ABNORMAL ABNORMAL NORMAL NORMAL 10 6 10 6 ABNORMAL ABNORMAL NORMAL NORMAL 10 6 10 6.
Gait normal & abnormal
-
Upload
ratan-khuman -
Category
Health & Medicine
-
view
112.131 -
download
3
Transcript of Gait normal & abnormal
![Page 1: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/1.jpg)
Gait(normal & abnormal)
Dr. P. Ratan Khuman (PT)M.P.T., (Ortho & Sports)
![Page 2: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/2.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
2
Definition Locomotion or gait –
It is defined as a translatory progression of the body as a whole produce by coordinated, rotatory movements of body segments.
Normal gait – It is a rhythmic & characterized by alternating
propulsive & retropulsive motions of the lower extremities.
![Page 3: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/3.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
3
Task involves in walking According to “Rancho Los Amigos” (RLA), California
Weight acceptance Single limb support Swing limb advance
![Page 4: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/4.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
4
Gait initiation A series of events occur from the initiation of
body movt to beginning of gait cycle. It is stereotyped activity in both young & old
healthy people. Total duration of this phase is about – 0.60sec
![Page 5: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/5.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
5
Kinematics of gait
![Page 6: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/6.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
6
Phases of gait Stance phase Swing phase
![Page 7: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/7.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
7
Stance phase It begins at the instant that one extremity
contacts the ground & continuous only as long as some portion of the foot is in contact with the ground.
It is approx 60% of normal gait duration.
![Page 8: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/8.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
8
Swing phase It begins as soon as the toe of one extremity
leaves the ground & ceases just before heel strike or contact of the same extremity.
It makes up 40% of normal gait cycle.
![Page 9: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/9.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
9
Double support Lower limb of one side of body is beginning its
stance phase & the opposite side is ending its stance phase.
During double support both the lower limb are in contact with the ground at the same time.
It account approx 22% of gait cycle. This phase is absent in running
![Page 10: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/10.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
10
Subdivision of phasesStance phase –1) Heel strike2) Foot flat3) Mid-stance4) Heel off 5) Toe off
Swing phase –1) Acceleration2) Mid-swing3) Deceleration
![Page 11: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/11.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
11
Comparison of gait terminology Traditional –
1) Heel strike2) Foot flat3) Mid-stance4) Heel off5) Toe off6) Acceleration7) Mid-swing8) Deceleration
RLA –1) Initial contact2) Loading response3) Mid-stance4) Terminal stance5) Pre-swing6) Initial swing7) Mid-swing8) Terminal swing
![Page 12: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/12.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
12
Traditional phases of gait
![Page 13: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/13.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
13
Stance phase Heel strike phase:
Begins with initial contact & ends with foot flat
It is beginning of the stance phase when the heel contacts the ground.
![Page 14: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/14.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
14
Stance phase Foot flat:
It occurs immediately following heel strike
It is the point at which the foot fully contacts the floor.
![Page 15: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/15.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
15
Stance phase Mid stance:
It is the point at which the body passes directly over the supporting extremity.
![Page 16: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/16.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
16
Stance phase Heel off:
the point following midstance at which time the heel of the reference extremity leaves the ground.
![Page 17: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/17.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
17
Stance phase Toe off:
The point following heel off when only the toe of the reference extremity is in contact with the ground.
![Page 18: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/18.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
18
Swing phase Acceleration phase:
It begins once the toe leaves the ground & continues until mid-swing, or the point at which the swinging extremity is directly under the body.
![Page 19: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/19.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
19
Mid-swing: It occurs approx when the
extremity passes directly beneath the body, or from the end of acceleration to the beginning of deceleration.
![Page 20: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/20.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
20
Swing phase Deceleration:
It occurs after mid-swing when limb is decelerating in preparation for heel strike.
![Page 21: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/21.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
21
Sub-divisions of stance phase
![Page 22: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/22.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
22
Sub-divisions of swing phase
![Page 23: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/23.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
23
Sub component of stance phase
![Page 24: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/24.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
24
Sub component of swing phase
![Page 25: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/25.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
25
RLA phases of gait
![Page 26: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/26.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
26
Initial contact It refer to the initial contact of the foot of
leading lower limb. Normally the heel pointed first to contact. In abnormal gait it is possible to either
whole foot or toes rather than the heel to strike.
![Page 27: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/27.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
27
Load response Begins at initial contact &
ends when the contra lateral extremity lifts off the ground at the end of the double-support phase.
It occupies about 11% of gait
![Page 28: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/28.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
28
Mid-stance phase (RLA) Begins when the contra-lateral
extremity lifts off the ground at about 11% of the gait cycle
Ends when the body is directly over the supporting limb at about 30% of the gait cycle.
![Page 29: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/29.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
29
Terminal stance (RLA) Begins when the body is
directly over the supporting limb at about 30% of the gait cycle
Ends just before initial contact of the contra-lateral extremity at about 50% of the gait cycle.
![Page 30: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/30.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
30
Pre-Swing (RLA) It is the last 10% of stance
phase and begins with initial contact of the contra-lateral foot (at 50% of the gait cycle) and ends with toe-off (at 60%).
![Page 31: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/31.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
31
Initial swing (RLA) Begins when the toe leaves
the ground & continues until max knee flexion occurs.
![Page 32: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/32.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
32
Mid-Swing (RLA) Encompasses the period
from maximum knee flexion until the tibia is in a vertical position.
![Page 33: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/33.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
33
Terminal swing (RLA) Includes the period from
the point at which the tibia is in the vertical position to a point just before initial contact.
![Page 34: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/34.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
34
Gait cycle
![Page 35: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/35.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
35
Variables of gait There are two basic variables which provide a basic
description of human gait. Time/ Temporal variable & Distance variables.
Provide essential quantitative information about gait
![Page 36: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/36.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
36
factors affecting variables Age, Gender, Height, Size & shape of bony
components, Distribution of mass in
body segments,
Joint mobility, Muscle strength, Type of clothing &
footwear, Habit, Psychological status.
![Page 37: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/37.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
37
variables Temporal variable –
Stance time Single-limb & double-
support time, Swing time, Stride and step time, Cadence and Speed
Distance variable – Stride length, Step length and width Degree of toe-out
![Page 38: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/38.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
38
Stance time: It is the amount of time that elapses during the
stance phase of one extremity in a gait cycle. Single-support time:
It is the amount of time that elapses during the period when only one extremity is on the supporting surface in a gait cycle.
![Page 39: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/39.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
39
Double-support time: It is the amount of time spent with both feet on
the ground during one gait cycle. The % of time spent increased in elderly
persons and in those with balance disorders. The percentage of time spent decreases as the
speed of walking increases.
![Page 40: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/40.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
40
Stride length: It is the linear distance from the heel strike of one
lower limb to the next heel strike of the same limb.
![Page 41: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/41.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
41
Step length: It is the linear distance from the heel strike of one
lower limb to the next heel strike of opposite limb.
![Page 42: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/42.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
42
Stride duration: It refers to amount of time taken to accomplish
one stride. Stride duration and gait cycle duration are
synonymous. One stride, for a normal adult, lasts approx 1 sec
![Page 43: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/43.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
43
Step duration: It refers to the amount of time spent during a
single step. Measurement usually is expressed as sec/step. When weakness or pain in limb, step duration
may be decreased on the affected side and increased on the unaffected side.
![Page 44: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/44.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
44
Cadence: It is the no of steps taken by a person per unit
of time. It is measured as the no of steps / sec or per
minute.Cadence = Number of steps / Time
![Page 45: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/45.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
45
Walking velocity: It is the rate of linear forward motion of the body,
which can be measured in meters or cm/second, meters/minute, or miles/hour.
Walking velocity (meters/sec)=Distance walked (meters)/time (sec)
![Page 46: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/46.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
46
Speed of gait: It is referred to as slow, free, and fast.
Free speed of gait refers to a person’s normal walking speed
Slow & fast speeds of gait refer to speeds slower or faster than the person’s normal comfortable walking speed, designated in a variety of ways.
![Page 47: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/47.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
47
Step width or width of the walking base: It is the measure of linear distance
between the midpoint of the heel of one foot and the same point on the other foot
![Page 48: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/48.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
48
Degree of toe-out (DTO): It represents the angle of foot formed by each
foot’s line of progression and a line intersecting the centre of the heel and the second toe.
The angle for men is about 70 from the line of progression of each foot at free speed walking.
The DTO decreases as the speed of walking increases in normal men.
![Page 49: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/49.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
49
Degree of toe out
![Page 50: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/50.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
50
Variables of gait
![Page 51: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/51.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
51
Path of COG Center of Gravity (CG):
Midway between the hips Few cm in front of S2
Least energy consumption if CG travels in straight line
![Page 52: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/52.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
52
![Page 53: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/53.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
53
Vertical displacement: Rhythmic up & down
movement Highest point: midstance Lowest point: double support Average displacement: 5cm Path: extremely smooth
sinusoidal curve
![Page 54: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/54.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
54
Lateral displacement: Rhythmic side-to-side
movement Lateral limit: mid-stance Average displacement: 5cm Path: extremely smooth
sinusoidal curve
![Page 55: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/55.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
55
Overall displacement: Sum of vertical &
horizontal displacement
Figure ‘8’ movement of CG as seen from AP view
Horizontalplane
Verticalplane
![Page 56: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/56.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
56
Saunders’ Determinants of gait Gait “determinants” was first described by
“Saunders & Coworkers” in 1953. Six optimizations used to minimize
excursion of CG in vertical & horizontal planes.
![Page 57: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/57.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
57
The “determinants” represent adjustments made by the pelvis, hips, knees, and ankles that help to keep movt of the body’s COG to a minimum.
By decreasing the vertical & lateral excursions of the body’s COM it was thought that energy expenditure would be less & gait more efficient.
![Page 58: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/58.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
58
Pelvic rotation: Forward rotation of the pelvis in the horizontal plane
is approx. 8o on the swing-phase side. It reduces the angle of hip flexion & extension It enables a slightly longer step-length
![Page 59: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/59.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
59
Pelvic tilt: 5o dip of the swinging side (i.e. hip abd) In standing, this dip is –
A +ve Trendelenberg sign It reduces the height of the apex of
the curve of CG
![Page 60: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/60.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
60
Knee flexion in stance phase Approx. 20o dip It shortens the leg in the middle of stance phase It reduces the height of the apex of CG curve
![Page 61: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/61.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
61
Ankle mechanism It lengthens the leg at heel contact It helps in smoothens the curve of CG It reduces the lowering of CG
![Page 62: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/62.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
62
Foot mechanism: Lengthens the leg at toe-off as ankle moves from
dorsiflexion to plantarflexion Smoothens the curve of CG Reduces the lowering of CG
![Page 63: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/63.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
63
Lateral displacement of body Physiologic valgus of the knee reduce side-to-
side movement of the COM in frontal plane. The normally narrow width of the walking
base minimizes the lateral displacement of CG Reduced muscular energy consumption due to
reduced lateral acceleration & deceleration
![Page 64: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/64.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
64
Physiological knee valgus
![Page 65: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/65.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
65
Abnormal (Atypical) Gait
![Page 66: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/66.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
66
There are numerous causes of abnormal gait. There can be great variation depending upon the
severity of the problem. If a muscle is weak, how weak is it? If joint motion is limited, how limited is it?
![Page 67: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/67.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
67
Pathological gaits Abnormality in gait may be caused by –
Pain Joint muscle range-of-motion (ROM) limitation Muscular weakness/paralysis Neurological involvement (UMNL/ LMNL) Leg length discrepancy
![Page 68: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/68.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
68
Types of pathological gait Due to pain –
Antalgic or limping gait – (Psoatic Gait) Due to neurological disturbance –
Muscular paralysis – both Spastic (Circumductory Gait, Scissoring Gait, Dragging or
Paralytic Gait, Robotic Gait[Quadriplegic]) and Flaccid (Lurching Gait, Waddaling Gait, Gluteus Maximus
Gait, Quadriceps Gait, Foot Drop or Stapping Gait,) Cerebellar dysfunction (Ataxic Gait) Loss of kinesthetic sensation (Stamping Gait) Basal ganglia dysfunction (FestinautGait)
![Page 69: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/69.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
69
Types of pathological gait Due to abnormal deformities –
Equinus gait Equinovarous gait Calcaneal gait Knock & bow knee gait Genurecurvatum gait
Due to Leg Length Discrepancy (LLD) – Equinus gait
![Page 70: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/70.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
70
Antalgic gait This is a compensatory gait pattern adopted in
order to remove or diminish the discomfort caused by pain in the LL or pelvis.
Characteristic features: Decreased in duration of stance phase of the affected
limb (unable of weight bear due to pain) There is a lack of weight shift laterally over the stance
limb and also to keep weight off the involved limb Decrease in stance phase in affected side will result in a
decrease in swing phase of sound limb.
![Page 71: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/71.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
71
Psoatic gait Psoas bursa may be inflamed & edematous, which
cause limitation of movement due to pain & produce a atypical gait. Hip externally rotated Hip adducted Knee in slight flexion
This process seems to relieve tension of the muscle & hence relieve the inflamed structures.
![Page 72: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/72.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
72
Gluteus maximus gait The gluteus maximus act as a
restraint for forward progression. The trunk quickly 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.
![Page 73: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/73.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
73
With foot in contact with floor, this requires less muscle strength to maintain the hip in extension during stance phase.
This shifting is referred to as a “Rocking Horse Gait” because of the extreme backward-forward movement of the trunk.
![Page 74: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/74.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
74
gluteus medius gait It is also known as “Trendelenberg gait” or
“Lurching Gait” when one side affected. The individual shifts the trunk over the
affected side during stance phase. When right gluteus medius or hip abductor
is weak it cause two thing: 1. The body leans over the left leg during stance
phase of the left leg, and 2. Right side of the pelvis will drop when the right
leg leaves the ground & begins swing phase.
![Page 75: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/75.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
75
Shifting the trunk over the affected side is an attempt to reduce the amount of strength required of the gluteus medius to stabilize the pelvis.
Bilateral paralysis, waddling or duck gait. The patient lurch to both sides while walking. The body sways from side to side on a wide base
with excessive shoulder swing. E.g. Muscular dystrophy
![Page 76: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/76.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
76
Quadriceps gait Quadriceps action is needed during heel strike &
foot flat when there is a flexion movement acting at the knee.
Quadriceps weakness/ paralysis will lead to buckling of the knee during gait & thus loss of balance.
Patient can compensate this if he has normal hip extensor & plantar flexors.
![Page 77: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/77.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
77
Compensation: With quadriceps weakness, the individual may lean
forward over the quadriceps at the early part of stance phase, as weight is being shifted on to the stance leg.
Normally, the line of force falls behind the knee, requiring quadriceps action to keep the knee from buckling.
By leaning forward at the hip, the COG is shifted forward & the line of force now falls in front of the knee.
This will force the knee backward into extension.
![Page 78: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/78.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
78
Another compensatory manoeuvre to use is the hip extensors & ankle plantar flexors in a closed chain action to pull the knee into extension at heel strike (initial contact).
In addition, the person may physically push on the anterior thigh during stance phase, holding the knee in extension.
![Page 79: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/79.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
79
genu recurvatum gait Hamstrings are weak, 2 things may happen
During stance phase, the knee will go into excessive hyperextension, 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.
![Page 80: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/80.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
80
hemiplegic gait With spastic pattern of hemiplegic leg
Hip into extension, adduction & medial rotation
Knee in extension, though often unstable Ankle in drop foot with ankle plantar
flexion and inversion (equinovarus), which is present during both stance and swing phases.
In order to clear the foot from the ground the hip & knee should flex.
![Page 81: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/81.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
81
But the spastic muscles won’t allow the hip & knee to flex for the floor clearance.
So the patient hikes hip & bring the affected leg by making a half circle i.e. circumducting the leg.
Hence the gait is known as “Circumductory Gait”. Usually, there will be no reciprocal arm swing. Step length tends to be lengthened on the involved
side & shortened on the uninvolved side.
![Page 82: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/82.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
82
Scissoring gait It results from spasticity of bilateral
adductor muscle of hip. One leg crosses directly over the
other with each step like crossing the blades of a scissor. E.g. Cerebral Palsy
![Page 83: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/83.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
83
Dragging or paraplegic gait There is spasticity of both hip & knee
extensors & ankle plantar flexors. In order to clear the ground the patient has
to drag his both lower limb swings them & place it forward.
![Page 84: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/84.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
84
Cerebral Ataxic or Drunkard’s gait
Abnormal function of cerebellum result in a disturbance of normal mechanism controlling balance & therefore patient walks with wider BOS.
The wider BOS creates a larger side to side deviation of COG.
This result in irregularly swinging sideways to a tendency to fall with each steps.
Hence it is known as “Reeling Gait”.
![Page 85: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/85.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
85
Sensory ataxic gait This is a typical gait pattern seen in patients
affected by tabes dorsalis. It is a degenerative disease affecting the posterior
horn cells & posterior column of the spinal cord. Because of lesion, the proprioceptive impulse
won’t reach the cerebellum. The patient will loss his joint sense & position for
his limb on space.
![Page 86: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/86.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
86
Because of loss of joint sense, the patient abnormally raises his leg (high step) jerks it forward to strike the ground with a stamp.
So it is also called as “Stamping Gait”. The patient compensated this loss of joint position
sense by vision. So his head will be down while he is walking.
![Page 87: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/87.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
87
Short shuffling or festinate gait
Normal function at basal ganglia are: Control of muscle tone Planning & programming of normal
movements. Control of associated movements like
reciprocal arm swing. Typical example for basal ganglia leision is
parkinsonism. Because of rigidity, all the joint will go for a
flexion position with spine stooping forward.
![Page 88: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/88.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
88
This posture displaces the COG anteriorly. So in order to keep the COG within the BOS, the
patient will no of small shuffling steps. Due to loss of voluntary control over the
movement, they loses balance & walks faster as if he is chasing the COG.
So it is called as “Festinate Gait”. Since his shuffling steps, it is otherwise called as
“Shuffling Gait”.
![Page 89: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/89.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
89
Foot drop or slapping gait This is due to dorsiflexor weakness caused
by paralysis of common peroneal nerve. There won’t be normal heel strike, instead
the foot comes in contact with ground as a whole with a slapping sound.
So it is also known as “Slapping gait”.
![Page 90: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/90.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
90
Due to plantarflexion of the ankle, there will be relatively lengthening at the leading extremity.
So to clear the ground the patient lift the limb too high.
Hence the gait get s its another name i.e. “High Stepping Gait”
![Page 91: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/91.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
91
Equinus gait Equinus = Horse Because of paralysis of dorsiflexor which result in
plantar flexor contracture. The patients will walk on his toes (toe walking). Other cause may be compensation by plantar
flexor for a short leg.
![Page 92: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/92.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
92
Unequal Leg Length We all have unequal leg length, usually a
discrepancy of approx 1/4 inch between the right and left legs.
Clinically, these smaller discrepancies are often corrected by inserting heel lifts of various thicknesses into the shoe.
Leg length discrepancy (LLD) are divided in – Minimal leg length discrepancy Moderate leg length discrepancy Severe leg length discrepancy
![Page 93: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/93.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
93
Minimal LLD Compensation occurs by dropping the
pelvis on the affected side. The person may compensate by leaning
over shorter leg (up to 3 inches can be accommodated with these tech).
![Page 94: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/94.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
94
Moderate LLD Approx between 3 & 5 cm, dropping the
pelvis on the affected side will no longer be effective.
A longer leg is needed, so the person usually walks on the ball of the foot on the involved (shorter) side.
This is called an “Equinnus Gait”.
![Page 95: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/95.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
95
Severe LLD It is usually discrepancy of more than 5 inches. The person may compensate in a variety of ways. Dropping the pelvis and walking in an equinnus
gait plus flexing the knee on the uninvolved side is often used.
To gain an appreciation for how this may feel or look, walk down the street with one leg in the street and the other on the sidewalk.
![Page 96: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/96.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
96
Equinovarous gait There will be ankle plantar flexion &
subtalar inversion. So the patient will be walking on the outer
border of the foot. E.g. CETV
![Page 97: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/97.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
97
Calcaneal gait Result from paralysis plantar flexors causing
dorsiflexor contracture. The patient will be walking on his heel (heel walking) It is characterized by greater amounts of ankle
dorsiflexion & knee flexion during stance & a shorter step length on the affected side.
Single-limb support duration is shortened because of the difficulty of stabilizing the tibia & the knee.
![Page 98: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/98.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
98
Knock knee gait It is also known as genu valgum gait. Due to decreased physiological valgus of knee. Both the knee face each other widening the BOS.
![Page 99: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/99.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
99
Bow leg gait It is also known as genu varum gait. Knee face outwards. Due to increase increased physiological
valgus of knee. The legs will be in a bowed position.
![Page 100: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/100.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
100
![Page 101: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/101.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
101
![Page 102: Gait normal & abnormal](https://reader038.fdocuments.net/reader038/viewer/2022102615/58f9b1e3760da3da068bc588/html5/thumbnails/102.jpg)
May 2, 2023 P.R.Khuman(MPT,Ortho & Sports)
102
Reference Lann S. Lippert, CLINICAL KINESIOLOGY and
ANATOMY, 4th edition, 2006 Cynthia C. Norkin, joint structure and function: A
comprehensive analysis 4th edition, 2005 Jacquelin perry, GAIT ANALYSIS normal and
pathological function, 1992