GAIT and its different types[Autosaved].pptx

Gait and it's type

1. GAIT ANALYSIS PRESENTED BY: GUIDED BY: DR. DEEPESH KHURANA DR PAWAN MISHRA PG RESIDENT CMCH, BHOPAL

2. What is ‘Gait’ ? It is defined as the systemic ,rhythmic ,co-ordinated ,semi rotatory movements of the lower limb ,trunk,arm and head resulting in an interplay between loss and recovery of balance with constant change in the centre of gravity causing forward propulsion of an organism in space.

3. PHASES OF GAIT The gait cycle is divided into two phases, STANCE PHASE and SWING PHASE. Stance phase is defined as the time during which the limb is in contact with the ground and supporting the weight of the body Swing phase is the time when the limb is advancing forward off the ground. Stance phase occupies 60% of the gait cycle and swing phase occupies 40%.

4. STANCE PHASE Stance phase can be divided into single limb support and double-limb support phases. There are two periods of double- limb support When both legs are in contact with the ground at the same time The second period of double limb support occurs at the end of the stance phase just before the swing phase as the body weight is shifted onto the other limb and the heel rises from the floor in preparation for push off.

5. SWING PHASE Swing phase encompasses three separate periods– Initial swing: It begins with the toe off and continues as the foot is raised from the ground and the limb moves forward. Midswing: It starts as the swing limb advances past the contralateral stance limb. The knee extends and the foot travels in the forward swinging arc. Terminal swing : It occurs at the end of the swing phase as the musculature of the forward swing limb smoothly stops the limb, preparing for initial contact with the ground, and the gait cycle is completed.

6. TIME SPENT ON EACH PHASE The percentage of time spent in each phase of gait is consistent among normal individuals. As the speed at which a person walks increases, the amount of time is spent in double limb support decreases. During running double limb support disappears and double limb float, a period during which neither leg is in contact with the ground.

7. CADENCE PARAMETRES STEP LENGTH: Distance between 2 feet during double-limb support STRIDE LENGTH: Distance one limb travels during stance and swing phases STEP TIME: Time needed to complete one step length CADENCE: Number of steps per minute WALKING VELOCITY: Distance traveled per time (m/sec)

8. Normal children have the ability to vary their walking speed; the ability to increase speed may be impaired in children with neurologic differences such as cerebral palsy.

9. NEUROLOGICAL 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. Miller and Scott proposed the concept of the “spinal locomotor generator,” designated neurons within the spinal cord that are responsible for reflex stepping movements.

10. Golgi tendon units, muscle spindles, and joint receptors produce neurologic feedback and serve as dampening devices for the coordination of gait. 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.

11. A child’s gait changes as the neurologic system matures. Infants normally walk with greater hip and knee flexion, flexed arms, and a wider base of gait than older children. As the neurologic system continues to develop in a cephalocaudal direction, the efficiency and smoothness of gait increase. However, 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.

12. FUNCTION OF GAIT The simplest function of gait is to travel from one point to another. Normal ambulation is likened to a controlled forward fall. The swing limb comes forward to stop the fall and accept the weight of the body. The joint motions inherent in normal gait serve this purpose. Body weight is transferred from one limb to the other in a smooth fashion, and the forward momentum of the body is sustained.

13. GAIT ENERGY Although gait is designed to be energy-efficient, bipedal gait is inherently unstable and inefficient. To conserve energy, coordinated movements of the joints of the lower extremities minimize the rise and fall of the center of gravity, located just anterior to the SECOND SACRAL VERTEBRA . Muscular activity during gait is precisely timed, and very few concentric contractions of the muscles are required during normal ambulation. Inertia is used to its fullest advantage to lessen the work of walking.

14. Abnormal deviations in gait can have significant physiologic costs and substantially increase the energy required to walk. Deviations such as a weak muscle, contracted joint, or impediment of a cast may change gait enough to increase the metabolic requirements, thereby causing the individual to tire easily.

15. The amount of energy required to walk can be measured by quantifying oxygen consumption and oxygen cost. Oxygen uptake and oxygen cost during walking are greater in children younger than 12 years than in teenagers. An indirect measure of energy expenditure is the heart rate, which rises as oxygen consumption increases.

16. DETERMINANTS OF GAIT DETERMINATS STRATEGY PELVIC ROTATION Decreases angle between limbs and ground, flattens arc of pathway of center of gravity, allowing stride to lengthen without increasing drop of center of gravity at point of initial contact . PELVIC TILT Decreases vertical displacement of center of gravity by approximately 50% and shortens pendulum of limb by knee flexion in swing phase

17. Knee flexion after initial contact in stance phase Reduces vertical displacement of center of gravity as weight of body is carried forward over stance limb Foot and ankle motion Smooths out path of center of gravity when coupled with knee motion Knee motion Smooths out path of center of gravity when coupled with foot and ankle motion Lateral displacement of pelvis Reduces lateral movement of center of gravity toward stance foot during gait cycle

18. These six strategies work in harmony to minimize the rise and fall of the center of gravity (vertical displacement) and the side to-side motion of the pelvis (horizontal displacement). The end result is the establishment of a smooth forward progression of the body’s center of gravity during gait. The center of gravity displaces an average of ⅛-inch during gait, with the lowest point at 50% of the gait cycle during double-limb support.

19. KINEMATICS Kinematics is 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, tibia, or feet).

20. The data are collected by the three-dimensional tracking of markers placed over bony landmarks by infrared cameras positioned in the gait laboratory. Normal kinematics for each plane are briefly described in the following sections.

21. MUSCLE ACTIVITY Types of muscle contraction : Concentric—generates power and accelerates body forward, muscle shortens. Eccentric—slows down and stabilizes joint motions during gait, muscle lengthens. Stance phase—muscles of leg and foot work to stabilize plantigrade foot Swing phase—momentum generated by gastrocsoleus and hip flexors at terminal stance carries leg forward

22. CONCENTRIC CONTRACTION Two large concentric contractions occur at terminal stance. The gastrocsoleus muscle contracts to lift the heel off the ground and push off. The iliopsoas muscle also contracts concentrically, flexing the hip and pulling the stance phase limb off the ground at terminal stance and early swing. During swing phase the Tibialis anterior undergoes concentric contraction. It dorsiflexes the ankle and provides clearance for the swing foot.

23. ECCENTRIC CONTRACTION Eccentric contraction slow down and smooth joint motions. The Tibialis anterior slows plantar flexion rate during initial contact. Gluteus medius controls pelvic tilt ( midstance). Hip adductors control lateral sway (late stance). Quadriceps stabilize knee at initial contact and preswing. Hamstrings control rate of knee extension at swing.

24. PEDOBRAOGRAPHY 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 and pressure and timing of the pressure can be documented. The foot is devided into different segment, termed masks, and the pressure in each mask can be studied.

25. MOTION MEASUREMENT A number of alternative technologies are available for the measurement of body segment spatial position and orientation ELECTROGONIOMETRY ACCELEROMETRY VIDEO CAMERA BASED SYSTEMS

26. GAIT ANALYSIS A comprehensive clinical gait analysis consists of a variety of components A video recording of indivisuals gait. Static physical examination measures. Segment and angular joint positions. Stride and temporal parameters Segment and joint angular displacements during gait (kinematics)

27. The forces and torque applied to the patients foot by the ground. The reactive intersegmental moments produced about the lower extremity joints by active and passive soft tissue forces as well as the associated mechanical power of the intersegmental moment during gait. Indications of muscle activity. Pedobarography Metabolic energy expenditure during rest and gait.

28. ABNORMAL GAIT The causes of abnormal gait are numerous. It may be temporary due toa sprained ankle, or permanent following a stroke. The following is a listing of abnormal gaits based on general cause or basis for the abnormality. Muscular weakness / paralysis Joint muscle range of motion(ROM) limitation. Neurological involvement Pain Leg length discrepancy

29. MUSCULAR WEAKNESS/PARALYSIS Muscle weakness can range from slight weakness to complete paralysis. With muscle weakness, the body tends to compensate by shifting the center of gravity over, or toward, the part that is involved. This reduces the moment of force (torque) on the joint, lessening the muscle strength required.

30. GLUTEUS MAXIMUS GAIT (ROCKING HORSE GAIT) The gluteus maximus acts as a restraint for forward progression. The trunk shifts posteriorly at heel strike (initial contact) This will shift the body’s COG posteriorly over the gluteus maximus, moving the line of force posterior to the hip joints.

31. With the foot in contact with the floor, this requires less muscle strength to maintain the hip in extension during stance phase. This shifting is sometimes referred to as a “rocking horse” gait because of the extreme backward-forward movement of the trunk.

32. TRENDLENBERG GAIT With a gluteus medius gait, the individual shifts the trunk over the affected side during stance phase. In , the right gluteus medius, or hip abductor, is weak causing two things to happen: (1) the body leans over the left leg during stance phase of the left leg, (2) the right side of the pelvis will drop when the right leg leaves the ground and begins swing phase. This gait is also referred to as a “Trendelenburg” gait

33. WEAK QUADRICEPS GAIT Depending upon whether only the quadriceps muscles , various compensatory maneuvers may be used. With quadriceps weakness, the individual may lean the body forward over the quadriceps muscles at the early part of stance phase, as weight is being shifted on to the stance leg. Normally, at this time, the line of force falls behind the knee, requiring quadriceps action to keep the knee from buckling.

34. By leaning forward at the hip, the COG is shifted forward and the line of force now falls in front of the knee. This will force the knee backward into extension. Another compensatory maneuver to use is the hip extensors and ankle plantar flexors in a closed chain action to pull the knee into extension at heel strike (initial contact).

35. GENU RECURVATUM GAIT If the hamstrings are weak, two things may happen. During stance phase, the knee will go into excessive hyperextension, sometimes referred to as “genu recurvatum” gait. During the deceleration (terminal swing) part of swing phase, without the hamstrings to slow down the swing forward of the lower leg, the knee will snap into extension

36. STEPPAGE GAIT An individual may compensate depending on the amount of weakness of the ankle dorsiflexors . If there is insufficient strength to move the ankle into dorsiflexion at the beginning of stance phase, the foot will land with a fairly flat foot. However, if there is no ankle dorsiflexion, the toes will strike first, which is commonly referred to as an equinus gait . Next, weak ankle dorsiflexors may not be able to support the body weight after heel strike moving toward foot flat (loading response) as they eccentrically contract. The result is “ foot slap .”.

37. With the dorsiflexors not being able to slow the descent of the foot, the foot slaps into plantar flexion as more weight is put on the leg. During swing phase, they may not be able to dorsiflex the ankle during swing phase. Gravity will cause the foot to fall into plantar flexion when it is off the ground. This is called “ drop foot .” As a result, the knee will need to be lifted higher for the dropped foot to clear the floor and “ steppage gait ” will result. The drum major in a marching band will utilize the elements of this gait when performing.

38. WEAK GASTROCNEMIUS AND SOLEUS GAIT When the triceps surae group (the gastrocnemius and soleus) is weak, there is no heel rise at push off (terminal stance), resulting in a shortened step length on the unaffected side. This is sometimes referred to as a “ sore foot limp .” Although this gait is noticeable on level ground, it becomes most pronounced when walking up an incline.

39. WADDLING GAIT A waddling gait is commonly seen with muscular and other types of dystrophies because there is diffuse weakness of many muscle groups. The person stands with the shoulders behind the hips, much like a person with paraplegia would balance resting on the iliofemoral ligament of the hips. There is an increased lumbar lordosis, pelvic instability, and Trendelenburg gait .

40. No reciprocal pelvis and trunk rotation occur . To swing the leg forward, the entire side of the body must swing forward. Normally, for example, as the right leg swings forward, the right arm swing backward. In this case, the right arm and leg swing forward together. Add this to the excessive trunk lean of Trendelenburg gait bilaterally, and one can see the waddling nature of the gait. A steppage gait is often present

41. JOINT OR MUSCLE ROM LIMITATION In this grouping, the joint is unable to go through its normal range of motion because either there is bony fusion or soft tissue limitation. This limitation can be the result of contractures of muscle, capsule, or skin.

42. When a person has a Hip flexion contracture , the involved unable to go in extension and hyperextension in midstance and push-off phases (terminal stance). the person will assume the salutation or greeting position in which the hip is flexed and the person’s trunk leans forward as if bowing. The involved leg may also simultaneous flex the knee when it normally would be extended

43. In a Fused hip, increased motion of the lumbar spine and pelvis can greatly compensate for hip motion. A decreased lordosis and posterior pelvic tilt will allow the leg to swing forward, whereas an increased lordosis and anterior pelvic tilt will swing the leg posteriorly. This is referred to as “ bell clapper gait ”.

44. KNEE FLEXION CONTRACTURE A knee flexion contracture will result in excessive dorsiflexion during midstance and an early heel rise during push-off (terminal stance). There is also a shortened step length of the unaffected side.

45. VAULTING GAIT If a knee fusion is present, the lower leg will be at a fixed length. That length will depend on the position of the joint. If the knee is in extension, the leg will be unable to shorten during swing phase. Therefore, to compensate, the person (1) must rise up on the toes of the uninvolved leg in a vaulting gait. (2) hike the hip of the involved side, (3) swing the leg out to the side, or (4) some variation of the three methods

46. CIRCUMDUCTED GAIT With a “circumducted gait,” the leg begins near the midline at push-off (terminal stance), swings out to the side during swing phase, then returns to the midline for heel strike. It is called an “abducted gait” if the leg remains in an abducted position throughout the gait cycle

47. NEUROLOGICAL INVOLVEMENT As would be expected, the amount of gait disturbance will depend on the amount and severity of neurological involvement.

48. HEMIPLEGIC GAIT Will vary depending on the severity of neurological involvement and the presence and amount of spasticity. There is an extension in the involved lower extremity. The hip goes into extension, adduction, and medial rotation. The knee is in extension .

49. The ankle has drop foot with ankle plantar flexion and inversion (equinovarus), during both stance and swing phases. The involved upper extremity may typically be in a flexion synergy . Usually, there will be no reciprocal arm swing . Step length tends to be lengthened on the involved side and shortened on the uninvolved side

50. ATAXIC GAIT Cerebellar involvement often results in an Ataxic gait . Lacking coordination leads to jerky uneven movements. Balance tends to be poor, and the person walks with a wide base of support (abducted gait). The person usually has difficulty walking in a straight line , and tends to stagger. Reciprocal arm motion also appears to be jerky, and uneven. All movements appear exaggerated

51. PARKINSONIAN GAIT A parkinsonian gait demonstrates diminished movement. The posture of the lower extremities and trunk tends to be flexed. The elbows partially flexed and little, or no, reciprocal arm swing. Stride length greatly diminished and the forward heel does not swing beyond the rear foot .

52. The person walks with a shuffling gait with the feet flat and weight mostly forward on the toes. The person has difficulty initiating movements. This shuffling gait tends to start slowly and increase in speed, and the person often has difficulty in stopping. It gives the appearance that the person’s feet are trying to catch up to the forward leaning trunk. This is called a festinating gait .

53. SCISSORS GAIT Spasticity in the hip adductors results in a scissors gait. This gait is most evident during swing phase in which the unsupported leg swings against or across the stance leg. The walking base is narrowed . The trunk may lean over the stance leg as the swing phase leg attempts to swing past it.

54. CROUCH GAIT A crouch gait describes the bilateral lower extremity involvement seen in spastic diplegia associated with cerebral palsy . There is often great variation in the gait from what is considered “typical.” There is excessive flexion, adduction, and medial rotation at the hips , and flexion at the knees .

55. Ankles plantar flexed . The pelvis maintains an anterior pelvic tilt Increased lumbar lordosis . To compensate, the reciprocal arm swing and horizontal displacement are exaggerated

56. PAIN When a person has pain in any of the joints of the lower extremity, the tendency is to shorten the stance phase . A shortened, often abducted, stance phase on the involved side results in a rapid and shortened step length of the uninvolved side . Reciprocal arm swinging is shortened as the step length is shortened, exaggerated, and often abducted. This gait is often referred to as antalgic gait .

57. If the pain is caused by a hip problem, the person will lean over that hip during weight-bearing. This will decrease the torque placed on the joint and the amount of pressure placed on the femoral head.

58. SHORT LIMB LENGTH When there is minimal leg length discrepancy, compensation occurs by dropping the pelvis on the affected side. The person may compensate by leaning over the shorter leg. Leg length discrepancies of up to 3 inches can be accommodated with these techniques. In descrepancies of 3 and 5 inches, dropping the pelvis on the affected side will no longer be effective.

59. This is called an Equinus gait. A severe LLD is > 5 inches. Dropping the pelvis and walking in an equinnus gait + flexing the knee on the uninvolved side is often used.

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