Gait & Gait AidsGait & Gait Aids دکترامیر هوشنگ واحدی

متخصص طب فیزیکی و توانبخشی

Normal Gait & Abnormal Normal Gait & Abnormal

GaitGait

Why we should know “Normal Gait”

If we have sound knowledge of the characteristics of normal gait

We can accurately detect & interprete deviations from the normal gait pattern

60% 40%

60%40%

20-25%

Cadence 70-130 step/minStride width 5-10cm

Abnormal gaitAbnormal gait

Stance phase◦Antalgic◦Lateral trunk bending◦Anterior trunk bending◦Posterior trunk bending◦Lordosis◦Hyperextended knee◦Excessive knee flexion◦Excessive Genu Valgum or Varum

◦Inadequate Dorsi-flexion control◦Insufficient Push-off◦Abnormal walking base◦Internal or external limb rotation◦Excessive medial or lateral foot

contact◦Vaulting

Swing phase◦Circumduction◦Hip hiking◦Internal or external limb rotation◦Inadequate Dorsiflexion control◦Abnormal walking base

Antalgic gaitAntalgic gaitPain in stance phase : knee, hip, foot pain

Lateral trunk bendingLateral trunk bending

◦Hip abductor weakness◦Hip dislocation, coxa vara,

slipped capital femoral epiphysis

◦Hip pain◦Perineal pressure◦Involved limb relatively

shorter◦Compensation for

abducted gait

Trendelenberg gaitTrendelenberg gaitGluteus Medius Gait

Anterior Trunk BendingAnterior Trunk Bending

Quadriceps weakness combined with weakness of gluteus maximus, gastrocnemius, or both

Pushing backward with the hand / lateral rotation

Posterior Trunk BendingPosterior Trunk Bending

Gluteus Maximus (Lurch) Gait

Hip-extensor weaknessKnee ankylosis, spasticity

or orthotic knee lockHip-extensor spasticity

Hyperextended kneeHyperextended knee

Quadriceps weaknessCapsular ligament laxityQuadriceps spasticityPlantar-flexion contracture or

spasticityCompensation for contralateral

limb shortening (hip-flexion or knee-flexion contracture)

Excessive knee flexionExcessive knee flexion

Knee-flexion or hip-flexion contracture

Knee-flexor spasticityUncompensated quadriceps

weaknessAnkle ankylosis, pes calcaneusPlantar-flexor weaknessInvolved limb relatively longer

Steppage gaitSteppage gait

Ankle dorsiflexion weakness : compensate by exaggerated hip and knee flexion

Foot drop / dragging

Slap footSlap foot

◦Ankle dorsiflexion weakness : early stance phase

Insufficient Push-OffInsufficient Push-Off

Flat foot gait Plantar-flexor weakness Rupture of the Achilles

tendon or the triceps surae Metatarsal pain, hallux

rigidus

Internal or External Limb Internal or External Limb RotationRotation

Internal rotation◦Biceps femoris weakness◦spasticity

External rotation◦Quadriceps weakness◦Inner hamstring weakness◦Spasticity

Abnormal walking baseAbnormal walking base

Wide Base (> 4 inch)◦Hip-abduction contracture◦Instability due to fear, proprioceptive

deficit, cerebellar problem◦Perineal pain◦Genu valgum

Narrow base (< 2 inch)◦Spasticity◦Genu varum

VaultingVaulting

Swing-phase limb is relatively longer

Hip hikingHip hiking

◦Increased ipsilateral length: hip -flexor or dorsiflexion weakness hip, knee, ankle ankylosis or spasticity insufficient hip or knee flexion

◦Contralateral shortness

CircumductionCircumduction

SpasticityHip flexor weaknessHamstring paralysisKnee or ankle ankylosis /

orthotic knee lockDorsiflexion weaknessPlantar-flexion contracture

Scissoring gaitScissoring gaitIn spastic CP with spasticity of

adductor m.

Crouched GaitCrouched GaitExcessive flexion of hip and knee due to

spasticity, muscle tightness or contractureSpastic CP

Parkinsonian gaitParkinsonian gait Trunk ,head ,neck forwar

d and knee flexed

wide base ,small shuffling

step

trend to fall forward and t

o increase speed (festinat

ion)

Hemiplegic gaitHemiplegic gait

Abnormal arm swing : adduction with flexion a

t shoulder ,elbow ,wrist and fingers

extensor synergy of lower limb: leg extension

,adduction and hip IR ,knee extension ,ankle a

nd foot plantarflexion and inversion.

Gait aids

Purpose of gait aidsPurpose of gait aidsIncrease area of support,

maintain center of gravity over support area

Redistribute weight-bearing area

RequirementsRequirementsROM, muscle strength and

endurance, coordination, trunk balance, sensory perception, mental status

Amount of weight-bearing permitted on lower limb

RequirementsRequirements

Shoulder depressor – latissimus dorsi, lower trapezius, pectoralis minor

Shoulder adductor – pectoralis major

Shoulder flexor, extensor and abductor – deltoid

Elbow extensor – tricepsWrist extensor – ECR, ECU Finger flexor – FDS, FDP, FPL, FPB

CrutchesCrutchesBody weight transmission with bilateral

axillary crutches = 80% of BW, nonaxillary crutches = 40-50% of BW

Good strength of upper limbs usually required – more weight bearing and propulsion

Unilateral non/partial weight bearing eg fracture, amputee -> 3-point gait

Bilateral partial weight bearing or incoordination/ataxia -> 2 or 4-point gait

Bilateral weakness of lower extremities eg paraplegia -> swing-to or through gait

Non-axillary crutches◦Lofstrand/forearm crutches ◦Platform crutch◦Wooden forearm orthosis (Kenny

stick)◦Triceps weakness orthoses (arm

orthoses) eg Warm Spring, Everett, Canadian crutch

Axillary crutchesAxillary crutches

Crutch length : measure anterior axillary fold to point 6 inches anterolateral from foot or to heel plus 1-2 inches

Hand piece : elbow flexed 30 degree, wrist max extension, finger fist

2-3 FB from apex of axillaCompressive radial neuropathies

Lofstrand/forearm crutchesLofstrand/forearm crutchesSingle aluminum tubular adjustable shaft,

handpiece, forearm piece 2 inches below elbow, forearm cuff anterior opening (hinge)

Elbow flexion 20 degreeCan release hand without loosing crutchRequires great skill, good strength of UEs,

trunk balance

Platform crutchPlatform crutch

Painful wrist and hand condition or elbow contractures, or weak hand grip

Platform, velcro strapElbow flexed 90 degrees

Crutch GaitsCrutch GaitsPoint gait – stability, slowSwing gait – more energy, fast

Four-point gaitFour-point gaitGood stability - at least 3 point contact

groundAtaxia or incoordinationSlowest, difficulty

Three-point gait/alternating Three-point gait/alternating two-point gaittwo-point gait

Non-weight-bearing gait for lower limb fracture or amputation

3-point PWB gait -> required 18-36% more energy per unit distance than normal

NWB required 41-61%more energy per unit distance than normal

Two-point gaitTwo-point gaitFaster than 4-point gait but less stabilityDecrease both lower limbs weight-bearing

Swing-through gaitSwing-through gaitFastest gait, requires functional

abdominal musclesRequired increase of 41-61% in net

energy cost (= 3-point NWB)

Swing-to gaitSwing-to gait

Both crutches -> both lower limbs almost to crutch level

CanesCanesBody weight transmission for unilateral

cane opposite affected side is 20-25%Gluteus medius weakness, or

pathological at knee or ankle

Walker/WalkeretteWalker/Walkerette

Wider and more stable base of support, but slow gait (interfere smooth reciprocal gait)

For patients requiring maximum assistance with balance, uncoordinated

Add wheels to front legs for who lack coordination or power in upper limbs

Front of walker 12 inches in front of patient

Shoulder relaxed and elbow flexed 20 degree

Three-point gait