Human Gait

1. GAIT - Dr. Gajanan Pandit

2. DEFINITION :- - Gait is defined as the systematic,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. - Differs from spot march ---- rhythm present but no forward propulsion. - Human gait is Biped Gait.Each leg performs function alternatively.Hence , called Alternate Bipedalism . - It is a Heel-Toe Gait.Heel touches the ground first followed by toes and heel leaving the ground first followed by the toes.

3. FEW FACTS :- - STEP LENGTH :- -Distance between right and left heel when step is taken. -Corresponds to length of foot + 25 cms . -In average adults,it is between 45-50 cms (15 inches). - STRIDE LENGTH :- -Distance covered by the same heel after a stride is taken (27-32 inches). -Varies according to the length of lower limb and height of the person.

4. - CADENCE :- -Number of steps taken per minute (90-120 /min). - During normal walking, a linear distance of 5-10 cm is maintained between midpoints of the feet.It is called ‘ Width of Base Support ‘. - During normal walking, there is slight out-toeing i.e foot is placed at an angle to the vertical (angle between the line of progression and longitudinal axis of the foot).It is about 8-15 degrees. ‘ Angle of Toe Out ’. - Slow run v/s Fast Walk :- -In slow run,there is always a stage when both feet are off the ground. -In fast walk,there is always a stage when both feet are on the ground.

5. CENTRE OF GRAVITY :- - Imaginary point at which all the weight of the body is concentrated at a given instant. - Lies 2 inches in front of the 2 nd Sacral Vertebra. - Follows a smooth sinusoidal curve and oscillates no more than 2 inches up and down and from side to side.

6. Phases :- - Human gait is Biphasic Gait. - Two phases :- (1) Stance Phase – starts with foot contact and ends with foot lift off.Accounts for 60% of the cycle. (2) Swing Phase - starts with foot lift off and ends with foot contact.Accounts for 40% of the cycle. Double limb support – that portion of the gait cycle when both feet are in contact with ground.Centre of gravity is at its lowest point.Kinetic energy is the maximum.

7. Movements occuring at the joints :- - HIP JOINT :- - flexion - adduction - external rotation - KNEE JOINT :- - initial flexion – to clear off the ground - followed by gradual extension - ANKLE JOINT :- - initial plantar flexion – resulting in push-off - then dorsiflexion – to clear off the ground

8. GAIT CLASSIFICATION :- PATHOLOGICAL CLASSIFICATION Pathology Predominantly Symmetrical Predominantly Assymetrical Upper motor neuron (UMN) Diplegia Quadriplegia Hemiplegia Brain Stem Ataxic Lower motor neuron (LMN) Spina Bifida Femoral nerve palsy Sensory Neuropathy Basal Ganglia Athetoid Cortical Apraxia Orthopedic Anteversion Tibial torsion Congenital Dislocation (CDH) Amputee Trans- tibial Trans-femoral

9. ANATOMICAL CLASSIFICATION Region Sagittal Frontal Transverse Foot Toe flexion Pes planus / supinatus In /out-toeing Ankle Equinus , Drop foot Excessive dorsiflexion Clonus Varus / Valgus Tibia Tibial Torsion Knee Stiff knee Recurvatum Abnormal loading Varus / Valgus Femur Femoral Anteversion Hip Forward trunk flexion Tendelenberg sign Pelvis Anterior/posterior tilt Rotation Spine Lordosis / kyphosis Duchenne sign Scoliosis Arms Abnormal swing Lateral thrust

10. FUNCTIONAL CLASSIFICATION Velocity Stride Length Cadence Stance Duration Step Length ( wrt . contralat .) Step Time ( wrt . contralat .) Step Width Antalgic Low Short Fast Short Long Short Wide Unstable Low Short Low Long Compensated Normal Short Fast Short Uncompensated Low Short Normal Apropulsive Reduced

11. Clinical Gait Analysis :- 1) Observational data :- -videotape in frontal & lateral view. -view in slow motion. 2) Gait parameters :- -Cadence – 90-120 steps/min -Step length – 0.7-0.9 m -Walking velocity – 60-90 m/min -Single limb support- 0.5-2 sec 3) Kinematic data :- -Linear & angular displacement of body segments in space is an important aspect. -joint motion recorded with electrogoniometers .. -most accurate – photographic (cine) methods.

12. 4) Force plate data :- -represents ground reaction force of walking generated by a force plate,set in the floor of gait walkway. -information regarding resultant reaction force with vertical and horizontal components, sheer force and torque vectors can be obtained. 5) Kinesiological data :- -broad term that combines motion,forces and muscle functions. 6) Energetics :- -deals with oxygen consumption during a specific task or activity.

13. Abnormal gait :- - 2 broad patterns :- (1) LIMPING – denotes painful condition on the affected side.Patient avoids weight bearing on affected side (decrease in stance phase). (2) Lurching – denotes variable failure of abduction mechanism.

14. Various types :- (1) ANTALGIC GAIT :- - Any gait which relieves pain is known as antalgic gait.Patient does not bear weight on the affected side.Therefore , body lurches to the opposite side. - decrease stance phase - decrease step length - decrease stride length

15. (2) TRENDELENBURG GAIT :- - Abductor lever mechanism :- - Ask patient to stand on one leg  opposite side ASIS tends to dip down . -This is prevented by contraction of the abductors (gluteus medius & minimus ) on the same side. -So ASIS level is maintained. Here body weight acts as load, hip joint as the fulcrum & abductors as the power. Defect in fulcrum i.e. fracture neck femur  dislocation of hip  Defect in power Opposite ASIS dips down i.e. Poliomyelitis  i.e TRENDELENBURG SIGN POSITIVE Gluteii paralysis 

16. Trendelenburg test + ve Trendelenburg test - ve

17. (3) WADDLING GAIT :- When Trendelenburg sign is present bilaterally, it will result in swaying of the patient side to side on a wide base.This is called waddling gait (duck gait).

18. (4) HIGH STEPPAGE/FOOT DROP/EQUINUS GAIT :- During heel strike attempt,toes drop to the ground first due to the foot drop. Hence, to clear the ground,patient will flex hip and knee excessively, raises the foot and slaps it on the floor forcibly. Common in foot drop due to muscle paralysis (common peroneal nerve palsy).

19. (5) STAMPING GAIT :- In posterior column affection of the spinal cord,there is loss of joint, position & vibration sense.One is not able to percieve the distance of floor from the feet resulting in a hard thump. e.g tabes dorsalis,syringomyelia,diabetes mellitus,leprosy,etc .

20. (6) SCISSOR GAIT :- Here one lower limb passes in front of the other lower limb due to marked adductor spasm as seen in cases of cerebral palsy.

21. (7) IN TOEING AND OUT TOEING :- When there is increased anteversion of femoral neck,there is internal rotation of the hip joint to contain femoral head in the acetabular cavity  results in internal rotation of the entire lower limb noted by inward pointing of the toes. This may persist or compensatory external torsion of tibia may occur.Hence , the toes point forward.In such a case, look at the patella.Due to femoral torsion, both patella point inwards rather than forwards  KISSING PATELLA. Normal range of out toeing is from 8 – 15 degrees….Usually associated with lateral tibial torsion…..results in CHARLIE CHAPLIN GAIT.

22. (8) SHORT LIMB GAIT :- < 1.5 cm ----- compensated by pelvic tilt while walking. upto 5 cm ---- compensated by equinus . > 5 cm --------- patient’s body dips down on that side.

23. (9) GLUTEUS MAXIMUS GAIT :- Due to gluteus maximus paralysis,it is not possible to extend the supported hip in the swing phase.This is overcome by backwaed lurch of the trunk.Therefore , while walking, forward & backward movements of the trunk occur.Hence , also called as ROCKING HORSE GAIT.

24. (10) HAND TO KNEE/QUADRICEPS GAIT :- Normally ,to transmit weight of lower limb during midstance , the knee is locked by quadriceps contraction.If it is weak,locking is hampered & buckling at knees will occur.Therefore , to stabilise the knee for weight bearing,patient places his hand in front of the knee and lower thigh region. e.g poliomyelitis

25. (11) CALCANEUS GAIT :- Just before the swing phase,there is push off at the ankle joint by plantar flexion.This is absent in paralysis or rupture of tendo-achilles.Weight is largely borne by the heel & there is widening & thickening of heel.Foot is flat on the ground. Occurs with weakness of triceps surae or contracture of dorsiflexors of ankle.

26. (12) SHUFFLING/FESTINANT GAIT :- Here, the patient takes short steps, has a stooping posture (flexed neck, trunk, hip, knee) and is propelled forward quickly as if trying to catch up with the centre of gravity which is placed anteriorly . (13) ATAXIC/CEREBELLAR GAIT :- Here, there is loss of sense of balance.patient sways in different directions during ambulation.

27. (14) HEMIPLEGIC GAIT :- There is rigidity in lower limb muscles due to UMN lesion. Therefore, extension at knee & plantar flexion at ankle prevail. Hence, there is circumduction of limb at hip while swinging the limb to achieve forward propulsion.

28. (15) STIFF HIP GAIT :- In normal gait, 20 degree flexion occurs at the hip.In stiff hip, patient does not flex hip.To compensate, patient raises the pelvis & semi- circumducts the limb to propel it forward. (16) STIFF KNEE GAIT :- Due to loss of flexion at knee,patient raises pelvis to clear off the ground and swing sideways with circumduction to propel it forward.Looks like that of a German Soldier marching. (17) FLAT FOOT :- There is affection of arches of the foot.Foot is flat on the ground.There is loss of spring in the gait.

29. OTHERS :- (1) BROAD BASED GAIT :- - Rare - Earlier seen in seamen due to habit of standing in boat with a broad base to balance self (centre of gravity falls between two feet). (2) HELICOPOD GAIT :- - Legs & feet thrown in half circles as in hemiplegia . (3) LATHYRIATIC GAIT :- -Combination of spasticity, hyperabduction & dragging of lower limb elements. (4) DRUNKERS/REELING GAIT :- - Irregular walk on a wide base,sideways swing without stability,tendency to fall with every step. - seen in drunken state or cerebellar inco -ordination. (5) KNOCK KNEE GAIT :- - Knees point & oppose each other while ankle & feet are kept apart. (6) GENU RECURVATUM GAIT :- - Hyperextension at knee.Seen in paralysis of hamstring ( e.g polio). (7) CHARCOT GAIT :- - In hereditary ataxia.

30. VARIATIONS OF NORMAL GAIT :- (1) ATHLETE’S GAIT :- At end of game,the players have a crouching attitude.This keeps the centre of gravity as low as possible  Prevents fatigue. (2) MOURNER’S GAIT :- In a mourning ceremony,people of various height are present. But crowd moves together at the same pace.This can be done by altering the cadence.However,this alteration cannot be sustained for a long time.Hence a tall person will alter his step length.he takes a step forward & then brings it back a bit.In such a case,there is more expenditure of energy.

31. (3) CRUTCH GAIT :- - Consider crutches & legs as four points…Either crutches move together or legs move together. 2 Point gait – double amputee with crutches. crutches are put forward & then body swung forwards (swing to or swing through). 3 Point gait – when weight is allowed on one leg, crutches are put forward & limb follows with the other limb off the ground. 4 Point gait – when limbs are allowed to bear weight but are not strong enough to do so unaided.Crutches & legs alternately put forwards singly to achieve 4 point gait.