gait margo prim haynes, pt, dpt, ma, pcs mary rose franjoine, pt, dpt, ms, pcs 2009
TRANSCRIPT
GAIT
Margo Prim Haynes, PT, DPT, MA, PCSMary Rose Franjoine, PT, DPT, MS, PCS
2009
2009 Margo Prim Haynes & Mary Rose Franjoine
Overview
Definitions Video of typical gait Developmental changes Gait cycle Ground reaction force vectors Atypical gait Lab
Learning Objectives
At the conclusion of this lecture the learner will:1. Describe the characteristics of early gait.2. Describe the key developmental factors that influence the
development and refinement of gait.3 . Identify and describe the characteristics of typical gait
differentiating components of stance phase from swing phase.
4. Visually identify key components of typical gait. 5. Describe the impact of ground reaction forces on the
stance limb. 6. Discriminate typical from atypical components of gait. 7. Design intervention strategies to address key impairments
that contribute to an atypical gait pattern.
Margo Prim Haynes & Mary Rose Franjoine
2009 Margo Prim Haynes & Mary Rose Franjoine
An Early Walker
Video Clip
2009 Margo Prim Haynes & Mary Rose Franjoine
Characteristics of Early Gait BOS wider than hips,
therefore hindfoot pronation (eversion) results
Contact with floor occurs with foot flat Heel to toe gait develops
by 2 yrs/ process complete by 3.5 yrs
Uneven step length
2009 Margo Prim Haynes & Mary Rose Franjoine
Characteristics of Early Gait
Hyperextension of knees throughout stance phase
Greater ant.-post. pelvic movement
Less lateral (pelvic tilting ) & rotational pelvic movement
2009 Margo Prim Haynes & Mary Rose Franjoine
Characteristics of Early Gait Greater hip & knee flexion
with abduction & external rotation of hip and tibia during swing phase
2009 Margo Prim Haynes & Mary Rose Franjoine
Characteristics of Early Gait
Upper Extremities (UE) in high, medium, then low guard with improved trunk balance
Reciprocal arm swing developing at 18 months
2009 Margo Prim Haynes & Mary Rose Franjoine
Kinematic Changes between 1 - 7 Years of Age
↑ duration of single limb stance (esp. to 2.5 yrs) ↑ walking velocity (esp. to 3.5 yrs) ↓ cadence and its variability ↑ step length (esp. to 2.5 yrs) Ratio of body width to stride width: ↑s rapidly
until 2.5 yrs, more slowly to 3.5 yrs, then plateaus
2009 Margo Prim Haynes & Mary Rose Franjoine
Indicators of Mature Gait
Greater % time in single limb stance with increased limb length and stability
Increased velocity Decreased cadence Greater step length Decreased base of support
2009 Margo Prim Haynes & Mary Rose Franjoine
Gait
Video
2009 Margo Prim Haynes & Mary Rose Franjoine
60% of cycle 40% of cycle
Perry 1992
2009 Margo Prim Haynes & Mary Rose Franjoine
Gait Cycle
Typical walking has 50-60 steps taken per minute
Two phases Stance phase Swing phase
2009 Margo Prim Haynes & Mary Rose Franjoine
Stance Phase
Heel contact (weight acceptance) to toe off 60% of gait cycle
2009 Margo Prim Haynes & Mary Rose Franjoine
Swing Phase
Toe off to before heel strike 40% of gait cycle
2009 Margo Prim Haynes & Mary Rose Franjoine
Quiet Standing
Slow shifting of body weight between limbs due to cardiac dynamics & lack of absolute proprioception Feet generally parallel COG slightly anterior to the ankle joint
Tendency for trunk to move forward & plantarflexors (pf) must hold to stand in place
To move, pf must “let go” (very difficult for children to do with CP as they rely on extension to stay up)
2009 Margo Prim Haynes & Mary Rose Franjoine
Functional Phases of Gait
Stance Phase (60%) Initial contact Loading response Single limb stance
Midstance Terminal stance
Pre-swing=toe off
Swing Phase (40%) Pre-swing Initial swing Midswing Terminal swing
2009 Margo Prim Haynes & Mary Rose Franjoine
Initial Contact
The instant at which foot touches floor Ankle locked in supination
Adduction, inversion, and plantarflexion
2009 Margo Prim Haynes & Mary Rose Franjoine
Loading Response
Begins immediately after heel contact (heel strike) & continues until other foot is lifted for swing (foot flat) Ankle unlocked in pronation
(abduction, eversion, and dorsiflexion
Double Stance Deceleration
2009 Margo Prim Haynes & Mary Rose Franjoine
Single Limb Stance
Period of time when opposite limb is going through swing phase
Foot/ankle moves to locked position of supination preparing the foot and ankle for push off.
2009 Margo Prim Haynes & Mary Rose Franjoine
Weight bearing Surface of Foot
At heel contact, weight is lateral to the midline of the heel
Weight moves forward in a straight line towards head of third metatarsal
Then weight shifts medially to allow push off from first metatarsal head when initial swing begins
2009 Margo Prim Haynes & Mary Rose Franjoine
Weight Bearing Surface of foot
2009 Margo Prim Haynes & Mary Rose Franjoine
Pre-Swing
Begins with initial contact of opposite limb and ends with ipsilateral toe-off
2009 Margo Prim Haynes & Mary Rose Franjoine
Initial Swing
Begins with lift of the foot from the floor and ends when swinging foot is opposite the stance foot
2009 Margo Prim Haynes & Mary Rose Franjoine
Midswing
Begins when swing limb is opposite stance limb and ends when swinging limb is forward and tibia is vertical
2009 Margo Prim Haynes & Mary Rose Franjoine
Terminal Swing
Begins with vertical tibia and ends when foot contacts (strikes) the floor
2009 Margo Prim Haynes & Mary Rose Franjoine
Sinusoidal Pattern
Limb motion during walking is based on maintaining a symmetric and low amplitude displacement of the center of gravity (COG) in the lateral and vertical directions. Initial Contact Double limb support Midstance
2009 Margo Prim Haynes & Mary Rose Franjoine Perry, 1992
Sinusoidal Pattern
2009 Margo Prim Haynes & Mary Rose Franjoine
Sinusoidal Pattern
COG: Lowest during initial contact Central and low during double limb support Highest and most lateral in midstance Moves 4 cm medial-lateral shift, 2 cm
vertical shift
2009 Margo Prim Haynes & Mary Rose Franjoine
Ground Reaction Force Vectors(GRFV)
Determines the stability or instability by relating alignment of GRFV to the joint centers
Ankle gains stability with 5° dorsiflexion Three forces (body vectors)
Falling body weight Ligamentous tension Body vector as passive stability when the joints
are hyperextended
2009 Margo Prim Haynes & Mary Rose Franjoine
Body vector as passive stability when the joints are hyperextended
Joints are locked by bodyweight vector on one sideand ligamentous tensionon the other.
← iliofemoral ligament
Posterior oblique ligament →
Perry 1992
This explains the posture of the child with hypotonicity
2009 Margo Prim Haynes & Mary Rose Franjoine
Perry 1992
Ground Force Reaction Vector
Initial contact to loading
2009 Margo Prim Haynes & Mary Rose Franjoine
Muscle Activation
Perry 1992
2009 Margo Prim Haynes & Mary Rose Franjoine
Critical Events for:
Initial contact is heel first contact
2009 Margo Prim Haynes & Mary Rose Franjoine
Critical Events for:
Loading response is hip stability, controlled knee flexion, and plantarflexion
2009 Margo Prim Haynes & Mary Rose Franjoine
b
Ground Force Reaction Vector
Perry 1992
2009 Margo Prim Haynes & Mary Rose Franjoine
b
Muscle Activation
(muscles are more balanced, therefore less hard work)
Perry 1992
2009 Margo Prim Haynes & Mary Rose Franjoine
Critical Events is:
Controlled tibial advancement to create a forward fall position.
2009 Margo Prim Haynes & Mary Rose Franjoine
c
Ground Force Reaction Vector
Perry 1992
2009 Margo Prim Haynes & Mary Rose Franjoine
c
Muscle Activation
Perry 1992
2009 Margo Prim Haynes & Mary Rose Franjoine
Critical Events is to have
Ankle locked in dorsiflexion with heel rise; trailing limb
Ankle mobility(This is where the children with
plantarflexion contractures have problems)
2009 Margo Prim Haynes & Mary Rose Franjoine
Gait Analysis
Observation Pedograph Motion analysis Dynamic electromyography Force plate recordings Energy cost measurement
2009 Margo Prim Haynes & Mary Rose Franjoine
Five Determinants of Gait1. Lateral pelvic movement (gluteus medius
prevents positive Trendelenberg)2. Rotational pelvic movement (one side moves
forward of the other side to minimize vertical shift of the COG, allows for stride length)
3. Knee flexion(allow for limb length adjustment)4. Knee/ankle/foot interactions (minimizes the
vertical shift of the COG) 5. Physiologic valgus (narrows BOS)
2009 Margo Prim Haynes & Mary Rose Franjoine
Five Determinants of Gait
1. Lateral pelvic movement (gluteus medius prevents positive Trendelenberg)
2. Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length)
3. Knee flexion(allow for limb length adjustment)
4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG)
5. Physiologic valgus (narrows BOS)
2009 Margo Prim Haynes & Mary Rose Franjoine
Five Determinants of Gait1. Lateral pelvic movement (gluteus medius prevents positive
Trendelenberg)
2. Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length)
3. Knee flexion(allow for limb length adjustment)4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG) 5. Physiologic valgus (narrows BOS)
2009 Margo Prim Haynes & Mary Rose Franjoine
Five Determinants of Gait
1. Lateral pelvic movement (gluteus medius prevents positive Trendelenberg)
2. Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length)
3. Knee flexion(allow for limb length adjustment)
4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG)5. Physiologic valgus (narrows BOS)
2009 Margo Prim Haynes & Mary Rose Franjoine
Five Determinants of Gait1. Lateral pelvic movement (gluteus medius prevents positive
Trendelenberg)2. Rotational pelvic movement (one side moves forward of the other side
to minimize vertical shift of the COG, allows for stride length)3. Knee flexion(allow for limb length adjustment)
4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG)
5. Physiologic valgus (narrows BOS)
2009 Margo Prim Haynes & Mary Rose Franjoine
Five Determinants of Gait1. Lateral pelvic movement (gluteus medius prevents positive
Trendelenberg)2. Rotational pelvic movement (one side moves forward of the other side
to minimize vertical shift of the COG, allows for stride length)3. Knee flexion(allow for limb length adjustment)4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG)
5. Physiologic valgus (narrows BOS)
2009 Margo Prim Haynes & Mary Rose Franjoine
Bibliography Perry J: Gait Analysis Normal and Pathological
Function, NJ: SLACK Inc. 1992 Shumway-Cook & Woollacott: Motor Control Theory
and Practical Applications, Baltimore: Williams & Wilkins, 1995
Sutherland D: Gait Disorders in Childhood and Adolescence, Baltimore: Williams & Wilkins, 1984
Weber & Weber: Mechanics of the Human Walking Apparatus, Berlin: Springer-Verlag, 1992
2009 Margo Prim Haynes & Mary Rose Franjoine
Original Template designed by: Margo Prim Haynes, PT, DPT, MA, PCS Jane Styer Acevedo, PT