Assessment of Gait

Question 1

stance

Answer 1

• foot on ground, allows for weight bearing and support
• “60% of normal cycle”
• Most problems in stance phase results in pain and causes the patient to limit involved extremity as little as possible.
• May be caused by shoe problems.
• components: heel strike, foot flat, mid stance, push off

Question 2

heel strike

Answer 2

Pain is elicited when the heel lands on the floor. Pain is caused by a spike of a bone in the heel that protrudes on the plantar surface of the oscalcis.

Question 3

swing

Answer 3

moving foot forward (40% of cycle)

-components: acceleration, misdoing, deceleration

Question 4

gait width

Answer 4

width of the base should not be more than 2-4 inches from heel to heel. Patients usually widen their gait if they feel dizzy or unsteady.

Question 5

gait length

Answer 5

Average step is approximately 15 inches. With pain or pathology of the lower extremity, the length of the step may decrease.

Question 6

normal gait

Answer 6

The width of the base should not be more than 2-4 inches from heel to heel. The body’s center of gravity should oscillate no more than 2 inches in a vertical direction. The knees should remain flexed during all of the stance phase. The pelvis and trunk should shift approximately 1 inch to the weight bearing side during gait. The approximate length of the step should be 15 inches. The average adult walks 90-120 steps per minute. During the swing phase, the pelvis should rotate 40 degrees forward with the opposite hip joint acting as the fulcrum.

Question 7

Abnormal gait

Answer 7

Observe for a greater width of base, shorter number of steps, uncoordinated footing and accentuated lateral shift of trunk and pelvis.

• Limps, deformities of extremities
• Use of supports such as walls or chair arms

Question 8

spastic hemiparesis

Answer 8

-The affected leg is stiff and extended with plantar flexion of the foot
· Movement of the foot results from pelvic tilting upward on the involved side
· The foot is dragged, often scraping the toe, or is circled stiffly outward and forward (circumduction)
· The affected arm remain fixed and abducted and does not swing
· Examples – cerebral palsy

Question 9

spastic diplegia (scissoring)

Answer 9

· Patient uses short steps, dragging the ball of the foot across the floor
· Legs are extended and the thighs tend to cross forward on each other at each step due to injury to the pyramidal system

Question 10

steppage/drop foot

Answer 10

· Hip and knee are elevated excessively high to lift the plantar flexed foot off the ground
· The foot is brought down to the floor with a slap
· Patient is unable to walk on heels
· Muscle weakness of tibialis anterior

Question 11

cerebellar ataxia

Answer 11

· Patient’s feet are wide based

· Staggering and lurching from side to side is often accompanied by swaying of the trunk

Question 12

sensory ataxia

Answer 12

· Patient’s gait is wide-based
· Feet are thrown forward and outward, bringing them down first on heels, then on toes
· Patient watches the ground to guide his/her steps
· Positive Romberg sign is present

Question 13

dystonia

Answer 13

· Jerky, dancing movements appear nondirectional

Question 14

ataxic gate

Answer 14

• imbalance and unsteadiness worse in dark or with eyes closed
• staggering gait looks like drunken sailor
• occurs as a lott of sensory info from feet or from cerebellar disorders

Question 15

abduction/adduction lurch

Answer 15

• AKA Trendelenburg’s gait
• During stance phase on affected side a weakened gluteus medius causes pt to tilt pelvis toward uninvolved side
• Muscle strength on the affected side not adequate to hold pelvis evenly

Question 16

extensor lurch

Answer 16

· Gluteus maximus muscle is weakened and patient must thrust his thorax posteriorly to maintain hip extension (an extensor or gluteus maximus lurch)

Question 17

flat foot

Answer 17

Patients with muscle weakness of the gastrocnemius-soleus group (S1-S2) may have a flat foot gait with no forceful toe off

Question 18

back knee

Answer 18

• Patients with quadriceps weakness cause knee to be unstable at heel strike
• they may manually push knee into extension with every step

Question 19

antalgic

Answer 19

· Patient limits the time of weight bearing on the affected leg to limit pain (pain, arthritis)

Question 20

what three systems are required for coordination of walking?

Answer 20

• CNS
• PNS
• Musculoskeletal

Question 21

apraxic gate

Answer 21

• organization of gait is impaired
• patient may freeze to ground, unable to initiate step (inability to start something)
• common in parkinson disease