Functional Assesment

Heri Wibisono
Gait Analysis
 Gait Analysis
• Normal gait
• Abnornal gait
- Equinas
- Drop foot/High step
- Antalgic
- Trendelenburg
- Short leg
 Normal Gait
• Stance phase
• Swing phase
 Abnormal gait
Equinas, common causes :
- cerebral palsy
- tight achilles tendon
- limb length discrepancy
 Abnormal gait
Drop foot/high step, common causes :
- direct injury to dorsiflexors
- deep perneal nerve palsy

Antalgic , many many causes

 Abnormal gait
Trendelenburg, caused by weak lower limb
abductors :
- L5 radiculopathy
- painful hip pathology
- femur neck fracture
- hip dislocation
 Abnormal gait
Short leg, comon causes :
- congenital hip dysplasia & hemiatrophy
- hypertrophy
- growth plate injury
- healed fracture
- chronic osteitis
 Crutch gait
Type of Crutch Gaits :
4-point alternate crutch gait
Sequence: right crutch, left foot; left crutch, right foot.
2-point alternate crutch gait
Sequence: right crutch and left foot; left crutch and right
foot (most closely resembles normal walking)
3-point alternate crutch gait
Sequence: both crutches and the weaker leg move
forward simultaneously; then the stronger extremity is
moved forward while placing most of the body weight on
the arms.
 Crutch gait
Type of Crutch Gaits :
Swing-to crutch gait
Sequence: bear weight on good leg (or legs);
advance both crutches forward simultaneously,
lean forward while swinging the body to a position
even with the crutches.
Swing-through crutch gait
Sequence: advance both crutches forward; lift legs
off the ground and swing forward landing in
advance of the crutches (fastest of all gaits).
 Functional activity
• Activity daily living

• Work

• Leissure
 Parameters functional assesment
• Barthel index
• Berg balance scale
• Oswestry disability index
• Lysholm knee scoring scale
• Katz index
• Shoulder pain and disability
• Functional independence measurement
The Fukuda Test for
Vestibular Function
 Vestibular Function
The vestibular system is the sensory
apparatus of the inner ear that helps
the body maintain its postural
equilibrium. The information furnished
by the vestibular system is also
essential for coordinating the position
of the head and the movement of the
eyes.
If you are feeling dizzy, have vertigo, or are having
problems maintaining your balance, then you may
be suffering from a vestibular system problem. Your
doctor may refer you to a physical therapist to
assess your problem and to provide strategies to
help manage your dizziness.
If you are feeling dizzy, your physical therapist may
use the Fukuda Step test to assess your condition
and to provide the best treatment for your vertigo.
The Fukuda Stepping test is one balance and
vestibular test that may also be performed
during a vestibular and balance exam. The test is
used to determine if there is vestibular system
weakness on one side of your body.
 How to Perform the Test
To perform the Fukuda Stepping Test, you
should first make sure you have plenty of space
around you. It is also a good idea to have a
friend or family member nearby to assist you in
performing the test.
 How to Perform the Test
• To start the test, stand in the middle of a room. Place a
small piece of tape on the floor in front of your toes to
mark your starting position.
• Close both eyes and hold your arms outstretched
directly in front of you. Now, start stepping in place.
Your pace should be comfortable as if you were taking
a brisk walk. Make sure someone is watching you so
you do not bump into anything in the room.
• Remain walking in place for 50 to 100 steps. After
stepping, open your eyes and determine how much
your body rotated to one side or the other.
 How to Assess the Results
After performing the Fukuda Stepping Test,
place a small piece of tape on the floor along the
front of your toes, and compare the angle of this
line with your original line. If you have taken
only 50 steps, then an angle of 30 degrees or
more may indicate vestibular weakness to the
side your body deviated.
 How to Assess the Results

If you performed the Fukuda Test for 100 steps,

an angle greater than 45 degrees indicates
single-sided vestibular weakness on the side
to which your body turned while doing the
test.
 Reliability
There is some question amongst healthcare
providers as to whether the Fukuda Test is a
reliable measure of vestibular function. One
study examined patients with confirmed
vestibular dysfunction on one side and
compared them to patients with no vestibular
function impairments. The results indicated that
it didn't matter if you had a vestibular problem
or not; some people rotated to one side, others
did not.
 Reliability
Another study found that in patients with
confirmed vestibular dysfunction, about 50%
turned toward the affected side, 25% turned
towards the unaffected side, and 25% remained
relatively stable with a turn of fewer than 45
degrees from the starting position. This
indicates that the Fukuda Stepping Test may not
be able to be used to indicate which side of your
vestibular system is affected.