Abnormal gait.ppt..........................

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1. Abnormal Gait analysis

2. Normal gait requires adequate strength
& ROM of all participating joints,
proprioception & balance.
The body can adapt during injury or
pathology by making certain
biomechanical compensations.

3. KINEMATIC GAIT ANALYSIS
In which the movement pattern are described
without regard to the force producing it.
The primary variable examined are-
i.Patterns of movements.
ii.Deviations from normal body posture
iii.Joint angles at specific joints in gait cycle.

4. Observational gait analysis
OGA is the most common method preferred
for gait analysis.
It involves examination of movement
patterns in gait cycle
I.Ankle
II.Knee
III.Hip
IV.Pelvis
V.trunk

5. A recording form comprising of common gait
deviations such as
I.Toe drag
II.Excessive plantar flexion or dorsiflexion
III.Excessive varus or valgus at knee.
IV.Trunk deviations

6. Directions for performing OGA
Select the area in which the pt. will walk and
measurement the distance that you want the pt. to
cover.
Position yourself to allow an unobstructed view.
Select the joint or segment to be observed first eg.
Ankle and foot.
Select either frontal view or sagittal view.
Observe the selected segment and note any
deviations.
Repeat the process for each segment.

7. What to look for:
Symmetric heel strikes and toe off.
Rotation of legs
Levelness of hip.
Level of shoulders
Side tilt of trunk
Rotation of trunk
Position of head and neck
Symmetric swinging of arms

8. Ankle and foot deviations
1.Initial contact
Foot slap - At hike strike, forefoot slaps the ground. It
can be due to weak or atrophied dorsiflexors. Look for
high steppage gait.
Toes first – toes contact ground instead of heel. The tip-
toe posture may be maintained throughout the phase
or heel may contact the ground. In leg length
discrepancy , PLANTAR FLEXORS CONTRACTURES, painful
heel.
Entire foot contacts the ground at heel strike .In
excessive fixed dorsiflexion or in case of weak or flaccid
dorsiflexors.

9. 2.MIDSTANCE
Excessive positional plantar flexion because of no
eccentric contraction of plantar flexors.
Heel lift in mid stance –heel does not contact the
ground in midstance.
Toe clawing- toes flex and grab the floor. May be
because of plantar flexor grasp reflex if partially
integrated.
Excessive positional dorsiflexion- tibia advances too
rapidly over the foot.

10. 3.Push off phase deviations
No roll off – insufficient transfer of weight
from lateral heel to medial forefoot.
Flaccidity or inhibition of plantarflexors ,
invertors and toe flexors.

11. Ankle and foot
swing phase
Toe drag – insufficient dorsiflexion so that the
forefoot and toes do not clear foot. Flaccidity
or weakness of dorsiflexors.
Varus – the foot excessively inverted.
Spasticity of invertors or weakness of
evertors.

12. Knee deviations
stance
At initial contact – excessive knee flexion - may be
due to weak quads , shorter length on opp. Side.
Foot flat – knee hyperextension ( genu recurvatum)-
weak or spastic quads , soleus.
Pushoff –
excessive more than 40 knee flexion – rigid trunk , hip and
knee contractures.
Limited knee flexion – overactive quads or plantarflexors.

13. Knee deviations
swing
Acceleration to swing –
 Excessive knee flexion ( more than 65)- in
dysmetria , diminished pre-swing knee, flexor
withdrawal reflex.
Limited knee flexion – pain , diminished knee
ROM.

14. HIP DEVIATIONS
At heel strike –
excessive flexion – hip and knee contractures , hypertonicity of
hip flexors.
Limited flexion –weakness of hip flexors , limited ROM at hip.
Foot flat-

limited hip extension – hip flexion contractures or spasticity.
abduction – contracture of gluteus medius , trunk lateral lean over
ipsilateral hip.
Adduction-spasticity of hip flexors. Pelvic drop to contralateral
side.
External rotation – excessive backward rotation of opposite pelvis.

15. Hip deviations in Swing
Circumduction – consisting of abduction,external
rotation ,adduction and internal rotation.
Possible causes- compensation for weak hip flexors or
a compensation for the inability
to shorten the leg so that it can clear the floor.
Hip hiking- shortening of swing leg by action of
quadratus lumborum.
Excessive hip deviation- flexion greater than 30
degree.- in case of foot drop.

16. Trunk deviations in stance
Lateral trunk lean- lean over the stance side-
due to weakness of gluteus medius of
opposite side.
Backward lean-resulting in hyperextension of
hip-weakness of gluteus maximus.
Forward lean – resulting in excessive hip
flexion- as a compensation to quads
weakness.

17. Pathological gaits

18. Parkinson gait
Also known as festinating gait
Increase in cadence
Short stride length
Short rapid shuffling steps
Lack of heel strike and toe off.

19. Parkinsons gait

20. TRENDELENBURG GAIT

22. Scissoring gait
It a type of spastic gait
Bilateral adductor spasm at hip and equinus
contracture in ankle.
Pt lean forwards and outwards – unable to clear ground while
taking steps – pt raises the corresponding shoulder and knee
the tilts the body to opposite side—raises the knee and bring
forward --- walks on toes– hip and trunk sway from side to side
and flurring of arms in all directions.

24. SCISSORING GAIT

25. Ataxic gait
Increased BOS
Walk like a drunk and tendency to swing to
sides
Frequent falls.

26. Sensory ataxic gait ( stamping gait)
Little sensory cues
Look at the ground with increase BOS.
Raises affected thigh, throws it forward and then
stamps down.

27. Waddling gait
Body sways side to side.
Increase base of support
Shoulders are thrown back and abdomen thrust out.
Total paralysis of gluteus medius on both sides.
In dystrophic pts, they may be due to shortening of
calf muscle.

28. Waddling gait

29. High steppge gait/ foot
drop gait
Paralysis of dorsiflexors
Popliteal nerve paralysis or poliomyelitis.
During swing phase unable to clear the
ground.
During heel strike – forefoot slaps on ground.

30. Hand to knee gait
Normally during midstance , the knee is actively
extended and locked. This action is performed by
quadriceps.
In paralysis of quadriceps – in polio or femoral nerve
injury. The knee buckles because of instability.
To stabilize the knee ,the locking is done by passively
pushing the knee backward manually by the pts
putting his hand over the front thigh.

31. Lordotic gait/gluteus maximus
gait
In midstance, there is a tendency for the body to fall
forward hence restrain by force by gluteus maximus
( eccentrically contracted to tilt pelvis posteriorly and
retain COG over the supporting leg.
If gluteus maximus paralysed – the patient leans
backwards during heel strike using the extensors of
spine and throwing head back to extend hip COG
over stance leg.

32. GM GAIT

33. Hemiplegic
gait/circumduction gait
In stroke patients.
Due to extensor synergy of L/L ( quads and calf).
Knee flexion is prevented in late stance( toe off).
If spasticity, the initial contact is with the toes first
with ankle inverted( equinovarus position) nd knee
goes into full extension.
Pseudolengthening of affected limb does not allow a
proper clearance of ground unless it is compensated
by circumduction at affected side or hip hiking on
involved side.

34. Antalgic gait
To minimize pain pt shortens the duration of
stance phase on painful side and quickly
transfers to painless side leg.
The swing phase shortens of uninvolved leg
is reduced and brought front of affected leg.

35. Guess??