Gait (Week 5--Aragaki) Flashcards
Things observational gait analysis should assess for
Joint ROM
Muscle function and activation
Timing
Energy requirement
Safety–fall risk
Cosmesis (general look of gait)
Step
Initial contact (IC) of one limb to IC of contralateral limb
Stride
IC of one limb to IC of same limb
Cadence
Steps per minute
Velocity
Distance per time
Normal = 3 mph
Percentage of time spent on one leg vs. two in gait
80% of gait cycle single limb support
20% of gait cycle double limb support
Increased double limb support for stability in elderly and toddlers
No double limb support in running
8 phases of gait cycle
Initial contact
Loading response
Midstance
Terminal stance
Pre-swing
(end of stance, beginning of swing)
Initial swing
Midswing
Terminal swing
Stance vs. swing
Stance is when limb is in contact with ground (initial contact thru pre-swing)
Swing is when limb is advancing in the air (initial swing thru terminal swing)
Important note about what muscles do during gait
They can either move or stabilize a limb joint
Do all gait deviations lead to disability or functional limitations?
No!
But analyzing the way someone walks can give insight to person’s symptoms or disease process
2 categories for atypical gait patterns
Primary
Compensatory
History to ask about when assessing gait
Falls
Pain
Medical problems
Past surgeries
What to look for on exam when assessing gait
Joint contractures
Muscle spasticity or weakness
Impaired sensation or balance
Also note the person’s shoes! (uneven wear pattern)
How to observe gait
View subject walk from side, front and behind
Listen for abnormal or asymmetric sounds and rhythms
Describe what you see/hear and at what phase you noticed it
Antalgic gait
AKA limp, hobble
Uneven weight distribution on lower limbs due to guarding from pain
May lean to one side, spend less time on painful limb and wince/groan
Gait deviation examples
Foot drop: very weak or absent dorsiflexion, initial contact with plantarflexed or flat foot; may need to “high step” to clear toes
Food slap: moderately weak dorsiflexion, cannot gently decelerate foot quietly
Foot drag: unable to clear foot during swing because of inadequate dorsiflexion, knee flexion or hip flexion
S1 radiculopathy
Can result in reduced strength in gastrocnemius, soleus, hamstring, and gluteal muscles
Gait abnormality is weak push off in pre-swing (last part of stance)
Spastic hemiparesis in stroke
Need to compensate for functional leg length discrepancy:
Vaulting: tip toe on strong side to help raise weaker (or longer) limb
Hip hiking: raising pelvis on weak side to clear limb
Circumduction: swing weak limg in wider arc to clear foot
Steppage: exaggerated hip and knee flexion to clear forefoot
In general, foot may be varus and knee hyperextended in these cases
Muscular dystrophy/myopathy
Trendelenburg gait: caused by weak gluteus medius muscle leading to drop in pelvis on opposite side; can compensate for this weakness by leaning trunk over affected hip giving a waddling appearance
Also will see lumbar lordosis (due to weak hip abductors), toe walking (weak quads so plantarflexion helps stabilize knees)
Parkinson’s disease
Festinating gait: characteristic “shuffle” of Parkinson’s Disease; increased cadence, reduced step length, postural instability and forward trunk lean; appears as if they’re “chasing their center of gravity”
Huntington’s disease
Chorea: dance-like maneuvering, exaaggerated writhing movements
Cerebellar ataxia
Ataxic gait: lack of coordination, widened base of support, unsteady limb placement and high fall risk
