Gait & Gait Aids

Associate professor shereen algergawy

Rheumatology and rehabilitation department

Normal Gait & Abnormal GaitNormal Gait & Abnormal Gait

Why we should know “Normal Gait”

If we have sound knowledge of the characteristics of normal gait

We can accurately detect & interprete deviations from the normal gait pattern

60% 40%

60%40%

20-25%

Stride width 5-10cm

Cadence 70-130 step/min

Abnormal gait Stance phase

Antalgic Lateral trunk bending Anterior trunk bending Posterior trunk bending Lordosis Hyperextended knee Excessive knee flexion Excessive Genu Valgum or Varum

Inadequate Dorsi-flexion control Insufficient Push-off Abnormal walking base Internal or external limb rotation Excessive medial or lateral foot contact Vaulting

Swing phase Circumduction Hip hiking Internal or external limb rotation Inadequate Dorsiflexion control Abnormal walking base

Antalgic gait

Pain in stance phase : knee, hip, foot pain

Lateral trunk bending

Hip abductor weakness Hip dislocation, coxa vara, slipped

capital femoral epiphysis Hip pain Perineal pressure Involved limb relatively shorter Compensation for abducted gait

Trendelenberg gait

Gluteus Medius Gait

Anterior Trunk Bending

Quadriceps weakness combined with weakness of gluteus maximus, gastrocnemius, or both

Pushing backward with the hand / lateral rotation

Posterior Trunk Bending

Gluteus Maximus (Lurch) Gait Hip-extensor weakness Knee ankylosis, spasticity or

orthotic knee lock Hip-extensor spasticity

Hyperextended knee

Quadriceps weakness Capsular ligament laxity Quadriceps spasticity Plantar-flexion contracture or spasticity Compensation for contralateral limb

shortening (hip-flexion or knee-flexion contracture)

Excessive knee flexion

Knee-flexion or hip-flexion contracture Knee-flexor spasticity Uncompensated quadriceps weakness Ankle ankylosis, pes calcaneus Plantar-flexor weakness Involved limb relatively longer

Steppage gait

Ankle dorsiflexor weakness : compensate by exaggerated hip and knee flexion

Foot drop / dragging

Slap foot

Ankle dorsiflexor weakness : early stance phase

Insufficient Push-Off

Flat foot gait Plantar-flexor weakness Rupture of the Archilles tendon or

the triceps surae Metatarsal pain, hallux rigidus

Internal or External Limb Rotation

Internal rotation Biceps femoris weakness spasticity

External rotation Quadriceps weakness Inner hamstring weakness Spasticity

Abnormal walking base

Wide Base (> 4 inch) Hip-abduction contracture Instability due to fear, proprioceptive

deficit, cerebellar problem Perineal pain Genu valgum

Narrow base (< 2 inch) Spasticity Genu varum

Vaulting

Swing-phase limb is relatively longer

Hip hiking

Increased ipsilateral length: hip -flexor or dorsiflexor

weakness hip, knee, ankle ankylosis or

spasticity insufficient hip or knee flexion

Contralateral shortness

Circumduction

Spasticity Hip flexor weakness Hamstring paralysis Knee or ankle ankylosis /

orthotic knee lock Dorsiflexor weakness Plantar-flexion contracture

Scissoring gait

In spastic CP with spasticity of adductor m.

Crouched Gait

Excessive flexion of hip and knee due to spasticity, muscle tightness or contracture

Spastic CP

Parkinsonian gait

Trunk ,head ,neck forward

and knee flexed

wide base ,small shuffling s

tep

trend to fall forward and to i

ncrease speed (festination)

Hemiplegic gait

Abnormal arm swing : adduction wit

h flexion at shoulder ,elbow ,wrist an

d fingers

extensor synergy of lower limb: leg

extension ,adduction and hip IR ,kne

e extension ,ankle and foot plantarfl

exion and inversion.

Gait aids

Purpose of gait aids

Increase area of support, maintain center of gravity over support area

Redistribute weight-bearing area

Requirements

ROM, muscle strength and endurance, coordination, trunk balance, sensory perception, mental status

Amount of weight-bearing permitted on lower limb

Requirements Shoulder depressor – latissimus dorsi,

lower trapezius, pectoralis minor Shoulder adductor – pectoralis major Shoulder flexor, extensor and abductor – deltoid

Elbow extensor – triceps Wrist extensor – ECR, ECU Finger flexor – FDS, FDP, FPL, FPB

Crutches Body weight

transmission with bilateral axillary crutches = 80% of BW, nonaxillary crutches = 40-50% of BW

Good strength of upper limbs usually required – more weight bearing and propulsion

Unilateral non/partial weight bearing eg fracture, amputee -> 3-point gait

Bilateral partial weight bearing or incoordination/ataxia -> 2 or 4-point gait

Bilateral weakness of lower extremities eg paraplegia -> swing-to or through gait

Non-axillary crutches Lofstrand/forearm crutches Platform crutch Wooden forearm orthosis (Kenny stick) Triceps weakness orthoses (arm

orthoses) eg Warm Spring, Everett, Canadian crutch

Axillary crutches Crutch length : measure anterior

axillary fold to point 6 inches anterolaterally from foot or to heel plus 1-2 inches

Hand piece : elbow flexed 30 degree, wrist max extension, finger fist

2-3 FB from apex of axilla Compressive radial neuropathies

Lofstrand/forearm crutches Single aluminum tubular

adjustable shaft, handpiece, forearm piece 2 inches below elbow, forearm cuff anterior opening (hinge)

Elbow flexion 20 degree Can release hand

without loosing crutch Requires great skill,

good strength of UEs, trunk balance

Platform crutch

Painful wrist and hand condition or elbow contractures, or weak hand grip

Platform, velcro strap Elbow flexed 90

degrees

Crutch Gaits

Point gait – stability, slow Swing gait – more energy, fast

Four-point gait

Good stability - at least 3 point contact ground

Ataxia or incoordination

Slowest, difficulty

Three-point gait/alternating two-point gait

Non-weight-bearing gait for lower limb fracture or amputation

3-point PWB gait -> required 18-36% more energy per unit distance than normal

NWB required 41-61%more energy per unit distance than normal

Two-point gait

Faster than 4-point gait but less stability

Decrease both lower limbs weight-bearing

Swing-through gait

Fastest gait, requires functional abdominal muscles

Required increase of 41-61% in net energy cost (= 3-point NWB)

Swing-to gait

Both crutches -> both lower limbs almost to crutch level

Canes

Body weight transmission for unilateral cane opposite affected side is 20-25%

Gluteus medius weakness, or pathological at knee or ankle

Cane eliminate necessary gluteus medius force and reduces compressional force on hip

Measure tip of cane to level of greater trochanter, elbow flexed 20-30 degree

Walker/Walkerette

Wider and more stable base of support, but slow gait (interfere smooth reciprocal gait)

For patients requiring maximum assistance with balance, uncoordinated

Add wheels to front legs for who lack coordination or power in upper limbs

Front of walker 12 inches in front of patient

Shoulder relaxed and elbow flexed 20 degree

Three-point gait