Gait/Abnormal Gait Flashcards
Other events besides what happens in the lower extremities must also be considered when looking at gait
Determinants of Gait
If you were to hold a marker against the blackboard, you would see a line that is up and down in a wave like fashion
Normal amount is approximately 2 inches
Highest at midstance
Lowest at heel strike
Vertical Displacement
Normal amount of vertical displacemnt is approximately 2 inches
It is Highest at ?
midstance
Normal amount of vertical displacemnt is approximately 2 inches
It is Lowest at ?
heel strike
- There is an equal amount of this displacement
- The center of gravity moves as the body weight shifts from side to side
- it is greatest during the single support phase at midstance
- The body must shift horizontally onto one foot so that the other foot can swing forward
- Usually about 2 inches
Horizontal Displacement
- When you walk, you do not walk in a tandem gait pattern, one step directly in front of the other
- If lines were drawn through the successive midpoints of heel contact on each foot, the distance would range from 2-4 inches
Width of Walking Base
- Step length should be equal in both distance and time
- The arms should swing with the opposite leg
- The trunk rotates forward as the leg progresses through the swing phase
- Arms swing in opposition to the trunk rotation helps to control the amount of trunk rotation by providing counter-rotation
Normal Gait
- Not all gait patterns that aren’t normal are a result of pathology
- The walking patterns of young children and elderly adults have characteristics different than that of normal adults
Age Related Gait Patterns
Differences in younger children tend to disappear as they get older
what are the differences?
- wide BOS
- fast cadence
- short stride lengths
- flat footed
- no arm swing
- short and choppy steps
for the elderly Generally, the fear of falling is a major contributor to changes in walking patterns as well as decreased muscle mass, less active lifestyle.
What are some characteristics
- Slow cadence
- More time in stance phase
- Longer periods of double support
- Shorter steps, decreasing vertical displacement
- Fewer, slower automatic movements
- Greater horizontal displacement as they have a wider BOS
Causes for Abnormal Gait
- Muscular Weakness
- Joint muscle ROM limitations/contractures
- Neurological Involvement
- Pain
- Leg Length Discrepancy
- Can range from slight weakness to complete paralysis
- The body tends to compensate by shifting the COG over/towards the part that is limited, reducing the torque (reduces moment arm) on the joint
- Lessens the muscle strength required
- The portion of the gait cycle limited will depend on which joint is affected
Muscular Weakness
- Trunk shifts posteriorly at heel strike
- Shifting the body’s COG posteriorly over GM, moving the line of force posterior to the hips
- With the foot in contact with the floor, this requires less muscle strength to maintain the hip in extension during stance phase
- Rocking Horse Gait
Gluteus Maximus Gait
- The individual shifts the trunk over the affected side during stance phase
- As the R side is weak:
- The left side of the pelvis will drop when the left leg leaves the ground and begins swing phase
- the body leans over the right (affected) leg during stance phase of the right leg
Gluteus Medius Gait
- Referred to as the Trendelenburg Gait
- Not to be confused with the normal amount of dipping of the pelvis
- The trunk shifting is a result of an attempt to reduce the amount of strength needed to stabilize the pelvis
Gluteus Medius Gait
Several different compensatory movements can be used
- Leaning the body forward over the quads as the weight is shifted onto the stance leg
- By leaning forward at the hip, the COG is shifted forward and the line of force now falls in front of the knee forcing the knee into hyperextension
- Using the hip extensors and ankle plantarflexors to pull the knee into extension at heel strike
- A person may also push on the anterior thigh during stance phase, physically holding the knee in extension
Quadriceps Weakness
2 Possibilities
In stance phase, the knee will go into excessive hyperextension
-Called genu recurvatum gait
Without the these eccentrically contracting to slow the swing during swing phase of gait, the knee snaps into extension
Hamstring Weakness
Sufficient strength in the ______ ________ will hold the foot in neutral at the end of swing phase and initial contact. It will also result in a slow, controlled eccentric lowering of the forefoot during loading response.
Ankle Dorsiflexors
Insufficient strength in the dorsiflexors will result in numerous abnormalities such as
This gait, is where the toes strike first
Tip toe down, and then the remainder of the foot contact the ground
Equinnus gait
Weak Ankle Dorsiflexors
If the dorsiflexors are unable to control the descent of the foot, the foot slaps into plantarflexion as more weight is put onto the leg
Foot slap
Weak Ankle Dorsiflexors
During swing phase, if the patient is unable to dorsiflex, they might experience a drop foot gait pattern and the knee will have to be lifted higher to clear the toes causing what type of gait.
steppage gait
- Commonly seen with muscular and other types of dystrophies because there is diffuse weakness of many muscle groups
- Shoulders begin behind the hips, much like a person with paraplegia would be resting on their “y” or iliofemoral ligament
- Increased lumbar lordosis, pelvic instability and trendelenburg gait. Little to no reciprocal pelvis and trunk rotation occur
- To swing the leg forward, the entire side of the body must swing forward and the ipsilateral side must swing forward as well
- Add to this the instability of a trendelenburg gait pattern causing an excessive trunk lean and you have a waddling gait pattern
- Steppage gait is also often present in this gait pattern
Waddling Gait
The hip is unable to go into hip extension during midstance and terminal stance
- To compensate, the person will assume a “salutation” or greeting position where the hip is flexed and the person’s trunk leans forward as if they are bowing
- The knee might be flexed as well
Hip Flexion Contracture
- Increased motion of the lumbar spine and pelvis compensate for hip motion
- A decreased lordosis and posterior pelvic tilt will allow the leg to swing forward where as an increased lordosis and anterior pelvic tilt will force the leg to swing posteriorly
- Called a “bell clapper” gait pattern, as the clapper in a bell would swing back and forth
Fused Hip
- Results in excessive dorsiflexion during midstance and an early heel rise during push-off (terminal stance)
- There is also a shortened step length of the unaffected side
- If present, the lower leg would be at a fixed length and that length would depend on the position of the joint
Knee Flexion Contracture
If the knee is in extension, the leg will be unable to shorten during swing phase
To compensate the person must
- Rise up onto the toes of the unaffected leg resulting in a vaulted gait
- Hike the hip of the involved side
- Swing the leg out to the side (circumducted gait)
- Or some variation of the above three methods
Knee Extension Fusion
- The leg begins near the midline at terminal stance, swings out to the side during swing phase and then returns to midline for heel strike
Circumducted Gait
A Circumducted Gait, but with the leg remaining in abduction instead of returning to midline
abducted gait
what makes up the Triceps Surae
Plantarflexors : Gastrocnemus, Soleus, Plantaris
Several things may result from this contracture:
- Hyperextension of the knee during midstance
- Limited ankle dorsiflexion
- Early heel rise during push off
- The knee is lifted higher during swing phase
- The toes will land first during heel strike
Steppage gait (What else caused steppage gait?
Triceps Surae Contracture
- Commonly called a triple arthrodesis because of fusion of the subtalar joint and the two transtarsal joints
- Results in a loss of pronation and supination with a limitation in plantarflexion and dorsiflexion
- Usually results in a shortened stride length
- Difficulty walking on uneven ground d/t the loss of supination and pronation
Ankle Fusion
Neurological Involvement Gait Patterns
Gait Disturbances
Depend on the amount and severity of neurological involvement?
Spasticity
Flaccidity
- Varies and depends on the severity of neurological involvement and the amount of spasticity
- Typically, there is an extension synergy involving hip extension, adduction and medial rotation
- The knee is often unstable
- Ankle demonstrates a drop foot with PF and inversion
Hemiplegic Gait
- Upper extremity is typically in a flexor synergy and there is no reciprocal arm swing
- Step length tends to be lengthened on the involved side and shortened on the uninvolved side
Hemiplegic Gait
- Cerebellar involvement results in an ataxic gait
- Lack of coordination results in jerky, uneven movements
- Poor balance, wide BOS (abducted gait)
- Difficulty with tandem walking
- Tends to stagger
- Reciprocal arm motion also appears jerky and uneven
- All movements appear exaggerated
Ataxic Gait
- Diminished movement
- Posture of the lower extremities and trunk tend to be flexed
- Elbows are partially flexed and there is little to no reciprocal arm swing
- Stride length is greatly diminished and the forward heel does not swing beyond the rearfoot
- Shuffling gait with feet flat and weight mostly on the toes
- The person has difficulty initiating and slowing movements and as the patient get moving, they have a difficult time slowing and it gives the appearance that their feet are trying to catch up to the forward trunk lean
Parkinsonian Gait
A Parkinson’s pt that gives the appearance that their feet are trying to catch up to the forward trunk lean
festinating gait pattern
- Spasticity in the hip adductors
- Most evident during the swing phase in which the unsupported leg swings against or across the stance leg
- Narrowed BOS
- Trunk may lean over the stance leg as the swing phase leg attempts to swing past it
Scissoring Gait
- Spastic diplegia (seen in CP), B LE involvement
- Excessive flexion, adduction and medial rotation at the hips and flexion at the knees
- Ankles are plantarflexed
- Pelvis maintains an anterior pelvic tilt and there is an increased lumbar lordosis
- Reciprocal arm swing and horizontal displacement are exaggerated
Crouch Gait
- Pain is a limiting factor in ambulatory status of a patient
- Tendency is to shorten the stance phase
- If it hurts to stand on it, they don’t want to stand on it!
- A shortened, abducted stance phase on the involved side results in a rapid and shortened step length on the uninvolved side
- Compensation in the reciprocal arm swing is evident
Pain/Antalgic gait
The person will tend to lean over the involved side to decrease the torque on the joint and the amount of weight bearing through the leg
Pain
- What amount of leg discrepancy is ¼” to 3”?
- Compensation occurs by dropping the pelvis on the affected side
- Adds stress to the low back and compensation is made by leaning over the shorter leg
Minimal
- What amount of leg discrepancy is 3” to 5”?
- Patient will tend to walk on the ball of their foot on their involved limb (or shorter side), known as an equinnus gait
Moderate discrepancy
What amount of leg discrepancy is >5”?
- Compensation in a variety of ways
- Dropping the pelvis and walking with equinnus plus flexing the knee on the uninvolved side
- Get an idea, walk outside with one leg on the street and one on the curb
Severe discrepancy
