioreceptive input.
 In an effort to know when the feet land and their location,
the patient will slam the foot hard onto the ground in order
to sense it. A key to this gait involves its exacerbation
when patients cannot see their feet (i.e. in the dark).
 This gait is also sometimes referred to as a stomping gait
since patients may lift their legs very high to hit the ground
hard.
 This gait can be seen in disorders of the dorsal columns
(B12 deficiency or tabes dorsalis) or in diseases affecting
the peripheral nerves (uncontrolled diabetes).

14. MYOPATHIC GAIT
 Hip girdle muscles are responsible for keeping the pelvis
level when walking. If you have weakness on one side, this
will lead to a drop in the pelvis on the contralateral side of
the pelvis while walking (Trendelenburg sign). With bilateral
weakness, you will have dropping of the pelvis on both sides
during walking leading to waddling. This gait is seen in
patient with myopathies, such as muscular dystrophy.

16. CHOREIFORM GAIT
(HYPERKINETIC GAIT)
 This gait is seen with certain basal ganglia
disorders including Sydenham's chorea,
Huntington's Disease and other forms of chorea,
athetosis or dystonia. The patient will display
irregular, jerky, involuntary movements in all
extremities. Walking may accentuate their baseline
movement disorder.

17. PARKINSONIAN GAIT
 In this gait, the patient will have rigidity and
bradykinesia.
 He or she will be stooped with the head and neck
forward, with flexion at the knees. The whole upper
extremity is also in flexion with the fingers usually
extended. The patient walks with slow little steps known
at marche a petits pas (walk of little steps). Arm swings
are decreased and the patient turns around stiffly-”all in
one piece”
 Patient may also have difficulty initiating steps. The
patient may show an involuntary inclination to take
accelerating steps, known as festination.
 This gait is seen in Parkinson's disease

19. GAIT OF OLDER AGE
 Speed, balance and agility decrease with aging.
Steps become short, uncertain and even shuffling.
The legs may be flexed at hips and knees. A cane
may bolster lost confidence.
 Due to aging process.

20. DIAGNOSING GAIT AND BALANCE PROBLEMS
 A physical and neurological examination can
diagnose gait or balance problems. Doctors
typically also ask questions about symptoms and
severity.
 Performance testing can then be used to assess
individual gait difficulties. Potential further tests to
identify causes include hearing tests, inner ear
imaging, and vision tests including watching eye
movement. Magnetic resonance imaging (MRI) or a
computed tomography (CT) scan can check the
brain and/or blood pressure/heart rates tests. A
doctor will look to find which part of the nervous
system is contributing to the gait and balance
problems.

21. GAIT AND BALANCE PROBLEM PROGNOSIS
 The prognosis of gait and balance problems is
dependent on the underlying medical condition.
 Falls in older adults, due to gait and balance
problems, are a common cause of mortality and
morbidity and can lead to injury, loss of
independence, and change in lifestyle.

22. FOR THE COMPLIMENTS AND COMMENTS
 Shah.indrajeet.dr@gmail.com
 dramitbhasme@gmail.com