Human locomotion, or walking, involves alternating between a stance phase where one foot is on the ground and a swing phase where the foot is off the ground. The gait cycle can be divided into these two phases and further subdivided. There are many types of gait deviations that can occur due to injuries, diseases or other impairments affecting the nervous system, muscles or bones. Common causes of gait deviations include stroke, cerebral palsy, spinal cord injuries or tumors, neurological conditions like Parkinson's disease or multiple sclerosis, and musculoskeletal problems. Kinesiotherapists evaluate gait to identify deviations and their causes in order to develop treatment plans.

1. HUMAN LOCOMOTION
GAIT ANALYSIS
Kinesiotherapy Clinical Training
Module 3

2. Human Locomotion
Human Locomotion (Walking)
•A process of locomotion in which the erect, moving body is supported first
by one leg and then the other
•Walking is initiated by creating a state of postural imbalance
• To initiate walking, a person leans forward, which creates a state of
imbalance
• To recover balance, one leg advances forward to receive the body weight
2
Human Locomotion

3. Human Locomotion
Human Locomotion (Walking)
•When walking :
• One foot is always in contact with the ground
• There is a brief period of double support during the gait cycle when both
feet are in contact with the ground
•The 4 limbs move in a diagonal reciprocal pattern
• Ex. – the right arm and the left leg move forward simultaneously,
followed by the left arm and right leg
•When running:
• There is a brief moment during the gait cycle when both feet are off the
ground
3Human Locomotion

4. Gait
Community Ambulator
• A person who is able to walk indoors and outdoors for the majority of their
activities with or without ambulation aids
Household Ambulator
• A person who is able to ambulate over short distances on level surfaces in
the home with or without ambulation aids
Exercise Ambulator
• Walking is limited to therapy sessions with a wheelchair needed for
mobility
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5. Gait Cycle Definitions
Step Length
• The distance from the initial point of contact of one foot to the initial point of
contact of the other foot
• Right step length equals left step length in normal gait
Stride Length
• The distance from initial contact of one foot to the following initial contact of
the same foot
• Equals double the step length in normal gait
Walking Base or Stride Width
• The side to side distance between heel strike of the left limb and heel strike of
the right limb. Typically measured from the ankle joint center
• During normal gait the distance is between 2-4 inches
• Walking with a wider base will increase stability but the person will not walk
as efficiently
Human Locomotion 5

6. Gait Cycle Definitions
Cadence
• The number of steps taken per minute
• Average cadence is 100-115 steps/min
Velocity
• Distance covered by the body in unit of time
• Usually measured in meters/minute
• Average velocity (m/min) = step length (m) x cadence (steps/min)
Walking Speed
• Walking speed varies and is dependent on factors such as height, weight,
age, terrain, surface, load, culture, effort, and fitness
• Average ambulation speed is 80m/min or approximately 3 miles/hour
.
6Human Locomotion

7. Gait Cycle
Phases of Gait
•There are two phases of the gait cycle
• Stance Phase – the period of time when the foot is in contact with the
ground. Involves 60% of the gait cycle
• Swing Phase – the period of time when the foot has no contact with the
ground. Involves 40% of the gait cycle
•During a complete gait cycle, each leg moves reciprocally from stance phase
to swing phase (i.e. when the right leg is in swing phase, the left leg is in
stance phase and vice versa)
7Human Locomotion

8. Gait Cycle
Stance Phase
•Can be divided into 5 subdivisions
•Initial Contact (Heel Strike) – when the heel or another part off the foot
contacts the ground
•Loading Response (Foot Flat) – following initial contact until the
contralateral extremity leaves the ground
•Midstance – when the contralateral extremity leaves the ground and ends
when the body’s weight is directly over the forefoot
•Terminal Stance (Heel Off) – From midstance to a point just prior to initial
contact of the contralateral extremity
•Preswing (Toe Off) – from the initial contact of the contralateral extremity
to just prior to the foot of the supporting leg leaving the surface of the
ground
•Stance phase is a closed kinetic chain movement
Human Locomotion 8

9. Gait Cycle
Swing Phase
• Can be divided into 3 subdivisions
• Initial swing (Acceleration) – begins with toe off and continues until
maximum knee flexion occurs
• Midswing – the period from maximum knee flexion until the tibia is vertical
or perpendicular to the ground
• Terminal Swing (Deceleration) – begins where the tibia is vertical and ends
at heel strike
• The swing action of the lower limb is assisted by gravity
• Swing phase is an open kinetic chain movement
• Less energy is consumed during swing phase than during stance phase
9Human Locomotion

10. Gait Cycle
Double Support
• The period of time when both feet are in contact with the ground
• This occurs twice in the gait cycle, at the beginning and at the end of
stance phase
• About 25% of the gait cycle is considered a double support phase
Single Support
• The period of time when only one foot is in contact with the ground
Center of Gravity Path During Ambulation
• Lateral Displacement
• During weight transfer (mid stance), the pelvis and trunk shift laterally
approximately 2 inches to the weight bearing side
Human Locomotion 10

11. Gait Cycle
Center of Gravity Path During Ambulation (cont.)
• Vertical Displacement
• The center of gravity moves up and down an average of 2 inches as the
body moves forward
• The highest vertical displacement occurs during the mid stance position of
stance phase
• The lowest vertical displacement occurs at the point of double support
• Horizontal Dip of the Pelvis
• The pelvis dips alternately around each hip that is in stance phase
• Displacement (or drop off) from the horizontal position does not exceed 5%
11Human Locomotion

12. Gait Deviation
Gait Deviation
• Any deviation from a normal bilateral reciprocal gait pattern
• Impaired gait patterns also include altered or exaggerated trunk or arm
movements
• Gait deviations can result from any of the following:
• Muscle imbalances or musculoskeletal injuries
• Neurological impairments
• Lower limb amputations
• Sensory/proprioception impairment
• Vestibular or visual impairment
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13. Gait Deviations
Hemiplegic Gait
• Unilateral weakness on the affected side
• Decreased step length, stance phase
• Arm flexed, adducted and internally rotated shoulder retraction
• Gluteal and quadriceps muscles are generally spastic
• Decreased knee and hip flexion
• Plantar flexion of the foot
• When walking
• The arm is generally held to one side and the normal arm swing is absent
• The affected leg is circumducted (dragged forward in a semicircle) due to
weakness of distal muscles (foot drop) and extensor hypertonia in the
lower limb
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14. Gait Deviations
Scissors Gait
• Adduction and internal rotation at the hip
• Hip and knees flexed slightly as if crouching
• Plantar flexion of the ankle
• Often mixed with or accompanied by a spastic gait
• Rigidity and excessive adduction of the leg in swing phase
• When walking:
• Abnormally narrow base
• Lower limb is dragged forward with toes scrapping the ground
• Knees and thighs hitting or crossing the mid line
• Trunk may lean over the stance leg as the swing leg attempts to swing past it
14Human Locomotion

15. Gait Deviations
Spastic Gait
• One or both legs are typically weak and abnormally stiff
• A stiff, foot-dragging walk caused by long-term muscle contraction.
• When walking:
• Legs are held closer together than normal
• Foot and toes drag the ground
Antalgic Gait
• Characterized by a shortened stance phase
• Limp to avoid pain on weight-bearing structures
• Very short stance phase
15Human Locomotion

16. Gait Deviations
Steppage Gait
• A compensatory gait for a toe/foot clearance problem
• Characterized by excessive flexion of the hip and knee in the swing phase
• Often associated with foot drop (weakness of foot dorsiflexion)
Parkinsonian Gait
• Stooped posture with head and neck forward , hip and knees flexed.
• Can have difficulty initiating steps
• Often short shuffling steps with weight mostly forward on toes and an
involuntary inclination to take accelerating steps, also known as
festination or festinating gait - feet trying to keep up with forward leaning
trunk
Human Locomotion 16

17. Gait Deviations
Trendelenburg Gait
• Caused by unilateral weakness of hip abductor
• Characterized by the dropping of the pelvis on the unaffected side of the
body at the moment of heel strike and through stance phase on the
affected side
• Results in an excessive lateral lean of the trunk to the affected side
Myopathic or Waddling Gait
• Caused by bilateral weakness of hip girdle muscles or joint pathology
• Exaggerated hip elevation
• Excessive lateral lean of the trunk to the affected side as pelvis drops on
contralateral side
17Human Locomotion

18. Gait Deviations
Ataxic Gait
• Clumsy, uneven, uncoordinated movements with a wide based of support
• Usually has difficulty walking in a straight line and tends to stagger
• All movements appear exaggerated
• Balance is poor.
Abnormal Gait Videos
• http://library.med.utah.edu/neurologicexam/html/gait_abnormal.html
18Human Locomotion

19. Gait Compensations
Pelvic or Hip Hike
• Caused by any impairment that limits the ability of the LE to functionally
shorten
• Used to aid in clearance of the swing limb
• The pelvis elevates during swing phase to provide extra clearance for the
advancing leg
Circumduction
• Caused by any impairment that limits the ability of the LE to reduce the
length of advancing limb
• The swing leg advances in a semi-circular arc, which creates extra clearance
for the advancing leg
19Human Locomotion

20. Gait Compensations
Vaulting
• Caused by any impairment that limits the ability of the LE to reduce the
length of the advancing limb
• Rising up on the toes of the stance foot so that the advancing limb can clear
the floor
Genu Recurvatum
• Excessive hyperextension of the knee during stance phase
• Trunk lurches forward
20Human Locomotion

21. Common Gait Deviation Causes
Hemiplegic Gait
• Stroke
• Brain trauma or tumor
Scissor Gait
• Cerebral Palsy
• Stroke
• Spinal Cord trauma
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22. Gait Deviation Causes
Spastic Gait
• Brain tumor
• Stroke
• Head trauma
• Cerebral Palsy
• Multiple Sclerosis
• Spinal cord trauma or tumor
• Amyotrophic Lateral Sclerosis
Antalgic Gait
• Pelvic girdle pain
• Osteoarthritis, tendonitis
• Fracture
• Infection
• Foot problems
• Injury
22Human Locomotion

23. Gait Deviation Causes
Steppage Gait
• Tibialis anterior muscle weakness
• Spastic plantar flexor
• Peripheral neuropathy
• Multiple sclerosis
• Spinal cord injury
• Poliomyelitis
Festinating Gait
• Parkinson Disease
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24. Gait Deviation Causes
Trendelenburg Gait
• Painful hip
• Weak hip abductors
• Leg length discrepancy
• Abnormal hip joint
Myopathic Gait
• Pregnancy
• Hip dysplasia
• Muscular Dystrophy
24Human Locomotion

25. References
• Thompson PD. Gait disorders. In: Bradley WG, Daroff RB, Fenichel GM,
Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa:
Butterworth-Heinemann Elsevier; 2008:chap 24.
• O’Sullivan, Susan B.; Schmitz, Thomas J. Physical Rehabilitation:
Assessment and Treatment 6th
Edition 2006
• Delisa, Joel; Gans, Bruce; Walsh, Nicolas Physical Medicine and
Rehabilitation: Principles and Practice Vol. 1 & 2 4th
Edition 2005
• http://library.med.utah.edu/neurologicexam/html/gait_abnormal.html
• http://stanfordmedicine25.stanford.edu/the25/gait.html
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