Gait Flashcards
Describe phases of gait
Stance phase (60%) Time foot is in contact with ground and bearing weight
Swing phase (40%) Time foot is not in contact with ground
Describe normal gait cycle
Stability in stance – we have to be able to transfer weight from one foot to the other and therefore need to be able to stand on one leg. This ability requires adequate neuromuscular and proprioceptive (joint position sense) function.
Foot clearance during the swing phase – we need to be able to raise the foot off the ground as we bring it forward
Pre-positioning for initial contact – we need to be able to prepare the position of the foot for the next stance phase
Adequate step length – the lower limb needs to be brought forward by a suitable distance during the swing phase before making contact with the ground during the next stance phase
Energy conservation – we need to make our movements as energy-efficient as possible (see notes below).
Describe stance phase
Initial contact – in normal gait the first part of the foot to strike the ground is the heel. ‘heel strike’
Loading response - this is the period of deceleration where the shock of then impact is absorbed by the knee and ankle joints. The person rocks forwards on their heel, ready to bring the rest of their foot into contact with the ground.
Mid-stance – the foot is flat on the ground and the centre of gravity of the body is shifted from behind the foot to in front of the foot, ready for forward propulsion.
Terminal stance – The ankle is plantarflexed and the heel of the supporting leg raises from the ground.
Pre-swing – The metatarsophalangeal joints flex to give a ‘push off’ by the toes
Describe swing phase
Initial swing – the knee flexes to enable the foot to clear the ground
Mid-swing – the hip flexes and the pelvis ‘swings’ forwards to enable forward progression (moving forwards). There is dorsiflexion of the ankle to the neutral (anatomical) position.
Terminal swing – the knee extends, and the foot is brought close to the ground in preparation for the initial contact (heel strike)
Define stride
The distance from initial contact with one leg to the next initial contact with the same leg
Define step
The distance from initial contact with the one leg to initial contact with the opposite leg
(there are 2 steps for every stride)
Define cadence
The number of steps per minute
Concentric contraction (shortening)
acceleration and power generation
Eccentric contraction (lengthening
deceleration and shock absorption
Isometric contraction (same length)
stability
why do you get pathological gait
Nerve lesions
Joint instability
Immobility of joints and pain
Observation and diagnosis of gait abnormalities
phases of walking lower limb joint movement stride length arm swing lateral movements of the shoulders and head.
Antalgic gait
Patients walk in a manner that reduces pain e.g in OA of hip
Walk with limp
Shortening stance phase of painful limb i.e. more time walking on less painful limb
Shorten swing phase in unaffected limb
Uneven gait
Walking stick to reduce laod throguh painful limb
Walking stick used in hand opposte the painful limb
Patient can lean towards the walking stick, shift their cenre of gravity away from painful limb and therefore reduce load through it during the stance phase
Trendelenburg gait
Lesion of superior gluteal nerve (and conseuqent muscle paralysis) e.g. as a complication of hip surgery or injections to buttock
Muscle pain and inhibiton of function e.g. in hip OA
Trauma e.g. fractures of greater trochanter (site of insertion of gluteaus mmedisu) or dislocation of hip)
Biomechanical hip instability e.g. developmental dysplasia of hip
Stance phase of trendelburg gait
Pelvis drps on unaffected side
Patient often tries to compensate for this by swining their toros over towards affected side
Hemiplegic gait
Due to paraslysis of one side of body
- Stroke - Consequence of cerebral palsy
Trauma to CNS e..g head injury, spinal cord injury
Patient has splasticity (continuous contraction) of affected side of body
Most severe in flexor mscles of upper limb
And extensor msucles of lower limb
Flexed upper limb and an extended lower limb
Cannot flex hip, knee or ankle
In order to take a step they need to lean towards the unaffected side of body then circumduct the paralysed leg
The patient cannot bear much weight on the paralysed
leg so the stance phase on this limb is very short.
Their gait therefore comprises a short step with the unaffected leg followed by circumduction of the affected leg
Diplegic gait
Spasticitct affects both lower limbs
Develops in cerebral palsy
Walks with v.narrow based gait (feet closed together)
Dragging both legs Scarping toes on ground
Spasticity in the hip adductors can cause the legs to cross the midline – this is referred to as scissoring
Spasticity in the hamstrings means that the knees are slightly flexed and spasticity in the gastrocnemius and soleus results in plantar-flexion of the ankles.
In a diplegic gait it is commonly the forefoot that makes the initial contact with the ground
High steppage gait
Weakness of ankle dorsiflexion = foot drop
When the foot is raised from the ground in the swing phase, the absence of active dorsiflexion means that the foot, under gravity, assumes a position of plantarflexion.
The patient therefore has to flex the hip much more than usual in order to lift their foot high off the ground and stop their toes from dragging along the floor.
During ‘initial contact’, the normal eccentric contraction of the tibialis anterior muscle is absent so the foot also tends to slap down onto the ground.
If the deep peroneal nerve is damaged but the superficial peroneal nerve is intact, instead of a classical high-steppage gait, the patient may compensate for the lack of dorsiflexion during the swing phase by everting their foot in a sudden motion, called an eversion flick.
Causes of high steppage gait
Causes
- Common peroneal nerve palsy e.g. trauma to the nerve following a fracture of the neck of the fibula; compression of the nerve against the fibular neck by a tightly applied plaster cast; - peripheral neuropathy (e.g. in poorly controlled diabetes) - Sciatica (Remember: the L4 myotome dorsiflexes the ankle - Neuromuscular disease e.g. Charcot-Marie-Tooth disease (a hereditary motor and sensory neuropathy).
Parkinsonian gait
Nerve cells in a part of the brain called the subtantia nigra degenerate, leading to reduction in a chemical called dopamine.
Dopamine plays a vital role in regulating body movement.
difficult to initiate movement. To counteract this they flex their neck and trunk forwards to move their centre of gravity in front of their lower limbs.
very short steps, known as a shuffling gait and may also exhibit a ‘festinant’ gait, which is the tendency to take accelerating steps.
typically have loss of arm swing whilst walking.
Ataxic gait - causes
Proprioceptive (loss of awareness of the position of your joints)
Cerebellar disease (normally coordinates elements of movement e.g. posture, balance, speech)
Vestibular (damage to the organs of balance in the inner ear)
3 types of cerebella dysfunction
Cerebellar dysfunction can be either:
Inherited – some degenerative conditions specifically affect the cerebellum
Acquired e.g. a stroke affecting the cerebellum
Due to acute alcohol intoxication (being ‘drunk’)
titubation
Patients often hold their arms outwards to help them to balance. Whilst standing still, the patient’s body may sway back and forth and from side to side
Patients will not be able to walk heel-to toes or in a straight line
