dutton chapter13 gait

7/25/2019 Dutton Chapter13 Gait

1/50

Chapter 13Chapter 13

Gait and posture analysisGait and posture analysis


2/50

OverviewOverview

It is not clear whether gait isIt is not clear whether gait is

learned or is pre-programmed atlearned or is pre-programmed at

the spinal cord level. However,the spinal cord level. However,once mastered, gait allows us toonce mastered, gait allows us to

move around our environment in anmove around our environment in an

efcient manner, requiring little inefcient manner, requiring little inthe way o conscious thought, atthe way o conscious thought, at

least in amiliar surroundings.least in amiliar surroundings.


3/50

The Gait CycleThe Gait Cycle

Walking involves the alternating actionWalking involves the alternating action

o the two lower etremitieso the two lower etremities

!he walking pattern is studied as a gait!he walking pattern is studied as a gaitcyclecycle

" !he!he gait cyclegait cycleis de#ned as the interval ois de#ned as the interval o

time $etween any o the repetitive eventstime $etween any o the repetitive events

o walking. %uch an event could includeo walking. %uch an event could includethe point when the oot initially contactsthe point when the oot initially contacts

the ground, to when the same oot contactsthe ground, to when the same oot contacts

the ground againthe ground again


4/50


!he gait cycle consists o two periods&!he gait cycle consists o two periods&

stance and swingstance and swing

" !he stance period!he stance period 'onstitutes approimately ()* o the gait cycle'onstitutes approimately ()* o the gait cycle

+escri$es the entire time the oot is in contact+escri$es the entire time the oot is in contact

with the ground and the lim$ is $earing weightwith the ground and the lim$ is $earing weight

egins with the initial contact o the oot on theegins with the initial contact o the oot on the

ground, and concludes when the ipsilateral ootground, and concludes when the ipsilateral ootleaves the groundleaves the ground

!he stance period takes a$out ).( sec during an!he stance period takes a$out ).( sec during an

average walking speedaverage walking speed


5/50


%wing period%wing period

" 'onstitutes approimately )* o'onstitutes approimately )* o

the gait cyclethe gait cycle" +escri$es the period when the oot+escri$es the period when the oot

is not in contact with the groundis not in contact with the ground

" egins as the oot is lited rom theegins as the oot is lited rom theground and ends with initial contactground and ends with initial contact

with the ipsilateral ootwith the ipsilateral oot


6/50

Stance PeriodStance Period

Within the stance period, two tasksWithin the stance period, two tasks

and our intervals are recogniedand our intervals are recognied

!he two tasks include weight!he two tasks include weightacceptance and single lim$ supportacceptance and single lim$ support

!he our intervals include!he our intervals include loadingloading

responseresponse,, mid stancemid stance,, terminalterminalstancestanceandandpre-swingpre-swing


7/50


Weight acceptanceWeight acceptance

"!he weight acceptance task occurs!he weight acceptance task occurs

during the #rst /)* o the stanceduring the #rst /)* o the stanceperiodperiod!he loading response interval $egins as!he loading response interval $egins as

one lim$ $ears weight while the other legone lim$ $ears weight while the other leg

$egins to go through its swing period.$egins to go through its swing period.!his interval may $e reerred to as the!his interval may $e reerred to as the

initial double stanceinitial double stanceperiod and consistsperiod and consists

o the #rst )-/)* o the gait cycleo the #rst )-/)* o the gait cycle


8/50


%ingle 0eg %upport%ingle 0eg %upport

" !he middle )* o the stance period is divided!he middle )* o the stance period is divided

equally into mid stance and terminal stanceequally into mid stance and terminal stance !he mid stance interval representing the #rst hal o!he mid stance interval representing the #rst hal o

the single lim$ support task, $egins as one oot isthe single lim$ support task, $egins as one oot is

lited, and continues until the $ody weight is alignedlited, and continues until the $ody weight is aligned

over the oreootover the oreoot

!he terminal stance interval is the second hal o the!he terminal stance interval is the second hal o the

single lim$ support task. It $egins when the heel o thesingle lim$ support task. It $egins when the heel o theweight $earing oot lits o1 the ground and continuesweight $earing oot lits o1 the ground and continues

until the contralateral oot strikes the grounduntil the contralateral oot strikes the ground


9/50


0im$ 2dvancement0im$ 2dvancement

" 3re-swing3re-swing..!his interval $egins with!his interval $egins with

initial contact o the contralateralinitial contact o the contralaterallim$ and ends with ipsilateral toe-lim$ and ends with ipsilateral toe-

o1. 2s $oth eet are on the 4oor ato1. 2s $oth eet are on the 4oor at

the same time during this interval,the same time during this interval,

dou$le support occurs or thedou$le support occurs or the

second time in the gait cycle.second time in the gait cycle.


10/50

Swing PeriodSwing Period

Within the swing period, one taskWithin the swing period, one task

and our intervals are recogniedand our intervals are recognied

!he task involves lim$!he task involves lim$advancementadvancement

!he our intervals include!he our intervals includepre-pre-

swingswing,, initial swinginitial swing,, mid-swingmid-swing,,andand terminal swingterminal swing


11/50


0im$ 2dvancement0im$ 2dvancement

Pre-swing.Pre-swing. In addition to representing theIn addition to representing the

#nal portion o the stance period and#nal portion o the stance period andsingle lim$ support task, the pre-swingsingle lim$ support task, the pre-swing

interval is considered as part o the swinginterval is considered as part o the swing

periodperiod

" Initial swingInitial swing. !his interval $egins with the. !his interval $egins with the

lit o the oot rom the 4oor and endslit o the oot rom the 4oor and ends

when the swinging oot is opposite thewhen the swinging oot is opposite the

stance oot.stance oot.


12/50


0im$ 2dvancement0im$ 2dvancement" Mid-swingMid-swing. !his interval $egins as the. !his interval $egins as the

swinging lim$ is opposite the stanceswinging lim$ is opposite the stancelim$, and ends when the swinginglim$, and ends when the swinginglim$ is orward and the ti$ia islim$ is orward and the ti$ia isverticalvertical

" Terminal swingTerminal swing. !his interval $egins. !his interval $eginswith a vertical ti$ia o the swing legwith a vertical ti$ia o the swing legwith respect to the 4oor, and endswith respect to the 4oor, and endsthe moment the oot strikes the 4oorthe moment the oot strikes the 4oor


13/50

Gait parametersGait parameters

'adence'adence" 'adence is de#ned as the num$er o'adence is de#ned as the num$er o

separate steps taken in a certain timeseparate steps taken in a certain time" 5ormal cadence is $etween 6) and /7)5ormal cadence is $etween 6) and /7)steps per minutesteps per minute!he cadence o women is usually (-6 steps!he cadence o women is usually (-6 steps

per minute slower than that o menper minute slower than that o men 'adence is also a1ected $y age, with'adence is also a1ected $y age, with

cadence decreasing rom the age o to thecadence decreasing rom the age o to theage o 8, and then again in advancing yearsage o 8, and then again in advancing years


14/50

Gait parametersGait parameters

%tride length%tride length" %tep length is measured as the distance%tep length is measured as the distance

$etween the same point o one oot on$etween the same point o one oot onsuccessive ootprints 9ipsilateral to thesuccessive ootprints 9ipsilateral to thecontralateral oot all:.contralateral oot all:.

" %tride length, on the other hand, is the%tride length, on the other hand, is thedistance $etween successive points odistance $etween successive points o

oot-to-4oor contact o the same ootoot-to-4oor contact o the same oot 2 stride is one ull lower etremity cycle2 stride is one ull lower etremity cycle!wo step lengths added together make the!wo step lengths added together make the

stride lengthstride length


15/50

Characteristics ofCharacteristics of

Normal GaitNormal Gait Gait involves the displacement o $odyGait involves the displacement o $ody

weight in a desired direction utiliing aweight in a desired direction utiliing a

coordinated e1ort $etween the ;oints ocoordinated e1ort $etween the ;oints othe trunk and etremities and thethe trunk and etremities and the

muscles that control or produce thesemuscles that control or produce these

motionsmotions

2ny intererence that alters this2ny intererence that alters thisrelationship may result in a deviation orrelationship may result in a deviation or

distur$ance o the normal gait patterndistur$ance o the normal gait pattern


16/50

Normal GaitNormal Gait


17/50

Center of GravityCenter of Gravity

(COG)(COG) +uring the gait cycle, the '>G is+uring the gait cycle, the '>G is

displaced $oth vertically anddisplaced $oth vertically and

laterallylaterally


18/50

oint !otions in Gaitoint !otions in Gait

!runk and ?pper =tremities!runk and ?pper =tremities

" +uring the gait cycle&+uring the gait cycle& !he swing o the arms is out o phase with the legs!he swing o the arms is out o phase with the legs

2s the upper $ody moves orward, the trunk twists2s the upper $ody moves orward, the trunk twists

a$out a vertical aisa$out a vertical ais

!he thoracic spine and the pelvis rotate in opposite!he thoracic spine and the pelvis rotate in opposite

directions to each other to enhance sta$ility anddirections to each other to enhance sta$ility and

$alance$alance

!he lum$ar spine tends to rotate with the pelvis!he lum$ar spine tends to rotate with the pelvis

!he shoulders and trunk rotate out o phase with!he shoulders and trunk rotate out o phase with

each other during the gait cycleeach other during the gait cycle


19/50


3elvis3elvis

"


20/50


%acroiliac @oint%acroiliac @oint" 2s the right leg moves through the swing period,2s the right leg moves through the swing period,

the position o the right innominate changes romthe position o the right innominate changes rom

one o etreme anterior rotation at the point oone o etreme anterior rotation at the point opre-swing to a position o posterior rotation at thepre-swing to a position o posterior rotation at thepoint o initial contactpoint o initial contact

" 2s the right etremity moves through the loading2s the right etremity moves through the loadingresponse to mid stance, the ilium on that sideresponse to mid stance, the ilium on that side$egins to convert rom a posteriorly rotated$egins to convert rom a posteriorly rotatedposition to a neutrally rotated position.


21/50


%acroiliac @oint%acroiliac @oint

"!he sacrum rotates orward around!he sacrum rotates orward around

a diagonal ais during the loadinga diagonal ais during the loadingresponse, reaching its maimumresponse, reaching its maimum

position at mid stance 9e.g., rightposition at mid stance 9e.g., right

rotation on a right o$lique ais atrotation on a right o$lique ais at

right mid stance:, and then $eginsright mid stance:, and then $eginsto reverse itsel during terminalto reverse itsel during terminal

stancestance


22/50


HipHip

" Hip motion occurs in all three planesHip motion occurs in all three planes

during the gait cycleduring the gait cycle AneeAnee

"!he knee 4ees twice and etends!he knee 4ees twice and etends

twice during each gait cycle& oncetwice during each gait cycle& onceduring weight $earing and onceduring weight $earing and once

during non-weight $earingduring non-weight $earing


23/50



24/50

!"scle #ctions!"scle #ctionsin Gaitin Gait

%pine and pelvis%pine and pelvis" +uring the swing period, the semispinalis,+uring the swing period, the semispinalis,

rotatores, multi#dus, and eternal o$liquerotatores, multi#dus, and eternal o$lique

muscles are active on the side toward whichmuscles are active on the side toward whichthe pelvis rotatesthe pelvis rotates

" !he erector spinae and internal o$lique!he erector spinae and internal o$liquea$dominal muscles are active on the oppositea$dominal muscles are active on the oppositesideside

" !he psoas ma;or and quadratus lum$orum!he psoas ma;or and quadratus lum$orumhelp to support the pelvis on the side o thehelp to support the pelvis on the side o theswinging lim$, while the contralateral hipswinging lim$, while the contralateral hipa$ductors also provide supporta$ductors also provide support


25/50


AneeAnee" +uring the swing period, there is very little+uring the swing period, there is very little

activity rom the knee 4eorsactivity rom the knee 4eors

" !he knee etensors contract slightly at the!he knee etensors contract slightly at theend o the swing period prior to initialend o the swing period prior to initialcontact. +uring level walking the quadricepscontact. +uring level walking the quadricepsachieve peak activity during the loadingachieve peak activity during the loadingresponse interval 97B* maimum voluntaryresponse interval 97B* maimum voluntary

contraction: and are relatively inactive $ycontraction: and are relatively inactive $ymid stance as the leg reaches the verticalmid stance as the leg reaches the verticalposition and ClocksD, making quadricepsposition and ClocksD, making quadricepscontraction unnecessarycontraction unnecessary


26/50


HipHip" +uring the early to mid portion o the swing+uring the early to mid portion o the swing

phase, the iliopsoas is the prime mover withphase, the iliopsoas is the prime mover with

assistance rom the rectus emoris, sartorius,assistance rom the rectus emoris, sartorius,gracilis, adductor longus, and possi$ly the tensorgracilis, adductor longus, and possi$ly the tensorascia latae, pectineus, and the short head o theascia latae, pectineus, and the short head o the$iceps emoris during the initial swing interval$iceps emoris during the initial swing interval

" In terminal swing, there is no apprecia$le actionIn terminal swing, there is no apprecia$le action

o the hip 4eors when am$ulating on levelo the hip 4eors when am$ulating on levelground. Instead the hamstrings and gluteusground. Instead the hamstrings and gluteusmaimus are strongly active to decelerate hipmaimus are strongly active to decelerate hip4eion and knee etension4eion and knee etension


27/50


HipHip

" !he adductor magnus muscle supports hip!he adductor magnus muscle supports hip

etension and also rotates the pelvisetension and also rotates the pelvis

eternally toward the orward legeternally toward the orward leg

" In mid stance, coronal plane muscle activityIn mid stance, coronal plane muscle activity

is greatest as the a$ductors sta$ilie theis greatest as the a$ductors sta$ilie the

pelvis. !he muscle activity initially ispelvis. !he muscle activity initially is

eccentric as the pelvis shits laterally overeccentric as the pelvis shits laterally overthe stance leg. !he gluteus medius andthe stance leg. !he gluteus medius and

minimus remain active in terminal stance orminimus remain active in terminal stance or

lateral pelvic sta$iliationlateral pelvic sta$iliation


28/50


AneeAnee

" Hamstring involvement is also importantHamstring involvement is also important

to normal knee unctionto normal knee unction..!he co!he coactivation o the antagonist musclesactivation o the antagonist muscles

a$out the knee during the loadinga$out the knee during the loading

response aid the ligaments inresponse aid the ligaments in

maintaining ;oint sta$ility, $y equaliingmaintaining ;oint sta$ility, $y equaliing

the articular surace pressurethe articular surace pressure

distri$ution, and controlling ti$ialdistri$ution, and controlling ti$ial

translation.translation.


29/50



30/50



31/50



32/50



33/50

$n%"ences on Gait$n%"ences on Gait

3ain3ain

3osture3osture


34/50

$n%"ences on Gait$n%"ences on Gait

>$esity>$esity

2ge2ge

0ateral and vertical displacement o0ateral and vertical displacement othe '>Gthe '>G

3roperly unctioning re4ees3roperly unctioning re4ees

Eertical Ground Feaction


35/50

Speci&c 'eviations ofSpeci&c 'eviations of

$ndivid"al oints$ndivid"al oints HipHip

" Inadequate powerInadequate power

" Inadequate or inappropriate range oInadequate or inappropriate range omotionmotion

" alrotationalrotation


36/50


$ndivid"al oints$ndivid"al oints AneeAnee

"!he common pro$lem at the knee!he common pro$lem at the knee

during the stance period is ecessiveduring the stance period is ecessive4eion. +uring the swing period, the4eion. +uring the swing period, the

most common error is due tomost common error is due to

inadequate motioninadequate motion


37/50


$ndivid"al oints$ndivid"al oints


38/50

#normal Gait#normal Gait

SyndromesSyndromes In general gait deviations allIn general gait deviations all

under our headings&under our headings&

"!hose caused $y weakness!hose caused $y weakness"!hose caused $y a$normal ;oint!hose caused $y a$normal ;oint

position or range o motionposition or range o motion

"!hose caused $y muscle contracture!hose caused $y muscle contracture"!hose caused $y pain!hose caused $y pain


39/50


SyndromesSyndromes 2ntalgic Gait2ntalgic Gait

" !he antalgic gait pattern can result rom!he antalgic gait pattern can result rom

numerous causes including ;ointnumerous causes including ;oint

in4ammation or an in;ury to the musclesin4ammation or an in;ury to the musclestendons and ligaments o the lower etremitytendons and ligaments o the lower etremity

" !he antalgic gait is characteried $y a!he antalgic gait is characteried $y a

decrease in the stance period on the involveddecrease in the stance period on the involved

side in an attempt to eliminate the weightside in an attempt to eliminate the weightrom the involved leg and use o the in;uredrom the involved leg and use o the in;ured

$ody part as much as possi$le$ody part as much as possi$le


40/50


SyndromesSyndromes =quinus Gait=quinus Gait

" =quinus gait 9toe-walking:, one o=quinus gait 9toe-walking:, one o

the more common a$normalthe more common a$normalpatterns o gait o patients withpatterns o gait o patients with

spastic diplegia, is characteried $yspastic diplegia, is characteried $y

oreoot strike to initiate the cycleoreoot strike to initiate the cycle

and premature plantar 4eion inand premature plantar 4eion inearly stance to midstanceearly stance to midstance


41/50


SyndromesSyndromes Gluteus maimus GaitGluteus maimus Gait

" !he gluteus maimus gait, which results!he gluteus maimus gait, which results

rom weakness o the gluteus maimus, isrom weakness o the gluteus maimus, is

characteried $y a posterior thrusting ocharacteried $y a posterior thrusting o

the trunk at initial contact in an attempt tothe trunk at initial contact in an attempt to

maintain hip etension o the stance legmaintain hip etension o the stance leg

" !he hip etensor weakness also results in!he hip etensor weakness also results in

orward tilt o the pelvis, which eventuallyorward tilt o the pelvis, which eventually

translates into a hyperlordosis o the spinetranslates into a hyperlordosis o the spine

to maintain postureto maintain posture


42/50


SyndromesSyndromes uadriceps Gaituadriceps Gait

" uadriceps weakness can result rom auadriceps weakness can result rom a

peripheral nerve lesion 9emoral:, a spinalperipheral nerve lesion 9emoral:, a spinal

$erve root lesion, rom trauma, or rom$erve root lesion, rom trauma, or romdisease 9muscular dystrophy:disease 9muscular dystrophy:

" uadriceps weakness requires that orwarduadriceps weakness requires that orward

motion $e propagated $y circumducting eachmotion $e propagated $y circumducting each

leg. !he patient leans the $ody toward theleg. !he patient leans the $ody toward theother side to $alance the center o gravity,other side to $alance the center o gravity,

and the motion is repeated with each stepand the motion is repeated with each step


43/50


SyndromesSyndromes %pastic Gait%pastic Gait

" 2 spastic gait may result rom either2 spastic gait may result rom either

unilateral or $ilateral upper motor neuronunilateral or $ilateral upper motor neuron

lesionslesions %pastic hemiplegic 9hemiparetic: gait%pastic hemiplegic 9hemiparetic: gait..!his type o!his type o

gait results rom a unilateral upper motor neurongait results rom a unilateral upper motor neuron

lesion and is requently seen ollowing alesion and is requently seen ollowing a

completed strokecompleted stroke

%pastic paraparetic gait. !his type o gait results%pastic paraparetic gait. !his type o gait results

rom $ilateral upper motor neuron lesions 9e.g.,rom $ilateral upper motor neuron lesions 9e.g.,

cervical myelopathy in adults and cere$ral palsycervical myelopathy in adults and cere$ral palsy

in children:in children:


44/50


SyndromesSyndromes 2taic Gait2taic Gait

"!he ataic gait is seen in two!he ataic gait is seen in two

principal disorders& cere$ellarprincipal disorders& cere$ellardisease 9cere$ellar ataic gait: anddisease 9cere$ellar ataic gait: and

posterior column disease 9sensoryposterior column disease 9sensory

ataic gait:ataic gait:


45/50


SyndromesSyndromes Steppage GaitSteppage Gait

" !his type o gait occurs in patients with a oot!his type o gait occurs in patients with a ootdropdrop

" 2 oot drop is the result o weakness or2 oot drop is the result o weakness orparalysis o the dorsi4eor muscles due to anparalysis o the dorsi4eor muscles due to anin;ury to the muscles, their peripheral nervein;ury to the muscles, their peripheral nervesupply, or the nerve roots supplying thesupply, or the nerve roots supplying themusclesmuscles

" !he patient lits the leg high enough to clear!he patient lits the leg high enough to clearthe 4ail oot o1 the 4oor $y 4eingthe 4ail oot o1 the 4oor $y 4eingecessively at the hip and knee, and thenecessively at the hip and knee, and thenslaps the oot on the 4oorslaps the oot on the 4oor


46/50


SyndromesSyndromes !rendelen$urg Gait!rendelen$urg Gait

" !his type o gait is due to weakness o the!his type o gait is due to weakness o the

hip a$ductors 9gluteus medius andhip a$ductors 9gluteus medius and

minimus:minimus:

" !he normal sta$iliing a1ect o these!he normal sta$iliing a1ect o these

muscles is lost and the patientmuscles is lost and the patient

demonstrates an ecessive lateral list indemonstrates an ecessive lateral list in

which the trunk is thrust laterally in anwhich the trunk is thrust laterally in anattempt to keep the center o gravity overattempt to keep the center o gravity over

the stance legthe stance leg


47/50


SyndromesSyndromes 3arkinsonian Gait3arkinsonian Gait

" !he parkinsonian gait is characteried $y a!he parkinsonian gait is characteried $y a

4eed and stooped posture with 4eion o4eed and stooped posture with 4eion o

the neck, el$ows, metacarpophalangealthe neck, el$ows, metacarpophalangeal

;oints, trunk, hips, and knees;oints, trunk, hips, and knees

" !he patient has difculty initiating!he patient has difculty initiating

movements and walks with short stepsmovements and walks with short steps

with the eet $arely clearing the ground.with the eet $arely clearing the ground.!his results in a shuing type o gait with!his results in a shuing type o gait with

rapid stepsrapid steps


48/50


SyndromesSyndromes Hysterical GaitHysterical Gait

" !he hysterical gait is non-speci#c and $iarre!he hysterical gait is non-speci#c and $iarre

" It does not conorm to any speci#c organicIt does not conorm to any speci#c organic

pattern with the a$normality varying rompattern with the a$normality varying rommoment to moment and rom onemoment to moment and rom oneeamination to anothereamination to another

" !here may $e ataia, spasticity, ina$ility to!here may $e ataia, spasticity, ina$ility tomove, or other types o a$normalitymove, or other types o a$normality

" !he a$normality is oten minimal or a$sent!he a$normality is oten minimal or a$sentwhen the patient is unaware o $eingwhen the patient is unaware o $eingwatched or when distractedwatched or when distracted


49/50

Post"rePost"re

Good posture is a su$;ective termGood posture is a su$;ective term

re4ecting what the clinicianre4ecting what the clinician

$elieves to $e correct $ased on$elieves to $e correct $ased onideal models.ideal models.

Generally speaking muscles canGenerally speaking muscles can

$e su$divided into&$e su$divided into&" 3ostural muscles3ostural muscles

" 3hasic muscles3hasic muscles


50/50

Post"rePost"re

!he a$ility to main correct posture!he a$ility to main correct posture

is related to a num$er o actors,is related to a num$er o actors,

which includes $ut is not limited to&which includes $ut is not limited to&" =nergy cost=nergy cost

" %trength and 4ei$ility%trength and 4ei$ility

"%tructural deormities%tructural deormities" +isease+isease

" 3ain3ain

dutton chapter13 gait

Documents