Gait, movements that produce locomotion

1. GAIT
movements that produces locomotion

2. Gait Cycle or Stride
A single gait cycle or stride is defined:
Period when 1 foot contacts the ground to when that
same foot contacts the ground again
Each stride has 2 phases:
Stance Phase
Foot in contact with the ground
Swing Phase
Foot NOT in contact with the ground
2

3. Stance Phase
Principal events during the stance phase
1. Heel strike
2. Foot-flat (followed by opposite heel-off)
3. Heel-rise (followed by opposite heel strike)
4. Toe-off
3

4. Principal events during the stance phase:
heel-strike, foot-flat, heel-off, toe-off
4

5. Activities occur in stance phase
Traditional Method
1. Heel Strike : double support
2. Foot flat : total contact
3. Mid-stance : total weight
bearing
4. Heel-off : heel clears the ground
5. Toe-off : toe clears the ground
RLA Method
1. Initial contact : heel strike
2. Loading response : double
support
3. Mid-stance : begins when
contralateral L/E clears the
ground & when the body come
straight line to supporting limb
4. Terminal stance : end of mid
stance to initial contact of CL
L/E
5. Pre-swing : period of clearance
from the ground
5

6. Initial Contact
Phase 1
The moment when the
red foot just touches the
floor.
The heel (calcaneous) is
the first bone of the foot
to touch the ground.
Meanwhile, the blue leg
is at the end of terminal
stance.
6

7. Static Positions at Initial Contact
Shoulder is extended
Pelvis is rotated left
Hip is flexed and
externally rotated
Knee is fully extended
Ankle is dorsiflexed
Foot is supinated
Toes are slightly
extended
7

8. Loading Response
Phase 2
The double stance period
beginning
Body wt. is transferred
onto the red leg.
Phase 2 is important for
shock absorption,
weight-bearing, and
forward progression.
The blue leg is in the
pre-swing phase.
8

9. Static Positions at Loading Response
Shoulder is slightly
extended
Pelvis is rotated left
hip is flexed and slightly
externally rotated
knee is slightly flexed
ankle is plantar flexing to
neutral
foot is neutral
Toes are neutral
9

10. Mid-stance
Phase 3
single limb support
interval.
Begins with the lifting of
the blue foot and
continues until body
weight is aligned over the
red (supporting) foot.
The red leg advances
over the red foot
The blue leg is in its mid-
swing phase.
10

11. Static Positions at Midstance
Shoulder is in neutral
Pelvis is in neutral
rotation
Hip is in neutral
Knee is fully extended
Ankle is relatively
neutral
Foot is pronated
Toes are neutral
11

12. Terminal Stance
Phase 4
Begins when the red heel
rises and continues until
the heel of the blue foot
hits the ground.
Body weight progresses
beyond the red foot
12

13. Static Positions at Terminal Stance
Shoulder is slightly
flexed
Pelvis is rotated left
Hip is extended and
internally rotated
Knee is fully extended
Ankle is dorsi flexed
Foot is slightly
supinated
Toes are neutral 13

14. Pre-swing
Phase 5
The second double
stance interval in the gait
cycle.
Begins with the initial
contact of the blue foot
and ends with red toe-
off.
Transfer of body weight
from ipsilateral to
opposite limb takes
place. 14

15. Static Positions at Pre-swing
Shoulder is flexed
Pelvis is rotated right
Hip is fully extended
and internally rotated
Knee is fully extended
Ankle is plantar
flexed
Foot is fully supinated
Toes are fully
extended 15

16. Swing phase
Principal events during the Swing phase
1. Acceleration: ‘Initial swing’
2. Mid swing : swinging limb overtakes the limb in
stance
3. Deceleration: ‘Terminal swing’
16

17. Activities occur in swing phase
Traditional Method
1. Acceleration : starts
immediately from toe
off
2. Mid stance : swing
directly beneath body
3. Deceleration : knee
extension and prepare
for heel strike
RLA Method
1. Initial swing : max.
knee flexion
2. Mid swing : from max.
knee flxn. to verticl.
Postn. of tibia
3. Terminal swing : from
verticl. Postn. of tibia
to initial contact
17

18. Initial Swing
Phase 6
Begins when the red foot
is lifted from the floor
and ends when the red
swinging foot is opposite
the blue stance foot.
It is during this phase
that a foot drop gait is
most apparent.
The blue leg is in mid-
stance.
18

19. Static Positions at Initial Swing
Shoulder is flexed
Spine is rotated left
Pelvis is rotated right
hip is slightly extended
and internally rotated
Knee is slightly flexed
Ankle is fully plantar
flexed
Foot is supinated
Toes are slightly flexed
19

20. Mid-swing
Phase 7
Starts at the end of the
initial swing and
continues until the red
swinging limb is in front
of the body
Advancement of the red
leg
The blue leg is in late
mid-stance.
20

21. Static Positions at Mid-swing
Shoulder is neutral
Spine is neutral
Pelvis is neutral
Hip is neutral
Knee is flexed 60-90°
Ankle is plantar flexed to
neutral
Foot is neutral
Toes are slightly
extended
21

22. Terminal Swing
Phase 8
Begins at the end of mid-
swing and ends when the
foot touches the floor.
Limb advancement is
completed at the end of
this phase.
22

23. Static Positions at Terminal Swing
Shoulder is extended
Spine is rotated right
Pelvis is rotated left
Hip is flexed and
externally rotated
Knee is fully extended
Ankle is fully dorsi flexed
Foot is neutral
Toes are slightly
extended
23

24. DISTANCE VARIABLES
Step length
Stride length
Width of walking base
Degree of toe out
24

25. Step Length
Distance between corresponding successive points
of heel contact of the opposite feet
Rt step length = Lt step length (in normal gait)
25

26. Stride Length
Distance between successive points of heel contact
of the same foot
Double the step length (in normal gait)
26

27. Walking Base
Side-to-side distance between the line of the two feet
Also known as ‘stride width’
Normal is 3.5 inches
27

28. Degree of toe out
Represents the angle of foot placement
It is the angle formed by each foot’s line of progression
and a line intersecting the centre of the heel and the
second toe
Normal angle is 7°for men at free speed walking
28

29. TEMPORAL VARIABLES
Stance Time : Is the amount of time that elapses
during the stance phase of one extremity in a gait cycle
Single support time : is the amount of time that
elapses during the period when only one extremity is on
the supporting surface in a gait cycle
Double support time : is the amount of time that a
person spends with both feet on the ground during one
gait cycle
Stride duration : is the amount of time it takes to
accomplish one stride
Step duration : is the amount of time spent during a
single step
29

30. TEMPORAL VARIABLES
Cadence
Number of steps per unit time
Normal: 100 – 115 steps/min
Cultural/social variations
Velocity
Distance covered by the body in unit time
Usually measured in cm/s
Instantaneous velocity varies during the gait cycle
Average velocity (m/min) = step length (m) x cadence (steps/min)
Comfortable Walking Speed (CWS)
Least energy consumption per unit distance
Average= 80 m/min (~ 5 km/h , ~ 3 mph)
30

31. DETERMINANTS OF GAIT
1. Lateral pelvic tilt
2. Knee flexion
3. Knee, ankle, foot interactions
4. Pelvic forward and backward rotation
5. Physiologic valgus of knee
DGs represents the adjustments made by above components
that help to keep movements of body’s COG to minimum.
They are credited with decreasing the vertical and lateral
excursions of the body’s COG and therefore decreasing
energy expenditure and making gait more efficient
31

32. Lateral pelvic tilt
During mid-stance the COG
reaches the peak level & the total
body supported by one lower
extremity
The pelvis slopes downwards
laterally towards the leg which is
in swing phase. i.e. rotation
about an anterior-posterior axis
Only anatomically possible if the
swing leg can be shortened
sufficiently (principally by knee
flexion) to clear the ground.
Where this is not possible (e.g.
through injury), the absence of
pelvic tilt and pronounced
movements of the upper body
are obvious.
32

33. Knee flexion
Another DG which
helps to reduce the
COG during mid-
stance
As the hip joint passes
over the foot during
the support phase,
there is some flexion
of the knee.
This reduces vertical
movements at the hip,
and therefore of the
trunk and head.
33

34. Knee, ankle, foot interactions
KAF interaction prevent
abrupt hike in COG from
heel strike to foot flat
After heel strike huge
upward displacement of
COG occurs
This is reduced by Knee
flexion, ankle plantar
flexion & foot pronation.
From mid stance to heel
off there is sudden drop in
COG
Ankle plantar flexion, knee
extension and foot
supination maintain this
34

35. Pelvic forward and backward rotation
Forward rotn. occurs in swing
phase
It starts during acceleration and
ends in deceleration
During mid-swing pelvis comes to
neutral position
Forward and backward rotation
help to prevent further reduction
in COG which started from mid-
stance
During deceleration both lower
extremities lengthens
This prevents in further reduction
of COG
35

36. Physiologic valgus of knee
Is minimised by having
a narrow walking base
i.e. feet closer together
than are hips.
Therefore less energy is
used moving hip from
side to side (less lateral
movement needed to
balance body over
stance foot)
Reduced lateral pelvic
displacement
36

37. Efficiency, and energy considerations
• Walking is very energy-
efficient: little ATP is required.
• This is because of various
mechanisms that ensure the
mechanical energy the body has
is passed on from one step to
the next.
• The two forms of mechanical
energy involved are
•kinetic energy (energy due
to movement
•potential energy (energy
due to position)
Economy (J m-1)
37

38. A conventional pendulum –
energy interconversion
P.E. – Potential energy
K.E. – Kinetic energy
Three points on a pendulum
swing are illustrated.
As the pendulum swings away
from the midpoint, in either
direction, KE is progressively
converted into PE
At the extreme points in the
swing, there is no KE at all and
all the energy is present as PE
38

39. Conventional pendulum action
during the swing phase
The legs move as conventional pendulums during the swing
phase (with a little assistance from the hip flexors).
This reduces the amount of muscle energy needed to move
the swinging leg forward
It also accounts for the “natural” frequency of gait that has
optimal energy efficiency
Although the legs swing forwards much like pendulums, they
are prevented from swinging backwards by foot strike.
During the stance phase, the leg can be viewed as an
“inverted pendulum”. This action also involves inter-
conversion of potential and kinetic energy 39

40. An “inverted” pendulum
The pendulum
“bounces”
backwards and
forwards, using
the springs.
40

41. “Inverted” pendulum action during the stance phase
During the stance phase, the leg can be viewed as an “inverted
pendulum”.
The forward momentum of the body gives it the necessary
initial angular velocity of rotation (taking the place of the
“spring” on the previous slide).
“Inverted” pendulum action also involves inter-conversion of
potential and kinetic energy, but in this case (unlike a
conventional pendulum) KE reaches a minimum at the
midpoint of the motion, and PE is highest at that point.
When reaching the endpoint of its “inverted swing” the stance
leg does not swing back, as a real inverted pendulum would,
because the foot is taken off the floor, the fulcrum transfers
from the foot to the hip, and the leg swings again as a
conventional pendulum. 41

42. Positive & negative Work
At a cadence of 105-112 steps/minute
between heel strike and foot flat
1. a brief burst of positive work (energy generation) occurs as the hip extensors contract
concentrically
2. while the knee extensors perform negative work (energy absorption) by acting
eccentrically to control knee flexion
from foot flat through mid-stance
1. Negative work is done by plantar flexors as the leg rotates over the foot during the
period of stance
2. Positive work of the knee extensors occurs during this period to extend the knee
late stance and in early swing
1. Positive work of plantar flexors and hip flexors increase the energy level of the body
In late swing
1. negative work is performed by the hip extensors as they work eccentrically to
decelerate the leg in preparation for initial contact
42

43. Forces
The principal forces are:
body weight (BW)
ground reaction force (GRF)
muscle force (MF)
BW and GRF are external forces; so the movement of
the centre of mass (CoM) can be predicted from them alone.
MF must be examined however if we wish to
consider either of the following:
movements of individual limbs or body segments,
why GRF changes in magnitude and direction
during the gait cycle.
43

44. Vitally important point:
Muscle forces can only influence
the movement of the body as a
whole indirectly, by their effects
on the GRF
44

45. Walking as a “controlled fall”
One way of beginning to understand the mechanics of
walking is to view the movements as a “controlled fall”
When starting a walk, we lean forward, overbalancing
from the equilibrium position.
This gives the upper part of the body forwards (and
downwards) motion
As the body falls forwards, a leg is extended forwards
and halts the fall
At the same time, the other leg “kicks off” in order to
keep the body moving forwards.
This forward momentum carries the body forward into
the next forward fall, i.e. the start of the next step
45

46. Walking as a controlled fall: forces
involved
When starting to move, we lean forward (MF)
As the body starts to fall (BW), a leg is extended
forwards and halts the fall (MF; GRF)
At the same time, the other leg “kicks off, upwards and
forwards” (MF; GRF) in order to keep the body
moving forwards.
This forward momentum carries the body forward into
the next forward fall, i.e. the start of the next step
46

47. Body weight
Always acts vertically downwards from the CoM
If its line of action does not pass through a joint, it
will produce a torque about that joint
The torque will cause rotation at the joint unless it is
opposed by another force (e.g. muscle, or ligament)
BW contributes to GRF
47

48. Ground reaction force
The force that the foot exerts on
the floor due to gravity & inertia
is opposed by the ground reaction
force
Ground reaction force (RF) may
be resolved into horizontal (HF)
& vertical (VF) components.
Understanding joint position &
RF leads to understanding of
muscle activity during gait
Forces are typically resolved into:
1. Vertical Compression (z)
2. Anterior-Posterior Shear (y)
3. Medial-Lateral Shear (x)
48

49. Muscle force
In gait, as in all human movement, muscle
activation generates internal joint moments
(torques) that:
Contribute to ground reaction force
Ensure balance
Increase energy economy
Allow flexible gait patterns
Slow down and/or prevent limb movements
Much muscle activity during gait is
eccentric or isometric, rather than
concentric 49

50. Center Of Pressure (COP)
Represents the centroid of foot
forces on the floor
This is an idealization, because
pressures are distributed all over
It is important, because we want
to know where the GRF is applied
to the body
When measured by a force plate, it
is more correctly called the point
of application of the GRF
Plotting the COP as it moves
under the foot:
1. Normal Path: Center of the
calcaneus or slightly lateral, curving
laterally and then medial
(pronation) and ending between
the 1st and second toes
2. Variable: Normal individuals can
have many COP trajectories, just
by changing the footgear
50

51. Muscles, Joints, and Forces
Eccentric
Concentric
Ground Reaction Force
51

52. Sagittal Plane Analysis
Initial Contact
Hip 30° of flexion,
knee is extended
ankle is neutral
GRF
Ant. to hip, drives the hip into
flexion
Ant. to knee drives the knee
into extension
Ankle into plantar flexion
Hip: hamstrings, gluteus maximus,
and adductor magnus (i to e)
Knee: quadriceps (c to e)
Tibiotalar joint: tibialis anterior (e)
Subtalar joint: anterior and lateral
compartment muscles (e)
52

53. Sagittal Plane Analysis
Loading Response
Hip extension 25°
Knee flexion to 20°
Ankle plantar flexion to 10°
Contralateral pelvis rotates
anterior
GRF
Ant. to hip
posterior to knee
posterior to ankle
Hip : extensors (e),
Abductors (e) limit contralateral
drop to 5°
Knee : Quadriceps fire (c)
Ankle :Tibialis anterior (e)
53

54. Sagittal Plane Analysis
Mid Stance
GRF through hip, knee, and
ankle
Muscular activity terminates
Hip and knee stability provided
by ligamentous restraints
GRF
Posterior to hip
Anterior to knee and ankle
Gastrosoleus complex fires to
initiate knee flexion
Pelvis continues to rotate,
abductors continue to resist
pelvic drop
54

55. Sagittal Plane Analysis
Terminal Stance
No change in GRF
Free forward fall
Strong activation of
gastrosoleus complex
55

56. Sagittal Plane Analysis
Pre-Swing
Hip 20° of hyperextansion
Knee 30° of flexion
Ankle 20° of plantarflexion
Toes 50° of hyper extension
GRF
posterior to hip, knee
anterior to ankle
Rapid flexion of knee from rapid
heel rise and unweighting of limb
Rectus femoris initiates hip flexion
Adductor longus fires
Hip : iliopsoas, adductor magnus,
adductor longus
Knee : Quadriceps
Ankle :Gastrosoleus complex
Toes : Ab.hal., FDB, FHB,
Introssei, lumb. 56

57. Sagittal Plane Analysis
Initial Swing
Hip 0-30° of flexion
Knee from 30-60° of flexion and
extension from 60-30°
Ankle 20° of plantarflexion to neutral
Foot clearance is passive due to rapid
hip flexion, unless gait is very slow
In slow gait, tibialis anterior and
hamstrings fire to help
Gait cadence (speed) governed by
accelerations of hip flexion during this
phase
Hip flexion
Rectus femoris
Iliacus
Adductor longus
Gracilis
Sartorius
Rest of limb is passive pendulum
57

58. Sagittal Plane Analysis
Mid Swing
Tibialis anterior fires to
maintain foot position
Knee extension and hip
flexion continue by inertia
58

59. Sagittal Plane Analysis
Terminal Swing
Decelerate knee extension
and hip flexion
Hamstrings
Gluteus max
Quads co-contract
Tibialis anterior maintains
ankle position
59

60. Frontal Plane Analysis
IC to LR
Pelvis : forward rotn.
Hip : med. rotn. of femur
Knee : increased valgus
Ankle : increased pronation
Thorax : Post. postion at
initial contact and begins
moving forward
Shoulder : extended and
moving forward
Gracilis, vastus medialis,
semitendinosus, LH of
biceps femoris
Tibialis post. to control
valgus thrust
60

61. Frontal Plane Analysis
LR to Mid-stance
Pelvis : Rt. side rotating
backward to reach neutral.
Lat. tilt towards the swinging
extremity
Hip : Med. rotn. of femur
continues to neutral.
Knee : Reduction in valgus
and tibia begins to rotate
laterally
Ankle-foot : neutral at mid-
stance
Thorax : Rt. side move
forward
Shoulder : Move forward
Hip abductors are active
Tibialis post. produce
supination
61

62. Frontal Plane Analysis
Mid-stance to TS
Pelvis : Rt. side move
Posteriorly
Hip : Lat. rotn. of femur and
adduction
Knee : lat. rotn. of tibia
Ankle & foot : supination of
subtalar jt. increases
Thorax : Rt. side move
forward
Shoulder : Rt. shoulder move
forward
Hip : inconsistent adductor
activity
Ankle plantar flexor activity
62

63. Frontal Plane Analysis
TS to PS
Pelvis : Lt. side move
forward, lat. tilting to swing
side ends as double support
begins
Hip : Abduction as wt.
shifted to opp. extremity, Lat.
rotn. of femur
Knee : Lat rotn. of tibia
Foot/Ankle : Wt. shifted to
toes. Supination of sub talar
joint
Thorax : Translation to the
left
Shoulder : Moving forward
Hip adductors control pelvis
Plantar flexion
63

64. Frontal Plane Analysis
IS to MS
Pelvis : Lat. pelvic tilt to the
rt. Right side move forward
Hip : Lat. rotn to med. rotn.
Knee : From lat. to med. rotn
Foot/Ankle : NWBing
subtalar joint returns to
supination
Thorax : Rt. side move
Posteriorly
Shoulder : Rt. side move
Posteriorly
Left gluteus medius on pelvis
64

65. Frontal Plane Analysis
MS to TS
Pelvis : Rt. side move
anteriorly
Hip : Lat. tilting to the left
med. rotn.
Knee : Med. rotn.
Ankle/Foot :
Thorax : Rt. side move
posteriorly
Shoulder : Rt. shoulder move
posteriorly
Right gluteus medius
65

66. A word on running
Walking is biomechanically like a
pendulum, KE to PE to KE
Running is biomechanically like a
spring
No double leg stance phase
Aerial phase or float period
Ground Reaction Force during
stance phase loads spring
(quads, achilles)
Unloading in preparation for
aerial phase is passive recoil
from tendons and connective
tissue and dynamic concentric
muscular contraction
66

67. Running: swing phase
Muscular rather than pendular
motion at hip.
Knee flexion, and ankle
dorsiflexion, bring CoM of the leg
closer to the hip. This reduces
moment of inertia and increases
angular velocity.
Knee movements largely passive
(i.e not due to muscle activity), and
result from transfer of momentum
from thigh.
Depending on the speed of
running, initial ground contact may
be with heel, whole foot, or ball of
foot.
67

68. Running: support phase
Hip: slight flexion followed by
extension. Gluteus maximus
activity initially eccentric
Knee: degree of flexion increases
with speed; that of extension
decreases. Quadriceps active at
knee, initially eccentrically
Ankle : dorsiflexion followed by
plantarflexion. Gastrocnemius and
soleus active during whole phase,
particularly so at the end.
Stretch shortening/energy
storage activity occurs at all
three joints
68

69. STAIR GAIT
Stair Ascent
Stance Phase
1. Weight acceptance
2. Pull up
3. Forward continuance
Swing Phase
1. Foot clearance
2. Foot Placement
Ascending stairs involves a large
amount of positive work that is
accomplished by concentric
action of the rectus femoris,
vastus lateralis, soleus and
medial gastrocnemeus
69

70. STAIR GAIT
Stair Descending
Swing Phase
1. Foot clearance
2. Foot Placement
Stance Phase
1. Weight acceptance
2. Pull up
3. Forward continuance
Descending stairs is achieved
mostly through eccentric activity of
same muscles and involves energy
absorption
The support moments exhibit
similar pattern in stair and level gait
But magnitude is greater in stair
gait
70

71. Sagittal Plane analysis of Stair gait
WA to PU
Hip : Extension from 60-
30° of flexion
Knee : Extension from
80-35° of flexion
Ankle : DF 20-25° of
DF, PF 25-15° of DF
Hip : Gluteus maximus,
Semitendinosus, Gluteus
medius
Knee : Vastus Lateralis,
Rectus femoris
Ankle : Tibialis anterior,
soleus, gastronemius
71

72. Sagittal Plane analysis of Stair gait
PU to FC
Hip : extension 30 - 5° of
flexion, flexion 5-20° of
flexion
Knee : Extension 35-10°
of flexion, flexion 5- 10°
of flexion
Ankle : PF 15°of DF to
15-10° of PF
Hip : Gluteus maximus,
gluteus medius,
semitendinosus
Knee : Vastus lateralis,
rectus femoris
Ankle : Soleus,
gastronemius, tibialis
anterior
72

73. Sagittal Plane analysis of Stair gait
Foot clearance through foot
placement
Hip : flexion 10-20° to 40-
60° of flexion, extension 40-
60° of flexion to 50° of
flexion
Knee : Flexion 10° of flexion
to 90-100° of flexion,
extension 90-100° of flexion
to 85° of flexion
Ankle : DF 10° of PF to 20°
of DF
Hip : Gluteus medius
Knee : semitendinosus,
vastus lateralis, rectus femoris
Ankle : Tibialis anterior
73

74. FACTORS INFLUENCING GAIT
Age
Gender
Assistive devices
abnormalities
74

75. FACTORS INFLUENCING GAIT
Age
A toddler has a higher COG, wider BOS, decreased
single leg support time, a shorter step length , a slower
velocity and a higher cadence in comparison to adult
3-5 year old showed increase in stride length adjusted to
leg length, step length and a faster speed in gait
From 6-13 years ROM of L/E were almost identical to
adults. However linear displacement, velocities and
accelerations are larger.
Elderly demonstrate a decrease in natural walking
speed, shorter stride and step length, longer duration of
double support periods and smaller swing to support
phase ratios
75

76. FACTORS INFLUENCING GAIT
Gender
Men Women
Joint angle increases as speed
increases
Gait speed faster i.e.. 118-134
cm/s
Step length larger
Not much joint angle increase
as compared to men
Gait speed slower i.e.. 110-129
cm/s
Step length smaller
Increased hip flexion and
decreased knee extension during
gait initiation
Increased knee flexion in pre-
swing
Increased stride length
Greater cadence 76

77. FACTORS INFLUENCING GAIT
Assistive devices
Canes are typically been used on the
contralateral side to an affected limb to reduce
forces acting at the affected limb
Use of cane on the contralateral side increase the
BOS and decrease muscle, GRF forces acting at
the affected hip and hip abductor & gluteus
maximus activity was reduced to 45%
Walker gait
77

78. COMMON GAIT ABNORMALITIES
A. Deformity(Contracture)
B. Muscle Weakness
C. Sensory Loss
D. Pain
E. Impaired Motor Control(Spasticity)
78

79. Ankle and Foot Gait Deviation
79

80. Knee Abnormal Gait
80

81. Knee Abnormal Gait
81

82. Knee Abnormal Gait
82

83. Knee Abnormal Gait
83

84. Hip Abnormal Gait
84

85. Hip Abnormal Gait
85

86. Pelvis and Trunk Pathological Gait
86

87. Pelvis and Trunk Pathological Gait
87

88. Pelvis and Trunk Pathological Gait
88

89. Pelvis and Trunk Pathological Gait
89

90. COMMON TYPES OF ABNORMAL GAITS
Scissor gait
Antalgic gait
Cerebellar ataxia
Festinating gait
Pigeon gait
Propulsive gait
Steppage gait
Stomping gait
Spastic gait
Myopathic gait
Magnetic gait
Trendelenburg gait
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91. Scissor gait
Hypertonia in the legs, hips and pelvis means these areas
become flexed, to various degrees, giving the appearance of
crouching, while tight adductors produce extreme adduction,
presented by knees and thighs hitting or crossing in a scissors-
like movement, while the opposing muscles, the abductors,
become comparatively weak from lack of use. Most common in
patients with spastic cerebral palsy,
usually diplegic and paraplegic varieties. The individual is forced
to walk on tiptoe unless the dorsiflexor muscles are released by
an orthaepedic surgical procedure.
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92. Antalgic gait
Person tries to avoid pain associated with the
ambulation. Often quick, short and soft foot
steps.
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93. Ataxic gait
Spinal - proprioceptive pathways of the spine or
brainstem are interrupted. There is loss of
position and motion sense. The person will walk
with a wide base of gait with foot slap at heel
contact. Often watch feet as they walk.
Cerebellar - coordinating functions of the
cerebella are interfered with, so the person tends
to walk with a wide base of gait with an unsteady
irregular gait, even if watching feet.
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94. Festinating gait
The patient has difficulty starting, but also has
difficulty stopping after starting. This is due to
muscle hypertonicity. The patient moves with
short, jerky steps.
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95. Pigeon gait
In-toe gait is a very common problem among
children and even adults. Fortunately, most in-
toeing that is seen in children is a growth and
developmental condition and will correct itself
without medical or surgical intervention.
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96. Propulsive gait
Disturbance of gait typical of Parkinsonism in
which, during walking, steps become faster and
faster with progressively shorter steps that pass
from a walking to a running pace and may
precipitate falling forward.
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97. Steppage gait
A manner of walking in which the advancing
foot is lifted high so that the toes clear the
ground. Steppage gait is a sign of foot-drop.
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98. Stomping gait
Sensory ataxia presents with an unsteady
"stomping" gait with heavy heel strikes, as well
as postural instability that is characteristically
worsened when the lack of proprioceptive input
cannot be compensated by visual input, such as
in poorly lit environments.
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99. Spastic gait
An unbalanced muscle action of certain muscle
groups leads to deformity. Prime example is
"Scissor gait" - adduction and internal rotation
of the hips with an equinus of the feet and
flexion of the knee.
the legs are held together and move in a stiff
manner, the toes seeming to drag and catch.
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100. Myopathic gait
The "waddling" is due to the weakness of the
proximal muscles of the pelvic girdle.
The patient uses circumduction to compensate
for gluteal weakness.
exaggerated alternation of lateral trunk
movements with an exaggerated elevation of the
hip.
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101. Magnetic gait
Normal pressure hydrocephalus (NPH) gait
disturbance is often characterized as a "magnetic
gait," in which feet appear to be stuck to the
walking surface until wrested upward and
forward at each step. The gait may mimic a
Parkinsonian gait, with short shuffling steps and
stooped, forward-leaning posture, but there is
no rigidity or tremor. A broad-based gait may be
employed by the patient in order to compensate
for the ataxia.
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102. Trendelenburg gait
The Trendelenburg gait is an abnormal gait caused by
weakness of the abductor muscles of the lower
limb, gluteus medius and gluteus minimus.
During the stance phase, the weakened abductor
muscles allow the pelvis to tilt down on the opposite
side. To compensate, the trunk lurches to the weakened
side to attempt to maintain a level pelvis throughout the
gait cycle. The pelvis sags on the opposite side of the
lesioned superior gluteal nerve.
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103. Hemiplegic Gait Demonstration
The patient has unilateral
weakness and spasticity with
the upper extremity held in
flexion and the lower
extremity in extension. The
foot is in extension so the leg
is "too long" therefore, the
patient will have to
circumduct or swing the leg
around to step forward. This
type of gait is seen with a
UMN lesion.
This girl has a right
hemiparesis. Note how she
holds her right upper
extremity flexed at the elbow
and the hand with the thumb
tucked under the closed
fingers (this is "cortical
fisting"). There is
circumduction of the right
lower extremity.
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104. Diplegic Gait Demonstration
The patient has spasticity in the
lower extremities greater than the
upper extremities. The hips and
knees are flexed and adducted with
the ankles extended and internally
rotated. When the patient walks
both lower extremities are
circumducted and the upper
extremities are held in a mid or low
guard position. This type of gait is
usually seen with bilateral
periventricular lesions. The legs are
more affected than the arms
because the corticospinal tract
axons that are going to the legs are
closest to the ventricles.
This man has an UMN lesion
affecting both lower extremities.
He has spasticity and weakness of
the legs and uses a walker to steady
himself. There is bilateral
circumduction of the lower
extremities.
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105. Neuropathic Gait Demonstration
This type of gait is most
often seen in peripheral
nerve disease where the
distal lower extremity is
most affected. Because
the foot dorsiflexors are
weak, the patient has a
high stepping gait in an
attempt to avoid
dragging the toe on the
ground.
This girl has weakness of
the distal right lower
extremity so she can't
dorsiflex her foot. In
order to walk she has to
lift her right leg higher
then the left to clear the
foot and avoid dragging
her toes on the ground.
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106. Myopathic Gait Demonstration
With muscular diseases, the
proximal pelvic girdle
muscles are usually the most
weak. Because of this the
patient will not be able to
stabilize the pelvis as they lift
their leg to step forward, so
the pelvis will tilt toward the
non-weight bearing leg which
results in a waddle type of
gait.
This young boy has pelvic
girdle weakness, which
produces a waddling type of
gait. Note the lumbar
hyperlordosis with the
shoulders thrust backwards
and the abdomen being
protuberant. This posture
places the center of gravity
behind the hips so the patient
doesn't fall forward because
of weak back and hip
extensors.
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107. Parkinsonian Gait Demonstration
This type of gait is seen
with rigidity and
hypokinesia from basal
ganglia disease. The
patient's posture is
stooped forward. Gait
initiation is slow and
steps are small and
shuffling; turning is en
bloc like a statue.
This man's gait is
bradykinetic and his
steps are smaller then
usual. There is also the
pill-rolling tremor in his
hands. He turns en bloc
and there is decreased
facial expression
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108. Choreiform Gait Demonstration
This is a hyperkinetic gait
seen with certain types of
basal ganglia disorders. There
is intrusion of irregular, jerky,
involuntary movements in
both the upper and lower
extremities.
Note the involuntary,
irregular, jerky movements of
this woman's body and
extremities, especially on the
right side. There are also
choreiform movements of
the face. A lot of her
movements have a writhing,
snake-like quality to them,
which could be called
choreoathetoisis.
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109. Ataxic Gait Demonstration
The patient's gait is wide-
based with truncal instability
and irregular lurching steps
which results in lateral
veering and if severe, falling.
This type of gait is seen in
midline cerebellar disease. It
can also be seen with severe
lose of proprioception
(sensory ataxia)
This woman's gait is wide-
based and unsteady. She has
to use a walker or hold on to
someone in order to maintain
her balance (note how hard
she has to work with the
hand that she's holding on
with in order to maintain her
balance). Her ataxia is even
more apparent when she tries
to turn.
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