Sunteți pe pagina 1din 71

-series of rhythmical alternating

movements of limb and trunk which


result in forward progression of the
COG
-time interval or sequence of motions
occurring between two consecutive initial
contacts of the same foot; each cycle
lasts for 1-2 seconds.
 Occurs when only one is on the
ground; 30% of the gait cycle: single
leg stance
 Both limbs are simultaneously in
contact with the ground; 20% of the
gait cycle; double leg stance
 % increases to more one slowly walks;
it becomes shorter as walking speed
increases and disappears in running
WALKING- 2 periods of double leg
support
RUNNING- with “double float” ( period of
time in which neither foot is in contact
with the ground)
1. Stance Phase
 Makes up to 60% of the gait cycle
during normal walking
 Occurs when the foot is on the ground
and bearing weight
 The Los Amigos National rehabilitation
Center (RLA) has developed different
terminology in which the subdivision
have been redefined and named.
1. HEEL STRIKE refers to the instant at
which the heel of the leading
extremity strikes the ground.
RLA: Initial contact refers to the
instant the foot of the leading
extremity strikes the ground.
2. FOOT FLAT- occurs immediately after
heel strike and is the point at which
the foot fully contacts the ground.
RLA: Loading response occurs
immediately following initial contact
and continues until the contralateral
extremity lifts off the ground at the
end of the double-support phase.
3. MIDSTANCE- is the point at which the
body weight is directly over the
supporting lower extremity.
RLA: Midstance begins when the
contralateral extremity lifts off the
ground and continues to a position in
which the body has progressed over
and ahead of the supporting extremity.
4. HEEL OFF is the point at which the
heel of the reference extremity leaves
the ground.
RLA: Terminal stance is the period from
the end of midstance to a point just
prior to initial contact of the
contralateral extremity or following
heel off of the reference extremity.
5. TOE OFF is the point at which only
the toe of the ipsilateral extremity is in
contact with the ground.
RLA: Preswing encompasses the period
from just following heel off to toe off.
 40% of the walking cycle
 Occurs when the foot is not bearing
weight and is moving forward.
1. Acceleration begins once the toe of
the reference (ipsilateral) extremity
leaves the ground.
- 10% of the swing phase
 RLA- Initial swing begins at the same
point as acceleration continues until
maximum knee flexion of the reference
(ipsilateral ) extremity occurs.
2. MIDSWING- occurs when the
ipsilateral extremity passes directly
beneath the body.( 80% of the swing
phase)
RLA- Midswing encompasses the period
immediately following maximum knee
flexion and continues until the tibia is
in a vertical position.
3. Decelaration occurs after the
midswing when the tibia passes
beyond the perpendicular and the knee
is extending in preparation for heel
strike.
-10% of the swing phase
RLA- Terminal swing includes the period
from the point at which the tibia is in
the vertical position to a point just
prior to initial contact.
TRADITIONAL RLA
Heel Strike Initial contact
Heel strike to foot flat Loading response
Foot flat to midstance Midstance
Midstance to heel off Terminal stance
Toe off Preswing
Toe off to accelaration Initial swing
Accelaration to Midswing
midswing Terminal swing
Midswing to
deceleration
 Traditional terminology – refers to
points in time
 RLA terminology- refers to lengths of
time
 Weight acceptance period of the stance
leg
 First 10% of the gait cycle
 A period of double support or double-
leg stance
 Consists of the single support or single
leg stance
 Accounts for the next 40% of the gait
cycle.
 Make up the weight-unloading period
 Accounts for the next 10% of the gait
cycle
 A period of double support.
1. BASE WIDTH- distance between the
two feet
 5 to 10 cm (2-4 inches)
 Wide base- cerebellar or inner ear
problems, diabetes or peripheral
neuropathy indicating loss of
sensation, tight hip abductors.
 2. STEP LENGTH- distance b/2
successive contact points on opposite
feet 37.5cm(15inches)
 Should be equal for both legs
 Increased in tall persons, decreased in
children, female at old, with age ,
fatigue, pain and disease.
3. STRIDE LENGTH- linear distance in
the plane of progression between
successive points of foot-to –floor
contact of the same foot. 75 cm (30
inches)
4. LATERAL PELVIC SHIFT(PELVIC LIST)
-Side to side movement of the pelvis
during walking.
- 5cm(2inches)
- increases if the feet are farther apart
 Causes relative adduction of the
weight bearing limb, facilitating the
adduction of the hip adductors.
 Weakness= trendelenburg gait
 5. VERTICAL PELVIC SHIFT
 Keeps the COG from moving up and
down more than
 5cm (2 inches) during the normal gait.
 High point occurs during midstance
and the low point occurs during initial
contact.
 The head is never higher during
normal gait than it is when the person
is standing on both feet.
 Swing Phase: hip is lower on the swing
side and patient must flex the knee
and dorsiflex the foot to clear the toe.
 6.PELVIC ROTATION
 Necessary to lessen the angle of the femur
with the floor; lengthens the femur.
 Decreases the amplitude if displacement
along the path travelled by the COG and
hereby increases the COG dip
 8 deg pelvic rotation with 4 deg
forward on the swing leg and 4 leg
posteriorly on the stance leg.
 Thorax rotated in the opposite
direction to maintain balance.
 5cm(2inches) anterior to the 2nd sacral
vertebra.
 It’s vertical and horizontal
displacement is a figure during walking
 Sinusoidal
 Number of steps per minute.
 90-120 steps per minute
 WALKING SPEED distance covered over
a period of time.
 slow70m./min
 Medium 95/min
 Fast 120m/min
The determinants of gait has two
important function namely:
1. Lessen the movement of the center
of the gravity, therefore reducing the
energy expenditure.
- COG is lowest during the period of
double support highest and midstance
- COG is lowest during the period of
double support highest and midstance.
2. Produce a smooth sinusoidal
movement
 Pelvic rotation
 Pelvic tilt
 Knee flexion in the stance phase
 Foot and ankle motion- synchronous
motion produces gradual rise/fall of
COG
 Knee flexion
 Lateral motion of the pelvis
1. For females ( compared to males)
- slower speed with greater
cadence
- decreased arm swing
- decreased lateral and vertical
head motion
- greater lateral and pelvic shift
2. Elderly
- slower speed with wider, shorter
steps
- decreased arm swing
- less pelvic rotation
- increased double support
3. When wearing high-heeled shoes
- slower speed, same cadence
- increased knee flexion during early
stance
- rapid movement to lower fore foot on
the floor
1. STRUCTURAL PATHOLOGIC GAITS
1.1 Inequality of leg length
 One leg is longer with discrepancy>1.5in.
-tiptoe at stance of shorter extremity
 One leg is longer with discrepancy<1.5
in.
- dipping of shoulder and dropping of
the pelvis on the affected side.
- apparent elevation of shoulder on
swing side.
- exaggerated hip, knee, ankle flexion
by contralateral extremity during
swing.
1.2 Hip Ankylosis
 compensatory motion of the lumbar
spine
 Exaggerated movement of the opposite
hip.
1.3 Knee joint stability
 sudden knee buckling
 Abnormal or excessive ROM of the
knee
1.4 Knee Contractures
 if flexion contracture is less than 30
degrees – there is limping apparent in
fast walking
 If flexion contracture is greater than
30 degrees- limping even in slow
walking
 extension contracture – during
STANCE have excessive rise of pelvis
and center of gravity with lack of shock
absorption during heel strike.
---- during SWING have hip
circumduction and hip hiking on the
affected side or tiptoeing on affected
side.
1.5 Limitation of foot and ankle motion
a) Equinus
- foot drop deformity usually due to
paralysis of the ant. compartment
muscles esp. the tibialis anterior
- heelstrike is absent and patient walks
with either a toe-heel gait or starts
with foot flat.
- when bilateral a steppage gait is
observed so that both feet(specifically
the ball of each foot)
horse from which it is named; to clear
the foot from the ground the patient
will do excessive hip and knee flexion.
b.) Calcaneus
-type of deformity that occurs in
paralysis of the gastocsoleus
- during gait this will present with an
apparent lack weakness of PUSH OFF.
 self-protective
 The result of injury to the pelvis, hip,
knee, ankle, or foot
 Stance phase on the affected leg-
shorter than non-affected leg( pt.
attempts to remove wt. from the aff.
Leg as quickly as possible)
 Decreased swing phase of the
uninvolved leg- shorter step length of
the uninvolved side, decreased walking
velocity and decreased cadence.
 Cerebellar ataxia- gait includes a lurch
or stagger, all movements are
exaggerated; drunken gait.
 Sensory ataxia- feet slap the ground
because they cannot be felt; patient
watches the feet while walking;
resulting gait is irregular, jerky, and
weaving
 secondary to weak hip extensors
 Patient thrusts the thorax posteriorly
at initial contact to maintain hip
extension of the stance leg
 Resulting gait involves a characteristic
backward lurch of the trunk.
 secondary to weak hip abductors
 Patient exhibit an excessive lateral list
in which the thorax is thrust laterally to
keep the COG over the stance leg
 Bilateral weakness- accentuated side
to side movement resulting in wobbling
gait or chorus girl swing gait.
 patient swings the affected leg
outward and ahead in a circle
(circumduction) or pushes it ahead
 Affected upper limb is carried across
the trunk for balance
 a.ka. neurogenic gait or flaccid gait
 Neck, trunk, and knees of the patient
are flexed
 Shuffling or short rapid steps
 Arms are held stiffly and do not have
their normal associative movement
 Patient may lean forward and walk
progressively faster as through unable
to stop (festating)
 Spastic paralysis of the hip adductor
muscle which causes the knees to be
drawn together so that the legs can be
swung forward only with great effort
 Seen in spastic paralegics
 a.k.a. spastic gait