Gait Analysis.pptx

Gait analysis and abnormal gaits

1. Gait Analysis Dr. Mohammad Taqi Ehsani PGy1 Resident of Orthopedics, fmic

2. Outline Phases of Gait Temporal Parameters Neurological Control of Gait Kinematics Kinetics Assess the Gait Abnormal Gaits

3. Observing a child’s gait is an integral part of the orthopedics examination A systematic approach to gait analysis—that is, looking at the trunk and each joint moving in all three planes (sagittal, coronal, and transverse)—can yield valuable information about the patient’s condition and help in establishing a treatment plan the patient needs to be as unclothed as deemed appropriate There should be adequate space for the child to walk comfortably and naturally

4. Phases of gait time during which the limb is in contact with the ground and supporting the weight of the body During running, double limb support disappears and is replaced by double-limb float, a period during which neither leg is in contact with the ground the time when the limb is advancing forward off the ground (the advancing limb is not in contact with the ground and body weight is supported by the contralateral limb)

5. Temporal Parameters Cadence: Normal 100-110 steps/min Velocity: average walking speed+80m/min

6. Neurologic Control of Gait The entire neurologic system plays a role in gait Most of the muscular actions that occur during gait are programmed as involuntary reflex arcs involving all areas of the brain and spinal cord The extrapyramidal tracts are responsible for most complex, unconscious pathways Voluntary modulation of gait (e.g., altering speed, stepping over an obstacle, changing direction) is made possible through interaction of the motor cortex The cerebellum is important in controlling balance when the neurologic system is abnormal (e.g., in cerebral palsy), the delicate control of gait is disturbed, leading to pathologic reflexes and abnormal movements.

7. kinematics defined as the study of the angular rotations of each joint during movement In simpler terms, kinematics denotes the motions observed and measured at the pelvis, hip, knee, and ankle during the stance and swing phases of gait Kinematics can be observed in three planes—the sagittal plane (flexion and extension), coronal plane (hip abduction and adduction), and transverse plane (rotation of the hips, tibiae, or feet) The data are collected by the three-dimensional tracking of markers placed over bony landmarks by infrared cameras positioned in the gait laboratory.

8. Kinetics Kinetics are the forces generated by the muscles and joints during gait. Kinetic data are reported as moments (forces acting about a center of rotation) and powers. These forces can be measured from force plates in a gait analysis laboratory

9. pedobarography Pedobarography is the measurement of plantar pressures during gait Using specialized force plates with a high number of sensors per area, the contact area of the foot and pressure and timing of the pressure can be documented Pressure data for the feet of younger children demonstrate a number of differences compared with those of adults. For example, younger children typically have higher medial midfoot pressure, which correlates clinically with lack of the longitudinal arch of the foot.

10. Assess the gait HEEL TO TOE We look for: Can maintain the streamline? Leaning to sides? Flapping on both side could be ATAXIA

11. Assess the gait WALKING IN HEELS Primary muscles that keep your toe above the grounds are dorsiflexors with innervated by deep fibular nerve

12. Assess the gait WALKING IN TOES Plantar flexors keeps the heel of the ground, innervated by tibial nerve

13. Assess the gait

14. Unterberger’s test or Fukuda stepping test Patient closes eyes and stretches arms out in front Walks on spot for a minute The knees raised as high as possible Patients with vertigo will start to turn his axis in particular direction Positive >45 degree

15. Abnormal gaits Hemiplegic gait Diplegic gait Neuropathic gait Myopathic gait Parkinsonian gait Ataxic gait Sensory ataxic gait Choreiform gait Antalgic gait

16. Hemiplegic gait Plegia or weakness on one side High flexor adductor tone, circumdact the leg

17. Diplegic gait Seen in CP patients Strong adductor tone (so thigh: scissoring gait) Planter flexing flexion in arms

18. Neuropathic gait Neuropathy Involvement of deep fibular nerve (lesion or neuropathy) Can’t keep dorsiflexors in contracting High steppage or drag the foot Unilaterally: Deep fibular nerve lesion, radiculopathy or nerve root compression of L4-5 Bilaterally: Diabetic neuropathy, Charcot-Marie tooth disease

19. Myopathic gait Myopathies, like positive Trendelenburg sign Dermatomyositis, poliomyelitis, sup. Gluteal nerve lesion, Duchenne muscular dystrophy, proximal hip muscle weakness Leaning, Hyper lordotic curve, waddling gait

20. Parkinsonian gait Parkinson's disease, Parkinsonian’s disease (drug induced) Very slow and small steps, tremor, hunch back, when stopped its hard to maintain themselves Positive retropulsion test

21. Ataxic gait Cerebellar lesion Sever alcohol intoxication Wide stance, hunched over, falling to sides

22. Sensory ataxic gait Dorsoculomn lesions, particularly involving proprioceptive sensation (body awareness sense, tells us where our body parts are without having to look for them) instead uses vibration Multiple sclerosis, Tabes Dorsalis, Tertiary Syphilis, B12 Deficiency

23. Choreiform gait Huntington’s disease, Sydenham chorea Rapid, jerky, irregular, uncontrollable and purposeless movements of trunk and arms In walking or standing

24. Antalgic gait Abnormal pattern of walking secondary to pain that cause limp The stance phase is shortened relative to swing phase good indication of weight-bearing pain

25. THANKS For your attention